Nausea / Vomiting and Chemotherapy

The side effects of chemotherapy depend on the type of chemotherapy and the amount given. Anticipating and managing side effects can help to minimize them and provide the best possible experience for the person receiving 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/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 occur, the following are four types of nausea and vomiting associated with chemotherapy to treat cancer:

  • Anticipatory nausea and vomiting

    After receiving a few treatments, some patients feel nausea and begin vomiting in anticipation of the next treatment. The reaction is usually caused by something related to the treatment, like the smell of alcohol or the sight of a medical uniform. Antinausea drugs do not always prevent anticipatory nausea and vomiting. Actions that calm or distract the person work more often. These actions may include guided imagery, medications, hypnosis, relaxation, behavioral modification, or other activities like 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

    The physical reaction that occurs within 24 hours of administration of the chemotherapy can be mild, moderate, or severe. Additional drugs may be given to control the nausea and vomiting. According to the National Cancer Institute, drugs (along with some of their brand names) that are commonly given alone or in combination to prevent or treat nausea and vomiting include the following:

    • Prochlorperazine (Compazine and many other brand names)

    • Haloperidol (Haldol), droperidol

    • Metoclopramide (Octamide, Metoclopramide Intensol, Reglan)

    • Ondansetron (Zofran), granisetron (Kytril), dolasetron (Anzemet), palonosetron (Aloxi)

    • Dexamethasone (Decadron and many other names), methylprednisolone (Medrol and many other names)

    • Dronabinol (Marinol)

    • Lorazepam (Ativan and many other names), alprazolam (Xanax and many other names)

    • Aprepitant (Emend)

    • Olanzapine (Zyprexa)

  • Delayed nausea and vomiting

    In some patients, nausea and vomiting may occur more than 24 hours after taking chemotherapy. This is more common in patients receiving high doses of chemotherapy, patients who experienced acute nausea and vomiting, women, patients who drink little or no alcohol, and young patients. Drugs that are used for acute nausea and vomiting can also be used in delayed nausea and vomiting. A newer medication called aprepitant (Emend) has been found to be useful in acute and delayed nausea. 

  • Nausea and vomiting in advanced cancer and chronic nausea and vomiting 

    In patients with advanced cancer, nausea and vomiting may become chronic -- not related to chemotherapy. The nausea may be related to other drugs 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 -- 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, which 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 minimize nausea and vomiting. It is very important to maintain the proper electrolyte balance and ensure that vomiting does not deplete the body of important nutrients. Report vomiting that lasts more than a day to your physician.

The NCI provides the following tips for dealing with nausea and vomiting:

Eating and drinking

  • Eat and drink slowly.

  • Drink liquids frequently and in small amounts.

  • Eat many small meals throughout the day instead of three full meals.

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

  • Drink clear, unsweetened fruit juice or light-colored, non-caffeinated soda.

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

  • Do not eat sweet, fatty, 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 do not 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, do not eat for at least several hours before treatment.

Other tips

  • Your physician may prescribe antinausea medications. Keep your physician 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.

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