Two of the most common side effects of chemotherapy, immunotherapy, and radiation therapy are nausea and vomiting (N&V). Attitudes toward these common side effects of cancer treatment have changed significantly in recent years.  Their impact on a patient’s quality of life is better understood and physicians are more attune to anticipating and helping patients deal with these often debilitating side effects.

You may feel nauseous but never vomit. Or the urge to vomit may pass but not the nausea or visa versa.  Every patient is different and as a result, efforts to control N&V will differ from patient to patient.  It is, therefore, important that you work with your health care team so that they can devise the most effective plan for dealing with your symptoms. For instance, keep a journal of your medication schedule and symptoms. A printable journal page can be found at this URL on the internet: http://www.cancerpage.com/centers/Sifeeffects/html/n_diary.html

Medications To Control Nausea

Most patients receive some sort of anti-nausea medication before they start chemotherapy. It is important for patients to discuss their medications and their own views on nausea and vomiting before they begin cancer treatment.

Your medical team can give you medicine called an antiemetic that blocks the impulse to vomit. Antiemetics are usually given before and after treatment and can be administered orally or intravenously. Different pharmaceutical products block the urge to vomit in different ways so while one agent might not work, another drug may. Sometimes, an anti-anxiety medication will be given along with the antiemetic especially if the anti-nausea drug alone isn’t working well.

Antiemetics can have side effects of their own.  5-HT₃ antagonists may cause dizziness, headache, and constipation. Corticosteroids can irritate the stomach, cause changes in mood and affect sleep patterns. They also can increase risk of infection and are not recommended for diabetic patients.  

Don’t be Complacent

While nausea and vomiting are common side effects of many cancer treatments, they shouldn’t be treated lightly. Talk to your medical team about what to expect.  If you've been prescribed medicine that isn't working or if you want to try out some alternative anti-nausea techniques, let them know. 

Call your medical team immediately if you experience any of the following:

• Persistent and unrelieved nausea for more than 24 hours.
• Two episodes of vomiting within 24 hours even though you are taking medicine to control it.
• Inability to eat or drink.
• Rapid weight loss.
• Signs and symptoms of dehydration such as light headedness, low urine output.

What You Can Do

There are steps you can take to augment the effects of antiemetics or make them unnecessary if the nausea is mild and you prefer not to take an antiemetic. Some of these methods will work for you, some won’t. Some will work for others but not for you.  Many of the techniques discussed below are also helpful in controlling pain.

Relaxation or meditation techniques relieve nausea or keep it from getting worse by reducing tension in the muscles. These techniques include simple breathing exercises, progressive muscle relaxation, and visualization that reduce tension and anxiety.

Imagery for nausea control is a method of allowing your mind and powers of concentration to focus on soothing images. It is a way of further extending the benefits of relaxation and distraction for your own benefit. Imagery can be thought of as a deliberate daydream that uses all of your senses—sight, touch, hearing, smell, and taste. Some people believe that imagery is a form of self-hypnosis, but the way imagery works in reducing nausea and pain is not completely understood.

Distraction involves focusing your attention on something other than your nausea. Many people use this method without realizing it when they watch television or listen to the radio to “take their minds off” the nausea or pain. Reading, cooking, or talking to family and friends can all work just as well.

Exercise can help relieve tension, depression and fatigue. Exercise such as swimming or walking can be comforting, can increase your energy level, and can provide a welcome, healthy distraction from your nausea. An exercise program should only be started after your doctor gives you the go-ahead.  

Acupressure has shown some natural antiemetic benefit.  To control nausea, apply pressure to the inner wrist three finger-breadths above the skin crease of the wrist. This particular pressure point is identified as P6. Many pharmacies carry wrist "bands" that put pressure on the P6 point which you can purchase.

Another acupressure point is located below the knee. Identified as point St36, it is located four finger widths below the kneecap, one finger width outside the shinbone. (A muscle flexes in this spot when you move your foot up and down) Pressure applied to St36 reportedly aids digestion and relieves nausea, stomach disorders and fatigue.  

Herbal Remedies such as ginger, chamomile, or peppermint may also help.

Chemotherapy

Almost all chemotherapy agents cause some degree of N&V.  Just how severe the symptoms are has to do with the type of chemo used and the dose at which it is administered. (Clicking on a chemotherapy agent below provides information from the National Library of Medicine about that agent, including brand names and side effects. A new window will open on your desktop.)

Chemo agents less likely to cause N&V

Bleomycin 
Busulfan
Chlorambucil (oral form) 
5-flourouracil  or 5-FU   - increases with high doses
Fludarabine
Hydroxyurea (oral form)
L-asparaginase  
Melphalan (oral form)
Mercaptopurine (oral form)
Methotrexate – low dose 
Thioguanine (oral form) 
Vinblastine
Vincristine
Vinorelbine

Chemo agents with moderate N&V potential

Capecitabine (oral form)  
Docetaxel
Doxorubicin – liposome
Etoposide (oral form/iv) 
Gemcitabine
Methotrexate – moderate dose
Mitomycin
Mitoxantrone
Paclitaxel
Teniposide
Thiotepa
Topotecan

Chemo agents with high N&V potential

Altretamine
Carboplatin
Carmustine
Cisplatin
Cyclophosphamide
Cytarabine
Dacarbazine
Dactinomycin
Daunorubicin  
Doxorubicin
Epirubicin
Idarubicin
Ifosfamide
Irinotecan
Lomustine
Mechlorethamine
Procarbazine (oral form)
Streptozocin

Radiation

Nearly half of all patients receiving radiation to the upper abdomen will develop some degree of nausea. Almost 90% of patients receiving total body irradiation, head, and total lymphoid irradiation will experience some degree of nausea and vomiting. Depending on the dose of treatment, nausea usually appears 1 to 2 hours after a treatment begins and lasts from 4 to 6 hours. But symptoms might also persist for several days after treatment is finished.  Every patient reacts differently.  Symptoms may also differ from treatment to treatment even though the treatment remains the same.

This page was last edited on 06/19/2003

Written by Rachael Myers Lowe, cancerpage.com
Reviewed by Sara Parkerson, RN, MSN, OCN, Maureen Wilkie, RN, CCM and Jane Quigley, RN, BSN