Nausea

• Nausea and vomiting can be side effects of cancer therapy.
• It is important that nausea and vomiting are controlled so you can continue treatment and have a better quality of life.
• Different types of nausea and vomiting are caused by chemotherapy, radiation therapy, and other conditions.

Nausea and vomiting can be 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. 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 oesophagus without vomiting.  Patients may have nausea more than vomiting.

Vomiting can be triggered by smell, taste, anxiety, pain, moving, or changes in the body caused by inflammation, poor blood flow, or irritation to the stomach.

• Many factors increase the risk of nausea and vomiting with chemotherapy
• Radiation therapy may also cause nausea and vomiting
• Other conditions may also increase the risk of nausea and vomiting in patients with advanced cancer

Nausea and vomiting with chemotherapy are more likely if you:

• Are treated with certain chemotherapy drugs.
• Had severe or frequent periods of nausea and vomiting after past chemotherapy treatments.
• Are female.
• Are younger than 50 years.
• Had morning sickness or vomiting with a past pregnancy.
• Have a tumor in the gastrointestinal tract, liver, or brain.
• Have constipation.
• Are receiving certain drugs, such as opioids (pain medicine).
• Have an infection, including an infection in the blood.
• Have kidney disease.

The following treatment factors may affect the risk of nausea and vomiting:

• The part of the body where the radiation therapy is given. Radiation therapy to the gastrointestinal tract, liver, or brain, or whole body is likely to cause nausea and vomiting.
• The size of the area being treated.
• The dose of radiation.
• Receiving chemotherapy and radiation therapy at the same time.
• If you are younger than 55 years.
• If you are female.
• If you have anxiety.
• Had severe or frequent periods of nausea and vomiting after past chemotherapy or radiation therapy treatments.

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:

• Brain tumors or pressure on the brain.
• Tumors of the gastrointestinal tract.
• High or low levels of certain substances in the blood.
• Medicines such as opioids.
   

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 smells 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 because of the smell of the 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:

• Having nausea and vomiting, or feeling warm or hot after the last chemotherapy session.
• Being younger than 50 years.
• Being female.
• A history of motion sickness.
• Having a high level of anxiety in certain situations.

Other factors that may make anticipatory nausea and vomiting more likely include:

• Expecting to have nausea and vomiting before a chemotherapy treatment begins.
• Doses and types of chemotherapy (some are more likely to cause nausea and vomiting).
• Feeling dizzy or lightheaded after chemotherapy.
• How often chemotherapy is followed by nausea.
• Having delayed nausea and vomiting after chemotherapy.
• A history of morning sickness during pregnancy.
   

Acute and delayed nausea and vomiting are common in patients being treated with chemotherapy. Acute and delayed nausea and vomiting with chemotherapy or radiation therapy are usually treated with drugs. 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 specific drug being given.
• The dose of the drug or if it is given with other drugs.
• How often the drug is given.
• The way the drug is given.
• The individual patient.

The following may make acute or delayed nausea and vomiting with chemotherapy more likely if you:

• Have had chemotherapy in the past.
• Have had nausea and vomiting after previous chemotherapy sessions.
• Are dehydrated.
• Are malnourished (poor eating).
• Have had recent surgery.
• Received radiation therapy.
• Are female.
• Are younger than 50 years.
• Have a history of motion sickness.
• Have a history of morning sickness during pregnancy.

Patients who have acute nausea and vomiting with chemotherapy are more likely to have delayed nausea and vomiting as well.

Radiation

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. Speak to your nurse or Consultant for further information.

Treatment without drugs is sometimes used to control nausea and vomiting.

Non-drug treatments may help relieve nausea and vomiting, and may help anti-sickness drugs work better. These treatments include:

• Diet

• Acupuncture  

• Relaxation

• CBT  (Cognitive Behaviour Therapy)