Managing Nausea & Vomiting from Cancer Treatment
Quick Facts
- Up to 80% of patients experience some nausea during chemotherapy
- Modern antiemetics can prevent nausea in most patients
- Prevention is more effective than treating established nausea
- Different chemotherapy drugs have different nausea risks
- Non-drug approaches can significantly help
Understanding Chemotherapy-Induced Nausea and Vomiting (CINV)
Nausea and vomiting are among the most feared side effects of cancer treatment. However, with modern prevention strategies and medications, most patients can achieve good control of these symptoms.
Why Does It Happen?
- Chemotherapy triggers: Certain drugs stimulate the vomiting center in the brain
- Serotonin release: Chemotherapy causes release of serotonin in the gut
- Psychological factors: Anxiety and previous experiences can contribute
- Other treatments: Radiation to abdomen, pain medications
Mild
Loss of appetite, mild queasiness
1-2 episodes of vomiting/day
Moderate
Decreased oral intake
3-5 episodes of vomiting/day
Severe
Minimal oral intake
6+ episodes/day, dehydration
Types of Nausea and Vomiting
By Timing
- Acute: Within 24 hours of treatment (most common)
- Delayed: 24 hours to several days after treatment
- Anticipatory: Before treatment, triggered by sights, smells, or thoughts
- Breakthrough: Despite preventive medications
- Refractory: Not responding to standard treatments
Risk Factors for CINV
Chemotherapy Emetogenic Risk Categories
| Risk Level | Frequency | Common Drugs |
|---|---|---|
| High | >90% without prevention | Cisplatin, Cyclophosphamide (high dose), Doxorubicin + Cyclophosphamide |
| Moderate | 30-90% | Carboplatin, Oxaliplatin, Irinotecan |
| Low | 10-30% | Paclitaxel, Docetaxel, 5-FU, Gemcitabine |
| Minimal | <10% | Bevacizumab, Bleomycin, Vincristine |
Patient Risk Factors
- Age <50 years (higher risk)
- Female gender
- History of motion sickness
- History of morning sickness during pregnancy
- Anxiety or high stress levels
- Previous chemotherapy with poor nausea control
- Little or no alcohol use (surprisingly, regular alcohol use is associated with lower risk)
Prevention Strategies
Before Chemotherapy
- Take prescribed anti-nausea medications as directed
- Eat light meal 1-2 hours before treatment
- Stay well hydrated
- Practice relaxation techniques
Day of Chemotherapy
- Take pre-medications 30-60 minutes before
- Bring distractions (music, reading)
- Use aromatherapy if helpful (peppermint, ginger)
- Avoid strong smells
After Chemotherapy
- Continue preventive medications as prescribed
- Eat small, frequent meals
- Rest but avoid lying flat after eating
- Track symptoms for your healthcare team
Medications for Nausea and Vomiting
5-HT3 Antagonists
Examples: Ondansetron (Zofran), Granisetron (Kytril), Palonosetron (Aloxi)
Use: First-line for acute CINV
How it works: Blocks serotonin receptors
Side effects: Headache, constipation
NK1 Antagonists
Examples: Aprepitant (Emend), Fosaprepitant, Rolapitant
Use: High-risk chemotherapy, delayed nausea
How it works: Blocks substance P
Side effects: Fatigue, hiccups
Corticosteroids
Examples: Dexamethasone, Methylprednisolone
Use: Combined with other antiemetics
How it works: Multiple mechanisms
Side effects: Insomnia, increased appetite
Dopamine Antagonists
Examples: Metoclopramide (Reglan), Prochlorperazine (Compazine)
Use: Breakthrough nausea
How it works: Blocks dopamine receptors
Side effects: Drowsiness, restlessness
Benzodiazepines
Examples: Lorazepam (Ativan), Alprazolam (Xanax)
Use: Anticipatory nausea, anxiety
How it works: Reduces anxiety
Side effects: Sedation, memory issues
Cannabinoids
Examples: Dronabinol (Marinol), Nabilone (Cesamet)
Use: Refractory nausea
How it works: Cannabinoid receptors
Side effects: Dizziness, euphoria
Medication Tips
- Prevention is more effective than treatment - take medications as prescribed
- Don't wait until severe nausea to take rescue medications
- Different medications work for different people
- Combination therapy is often most effective
- Report ineffective medications to your team
Dietary Management
Eating Strategies
✅ Foods to Try
- Bland foods (toast, crackers, rice)
- Clear liquids (broth, tea, juice)
- Cold foods (may have less odor)
- Ginger (tea, candies, cookies)
- Peppermint
- Small, frequent meals
- High-protein snacks
❌ Foods to Avoid
- Greasy, fried, fatty foods
- Spicy foods
- Strong-smelling foods
- Very sweet foods
- Large meals
- Hot foods (let cool first)
- Favorite foods (save for good days)
💧 Hydration Tips
- Sip fluids throughout the day
- Try ice chips or popsicles
- Drink between meals, not during
- Room temperature may be better
- Try electrolyte drinks
- Avoid caffeine if dehydrated
🍽️ Meal Timing
- Eat every 2-3 hours
- Don't skip meals
- Largest meal when feeling best
- Light snack before bed
- Wait 30-60 min after eating to lie down
- Eat slowly and chew thoroughly
Non-Drug Approaches
Complementary Techniques
- Acupuncture/Acupressure: P6 point on wrist (Sea-Bands)
- Deep Breathing: Slow, controlled breaths can reduce nausea
- Guided Imagery: Visualization of calm scenes
- Progressive Muscle Relaxation: Systematic tension and release
- Aromatherapy: Peppermint, lemon, or ginger scents
- Distraction: Music, TV, games, conversation
- Fresh Air: Open windows or step outside
- Cool Compress: On forehead or back of neck
- Keep crackers by bedside
- Eat dry toast before getting up
- Rise slowly from bed
- Avoid brushing teeth immediately
- Try ginger tea first thing
- Eliminate cooking odors (open windows, use exhaust fan)
- Have others cook if possible
- Use unscented products
- Keep living spaces cool
- Wear loose clothing
- Establish a routine
- Plan activities for when you feel best
- Rest after meals (sitting up)
- Avoid triggers you've identified
- Practice stress management
When to Seek Help
🚨 Call Your Healthcare Team If:
- Vomiting more than 3 times in an hour
- Unable to keep fluids down for 24 hours
- Signs of dehydration:
- Dark urine or no urination for 8+ hours
- Dizziness or lightheadedness
- Dry mouth, cracked lips
- Rapid heartbeat
- Blood in vomit
- Severe abdominal pain
- Fever over 100.4°F (38°C)
- Confusion or extreme weakness
- Prescribed medications not working
What to Tell Your Team
- When nausea/vomiting started
- Frequency and amount
- What medications you've taken
- What you've been able to eat/drink
- Any other symptoms
- What makes it better or worse
Symptom Tracking Tool
Daily Nausea & Vomiting Log
Track your symptoms to help your healthcare team optimize your treatment:
Print this page or keep a notebook to share with your healthcare team at appointments.
Tips from Other Patients
"I found that sucking on ice chips during chemo really helped. Also, peppermint tea became my best friend."
"Sea-Bands (acupressure wristbands) worked better than I expected. Worth trying!"
"Don't be a hero - take the anti-nausea meds before you feel sick. Prevention really is key."
Additional Resources
Medical Disclaimer: This information is for educational purposes only. Always follow your healthcare team's specific instructions for managing nausea and vomiting. Contact your team if symptoms worsen or don't improve with prescribed treatments.