Nausea and Vomiting

 

What is nausea and vomiting?

Nausea is the uneasy feeling in the stomach that suggests that you may need to throw up. People often describe it as feeling “sick to the stomach” or “queasy.” Vomiting is when the stomach forcefully pushes its contents up and out through the mouth. A person can have nausea without vomiting, vomiting without much warning, or both.


What does nausea and vomiting look like?

Nausea may cause a person to look pale, sweaty, uncomfortable, or less interested in food. They may have a bad taste in their mouth, or certain smells may make them feel worse. Vomiting may happen once or repeatedly. Some people also have gagging, retching, stomach cramps, dizziness, or trouble keeping food and drinks down. If vomiting continues, the body can lose too much fluid, and the person can become dehydrated.


Who gets nausea and vomiting?

Anyone getting chemotherapy can have nausea or vomiting, but the chance is not the same for every treatment. Cancer treatments are grouped into different risk levels for nausea, which means how likely a drug or treatment regimen is to cause vomiting if no anti-nausea medicine is given. In general, high-risk chemotherapy causes vomiting in more than 90% of patients without prevention, moderate-risk causes it in 30% to 90%, low-risk in 10% to 30%, and minimal-risk in less than 10%. The risk level helps the care team choose how strong the prevention plan should be.

A person’s own body can also affect risk. Some people are simply more likely to feel sick from treatment than others. Prior problems with nausea, motion sickness, pregnancy-related nausea, or poor nausea control during an earlier chemotherapy cycle can all increase the risk of experiencing nausea/vomiting during treatment.


How do you prevent nausea and vomiting?

The main goal is to prevent nausea and vomiting because once symptoms begin, they can be harder to control. The timing of prevention also matters. Nausea risk can mainly be in the first 24 hours after chemotherapy, while some therapies can potentially cause nausea up to 5 days after treatment. This is why some anti-nausea medicines are given right before chemotherapy, while others may be continued for a few more days at home.
The medicines used most often belong to a few main groups: 

For high-risk chemotherapy, prevention usually consists of a 3 or 4-drug plan. This often includes a combination of a 5-HT3 blocker, dexamethasone, NK1 blocker, and/or olanzapine. For moderate-risk chemotherapy, prevention is usually a 2-drug plan for many regimens; however, some patients may need a 3-drug regimen. For low-risk chemotherapy, patients often receive just one medicine before treatment, such as dexamethasone or ondansetron. For minimal-risk chemotherapy, routine prevention medicine is often not needed, though rescue medicine may still be available if symptoms happen.

How is nausea and vomiting treated?

Even with good prevention, some patients still develop nausea or vomiting. When that happens, doctors often use a breakthrough treatment plan. “Breakthrough” means symptoms happen even though preventive medicine was already given. Commonly used medications for breakthrough symptoms include:

If nausea and vomiting keep happening over repeated cycles, the treatment plan may be changed for the next chemotherapy cycle. For example, the team may add olanzapine, add an NK1 blocker, switch the 5-HT3 blocker, or extend how long medicine is continued after treatment.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

Treatment Options

References

PDQ Supportive and Palliative Care Editorial Board. Nausea and Vomiting (PDQ®): Health Professional Version. 2015 Jul 17. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-.