Nausea and Vomiting (PDQ®)
Nausea and vomiting are serious side effects of cancer therapy.
Nausea is an unpleasant wavelike feeling in the back of the throat and/or stomach that may lead to 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 have improved, nausea and vomiting are still serious side effects of cancer therapy. Some patients are bothered more by nausea than by vomiting.
Nausea and vomiting must be controlled to maintain the patient's treatment and quality of life.
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. Uncontrolled nausea and vomiting can cause the following:
- Chemical changes in the body.
- Mental changes.
- Loss of appetite.
- A torn esophagus.
- Broken bones.
- Reopening of surgical wounds.
There are four types of nausea and vomiting that are caused by cancer therapy:
Anticipatory nausea and vomiting: If a patient has had nausea and vomiting after the previous three or four chemotherapy treatments, he or she may have anticipatory nausea and vomiting. The smells, sights, and sounds of the treatment room may remind the patient of previous times and may trigger nausea and vomiting before a new cycle of chemotherapy has even begun.
Acute nausea and vomiting: Usually happen within 24 hours after beginning chemotherapy
Delayed nausea and vomiting: Happen more than 24 hours after chemotherapy. Also called late nausea and vomiting.
Chronic nausea and vomiting: In patients with advanced cancer, chronic nausea and vomiting may be caused by the following:
- Brain tumors or pressure on the brain.
- Colon tumors.
- Stomach ulcers.
- High or low levels of certain substances in the blood.
- Medicines such as opioids or antidepressants.
- Radiation therapy.
Chemotherapy and radiation therapy are the most common causes of nausea and vomiting in patients being treated for cancer.
Nausea is controlled by a part of the central nervous system that controls involuntary body functions (like the heart beating). Vomiting is a reflex controlled by a vomiting center in the brain. Vomiting can be triggered by smell, taste, anxiety, pain, motion, poor blood flow, irritation, or changes in the body caused by inflammation.
The most common causes of nausea and vomiting are:
Many factors increase the risk for nausea and vomiting.
Nausea and vomiting are more likely if the patient:
- Had severe or frequent periods of nausea and vomiting after past chemotherapy sessions.
- Is female.
- Is younger than 50 years.
- Has a fluid and/or electrolyte imbalance (dehydration, too much calcium in the blood, or too much fluid in the body's tissues).
- Has a tumor in the GI tract, liver, or brain.
- Has constipation.
- Is receiving certain drugs, such as opioids (pain medicine).
- Has an infection or blood poisoning.
- Has kidney disease.
- Has anxiety.
Anticipatory Nausea and Vomiting
Anticipatory nausea and vomiting may occur after several treatment sessions.
Anticipatory nausea and vomiting occur in some patients after they have had several courses of treatment. This 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 alcohol alone. The more chemotherapy sessions a patient has, the more likely it is that anticipatory nausea and vomiting will develop. The following may make anticipatory nausea and vomiting more likely:
- Being younger than 50 years.
- Being female.
- Having any of the following, after the last chemotherapy session:
- Nausea and vomiting.
- Feeling warm or hot.
- Feeling weak.
- Feeling dizzy or lightheaded.
- A history of motion sickness.
- Having a high level of anxiety.
- Certain types of chemotherapy (some are more likely to cause nausea and vomiting).
- Having morning sickness during pregnancy.
The earlier that anticipatory nausea and vomiting is identified, the more effective treatment may be.
Treatment of anticipatory nausea and vomiting is more likely to work when symptoms are treated early. Although antinausea drugs do not seem to help, the following types of treatment may decrease symptoms:
- Muscle relaxation with guided imagery.
- Behavior changing methods.
- Distraction (such as playing video games).
Acute or Delayed Nausea and Vomiting
Acute and delayed nausea and vomiting are common in patients being treated for cancer.
How often nausea and vomiting occur and how severe they are may be affected by the following:
- The specific drug.
- 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.
Acute nausea and vomiting are more likely in patients who:
- Have had nausea and vomiting after previous chemotherapy sessions.
- Are female.
- Drink little or no alcohol.
- Are young.
Delayed nausea and vomiting are more likely in patients who:
- Are receiving high-dose chemotherapy.
- Are receiving chemotherapy two or more days in a row.
- Have had acute nausea and vomiting with chemotherapy.
- Are female.
- Drink little or no alcohol.
- Are young.
Acute and delayed nausea and vomiting are usually treated with drugs.
Acute and delayed nausea and vomiting are usually treated with antinausea drugs. Some types of chemotherapy are more likely to cause acute nausea and vomiting. Drugs may be given before each treatment to prevent nausea and vomiting. After chemotherapy, drugs may be given to prevent delayed 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.
Ginger is being studied in the treatment of nausea and vomiting.
The following table shows drugs that are commonly used to treat nausea and vomiting caused by cancer treatment:Drugs Used to Treat Nausea and Vomiting Caused by Cancer TreatmentDrug NameType of Drug Droperidol, haloperidol, metoclopramide, prochlorperazine and other phenothiazinesDopamine receptor antagonists Dolasetron, granisetron, ondansetron, palonosetronSerotonin receptor antagonistsAprepitantSubstance P/NK-1 antagonists Dexamethasone. methylprednisolone, dronabinolCorticosteroidsCannabinoidsMarijuana, nabiloneAlprazolam, lorazepam, midazolamBenzodiazepinesOlanzapineAntipsychotic/monoamine antagonists
Chronic Nausea and Vomiting in Advanced Cancer
Treatment of nausea and vomiting in advanced cancer includes ways to keep bowel habits regular.
In patients with advanced cancer, constipation is one of the most common causes of nausea. To prevent constipation, it is important that a regular bowel routine be followed, even if the patient isn't eating. Laxatives that soften the stool or stimulate the bowel may help prevent constipation, especially if the patient is being treated with opioids for cancer pain. Patients with advanced cancer usually cannot handle high-fiber diets or laxatives with psyllium or cellulose that need to be taken with a lot of fluids.
Enemas and rectal suppositories are used for short-term, severe episodes of constipation. Patients who have a loss of bowel function because of nerve damage (such as a tumor pressing on the spinal cord) may need suppositories for regular bowel emptying. Enemas and rectal suppositories are not used in patients who have damage to the bowel wall. (See the Constipation section in the PDQ summary on Gastrointestinal Complications and the Using Drugs to Control Pain section in the PDQ summary on Pain.)
Nausea and vomiting are sometimes caused by a blocked bowel.
Patients who have advanced cancer may have a blocked bowel caused by a tumor. If the bowel is partly blocked, the doctor may put a nasogastric tube through the nose and esophagus into the stomach to make a temporary passage. If the bowel is completely blocked, the doctor may insert a gastrostomy tube through the wall of the abdomen directly into the stomach to relieve the build-up of fluid and air. Also, medicines and liquids can be given directly into the stomach through the tube.
Sometimes, the doctor may create an ileostomy or colostomy by bringing part of the small intestine or colon through the abdominal wall to form an opening on the outside of the body. For certain colorectal blockages, an expandable metal tube called a stent may be put in, to open the blocked area.
Medicines may also be used to treat nausea and vomiting and relieve pain.
Treating Nausea and Vomiting Without Drugs
Treatment without drugs is sometimes used to control nausea and vomiting.
- Nutrition changes (see the Nausea section in the PDQ summary on Nutrition in Cancer Care for more information).
- Acupuncture and acupressure (see the PDQ summary on Acupuncture for more information).
- Behavior therapy.
- Relaxation methods: Guided imagery and hypnosis are relaxation techniques that have been studied and shown to be helpful in anticipatory nausea and vomiting.
Radiation Therapy and Nausea and Vomiting
Radiation therapy may cause nausea and vomiting.
Radiation therapy may cause nausea and vomiting, especially in patients who are receiving radiation therapy to the gastrointestinal tract, liver, or brain. The risk for nausea and vomiting increases as the dose of radiation and the size of the area being treated increase. Nausea and vomiting caused by radiation therapy usually occur one-half hour to several hours after treatment. Patients may have fewer symptoms on days they do not have radiation therapy.