Nausea and Vomiting
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.
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
- Bleeding in the stomach or intestines
Managing Nausea and Vomiting
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.
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.
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
- These therapies can be considered as an addition to antiemetic drugs
- Glutamine should not be recommended for improving nausea and vomiting during chemotherapy.
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.|
- Plans, protocols and programs
- Abrams & Weil integrative medicine approaches7
- Alschuler & Gazella complementary approaches8
- Block program9
- Chang strategies10
- McKinney protocols11
- Traditional systems
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.
- American Society of Clinical Oncology Cancer.Net: Nausea and Vomiting
- National Cancer Institute: Nausea and Vomiting in People with Cancer
- Dosing and drug interactions for supplements: Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010.
- Block KI. Life Over Cancer: The Block Center Program for Integrative Cancer Care. New York: Bantam Dell. 2009; provides information on multiple approaches for managing nausea and vomiting
- McKinney N. Naturopathic Oncology, 3rd Edition. Victoria, BC, Canada: Liaison Press. 2016.
- Cookbooks with tips and recipes for those experiencing N&V:
- Katz R, Edelson M. The Cancer Fighting Kitchen. Berkeley, California: Ten Speed Press. 2017.
- Bratton S, Iannota J. The Meals to Heal Cookbook. Savor Health, 2017.
- Clinical Practice Guidelines:
- National Comprehensive Cancer Network clinical practice guidelines for antiemesis (login required)
- Deng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120.
- Deng GE, Rausch SM et al. Complementary therapies and integrative medicine in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e420S-e436S.
- Greenlee 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
- National Comprehensive Cancer Network Patient and Caregiver Resources
- Michael Lerner: Choices In Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer
- healthjourneys: Meditations
- Donald I. Abrams, MD, and Andrew T. Weil, MD: Integrative Oncology, 2nd Edition
- American Society of Clinical Oncology: Cancer.Net
- United Patients Group: Informative Videos on Medical Cannabis & Marijuana
- Wayne Jonas, MD: Your Healing Journey: A Patient’s Guide to Integrative Breast Cancer Care
- September 2018 Issue of the Journal of Alternative and Complementary Medicine
- Dwight McKee, MD, editor: Clinical Pearls