Nausea and Vomiting with Chemotherapy

The side effects of chemotherapy depend on the type of chemotherapy and the amount given. Anticipating and managing side effects can help to reduce them and provide the best possible experience when having chemotherapy.

What are the types of nausea and vomiting associated with chemotherapy?

As each person's individual medical profile and diagnosis is different, so is his or her reaction to treatment. Side effects may be severe, mild, or absent. Be sure to discuss with your cancer care team possible side effects of treatment before the treatment begins.

According to the National Cancer Institute (NCI), based on the time when the side effects happen, the following are several types of nausea and vomiting associated with chemotherapy to treat cancer:

Anticipatory nausea and vomiting

After receiving a few treatments, some people feel nauseous and begin vomiting in anticipation of the next treatment. The reaction is usually caused by something related to the treatment, like the smell of an alcohol swab or the sight of a medical uniform. Antinausea medicines don't always prevent anticipatory nausea and vomiting, but may help. Actions that calm or distract the person work more often. These actions may include guided imagery, hypnosis, relaxation, behavioral modification, or other activities like music or video games. Anticipatory nausea is usually a learned response and the best prevention is to aggressively prevent and/or treat acute and delayed nausea.

Acute nausea and vomiting

This physical reaction happens within 24 hours after getting chemotherapy. The reaction can be mild, moderate, or severe. Your healthcare provider may give you additional drugs to control the nausea and vomiting.

Delayed nausea and vomiting

In some people, nausea and vomiting may happen more than 24 hours after taking chemotherapy. This is more common in people receiving high doses of chemotherapy, those who experienced acute nausea and vomiting, women, people who drink little or no alcohol, and young people. Medicines that are used for acute nausea and vomiting can also be used in delayed nausea and vomiting. A newer medicine called aprepitant, or its IV (intravenous) form fosaprepitant, has been found to be useful in acute and delayed nausea. 

Nausea and vomiting in advanced cancer and chronic nausea and vomiting

In people with advanced cancer, nausea and vomiting may become chronic and not related to chemotherapy. The nausea may be related to other medicines taken to relieve pain or depression, or it may be the direct result of a brain or colon tumor. People with advanced cancer may also experience constipation, abnormal levels of substances in the blood, dehydration, and stomach ulcers. These are all conditions that can contribute to nausea and vomiting.

What causes nausea and vomiting?

The brain controls nausea and vomiting. Nausea is controlled by autonomic nerves. These nerves control involuntary bodily functions, such as heartbeat and breathing. Various irritants, such as smells, taste, anxiety, pain, motion, or digestive chemicals, can trigger a vomiting center in the brain to initiate vomiting as a reflex. Many factors influence whether a person will experience nausea and vomiting. Some chemotherapy drugs are more likely to cause reactions than others. Females and people under the age of 50 are more likely to experience nausea and vomiting. People who are prone to motion sickness or anxiety are more likely to react to chemotherapy with nausea and vomiting.

Managing nausea and vomiting

Sometimes, a combination of antinausea drugs and alternative therapies will help to reduce nausea and vomiting. It is very important to maintain the proper electrolyte balance and make sure that vomiting does not deplete the body of important nutrients. Uncontrolled nausea and vomiting are serious problems that must be managed to prevent malnutrition, dehydration, and mental changes. All of these problems negatively impact your quality of life and ability to perform daily activities. Report vomiting that lasts more than a day to your healthcare provider.

The American Cancer Society provides the following tips for dealing with nausea and vomiting:

Eating and drinking

• Eat and drink slowly.

• Eat many small meals throughout the day instead of 3 full meals and have a snack at bedtime.

• Avoid strong smells by eating food that is cold or at room temperature.

• Drink clear liquids served cold and sipped slowly often throughout the day.

• If you are nauseated in the morning, keep dry foods, such as cereal or crackers at your bedside. Eat them before you get up (but not if you have throat or mouth sores or a lack of saliva).

• Don't eat sweet, fatty, spicy, or fried foods.

• Savor mints or tart candies (but nothing tart if you have mouth sores).

• Chew your food well to help with digestion.

• Drink an hour before or after, instead of with, each meal.

• Rest but don't lie down for at least several hours after eating.

Eating before treatment

• A light meal before treatment is helpful unless you become nauseated during chemotherapy. If nausea is a problem, don't eat for at least several hours before treatment.

Other tips

• Your healthcare provider may prescribe antinausea medicines. Keep your healthcare provider informed as to their effectiveness.

• Avoid strong smells that may be unpleasant for you, such as cooking smells, perfume, and smoke.

• If you are feeling nauseated, distract yourself.

• Breathe deeply and slowly when you are feeling nauseated.

• Wear loose-fitting clothes.