Nausea and Vomiting (Patient)

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 cancertherapy. 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 surgicalwounds.

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.
• Colontumors.
• 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, prochlorperazine and other phenothiazines	Dopamine receptorantagonists
Dolasetron, granisetron, ondansetron, palonosetron	Serotonin receptor antagonists
Aprepitant	Substance P/NK-1 antagonists
Dexamethasone. methylprednisolone, dronabinol	Corticosteroids
Cannabinoids
Marijuana, nabilone
Alprazolam, lorazepam, midazolam	Benzodiazepines
Olanzapine		Antipsychotic/monoamine antagonists