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
According to the National Cancer Institute (NCI), based on the time when the side
effects happen, 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 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 do not 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 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 happen within 24 hours after getting chemotherapy. The
reaction can be mild, moderate, or severe. Additional drugs may be given to control
the nausea and vomiting. According to the NCI, medicines (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:
Ondansetron, granisetron, dolasetron, palonosetron
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 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
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 in order
to prevent malnutrition, dehydration, and mental changes. All of these problems negatively
impact the patient's 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
Eating and drinking
Eat and drink slowly.
Drink liquids often 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, noncaffeinated soda.
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).
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
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,
If you are feeling nauseated, distract yourself.
Breathe deeply and slowly when you are feeling nauseated.
Wear loose-fitting clothes.