Nausea and vomiting

Feeling sick or queasy (nausea) and vomiting (throwing up) is a common problem for people being treated for cancer, however there are many things that can help your nausea and vomiting become well managed and controlled.

What causes nausea and vomiting during cancer treatment?

Nausea and vomiting may be caused by the cancer itself or the treatment you are receiving. Chemotherapy drugs vary in the incidence and severity of nausea and vomiting they cause, in addition to how quickly it may start and how long it lasts. Feeling emotions such as anxiety or anticipation may also influence whether you feel sick or not. Other medications may increase your risk of nausea and vomiting, such as pain medications, antibiotics and antifungals.

What are the symptoms of nausea and vomiting?

After chemotherapy, some people develop nausea and vomiting within minutes or hours while others may develop symptoms two to three days later. The nausea and vomiting may last for up to 24 hours or in some cases can last up to seven days. Some people feel sick before their treatment or when a circumstance such as a smell or sight reminds them of their treatment. This is known as anticipatory nausea and vomiting. Associated with nausea and vomiting, you may look pale and experience sweating and excess saliva.

How can nausea and vomiting be prevented/managed?

There are a number of medications available to treat, prevent or control nausea and vomiting. These medications, called antiemetics, can be taken as a tablet or a wafer, given by suppository or directly into a vein through a drip. Often a combination of different types of antiemetics will be given.

Antiemetics will be given before chemotherapy and then you will be provided with some tablets or wafers to take home. It’s important that you take the medication regularly as directed by your doctor. If the medications you are given don’t seem to be working well, you should speak to your care team as a different medication might work better for you.

Alternative treatments:

  • hypnosis may be effective for anticipatory nausea and vomiting
  • progressive muscle relaxation in combination with guided imagery is likely to be effective
    • progressive muscle relaxation (PMR) is a technique of alternately tensing and relaxing muscle groups in sequence throughout the body
    • guided imagery involves the use of mental visualisation and imagination to enhance relaxation and alter specific experiences

Strategies such as aromatherapy, massage, exercise, acupressure and acupuncture may help but their effectiveness remains unproven. Talk to your care team if you are interested in more information about any of these techniques.

Some approaches you can take to help prevent or control nausea and vomiting include:

  • taking antiemetics 30 minutes before you eat
  • minimising the use of products with strong smells such as perfumes or certain cleaning products
  • avoiding eating or preparing food when feeling sick. If possible have someone else do the cooking or try to prepare and freeze meals in advance for those days when you do not feel like cooking
  • eating small amounts of food more frequently – commonly called grazing
  • eating bland food rather than strong smelling or spicy food
  • avoiding high fat, greasy and fried food
  • drinking plenty of fluids throughout the day (small amounts regularly)
  • avoiding drinking too much before a meal
  • avoiding alcohol and high volumes of coffee
  • ginger may help with nausea; try biscuits, tea or ginger beer
  • peppermints or peppermint tea may help

When should I seek help from a health professional?

If vomiting becomes severe or occurs frequently within the first 24 to 48 hours, please contact your care team.

Always seek medical advice if you:

  • have nausea that lasts for more than a few days, or if the nausea keeps you from doing things that are important to you
  • vomit more than once or twice a day for two days
  • cannot keep any liquids or food down for more than 24 hours
  • show signs of dehydration:
    • reduced urine output
    • rapid heart rate
    • headaches
    • flushed, dry skin
    • coated tongue
    • irritability
    • confusion
    • dizziness

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