Cancer Treatment and Nausea

Cancer Treatment and Nausea: What You Can Do
All Rights Reserved

What causes nausea in cancer patients?

Chemotherapy is the number one cause of nausea in cancer patients. The drugs used to destroy cancer cells are also toxic to healthy cells in the digestive tract. Chemo also causes chemicals to be released in the digestive tract that eventually stimulate the portion of the brain that controls vomiting and nausea.

Other causes of nausea during cancer treatment include radiation therapy and other medications. Sometimes the cancer itself will make the patient nauseated, particularly if it's a cancer of the digestive system. Cancer-related fatigue is another cause of nausea.

In addition, constipation -- a common side effect of cancer treatment -- can contribute to nausea by slowing down digestion so that the food moves sluggishly through the body. Patients can help reduce constipation by taking in ample dietary fiber and using laxatives if necessary.

Prevention strategies for chemo-related nausea

The first step to preventing nausea, says Redwing Keyssar, palliative care program coordinator for Seniors-at-Home, a program of Jewish Family and Children's Services in the San Francisco Bay Area, is to take the threat of nausea seriously. If the doctor says that a chemotherapy drug is likely to cause nausea, listen to the warning and take preventive steps.

It's common for patients to wait until they feel really nauseated before starting to treat it, says Keyssar, b ut that approach often backfires. "Once the place in the brain that controls vomiting is activated, it's hard to stop," she says.

If the person you're caring for isn't keen on taking medication for symptoms that haven't appeared yet, explain -- or better yet, have his doctor explain -- that nausea is one of the reasons some patients don't want to continue cancer treatment, so doctors make it a priority to try to control nausea before it starts.

Certain chemotherapy drugs are more likely to cause nausea and vomiting than others. These include:

  • Carboplatin
  • Carmustine (BiCNU)
  • Cisplatin (Platinol)
  • Cyclophosphamide (Cytoxan)
  • Dacarbazine (DTIC-Dome)
  • Mechlorethamine (Mustargen)
  • Streptozocin (Zanosar)

If the chemotherapy regimen includes one of these drugs, he's likely to suffer from nausea and vomiting after treatment. Many other chemotherapy drugs also cause nausea when given at high doses, so find out what drug he's taking and whether the dosage is high or low, so you can anticipate whether he's likely to experience nau sea.

Most people undergoing chemotherapy are prescribed drugs to prevent nausea and vomiting. Known as antiemetics, these drugs work by regulating the chemicals in the brain that control nausea. Some are given orally and some intravenously, and they're used alone or in combination.

Usually, the doctor will begin treatment with antiemetics before chemotherapy begins, and the treatment will continue for several hours or days after each dose of chemo. It's important to take a proactive approach with antiemetics because once nausea and vomiting begin, they're much more difficult to control.

Commonly used antiemetics include:

  • Ondansetron (Zofran)
  • Dolasetron (Anzemet)
  • Granisetron (Kytril)
  • Aprepitant (Emend 09)
  • Palonosetron (Aloxi)
  • Dexamethasone (Decadron)
  • Methylprednisolone
  • Dronabinol (Marinol)
  • Prochlorperazine
  • Metoclopramide (Reglan)
  • Lorazepam (Ativan)

Anxiety can also play a key role in triggering nausea, Keyssar says. Experts don't know why, but people with high levels of anxiety tend to experience more nausea. And, ironically, if someone is worried about feeling nauseated, the worry itself can make nausea more likely. To prevent this from happening, ask the doctor about medication to treat anxiety, Keyssar says.

Another way to prevent nausea from hitting as severely after chemo: Eat a light meal a couple of hours before each treatment.

Medications and herbs to control nausea during chemo

In addition to treatment with antiemetics before chemotherapy, many medications -- including those mentioned above -- are available to help control vomiting and nausea on an ongoing basis. Keep in mind that if the first medication the doctor tries isn't effective it doesn't mean another one won't work. Every patient's response is individual, and finding a solution is often a process of trial and error.

Likewise, one medication may work for a while and then mysteriously lose its effectiveness. The doctor has an arsenal of medications to chose from, so don't hesitate to call and request a switch.

Another option is to combine drug-based antinausea treatment with alternative approaches. In recent years, many cancer patients have found that simultaneous treatment by an herbalist specializing in Chinese herbal medicine (CHM) can make a big difference in reducing nausea and vomiting and strengthening the body to withstand chemotherapy.

With the recent publication of a study in the Annals of Oncology showing a significant reduction in nausea among patients treated with CHM, many leading cancer centers are starting to incorporate this alternative treatment.

If this approach sounds appealing, ask the doctor about additional treatment by a CHM practitioner or look for a clinic specializing in such a program, which can coordinate communication between the CHM specialist and his doctor.

Many cancer patients have found that smoking marijuana reduces nausea and stimulates appetite. It's currently legal in eight states for this specific purpose, although there are conflicts between national and state laws, and the issue is complex. For more information, contact the National Organization for Reform of Marijuana Laws .

Practical ways to avoid nausea in cancer patients

In addition to medication, there are other ways to avoid or reduce nausea. Even little changes can make a big difference. Try these:

Serve small meals. Prepare food in small, easy-to-serve portions, and suggest that the person you're caring for eat many small meals throughout the day rather than three large ones.

Keep lots of snacks available. High-carbohydrate foods like crackers and toast help settle the stomach and move through the digestive system quickly. Keep snacks next to the bed so he can have a few bites before getting up. Keep jars of nuts, dried fruit, small crackers, and other snacks around the house, and encourage him to eat a handful whenever he can manage it.

Protect the patient from unpleasant smells. Scents can be powerful nausea triggers for someone undergoing chemotherapy. Take steps to avoid strong odors -- move the garbage can to the garage, put the cat litter downstairs, park the car at the curb, so he doesn't have to smell exhaust in the garage.

Ta ke particular care to avoid food-related smells before meals, which can set off a wave of nausea that will keep him from eating. Have him stay out of the kitchen while food is being prepared, and if possible, have him sit outside in the fresh air. Avoid food with a strong smell, such as fish, and serve meals cool or at room temperature when possible, since hot food tends to have a stronger odor.

Try enhancing the taste of food -- without odors -- by seasoning with salt, lemon juice, and condiments like catsup, pickles, and olives.

Encourage rest after meals. Activity slows digestion, which tends to increase nausea. It can help to take a rest after eating, either sitting up or with his back and shoulders raised on pillows. He shouldn't lie flat on his back, as this can cause heartburn and nausea. Loosen his clothing and keep the room cool, with plenty of fresh air.

Offer plenty of liquids. Drinking lots of water helps prevent nausea, but other liquids are good too. Flat ginger ale is popular with cancer patients, as is cold ginger and peppermint tea or other types of herbal teas. Ice chips are popular, but if they get boring, offer frozen fruit ice pops.

Prevent sour mouth. A dry, sour taste in the mouth is a common side effect of cancer treatment, and it can also trigger nausea. Encourage the person in your care to rinse his mouth out with water as often as possible, particularly before meals. Chewing on peppermint candy, lemon drops, or ginger candy also helps.

Distract him after meals . Thinking about something else can help prevent nausea from occurring after meals. Get out a board game or watch a movie together. Relaxation techniques such as guided meditation help reduce nausea as well.

The main thing to keep in mind about cancer-related nausea is that it's an ever-evolving process that you have to take day by day. Some days will be bad days, when your main focus will be keeping the patient as comfortable as possible. Other days will be good days, when you can take advantage of his feeling better to help him eat well and build up his strength. He'll probably appreciate anything you can do to help him weather the ups and downs.

Melanie Haiken

Melanie Haiken discovered how important it is to provide accurate, targeted, usable health information to people facing difficult decisions when she was health editor of Parenting magazine. See full bio

9 months, said...

I finished chemo 23 days ago, (cisplatin and taxol), but have continued with nausea and vomiting. I don't have just nausea. How long should I expect this to continue. This week, I have vomited 3 out of 4 days, so it is not going well. Any help?

about 3 years, said...

All the suggestions on how to help with nausea really helped me to understand what I could do to help my husband who is in his 1st treatment in his second course of chemo. His tummy is always upset. I'll show him this & perhaps he will take the anti-nausea pills the dr. prescribed.

over 3 years, said...

Just the possible options to prevent excessive Nausea is good to know. I am reading up on these articles as my wife has been diagnosed with Multiple Myeloma and is tommorrow undergoing her 6th dose of Velcade and Dexa

almost 4 years, said...

wouldn't probiotics be helpful to ease stomach pain and digestive system? Would have to do after each Chemo treatment.

over 5 years, said...

My Nausea drug of choice in Zofran. I have a very temperamental stomach and just about every IV drug I have had makes be violently ill. The meds are available and they work--very effectively. USE THEM!!!

over 6 years, said...

costipation. i will make sure ..... i try not to get constipation. if i have to take laxativies if necessary. t y

over 6 years, said...

Dear anon, my dad had horrible nausea during his cancer treatment as well. What worked well for us when he was really having difficulty was smoothies; we'd make them super nutritious with protein powder, yogurt, etc and eventually when we were trying to help him keep weight on we'd use ice cream too. Good luck, I'll be thinking about you!

over 6 years, said...

p.s. my dad is also went through cancer treatments (prior to the vertigo) and was only able to eat crackers and boost during that time.

over 6 years, said...

Still looking for things my dad can eat... He has been suffering from BPPV (vertigo) for almost 6 weeks and has been so nauseaus he hadn't been able to keep much food down. After 10 days in the hospital and IV's, we finally brought him home. The ONLY thing he has been able to eat is oatmeal - we have been fortifying it with quinoa and hemp seeds and organic maple syrup. Maybe more nutritious than crackers. I will try the distraction techniques as well. Thanks!

over 6 years, said...

Dear Destanme, thanks for your information, I do agree that Chinese medicine can be enormously helpful to people going through chemo. When my father was being treated with chemo and radiation for esophageal cancer, we used Chinese medicine, and it did strengthen his digestive system, improve his appetite, and help him tolerate the harsh treatments.

over 6 years, said...

I treat patients who are under going Chemo treatments with Chinese Medicine. Emotions often cause upset stomach as often seen in children who vomit when emotionally upset or people who eat (or don't eat) when stressed out. In Chinese Medicine this is known as Liver invading Spleen/Stomach. By calming the emotions you can calm the stomach. Another reason for nausea is that the patient is intentionally being poisoned to kill off cancer. The body naturally wants to expel these toxins; vomiting is a way in which the body can void itself of toxins (food poisoning, etc). We know that they cannot vomit away the chemo but the body is trying what it knows. Before chemo begins you can strengthen the digestive system so that it is less easily offended. After chemo you can assist the body in voiding the toxins, which are no longer needed therapeutically. I highly recommend combined Chinese Medical treatments WITH chemotherapy to offset side effects and allow patients to continue their treatments.

about 7 years, said...

It helped me identify triggers that I didn't recognize that have been affecting me.

about 7 years, said...

thanks very much very helpful for my sister in law with cancer of the bowel. You answered some great questions so far a great site for me to copy for my sister inlaw with no computer at age 64 Ron

about 7 years, said...

Great articles for chemo. and stomah pain

over 7 years, said...

My mother has stage 3 breast cancer and she has gone through chemo and radiation and I have to say, she did not once have any nausea. I can't, right this minute, say what treatment was used, but thank goodness she did not experience that! The appetite was not real good, but no matter what she ate she kept it down. Her oncologist, Dr. Soniwalla, was a God send and he told us the breakthroughs made it possible to have the chemo and not the nausea and he was right.

almost 10 years, said...

Really helped me understand what my father could be going through.