Nausea and vomiting are side effects of cancer therapy and affect most patients who have chemotherapy. Radiation therapy to the brain, gastrointestinal tract, or liver also cause nausea and vomiting.
Nausea is an unpleasant feeling in the back of the throat and/or stomach that may come and go in waves. It may occur before 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 for nausea and vomiting have improved, nausea and vomiting are still serious side effects of cancer therapy because they cause the patient distress and may cause other health problems. Patients may have nausea more than vomiting.
Nausea is controlled by a part of the autonomic nervous system which controls involuntary body functions (such as breathing or digestion). Vomiting is a reflex controlled in part by a vomiting center in the brain. Vomiting can be triggered by smell, taste, anxiety, pain, motion, or changes in the body caused by inflammation, poor blood flow, or irritation to the stomach.
It is important that nausea and vomiting are controlled so that the patient can continue treatment and have a better 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. Nausea and vomiting that are not controlled can cause the following:
Chemical changes in the body.
- Mental changes.
- Loss of appetite.
- A torn esophagus.
- Broken bones.
- Reopening of surgical wounds.
Different types of nausea and vomiting are caused by chemotherapy, radiation therapy, and other conditions.
Nausea and vomiting can occur before, during, or after treatment.
The types of nausea and vomiting include:
Anticipatory: Nausea and vomiting that happen before a chemotherapy treatment begins. If a patient has had nausea and vomiting after an earlier chemotherapy session, he or she may have anticipatory nausea and vomiting before the next treatment. This usually begins after the third or fourth treatment. The smells, sights, and sounds of the treatment room may remind the patient of previous times and may trigger nausea and vomiting before the chemotherapy session has even begun.
Acute: Nausea and vomiting that happen within 24 hours after treatment starts.
Delayed: Nausea and vomiting that happen more than 24 hours after chemotherapy. This is also called late nausea and vomiting.
Breakthrough: Nausea and vomiting that happen within 5 days after getting antinausea treatment. Different drugs or doses are needed to prevent more nausea and vomiting.
Refractory: Nausea and vomiting that does not respond to drugs.
Chronic: Nausea and vomiting that lasts for a period of time after treatment ends.
Radiation therapy may also cause nausea and vomiting.
The following treatment factors may affect the risk of nausea and vomiting:
The part of the body where the radiation therapy is given. Radiation therapy to the gastrointestinal tract, liver, or brain, or whole body is likely to cause nausea and vomiting.
- The size of the area being treated.
- The dose of radiation.
- Receiving chemotherapy and radiation therapy at the same time.
The following patient factors may cause nausea and vomiting with radiation therapy if the patient:
- Is younger than 55 years.
- Is female.
- Has anxiety.
- Had severe or frequent periods of nausea and vomiting after past chemotherapy or radiation therapy treatments.
Patients who drank large amounts of alcohol over time have a lower risk of nausea and vomiting after being treated with radiation therapy.
Many factors increase the risk of nausea and vomiting with chemotherapy.
Nausea and vomiting with chemotherapy are more likely if the patient:
- Is treated with certain chemotherapy drugs.
- Had severe or frequent periods of nausea and vomiting after past chemotherapy treatments.
- Is female.
- Is younger than 50 years.
- Had morning sickness or vomiting with a past pregnancy.
- 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 gastrointestinal tract, liver, or brain.
- Has constipation.
- Is receiving certain drugs, such as opioids (pain medicine).
- Has an infection, including an infection in the blood.
- Has kidney disease.
- Patients who drank large amounts of alcohol over time have a lower risk of nausea and vomiting after being treated with chemotherapy.
Anticipatory nausea and vomiting
Anticipatory nausea and vomiting may occur after several chemotherapy treatments.
In some patients, after they have had several courses of treatment, nausea and vomiting may occur before a treatment session. This is called anticipatory nausea and vomiting. It 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 an alcohol swab. The more chemotherapy sessions a patient has, the more likely it is that anticipatory nausea and vomiting will occur.
Having three or more of the following may make anticipatory nausea and vomiting more likely:
- Having nausea and vomiting, or feeling warm or hot after the last chemotherapy session.
- Being younger than 50 years.
- Being female.
- A history of motion sickness.
- Having a high level of anxiety in certain situations.
Other factors that may make anticipatory nausea and vomiting more likely include:
- Expecting to have nausea and vomiting before a chemotherapy treatment begins.
- Doses and types of chemotherapy (some are more likely to cause nausea and vomiting).
- Feeling dizzy or lightheaded after chemotherapy.
- How often chemotherapy is followed by nausea.
- Having delayed nausea and vomiting after chemotherapy.
- A history of morning sickness during pregnancy.