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Nausea and Vomiting (PDQ®): Supportive care - Patient Information [NCI]

This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.

Nausea and Vomiting

General Information

Nausea and vomiting are serious side effects of cancer therapy.

Nausea is an unpleasant wavelike feeling in the back of the throat and/or stomach that may lead to 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 have improved, nausea and vomiting are still serious side effects of cancer therapy. Some patients are bothered more by nausea than by vomiting.

Nausea and vomiting must be controlled to maintain the patient's treatment and 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. Uncontrolled nausea and vomiting can cause the following:

  • Chemical changes in the body.
  • Mental changes.
  • Loss of appetite.
  • Malnutrition.
  • Dehydration.
  • A torn esophagus.
  • Broken bones.
  • Reopening of surgical wounds.

There are four types of nausea and vomiting that are caused by cancer therapy:

  • Anticipatory.
  • Acute.
  • Delayed.
  • Chronic.

Anticipatory nausea and vomiting: If a patient has had nausea and vomiting after the previous three or four chemotherapy treatments, he or she may have anticipatory nausea and vomiting. The smells, sights, and sounds of the treatment room may remind the patient of previous times and may trigger nausea and vomiting before a new cycle of chemotherapy has even begun.

Acute nausea and vomiting: Usually happen within 24 hours after beginning chemotherapy

Delayed nausea and vomiting: Happen more than 24 hours after chemotherapy. Also called late nausea and vomiting.

Chronic nausea and vomiting: In patients with advanced cancer, chronic nausea and vomiting may be caused by the following:

  • Brain tumors or pressure on the brain.
  • Colon tumors.
  • Stomach ulcers.
  • Dehydration.
  • High or low levels of certain substances in the blood.
  • Medicines such as opioids or antidepressants.
  • Radiation therapy.

Causes

Chemotherapy and radiation therapy are the most common causes of nausea and vomiting in patients being treated for cancer.

Nausea is controlled by a part of the central nervous system that controls involuntary body functions (like the heart beating). Vomiting is a reflex controlled by a vomiting center in the brain. Vomiting can be triggered by smell, taste, anxiety, pain, motion, poor blood flow, irritation, or changes in the body caused by inflammation.

The most common causes of nausea and vomiting are:

  • Chemotherapy.
  • Radiation therapy to the gastrointestinal (GI) tract, liver, or brain.

Many factors increase the risk for nausea and vomiting.

Nausea and vomiting are more likely if the patient:

  • Had severe or frequent periods of nausea and vomiting after past chemotherapy sessions.
  • Is female.
  • Is younger than 50 years.
  • 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 GI tract, liver, or brain.
  • Has constipation.
  • Is receiving certain drugs, such as opioids (pain medicine).
  • Has an infection or blood poisoning.
  • Has kidney disease.
  • Has anxiety.

Anticipatory Nausea and Vomiting

Anticipatory nausea and vomiting may occur after several treatment sessions.

Anticipatory nausea and vomiting occur in some patients after they have had several courses of treatment. This 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 alcohol alone. The more chemotherapy sessions a patient has, the more likely it is that anticipatory nausea and vomiting will develop. The following may make anticipatory nausea and vomiting more likely:

  • Being younger than 50 years.
  • Being female.
  • Having any of the following, after the last chemotherapy session:
    • Nausea and vomiting.
    • Feeling warm or hot.
    • Feeling weak.
    • Sweating.
    • Feeling dizzy or lightheaded.
  • A history of motion sickness.
  • Having a high level of anxiety.
  • Certain types of chemotherapy (some are more likely to cause nausea and vomiting).
  • Having morning sickness during pregnancy.

Treatment of anticipatory nausea and vomiting should begin early.

Treatment of anticipatory nausea and vomiting is more likely to work when symptoms are treated early. Although antinausea drugs do not seem to help, the following types of treatment may decrease symptoms:

  • Muscle relaxation with guided imagery.
  • Hypnosis.
  • Behavior changing methods.
  • Biofeedback.
  • Distraction (such as playing video games).

Psychologists and other mental health professional with special training in these treatments can often help patients with anticipatory nausea and vomiting.

Acute or Delayed Nausea and Vomiting

Acute and delayed nausea and vomiting are common in patients being treated for cancer.

Chemotherapy is the most common cause of nausea and vomiting that is related to cancer treatment.

How often nausea and vomiting occur and how severe they are may be affected by the following:

  • The specific drug.
  • The dose of the drug or if it is given with other drugs.
  • How often the drug is given.
  • The way the drug is given.
  • The individual patient.

Acute nausea and vomiting are more likely in patients who:

  • Have had nausea and vomiting after previous chemotherapy sessions.
  • Are female.
  • Drink little or no alcohol.
  • Are young.

Delayed nausea and vomiting are more likely in patients who:

  • Are receiving high-dose chemotherapy.
  • Are receiving chemotherapy two or more days in a row.
  • Have had acute nausea and vomiting with chemotherapy.
  • Are female.
  • Drink little or no alcohol.
  • Are young.

Acute and delayed nausea and vomiting are usually treated with drugs.

Acute and delayed nausea and vomiting are usually treated with antinausea drugs. Some types of chemotherapy are more likely to cause acute nausea and vomiting. Drugs may be given before each treatment to prevent nausea and vomiting. After chemotherapy, drugs may be given to prevent delayed vomiting. Some drugs last only a short time in the body and need to be given more often. Others last a long time and are given less often.

The following table shows drugs that are commonly used to treat nausea and vomiting caused by cancer treatment:

Drugs Used to Treat Nausea and Vomiting Caused by Cancer Treatment

Drug Name Type of Drug
Droperidol,haloperidol,metoclopramide,prochlorperazineand otherphenothiazines Dopaminereceptor antagonists
Dolasetron,granisetron,ondansetron,palonosetron Serotoninreceptor antagonists
Aprepitant Substance P/NK-1 antagonists
Dexamethasone.methylprednisolone,dronabinol Corticosteroids
Cannabinoids
Marijuana,nabilone
Alprazolam,lorazepam,midazolam Benzodiazepines
Olanzapine Antipsychotic /monoamine antagonists

Chronic Nausea and Vomiting in Advanced Cancer

Nausea and vomiting in advanced cancer has many causes.

Patients with advanced cancer commonly have chronic nausea and vomiting, which can decrease the quality of life. Nausea and vomiting related to advanced cancer may be caused by the following:

  • Opioids, other pain medicines, and antidepressants.
  • Constipation (a common side effect of opioid use).
  • Brain and colon tumors.
  • High or low levels of certain substances (such as calcium and salt) in the blood.
  • Dehydration.
  • Stomach ulcers.
  • Infections in the mouth or upper airway.

Treatment of nausea and vomiting in advanced cancer includes ways to keep bowel habits regular.

In patients with advanced cancer, constipation is one of the most common causes of nausea. To prevent constipation, it is important that a regular bowel routine be followed, even if the patient isn't eating. Laxatives that soften the stool or stimulate the bowel may help prevent constipation, especially if the patient is being treated with opioids for cancer pain. Patients with advanced cancer usually cannot handle high-fiber diets or laxatives with psyllium or cellulose that need to be taken with a lot of fluids.

Enemas and rectal suppositories are used for short-term, severe episodes of constipation. Patients who have a loss of bowel function because of nerve damage (such as a tumor pressing on the spinal cord) may need suppositories for regular bowel emptying. Enemas and rectal suppositories should not be used in patients who have damage to the bowel wall. (See the Constipation section in the PDQ summary on Gastrointestinal Complications and the Side Effects of Opioids section in the PDQ summary on Pain.)

Nausea and vomiting are sometimes caused by a blocked bowel.

Patients who have advanced cancer may have a blocked bowel caused by a tumor. If the bowel is partly blocked, the doctor may put a nasogastric tube through the nose and esophagus into the stomach to make a temporary passage. If the bowel is completely blocked, the doctor may insert a gastrostomy tube through the wall of the abdomen directly into the stomach to relieve the build-up of fluid and air. Also, medicines and liquids can be given directly into the stomach through the tube.

Sometimes, the doctor may create an ileostomy or colostomy by bringing part of the small intestine or colon through the abdominal wall to form an opening on the outside of the body. For certain colorectal blockages, an expandable metal tube called a stent may be put in, to open the blocked area.

Medicines may also be used to treat nausea and vomiting and relieve pain.

Treating Nausea and Vomiting Without Drugs

Treatment without drugs is sometimes used to control nausea and vomiting.

Non-drug treatments may help relieve nausea and vomiting, and may help antinausea drugs work better. These treatments include:

  • Nutrition changes (see the Nausea section in the PDQ summary on Nutrition in Cancer Care for more information).
  • Acupuncture and acupressure (see the PDQ summary on Acupuncture for more information).
  • Behavior therapy.
  • Relaxation methods: Guided imagery and hypnosis are relaxation techniques that have been studied and shown to be helpful in anticipatory nausea and vomiting.

Radiation Therapy and Nausea and Vomiting

Radiation therapy may cause nausea and vomiting.

Radiation therapy may cause nausea and vomiting, especially in patients who are receiving radiation therapy to the gastrointestinal tract, liver, or brain. The risk for nausea and vomiting increases as the dose of radiation and the size of the area being treated increase. Nausea and vomiting caused by radiation therapy usually occur one-half hour to several hours after treatment. Patients may have fewer symptoms on days they do not have radiation therapy.

Changes to This Summary (04 / 02 / 2013)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

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About PDQ

PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

Images in the PDQ summaries are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in the PDQ summaries, along with many other cancer-related images, are available in Visuals Online, a collection of over 2,000 scientific images.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

A clinical trial is a study to answer a scientific question, such as whether one method of treating symptoms is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. Some patients have symptoms caused by cancer treatment or by the cancer itself. During supportive care clinical trials, information is collected about how well new ways to treat symptoms of cancer work. The trials also study side effects of treatment and problems that come up during or after treatment. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients who have symptoms related to cancer treatment may want to think about taking part in a clinical trial.

Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).

Last Revised: 2013-04-02


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