I want to start by saying not all cancer patients have chemo and some chemo is not as bad as others. With the great advances in cancer research, there are now a wide range of cancer treatments. In fact the chemotherapies of today have much-reduced side effects compared to those experienced by our parent’s generation.
Nevertheless, chemotherapy is still a cancer treatment that many patients dread, and sometimes the side effects are quite harsh, affecting hair growth, causing skin irritability, and a number of other side effects that are described elsewhere on this site.
This article explores what chemotherapy-induced nausea and vomiting (sometimes referred to as CINV) are, why they occur, and what you can do about it. But before you read any further please remember that each chemo experience is unique and the below are generalizations.
FAQ about nausea and vomiting caused by chemo
What is the cause of nausea and vomiting in chemo patients?
The exact cause of nausea and vomiting in chemo patients is still not completely understood. Some studies have shown the brain may be triggered by this cancer treatment to sent signals to the body to cause nausea and vomiting (a natural instinct to dispel a harsh drug perhaps?).
Cancer research into this area allows the best anti-nausea medicines to be created. Currently, many anti-nausea drugs that are used attempt to block different parts of the brains pathways to control and prevent CINV.
Who is at risk of nausea and vomiting after chemotherapy?
The doctor prescribing the cancer treatment will say whether it is likely to cause nausea and vomiting. However, not everyone will react in the same way and there are several things that might make someone more vulnerable to nausea and vomiting.
Risk factors that increase your likelihood that someone will have chemotherapy-induced nausea and vomiting include:-
✓ Being female.
✓ Being younger than 50.
✓ There is alot of anxiety.
✓ There is an expectation of CIVN.
✓ There is a history of motion sickness, pregnancy morning sickness or other treatments make you feel sick.
✓ There is a tendency to vomit when ill.
What does chemo nausea feel like and when does it happen?
Although not everyone feels sick during or after chemotherapy if they do it will usually start a few hours after treatment. There are several different types of nausea and vomiting and these are classed as when they occur.
Anticipatory nausea and vomiting is a learned or conditioned response and is the result of previous experiences that led to nausea and vomiting. Anticipatory nausea and/or vomiting can happen before or during cancer treatment.
Acute nausea and vomiting can happen within minutes to hours after treatment is given, and usually within the first 24 hours. This is more common when treatment is given by IV infusion or when taken by mouth.
Delayed nausea and vomiting usually begin after 24 hours and can last for a few days. This is specific to certain types of chemo only.
Breakthrough CIVN happens after you have has anti-sickness treatment/medicines, but have nausea and vomiting anyway.
Refractory vomiting occurs when the anti-sickness drugs stop working and may happen after a few or even after several chemo treatments.
In all the above cases specific support and treatments are available. Any doctor/healthcare professional who is dealing with the chemo would be able to help. If you are the cancer patent reading this and experiencing any of these types o nausea please ask your doctor for help.
Different treatments and lifestyle changes to alleviate nausea and vomiting are discussed later in this article.
How to reduce nausea from chemo
There are many things that can help avoid, remove or reduce nausea and vomiting. From changing eating habits to prescribed medications.
Changing eating habits can help with chemotherapy nausea
Things to try
These anti-nausea tricks that help some cancer patients with CINV
- If the smell of cooked or cooking food makes you feel sick, try to have cold or slightly warm food.
- Several small meals and snacks throughout the day, instead of large portions can reduce the feeling of nausea.
- Chewing food well can trick the stomach into thinking there is less in there and prevent nausea and vomiting.
- You could try having small meals a few hours before treatment, but not just before.
- Light, bland foods, such as plain toast or crackers, are better than rich foods.
- Eat before you get hungry.
Things to avoid
The below are likely to cause or can increase nausea.
- Fried and fatty foods.
- Foods that smell strong.
- Filling your stomach with a large amount of liquid before eating.
- Too much activity straight after eating.
- Mixing hot and cold foods.
We also recommend that avoid eating your favorite foods during the time you feel sick. If you do, they will no longer be favorite foods as you could begin to associate them with nausea and vomiting.
Additions to the diet can help
There are certain foods that can help with chemotherapy nausea:
Crystallized stem ginger on its own or adding freshly ground ginger to your favourite dishes, or to hot water or tea to make a soothing drink and are all documents to relieve nausea symptoms.
Sipping ginger ale can also help and has the double bonus of being a fizzy drink, which relieves symptoms also.
Peppermint is thought to slow down gut movement and therefore relieves nausea and vomiting. That is why sucking mints or drinking peppermint tea can help.
Fresh or tinned pineapple chunks can help keep your mouth fresh and moist.
Drinking well can help
It’s always important to try to drink plenty, even if you can’t eat. Small sips slowly through the day can help.
Try drinking these throughout the day:
- Clear, sweet liquids, like fizzy drinks or fruit juice.
- Ice cold or clear fluids.
- Prune juice and hot drinks, which can help to make your bowels work if you are constipated.
Drinks to avoid include caffeine, orange and grapefruit juice, which may irritate your stomach.
Anti-sickness acupressure bracelets can help with the side effects of chemotherapy. These include a hard plastic stud that you position in the middle of the inside of your wrist. The aim of these bracelets is that the acupressure point on the inside of the wrist helps control the sickness. It is suggested that it calms the vomiting center of the brain and reduces nausea.
Focus on your surroundings
- Try not to lay flat for at least two hours after eating.
- After eating rest by sitting up or reclining with your head elevated.
- Get fresh air after eating.
- Wearing loose clothing can be helpful.
- Exercising after eating can slow down digestion and increase discomfort.
- Try not to get over tired because you could find things more difficult to cope with when you are exhausted. If you can, relax and keep your mind off the chemotherapy. Bring soothing music, a funny film, relaxation tapes, or CD’s, with you to chemo, or even a friend
Relaxation techniques such as hypnosis and meditation (focusing the mind), breathing exercises, or muscle relaxation (tensing and relaxing the muscles) can help decrease nausea and vomiting.
There are many types of drugs that can be used to control nausea and vomiting. These are called anti-sickness (anti-emetic) drugs. The type of treatment given depends on the cause of the sickness.
Some of these drugs work on the brain by preventing stimulation of the vomiting center. Others work on the gut by speeding up the rate at which the stomach empties. This helps move food through the intestines quickly.
Treatment is often a combination of different drugs and often it’s a matter of finding the right one that works for the specific cancer patient.
How to cope emotionally with chemotherapy nausea
Please don’t give yourself a hard time if you really don’t feel like eating for a few days after chemotherapy. You can still drink and it is important that you do. You can make up for lost calories in between treatments.
When to contact your doctor
You must tell your cancer care team if you suffer nausea or vomiting because there are many remedies available. But be aware that may take more than several attempts to find the medicines that actually work best for you and you may need a combination for medications and changes in eating habits to help.
Nausea and vomiting can also be caused by medical conditions unrelated to chemotherapy. So please do contact your doctor if:
- You continue to have nausea or vomiting, despite taking anti-nausea medications.
- Nausea interferes with your ability to eat.
- You feel bloated.
- You have been vomiting 4-5 times in a 24 hour period.
- There is pain or you have a swollen stomach before nausea and vomiting occurs.
Everyone with cancer and everyone having cancer treatment will respond differently. Please don’t let any of the above scare you if you are a cancer patient or know someone with cancer. And don’t forget that if you or your loved one does get CIVN there is plenty you can do about it.
If you are preparing for chemotherapy
Here are some questions you might want to ask your doctor or health professional regarding having CINV
- Which chemo drugs will I be given?
- How will the drugs be given to me?
- How do these side effects compare with side effects of other treatments?
- What can I do to get ready for the cancer treatment and decrease the chance of side effects?
- Will I need to change my diet in any way?
- Will I need to change my activities?
- How might I feel during and after the chemo treatments?
- What can I do to help with nausea, vomiting, fatigue side effects?
- How will this affect my daily life and work?
If you know someone about to have chemotherapy
It’s not easy seeing someone you know go through chemotherapy. It is often hard to know how to talk to and how support a chemo patient. Cancer gifts can ease this stress and show that you care. But there is no ‘one size fits all’ when it comes to the right thing to give.
Most of our care packages are suitable for cancer patients who suffer from chemotherapy nausea. In many gift boxes, we provide peppermint tea, ginger teas or crystallized ginger. We also provide water bottles and acupressure bands in most of our deluxe and chemotherapy gifts. Comforting items are also supplied such as hand warmers and bed socks for cold hands and feet which can be another chemotherapy side effect.
Please check them out and let us know what you think.
Dr Cohen started her working life as a research scientist and lecturer with over 100 peer-reviewed scientific publications.
She followed a classical scientific career until she left mainstream science in 2000 (which coincided with the birth of her first daughter) to establish the Life Science Communications company, Euroscicon Ltd.
Euroscicon Ltd was her first company (which she sold in 2016).
In 2013 Dr Cohen was diagnosed with Cancer and set up Cancer Care Parcel which provides appropriate gifts for people with cancer.
Dr Cohen is the lead scientific advisor at Optimised Healthcare. A medical profiling company which provides advanced disease prediction, prevention and wellness optimization services.
She also works with and establishes businesses and charities which benefit local, national and international communities.