Nausea and Vomiting

Key Points

  • Unmanaged nausea and vomiting can lead to dehydration, serious electrolyte imbalance, weight loss and anticipatory nausea and vomiting.
  • Many effective antiemetic regimens are available for specific types of cancer treatment.
  • A number of complementary approaches can enhance your antiemetic regimen and improve your comfort.

Anticipatory or Delayed Nausea and Vomiting

Anticipatory nausea and vomiting (ANV) is a conditioned anxiety response; the mind associates experiencing nausea and vomiting with the various stimuli in the environment where the nausea and vomiting occur. If nausea and vomiting happens frequently enough, you may develop N&V merely by seeing the infusion center, the IV needle or even the chemotherapy nurse.

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Nausea and vomiting (N&V) is one of the most distressing side effects that people with cancer experience. Unmanaged N&V can lead to dehydration, serious electrolyte imbalance, weight loss and anticipatory nausea and vomiting.

Causes of Nausea and Vomiting

Most common causes:

  • Certain chemotherapy and targeted immunotherapy regimens
  • Other medications
  • Radiation therapy to the whole body or certain parts of the body (such as the abdominal area or the brain’s vomiting center).
  • Cancer in the brain
  • Electrolyte imbalances
  • Blocked intestines
  • Infections
  • Bleeding in the stomach or intestines

Managing Nausea and Vomiting

Conventional Approaches

Many effective antiemetic regimens are available for specific types of cancer treatment. Some of the drugs have been formulated to dissolve under your tongue for quicker effect and to reduce its risk of being vomited. The American Society of Clinical Oncology (ASCO)’s Cancer.Net webpage on Nausea and Vomiting provides an excellent listing and summary of various specific antiemetic regimens, as well as questions to ask your healthcare team about N&V.

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Complementary Approaches

A number of complementary approaches can enhance your antiemetic regimen and improve your comfort. The National Cancer Institute (NCI) suggests that deep breathing, guided imagery, hypnosis, and other relaxation techniques such as listening to music, reading a book, or meditating may help some people. NCI also suggests a number of dietary and eating tips that are often helpful: Nausea and Vomiting in People with Cancer.

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Clinical Practice Guidelines

Clinical practice guidelines from the Society for Integrative Oncology (SIO) list the following integrative approaches as helpful for controlling chemotherapy induced N&V in people with breast cancer:3

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Cautions

ASCO’s Cancer.Net cautions:

“Some herbal products, like ginger, may help with nausea. However, you should discuss your plans with your healthcare team before starting any alternative or complementary treatments. These options should not be used as a replacement to medical treatments such as the ones listed [on the ASCO webpage]. There is not enough evidence to recommend a cannabinoid such as medical marijuana to prevent or treat nausea and vomiting from chemotherapy or radiation therapy. However, the FDA-approved cannabinoids dronabinol (Marinol, Syndros) or nabilone (Cesamet) are recommended to treat nausea and vomiting that does not improve with the standard antiemetics discussed above.”6

Integrative Plans, Protocols and Medical Systems

For more information about plans and protocols, see our Integrative Plans and Protocols page.

Commentary

Laura Pole, RN, OCNS, October 18, 2018: Janie Brown is an oncology nurse and co-founder of a cancer retreat program and centre in Vancouver, British Columbia. Her BCCT story, The Power of the Integrative Approach in Breast Cancer Treatment (see in Personal Stories below), is a treasure trove of helpful information. She describes how her partner with breast cancer and her team made decisions about chemotherapy, wove in useful complementary therapies to prevent and minimize treatment side effects and created a caring community. The integrative plan staved off the usual chemotherapy side effects of peripheral neuropathy, mucositis, fatigue, nausea and neutropenia.

Ruth Hennig, a two-time breast cancer survivor and member of the BCCT team, has written blog posts describing her experience using acupuncture and other complementary approaches to bolster her resilience during treatment and tame her anxiety upon learning the breast cancer had recurred. Her tips and insights for taking care of herself after a double mastectomy are simple and practical, and they may be incredibly valuable for others having a mastectomy. See her posts in the Our Blog box below.

Written by Laura Pole, RN, MSN, OCNS, and reviewed by Nancy Hepp, MS; most recent update on October 18, 2018.

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