Managing Nausea and Vomiting during Cancer: A Whole Person Approach - CancerChoices



Managing Nausea and Vomiting during Cancer: A Whole Person Approach

Nausea and vomiting at a glance

Gastrointestinal upsets such as nausea and vomiting can be common during some cancer treatments. Cancers in certain areas of the body can also cause nausea and vomiting. Finding relief can not only greatly enhance your quality of life, but may help you maintain your body weight and even complete your treatment. Several lifestyle practices and complementary therapies can help you manage nausea and vomiting. 

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Nausea and vomiting: an overview

What are nausea and vomiting?

Nausea is a feeling of queasiness and the need to retch or vomit. Vomiting can lead to dehydration, and so drinking small amounts of water frequently is recommended.1NCCN Guidelines for Patients: Nausea and Vomiting. National Comprehensive Cancer Network. 2022. Viewed September 12, 2024. 

Nausea and vomiting and cancer

What can cause or trigger nausea and vomiting with cancer?

You may experience nausea and vomiting at many different times during your cancer experience. Some types of chemotherapy—such as cisplatin, carboplatin, or doxorubicin—can cause immediate and/or delayed nausea or vomiting. It is not uncommon to experience nausea a day or more after treatment. Radiation therapy to certain parts of the body may cause nausea and/or vomiting during treatment or immediately after. Some drugs to ease other cancer symptoms, such as opioids, can also cause nausea and vomiting.2Mayo Clinic staff. Nausea and vomiting. Mayo Clinic. December 7, 2023. Viewed September 10, 2024.

Cancer in some parts of the body, such as in the pancreas, brain, or abdomen, may also cause nausea and vomiting. Cancer can also cause imbalances, such as too much calcium in the blood, that lead to nausea and vomiting. Anticipating the risk of nausea and vomiting so they can be prevented or minimized, as well as identifying the cause, are important to identify the best treatment.

Anticipatory nausea and vomiting  

Anticipatory nausea and vomiting (ANV) occurs when you feel nauseated or vomit before receiving chemotherapy. This may be triggered by reminders of previous treatments, such as the sight of the clinic or the smell of medication. It’s a learned response that can develop after experiencing nausea during prior chemotherapy sessions. You should inform your doctor if you begin to feel queasy or anxious before treatments, as early intervention can help manage symptoms. You should also mention any specific triggers and ask about medications or therapies, like relaxation techniques, systematic desensitization,3Patel P, Robinson PD et al. Prevention and treatment of anticipatory chemotherapy-induced nausea and vomiting in pediatric cancer patients and hematopoietic stem cell recipients: clinical practice guideline update. Pediatric Blood & Cancer. 2021 May;68(5):e28947; Morrow GR, Asbury R et al. Comparing the effectiveness of behavioral treatment for chemotherapy-induced nausea and vomiting when administered by oncologists, oncology nurses, and clinical psychologists. Health Psychology. 1992;11(4):250-6; Morrow GR. Effect of the cognitive hierarchy in the systematic desensitization treatment of anticipatory nausea in cancer patients: a component comparison with relaxation only, counseling, and no treatment. Cognitive Therapy and Research. 1986;10:421-446. or aromatherapy that might reduce ANV. A key way to prevent ANV from developing is to develop a medical plan to prevent or minimize nausea and vomiting. Taking antiemetics as prescribed is also important. 

What else can cause or contribute to nausea and vomiting?

Aside from the cancer-related causes above, nausea and vomiting can have many different origins. Common causes relevant to people with cancer: 

  • General anesthesia
  • Intestinal obstruction
  • Migraines
  • Infections
  • Anxiety
  • Pain 
  • Dehydration 
  • Imbalances of hormones or electrolytes such as high calcium or low sodium in the blood

What are signs and symptoms of nausea and vomiting?

When someone has nausea, they feel sick to their stomach and may have the urge to throw up. Continued nausea and vomiting can also lead to other symptoms (listed below), specifically dehydration if the ability to take in fluids and food is impaired. Be sure to let your doctor know if you are unable to keep fluids down and are vomiting for more than 24 hours.4Understanding Nausea and Vomiting. American Cancer Society. June 26, 2024. Viewed September 10, 2024. 

  • The urge to vomit
  • Vomiting
  • Queasiness
  • Pain or bloating in the abdomen
  • Headache
  • Fatigue 
  • Lack of appetite
  • Weight loss
  • Dizziness

Top evidence-based practices and therapies for managing nausea and vomiting 

We present approaches to reducing nausea and vomiting backed by modestsignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently), goodsignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently), or strongconsistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analyses of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results (this is the CancerChoices definition; other researchers and studies may define this differently) evidence of effectiveness from clinical guidelines and our therapy reviews. If your nausea and vomiting are caused by medical conditions, treating the underlying condition may be needed to relieve your symptoms.

Conventional therapies

Several very effective antinausea (antiemetic) drugs and other treatments are available.  Ask your oncologist for conventional treatments if you are experiencing nausea and/or vomiting.  

If you are prescribed antiemetic and anti-anxiety medication before and after cancer treatment, taking it as prescribed is important for best effect. Tell your doctor of any of these situations:

  • You miss a dose
  • You can’t keep the medication down
  • It isn’t working
  • It causes unpleasant or serious side effects

Some chemotherapy drugs can cause delayed nausea and vomiting up to 48 hours after treatment. Antiemetic regimens can successfully control this situation.

Complementary therapies

Supplements and natural products

Other complementary therapies

Recommended against; avoid use

Glutamine is not recommended for improving nausea and vomiting during chemotherapy due to a lack of effect in two studies.27Greenlee H, DuPont-Reyes MJ et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: A Cancer Journal for Clinicians. 2017 May 6;67(3):194-232 (this set of guidelines has been endorsed by the American Society of Clinical Oncology (ASCO): Lyman GH, Greenlee H et al. Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. Journal of Clinical Oncology. 2018 Sep 1;36(25):2647-2655).

Helpful links

Oregon Clinic logo

BRAT Diet › Includes an expanded list of foods for the customary BRAT (bananas, rice, apples, and toast) diet for people recovering from vomiting and/or diarrhea

Cookbooks with tips and recipes for those experiencing nausea and vomiting:

Information for health professionals

Clinical practice guidelines

Pediatric Oncology Group of Ontario makes recommendations for preventing and treating anticipatory chemotherapy-induced nausea and vomiting in pediatric cancer patients:28Patel P, Robinson PD et al. Prevention and treatment of anticipatory chemotherapy-induced nausea and vomiting in pediatric cancer patients and hematopoietic stem cell recipients: clinical practice guideline update. Pediatric Blood & Cancer. 2021 May;68(5):e28947. 

  • Optimize acute and delayed CINV control to minimize the risk of anticipatory CINV.
  • Consider offering cooperative patients one or more of the following nonpharmacological interventions for secondary prevention of anticipatory CINV: hypnosis, systematic desensitization, or relaxation techniques.
  • Consider using lorazepam for secondary prevention of anticipatory CINV.
  • We suggest that ginger not be used routinely for secondary prevention of anticipatory CINV.
  • Do not use clonidine for secondary prevention of anticipatory CINV.

Authors

Nancy Hepp, MS

Lead Researcher
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher and writer for CancerChoices and also served as the first program manager. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher

Christine Mineart, MPH

CancerChoices Program Director
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Christine has a dynamic background in the life sciences, public health, and program operations. Her career began at the lab bench with a Gates Foundation-funded HIV Vaccine research group, which led her to graduate studies in public health epidemiology at UC Berkeley. Her research experience spans clinical epidemiology research to evaluating the impacts of community nutrition programs in Los Angeles, the Central Valley, and Oakland. Most recently she has worked in executive operations for a seed-stage venture capital firm based in San Francisco. Personally, Christine is passionate about holistic health and wellness. She is a clinical herbalist and Reiki master, and she has been practicing yoga for 15+ years. She brings a breadth of experiences to her work leading the CancerChoices program.

Christine Mineart, MPH CancerChoices Program Director

Reviewer

Laura Pole, MSN, RN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, MSN, RN, OCNS Senior Clinical Consultant

Last update: November 4, 2024

Last full literature review: November 2024

CancerChoices provides information about integrativein cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.

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