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Nausea and vomiting related to cancer treatment (PDQ®) -Version for patients 

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 IN THIS PAGE
General information
Causes
Anticipatory nausea and vomiting
Acute or delayed nausea and vomiting
Treatment of nausea and vomiting without medication
Nausea and vomiting related to treatment in children
Information about this PDQ summary
Information about the PDQ
Purpose of this summary
Reviewers and updates
Information about clinical trials
Permissions for the use of this summary
Clause on the disclaimer

For more information General information

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General information
IMPORTANT POINTS
Nausea and vomiting are serious side effects of cancer treatment.
It is important to control nausea and vomiting so that the patient can continue treatment and improve their quality of life.
Chemotherapy, radiation therapy and other conditions cause different types of nausea and vomiting.
Nausea and vomiting are serious side effects of cancer treatment.
Nausea and vomiting are side effects of cancer treatment that affect the majority of patients receiving chemotherapy. Radiation therapy to the brain, gastrointestinal tract, or liver also causes nausea and vomiting.
Nausea is an unpleasant sensation in the back of the throat or the stomach that comes and goes in waves. Sometimes nausea occurs before vomiting. Vomiting is throwing stomach contents through the mouth. The arcades are the movements of the stomach and the esophagus without vomiting; they are also called dry arcades. Although the treatments for nausea and vomiting have improved, these symptoms are still serious side effects of cancer treatment because they cause suffering in the patient and sometimes cause other health problems. It is possible that patients have more nausea than vomiting.
A part of the autonomic nervous system controls nausea, this system directs the involuntary functions of the body (such as breathing or digestion). The vomiting center in the brain partially controls the vomiting reflex. The triggers of vomiting are odors, tastes, anxiety, pain, movements or changes in the body caused by inflammation, poor blood flow or irritation in the stomach.
It is important to control nausea and vomiting so that the patient can continue treatment and improve their quality of life.
It is very important to prevent and control the nausea and vomiting of patients with cancer so that they can continue with the treatment and carry out the activities of their daily lives. Nausea and vomiting that are not controlled can cause the following problems:
Chemical changes in the body.
Mental changes
Loss of appetite
Malnutrition.
Dehydration
Tear in the esophagus
Broken bones.
Surgical wounds that reopens after healing.
Chemotherapy, radiation therapy and other conditions cause different types of nausea and vomiting.
Nausea and vomiting occur before, during or after treatment.


The types of nausea and vomiting are described below:
Acute: nausea and vomiting that occur in the first 24 hours after the start of treatment.
Deferred (delayed): nausea and vomiting that occur 24 hours after the start of chemotherapy. They are also called late nausea and vomiting.
Anticipatory: nausea and vomiting that occur before starting chemotherapy. If the patient suffered from nausea and vomiting after a previous chemotherapy session, he may have anticipatory nausea and vomiting before the next treatment. Usually, this happens after the third or fourth treatment. The smells, appearance and sounds of the treatment room can remind the patient of previous episodes and this is likely to trigger nausea and vomiting even before the start of the chemotherapy session.
Intercurrent (episodic): nausea and vomiting that occur within 5 days after treatment to relieve nausea. Different medications or doses are needed to help prevent more nausea and vomiting.
Resistant to treatment: nausea and vomiting that do not respond well to medications.
Chronic: nausea and vomiting that remain for a time after finishing treatment.
Causes


IMPORTANT POINTS
Many factors increase the risk of nausea and vomiting during chemotherapy.
Radiation therapy also causes nausea and vomiting.
Other conditions also increase the risk of nausea and vomiting in patients with advanced cancer.
Many factors increase the risk of nausea and vomiting during chemotherapy.
Nausea and vomiting are more likely to occur during chemotherapy if the patient has the following characteristics:
Get treatment with certain chemotherapy drugs.
He suffered from severe or frequent nausea and vomiting after previous chemotherapy treatments.
She is a woman.
He is less than 50 years old.
Had dizziness or vomiting during a previous pregnancy.
You have fluid or electrolyte imbalance (dehydration, too much calcium in the blood or too much fluid in the tissues of the body).
You have a tumor in the gastrointestinal tract, the liver, or the brain.
He suffers from constipation.
You receive certain medications, such as opioids (medicines to relieve pain).
You have an infection, even a blood infection.
He has kidney disease.
Patients who consumed large amounts of alcoholic beverages for a time have a lower risk of nausea and vomiting after chemotherapy treatment.

Radiation therapy also causes nausea and vomiting.
The following treatment factors may affect the risk of nausea and vomiting:

The part of the body that receives radiation therapy. Radiation therapy to the gastrointestinal tract, liver or brain, or the entire body is more likely to cause nausea and vomiting.
The size of the area under treatment.
The radiation dose.
Receive chemotherapy and radiotherapy at the same time.
It is possible that patient factors cause nausea and vomiting during radiotherapy if the patient has the following characteristics:
He is less than 55 years old.
She is a woman.
He suffers from anxiety.
He experienced periods of severe or frequent nausea and vomiting after previous chemotherapy or radiotherapy treatments.
Patients who consumed large amounts of alcoholic beverages for a time have a lower risk of nausea and vomiting after radiation therapy.

Other conditions also increase the risk of nausea and vomiting in patients with advanced cancer.
Other conditions also cause nausea and vomiting. The causes of chronic nausea and vomiting in advanced cancer patients are described below:
Tumors of encephalon or pressure in the encephalon.
Tumors of the gastrointestinal tract.
High or low concentrations of certain substances in the blood.
Medications such as opioids.


Anticipatory nausea and vomiting
IMPORTANT POINTS
Anticipatory nausea and vomiting may occur after several chemotherapy treatments.
The earlier the anticipatory nausea and vomiting are identified, the more effective the treatment could be.
Anticipatory nausea and vomiting may occur after several chemotherapy treatments.
In some patients, they go through several treatment cycles until nausea and vomiting occur before a treatment session. These are called anticipatory nausea and vomiting. They are triggered by odors in the treatment room. For example, a person who begins chemotherapy and at the same time smells a swab with alcohol may later suffer from nausea and vomiting only with the smell of alcohol swab. As the patient undergoes more chemotherapy sessions, he is more likely to have more anticipatory nausea and vomiting.

The probability of having anticipatory nausea and vomiting is greater if three or more of the following characteristics are met:
Have nausea and vomiting, or feel warm or hot after the last session of chemotherapy.
Be less than 50 years old
To be a woman.
Have a history of dizziness.
Have high degrees of anxiety in certain situations.
Other factors that also increase the likelihood of developing anticipatory nausea and vomiting are described below:
Expectations of nausea and vomiting before the start of chemotherapy.
Certain doses and types of chemotherapy (some types are more likely to cause nausea and vomiting).
Sensation of dizziness or vertigo after chemotherapy.
Frequency of nausea after chemotherapy.
Nausea and late vomiting after chemotherapy.
History of nausea in the morning during pregnancy.

The earlier the anticipatory nausea and vomiting are identified, the more effective the treatment could be.
When symptoms of anticipatory nausea and vomiting are diagnosed early, treatment is more likely to work.

Psychologists and other mental health professionals with special training often manage to help patients with anticipatory nausea and vomiting. The following types of treatments can be used:
Muscle relaxation and guided images.
Hypnosis.
Methods of behavior modification.
Biofeedback.
Distractions (such as video games).
Anti-nausea medications do not seem to control anticipatory nausea and vomiting.


Acute or delayed nausea and vomiting
IMPORTANT POINTS
Acute or delayed nausea and vomiting are common in patients treated with chemotherapy.
Acute or delayed nausea and vomiting from chemotherapy or radiation therapy is usually treated with medications.
Acute or delayed nausea and vomiting are common in patients treated with chemotherapy.
Chemotherapy is the most common cause of nausea and vomiting related to cancer treatment.

The following factors affect the frequency and severity of nausea and vomiting:

The specific medication that is administered.
The dose of the medication or if it is administered with other medications.
The frequency of drug administration.
The form of administration of the medicine.
The individual factors of the patient.
The likelihood of acute or delayed nausea and vomiting increases when the patient has the following characteristics:
He received chemotherapy in the past.
He presented with nausea and vomiting after previous sessions of chemotherapy.
He is dehydrated.
He is malnourished.
He underwent a recent surgery.
He received radiotherapy.
She is a woman.
He is less than 50 years old.
He has a history of dizziness.
Have a history of nausea in the morning.
Patients who present with acute nausea and vomiting during chemotherapy are also more likely to have delayed nausea and vomiting.
Acute or delayed nausea and vomiting from chemotherapy or radiation therapy is usually treated with medications.
Medications may be given before each treatment to prevent nausea and vomiting. After chemotherapy, medications can be given to prevent delayed vomiting. It is possible that patients receiving chemotherapy for several days in a row need treatment for acute and delayed nausea and vomiting. Some medications remain in the body only for a short period and need to be administered more often. Others last a long time and are administered less frequently.


The following table presents the type and name of medications that are commonly used to prevent nausea and vomiting caused by chemotherapy.

Drugs used to prevent nausea and vomiting caused by chemotherapy
Name of the medicine Type of medicine
Chlorpromazine, prochlorperazine, promethazine Phenothiazines
Droperidol, haloperidol Butyrophenones
Metoclopramide, trimethobenzamide substituted benzamides
Dolasetron, granisetron, ondansetron, palonosetron Serotonin receptor antagonists
Aprepitant, fosaprepitant, netupitant, rolapitant Antagonists of substance P / NK-1
Dexamethasone, methylprednisolone Corticosteroids
Alprazolam, lorazepam Benzodiazepines
Olanzapine Antipsychotics / monoamine oxidase inhibitors
Cannabis, dronabinol, ginger, nabilona Other
The following table shows the type and name of medications that are commonly used to prevent nausea and vomiting caused by radiation therapy.

Drugs used to prevent nausea and vomiting caused by radiation therapy
Name of the medicine Type of medicine
Dolasetron, granisetron, ondansetron, palonosetron Serotonin receptor antagonists
Dexamethasone Corticosteroids
Metoclopramide, prochlorperazine Dopamine receptor antagonists
It is not known whether it is better to administer the anti-nausea medication during the first 5 days of radiation treatment or during the entire treatment cycle. Talk to your doctor about the treatment plan that works best for you.


Treatment of nausea and vomiting without medication
IMPORTANT POINTS
Sometimes treatments without medications are used to control nausea and vomiting.
Sometimes treatments without medications are used to control nausea and vomiting.
Non-drug treatments may help relieve nausea and vomiting, and may improve the effectiveness of anti-nausea medications. These treatments are the following:
Changes in diet (for more information see the section on Nausea in the PDQ summary Nutrition in cancer treatment).
Acupuncture and acupressure (for more information, see the PDQ Acupuncture summary).
Relaxation methods such as guided images and hypnosis.
Behavioral therapy
Nausea and vomiting related to treatment in children


IMPORTANT POINTS
Nausea and vomiting in children treated with chemotherapy are a serious problem.
Children sometimes have anticipatory nausea and vomiting.
In children, acute nausea and vomiting are usually treated with medications and other methods.
Deferred nausea may be difficult to detect in children.
Nausea and vomiting in children treated with chemotherapy are a serious problem.
As in adults, nausea in children receiving chemotherapy is more problematic than vomiting. Children have acute or delayed nausea and vomiting.

Children sometimes have anticipatory nausea and vomiting.
Children who have nausea and vomiting after chemotherapy may have the same symptoms before the next treatment when they observe, smell, or hear sounds from the treatment room. These are called anticipatory nausea and vomiting.

When the child's nausea and vomiting are well controlled during chemotherapy treatment, the child may have less anxiety before the next treatment and is less likely to have anticipatory symptoms.

Health professionals who treat children suffering from anticipatory nausea and vomiting found that children benefit from the following strategies:

Hypnosis.
Medications used to treat anxiety in doses that are adjusted according to the child's age and needs.
In children, acute nausea and vomiting are usually treated with medications and other methods.
Medications may be given before each treatment to prevent nausea and vomiting. After chemotherapy, medications can be given to prevent delayed vomiting. It is possible that patients receiving chemotherapy for several days in a row need treatment for acute and delayed nausea and vomiting. Some medications remain in the body only for a short period and need to be administered more often. Others last a long time and are administered less frequently.

The following table presents the type and name of medications that are commonly used to prevent nausea and vomiting caused by chemotherapy. Different types of medications can be administered at the same time to treat acute and delayed nausea and vomiting.

Drugs used to prevent nausea and vomiting caused by chemotherapy

Non-drug treatments may help relieve nausea and vomiting, and may improve the effectiveness of anti-nausea medications in children. These treatments are the following:

Acupuncture.
Acupressure
Guided images
Music therapy
Muscle relaxation training.
Support groups for children and their families.
Virtual reality games.
The nutritional support includes the following aspects:

Consume smaller meals more often.
Avoid odors from food and other strong odors.
Avoid spicy, greasy or salty foods.
Consume "homemade meals" that were previously useful to prevent nausea.
Take anti-nausea medications before meals.
Deferred nausea may be difficult to detect in children.
Unlike adults, delayed nausea and vomiting in children may be more difficult for parents and caregivers to identify. A change in the child's eating pattern may be the only sign of a problem. In addition, most chemotherapy treatments used in children are scheduled for several days. This makes it unclear the time of presentation or the risk of delayed nausea.

Studies on the prevention of delayed nausea and vomiting in children are few. Children are usually treated in the same way as adults, with doses of anti-nausea medications that adjust for age



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