As Jane enters the cancer center for her third cycle of chemotherapy, she notices a queasiness beginning to build in the pit of her stomach; her heart begins to race, and she feels the back of her neck getting hot. Jane is most likely experiencing anticipatory nausea, a form of ill feeling brought on by the sights and smells connected with a previous experience.
Nausea is clearly one of the associations people make when they think of chemotherapy, but chemotherapy is not the only type of cancer treatment that can produce nausea. Surgical anesthesia, pain medications, antibiotics, and radiation therapy to the brain or the gut can also trigger this side effect.
Nausea often results in an aversion to food, which in turn can lead to malnourishment, weight loss, and muscle wasting. Vomiting, a sidekick to nausea, can lead to dehydration and an increase in fatigue and malaise.
In addition, specific factors can increase your risk for nausea and vomiting, such as:
- Age younger than 50
- Being female
- History of motion sickness, or nausea during pregnancy
- High levels of anxiety
- Little or no alcohol consumption
National guidelines have been established for the use of antinausea therapies that can be given before and after surgery, radiation treatment, chemotherapy (Table), and targeted therapy. There are different areas in the body that are responsible for causing nausea. This is why nausea is often treated with a variety of different medications and strategies.
The good news is that acute nausea (occurring in the first 6 hours of treatment), delayed nausea (occurring days after treatment), and anticipatory nausea can each be managed, or even prevented altogether.
Prevention and Management
Prevention is your first line of defense against nausea and vomiting. Preventive medications interfere with triggers located in the vomiting center and chemoreceptor zone, 2 areas of the brain that can cause nausea and vomiting. These medications should be used before chemo and for several days after treatment.
If nausea and vomiting still occur (breakthrough nausea), certain medications can relieve the symptoms and reduce the vomiting. Understanding how to use antinausea medications in the days after treatment is key to successful prevention and management.
Tips for Self-care
Medications are not the only way to prevent nausea and vomiting. Here is a list of some self-care tips to keep your spirit up and food down:
- Drink plenty of fluids during therapy to help reduce the nausea: fatigue, dizziness, dark yellow urine, and feeling thirsty are signs that more fluid (preferably water) is needed. Sipping water throughout the day can help improve absorption
- Eat small, frequent meals: serve meals on a small plate, and avoid greasy, smelly, or heavy foods
- Ginger has been shown to reduce symptoms of nausea: make a ginger tonic by peeling and cutting fresh ginger into half-inch pieces and steeping it in hot water for 5 to 10 minutes; ginger tea can be consumed hot or cold
- Consider using acupressure bands (used to prevent motion sickness): these bands put pressure on a specific energy point located on the wrist
- Use deep breathing and relaxation techniques (such as visualization, meditation, music) to reduce your worries about getting nauseated
Talk With Your Care Team
Effective communication with your oncology team is the most effective way to establish a plan to eliminate nausea and vomiting. Without a clear understanding of how antinausea medications work, and what additional approaches can be used, you may suffer needlessly.
Jane and her oncologist discuss the symptoms she experienced when she came into the cancer center. She is referred to a support class to learn how to use progressive muscle relaxation (tensing and relaxing groups of muscles) and guided imagery. She found that both of these techniques were helpful in eliminating anticipatory nausea, as well as reducing her concern about experiencing nausea and vomiting during and after her cancer treatment.