Nausea and vomiting are side effects of cancer therapy and affect most patients who have chemotherapy. Radiation therapy to the brain, gastrointestinal tract, or liver also cause nausea and vomiting.
Nausea is an unpleasant feeling in the back of the throat and/or stomach that may come and go in waves. It may occur before vomiting. Vomiting is throwing up the contents of the stomach through the mouth. Retching is the movement of the stomach and esophagus without vomiting and is also called dry heaves. Although treatments for nausea and vomiting have improved, nausea and vomiting are still serious side effects of cancer therapy because they cause the patient distress and may cause other health problems. Patients may have nausea more than vomiting.
Nausea is controlled by a part of the autonomic nervous system which controls involuntary body functions (such as breathing or digestion). Vomiting is a reflex controlled in part by a vomiting center in the brain. Vomiting can be triggered by smell, taste, anxiety, pain, motion, or changes in the body caused by inflammation, poor blood flow, or irritation to the stomach.
It is very important to prevent and control nausea and vomiting in patients with cancer, so that they can continue treatment and perform activities of daily life. Nausea and vomiting that are not controlled can cause the following:
Nausea and vomiting can occur before, during, or after treatment.
The types of nausea and vomiting include:
Nausea and vomiting with chemotherapy are more likely if the patient:
Patients who drank large amounts of alcohol over time have a lower risk of nausea and vomiting after being treated with chemotherapy.
The following treatment factors may affect the risk of nausea and vomiting:
The following patient factors may cause nausea and vomiting with radiation therapy if the patient:
Patients who drank large amounts of alcohol over time have a lower risk of nausea and vomiting after being treated with radiation therapy.
Nausea and vomiting may also be caused by other conditions. In patients with advanced cancer, chronic nausea and vomiting may be caused by the following:
In some patients, after they have had several courses of treatment, nausea and vomiting may occur before a treatment session. This is called anticipatory nausea and vomiting. It is caused by triggers, such as odors in the therapy room. For example, a person who begins chemotherapy and smells an alcohol swab at the same time may later have nausea and vomiting at the smell of an alcohol swab. The more chemotherapy sessions a patient has, the more likely it is that anticipatory nausea and vomiting will occur.
Having three or more of the following may make anticipatory nausea and vomiting more likely:
Other factors that may make anticipatory nausea and vomiting more likely include:
When symptoms of anticipatory nausea and vomiting are diagnosed early, treatment is more likely to work.
Psychologists and other mental health professionals with special training can often help patients with anticipatory nausea and vomiting. The following types of treatment may be used:
Antinausea drugs given for anticipatory nausea and vomiting do not seem to help.
Chemotherapy is the most common cause of nausea and vomiting that is related to cancer treatment.
How often nausea and vomiting occur and how severe they are may be affected by the following:
The following may make acute or delayed nausea and vomiting with chemotherapy more likely if the patient:
Patients who have acute nausea and vomiting with chemotherapy are more likely to have delayed nausea and vomiting as well.
Drugs may be given before each treatment, to prevent nausea and vomiting. After chemotherapy, drugs may be given to prevent delayed vomiting. Patients who are given chemotherapy several days in a row may need treatment for both acute and delayed nausea and vomiting. Some drugs last only a short time in the body and need to be given more often. Others last a long time and are given less often.
The following table shows drugs that are commonly used to prevent nausea and vomiting caused by chemotherapy and the type of drug.
Drug Name | Type of Drug |
---|---|
Chlorpromazine, prochlorperazine, promethazine | Dopamine receptor antagonists: phenothiazines |
Haloperidol, droperidol | Dopamine receptor antagonists: butyrophenones |
Metoclopramide, trimethobenzamide | Dopamine receptor antagonists: substituted benzamides |
Dolasetron, granisetron, ondansetron, palonosetron | Serotonin receptor antagonists |
Aprepitant, fosaprepitant, netupitant, rolapitant | Substance P/NK-1 antagonists |
Dexamethasone, methylprednisolone | Corticosteroids |
Alprazolam, lorazepam | Benzodiazepines |
Olanzapine | Antipsychotic/monoamine antagonists |
Dronabinol, nabilone, cannabis, ginger | Other |
The following table shows drugs that are commonly used to prevent nausea and vomiting caused by radiation therapy and the type of drug:
Drug Name | Type of Drug |
---|---|
Granisetron, ondansetron, palonosetron, dolasetron | Serotonin receptor antagonists |
Dexamethasone | Corticosteroids |
Metoclopramide, prochlorperazine | Dopamine receptor antagonists |
It is not known whether it is best to give antinausea medicine for the first 5 days of radiation treatment or for the full treatment course. Talk with your doctor about the treatment plan that is best for you.
Non-drug treatments may help relieve nausea and vomiting, and may help antinausea drugs work better. These treatments include:
Like adults, nausea in children receiving chemotherapy is more of a problem than vomiting. Children may have anticipatory, acute, and/or delayed nausea and vomiting.
Children who have nausea and vomiting after a chemotherapy treatment may have the same symptoms before their next treatment when the child sees, smells, or hears sounds from the treatment room. This is called anticipatory nausea and vomiting.
When the child’s nausea and vomiting is well controlled during and after a chemotherapy treatment, the child may have less anxiety before the next treatment and less chance of having anticipatory symptoms.
Health professionals caring for children who have anticipatory nausea and vomiting have found that children may benefit from:
Drugs may be given before each treatment to prevent nausea and vomiting. After chemotherapy, drugs may be given to prevent delayed vomiting. Patients who are given chemotherapy several days in a row may need treatment for both acute and delayed nausea and vomiting. Some drugs last only a short time in the body and need to be given more often. Others last a long time and are given less often.
The following table shows drugs that are commonly used to prevent nausea and vomiting caused by chemotherapy and the type of drug. Different types of drugs may be given together to treat acute and delayed nausea and vomiting.
Drug Name | Type of Drug |
---|---|
Chlorpromazine, prochlorperazine, promethazine | Dopamine receptor antagonists: phenothiazines |
Metoclopramide | Dopamine receptor antagonists: substituted benzamides |
Granisetron, ondansetron, palonosetron | Serotonin receptor antagonists |
Aprepitant, fosaprepitant | Substance P/NK-1 antagonists |
Dexamethasone, methylprednisolone | Corticosteroids |
Lorazepam | Benzodiazepines |
Olanzapine | Atypical antipsychotic |
Dronabinol, nabilone | Other drugs |
Non-drug treatments may help relieve nausea and vomiting, and may help antinausea drugs work better in children. These treatments include:
Dietary support may include:
Unlike in adults, delayed nausea and vomiting in children may be harder for parents and caregivers to see. A change in the child’s eating pattern may be the only sign of a problem. In addition, most chemotherapy treatments for children are scheduled over several days. This makes the timing and risk of delayed nausea unclear.
Studies on the prevention of delayed nausea and vomiting in children are limited. Children are usually treated the same way as adults, with doses of drugs that prevent nausea adjusted for age.
For more information from the National Cancer Institute about nausea and vomiting related to cancer treatment, see the following:
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PDQ® Supportive and Palliative Care Editorial Board. PDQ Nausea and Vomiting Related to Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/about-cancer/treatment/side-effects/nausea/nausea-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389289]
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