Nausea and Vomiting

Nausea is the sensation of the need to vomit.  Vomiting occurs when stomach muscles contract and push stomach contents up through the mouth.  Nausea and vomiting are usually experienced in conjunction with one another.

These two symptoms are usually present for most cancer patients, however they are experienced in different ways, varying from person to person.  Some patients do not experience nausea or vomiting at all.  Others may experience only mild episodes, while some experience severe nausea and vomiting.  New drugs known as antiemetics can be used to prevent and control nausea and vomiting.

It is critical for patients to be proactive in controlling vomiting, which can lead to dehydration.  Nausea and vomiting can cause insomnia, fatigue and anorexia.  Also, severe nausea and vomiting can interrupt cancer treatment plans.

 

Who experiences nausea and vomiting?

Chemotherapy patients are likely to experience nausea and vomiting.  Drugs used during chemotherapy can cause severe nausea and vomiting in some cases.  Some drugs are more likely to cause nausea and vomiting than others.  Dosage and frequency are significant factors in likelihood of nausea and vomiting.  Physicians will be able to advise patients of risks of their particular form of chemotherapy.

Risk of nausea and vomiting during radiation therapy depends upon the treated area of the body.  Those receiving radiation therapy focused upon the upper abdominal area are likely to experience nausea and vomiting. Treatment schedule is also a significant factor.

Many pain medications, such as strong opioids can also cause nausea and vomiting.

 

What causes nausea and vomiting?

Reactions between the stomach and brain during treatment cause nausea and vomiting.  When cells lining the inside of the stomach are damaged, a signal is sent to the portion of the brain that controls vomiting.  This part of the brain then sends signs to trigger the body to feel nausea and induce vomiting.

 

When does nausea and vomiting occur?

 

Timing of nausea and vomiting during chemotherapy

 

 

Opioids may cause vomiting a few hours after consumption.  However, a person may develop tolerance to opioids and will eventually cease to experience nausea and vomiting.

 

Managing Nausea and Vomiting

Antiemetic drugs may help control nausea and vomiting.  Most can be given as a pill or intravenously, however injecting drugs usually act more quickly.  Some antiemetic drugs are designed for mild symptoms while others are used for more severe nausea and vomiting.  Acute and delayed symptoms can be treated using specifically designed antiemetic drugs.

Which antiemetic drugs a physician prescribes may depend upon which chemotherapy drugs are currently being used in treatment.  Sometimes a combination of drugs is useful.  It is also important to take antiemetic drugs at specific intervals after treatment.  Patients should consult their doctor to find out the safest and most effective times to take antiemetic drugs.

Doctors usually prescribe antiemetic drugs to be taken before scheduled radiation therapy.  For symptoms related to opioids, antiemetics are prescribed at the onset of nausea and vomiting.  If nausea and vomiting continue despite taking antiemetic drugs, an increased dose or change in type of antiemetic may help.

Lifestyle changes can also help to relieve nausea and vomiting.  Progressive muscle relaxation, biofeedback, guided imagery, and self-hypnosis may also reduce nausea and vomiting.  Changes in eating habits may also be beneficial.  Eating several small meals throughout the day while drinking plenty of fluids can help minimize symptoms.

 

When should patients consult a doctor about nausea and vomiting?

If a patient is experiencing nausea and vomiting, despite antiemetic drugs, then a doctor should be consulted.  Immediate attention from a physician is needed if any of the following occur:

 

• More than three episodes of vomiting per hour for at least 3 hours
• Blood in vomit
• Coffee ground-like appearance in vomit
• Consistent vomiting after taking medications
• Weakness and dizziness
• Unable to eat solid foods for more than 2 days