Will I Have Terrible Nausea and Vomiting During My Chemotherapy Treatment?

For decades, chemotherapy has been connected to the side effects of serious nausea and vomiting. While these side effects are a common result of chemotherapy, not all chemotherapy medications are known to cause vomiting and nausea. Additionally, not all people experience these side effects to the same degree from cancer medications. Drugs used to treat are powerful and many can result in adverse side effects including vomiting and nausea. Fortunately, many new medications are also available on the market that can control vomiting and nausea more powerfully than previous medications did.

Avoiding both nausea and vomiting is much easier than attempting to get the condition under control after it happens. As a result, before beginning chemotherapy, you will receive medications to help you avoid nausea.

Nausea is the experience of encountering an unpleasant and wavelike sensation in the back of a person’s throat that leads to vomiting. Vomiting involves the forceful expulsion of the material inside a person’s stomach through that individual’s mouth. Retching involves either esophageal or gastric movements of vomiting without emitting vomit.

Why Chemotherapy Makes People Sick

While chemotherapy is a helpful medication, your body views the medicine as a foreign substance. As a result, your body fires warning signals in your brain as well as your digestive tract. This activates a part of your brain called the vomiting center and sends out chemicals that make you nauseous. Chemotherapy can disrupt your digestive system as well, which can result in nausea.

Scientific research has been made regarding the understanding of neuropsychological factors that control nausea and vomiting. Both of these elements are controlled or mediated by a person’s central nervous system. Nausea is controlled through a person’s autonomic nervous system. Vomiting is the result of stimulation of a reflex that includes the combination of various simulations including the chemoreceptor trigger zone, the cerebral cortex and limbic system that respond to sensory stimulation, the part of the inner ear that controls body motion, and peripheral stimuli from both visceral organs and vasculature.

Neurotransmitters located in the part of the body that controls vomiting as well as enterochromaffin cells located in the gastrointestinal tract emit efferent impulses that are then carried to the abdominal musculature as well as the respiratory center and salvation center.

            Some of the signals that are known to make the vomiting part of a person’s brain throw up include:

• A signal from the cerebral cortex and limbic system’s reaction to the sight, smell, taste, emotions, and/
• Signals from a section of the brain called the chemoreceptor trigger zone, which reacts to either chemicals or drugs in a person’s blood
• Signals from nerves and other organs respond to irritation or disease
• Signals from a portion of the inner ear that responds to motion and cause motion sickness in people

Chemotherapy impacts a person’s stomach as well as the location in the brain that is responsible for controlling vomiting. Many medications are currently available to help either control or reduce these side effects. Not all medications work similarly for all individuals and it is sometimes critical to change the medication that you use or combine more than only one medication to obtain the best possible nausea relief. Some individuals encounter slight nausea during chemotherapy, while others become more substantially nauseated for only a short period while receiving chemotherapy.

Some of the pathways that are involved in chemotherapy-cause nausea and vomiting include:

• The critical part of chemotherapy-caused nausea and vomiting is the activation of the chemoreceptor zone by chemotherapy agents in a person’s blood
• The smell and sight of chemotherapy are the primary cause of anticipatory nausea and vomiting that impact people who have had previous vomiting spells in previous chemotherapy cycles

Symptoms may start soon after treatment or 8-12 hours afterward and might last only for a few hours or up to as much as 24 hours after therapy is given. Some people might even begin to feel ill before their treatment begins which is referred to as anticipatory nausea and vomiting, which is often more psychological or as the result of the expectation that you will become nauseous and vomit. It’s a good idea to let your medical provider or medical team know if you are encountering serious nausea, have vomiting, and whether anticipatory nausea occurs before the start of a new cycle of chemotherapy in reaction to stimuli including sights, sounds, or smells of the place where treatment is provided. Anticipatory nausea is a conditioned response that happens after three or four previous chemotherapy treatments after the person experiences acute or delayed nausea and vomiting for longer than a day.

Chemotherapy can result in three types of nausea as well as vomiting. These three types of nausea include:

• Acute nausea begins a few hours after a person starts chemotherapy
• Delayed nausea which do not become active until 24 hours after treatment has the potential to last for several days. Delayed nausea is connected to chemotherapy drugs like cyclophosphamide, cisplatin, and other medications given at high doses on 2 or more consecutive days
• Anticipatory nausea, which begins before a person gets nausea because an individual expects to get sick.
• Breakthrough nausea and vomiting occur within 5 days of using antiemetics and might require rescue
• Refractory nausea and vomiting, which does not respond to treatment
• Nausea and vomiting can sometimes be connected with potential etiologies, which are neither well known nor examined. Some potential causal factors include cranial, gastrointestinal, and drug-induced.

Consistent vomiting can have a negative impact. Vomiting in this way can dry your body out, steal nutrients that your body needs, and leave you weak. You might also experience an electrolyte imbalance, which means that your body does not have a sufficient amount of things like potassium and sodium, which make your body run properly. If you do not feel well, you might have to lower the dosage of chemotherapy that you receive or even entirely stop chemotherapy treatment.

If you cannot hold liquids down, you might later become dehydrated and need to have fluid administered to you intravenously. Substantial dehydration might necessitate that you be hospitalized.

A person is more likely to have nausea if that individual experiences certain problems. Some factors that raise a person’s chances of experiencing chemotherapy include:

• Being a female
• Being younger than 50
• A person’s electrolyte and fluid imbalances
• History of alcohol abuse. People with a higher intake of alcohol are less inclined to experience nausea and vomiting.
• Incidence and severity of nausea and vomiting during previous rounds of chemotherapy
• Receiving several types of chemotherapy together
• Receiving the medication by vein instead of by mouth
• Taking a large dose of chemotherapy
• Tending to get motion sickness
• Tumor presence or growth in the gastrointestinal tract
• Whether a person is taking certain drugs including opioids

Medical staff must be aware of the potential causes and factors of nausea and vomiting, particularly in people being treated for cancer who receive various treatments and medications.

Medications that You Can Take for Nausea and Vomiting 

Your medical team can prescribe you medication before you receive chemotherapy to avoid getting sick. You might take one or more of these medications to block transmission to the party of your brain that is responsible for making you ill:

• Rolapitant
• Aprepitant
• Ondanestron
• Granisetron
• Palonestron
• Dolasetron

A person can receive that medication through the mouth or vein. Besides the previously listed medications, some of the other types of medications that a person can take to deal with nausea include:

• Anti-anxiety medications
• Cannabinoids
• Corticosteroids
• Dopamine antagonists
• Motion sickness medications

Marijuana as a Method for Treating Nausea and Vomiting

The relationship between marijuana and its usage as a medication to control nausea and other side effects during cancer treatment is complex. Some of the important factors to consider include:   

• Cancer patients who take medical cannabis report improvement in various symptoms including anxiety, depression, loss of appetite, sleep disruption, nausea, fatigue, pain, and vomiting shortly after starting the medication.
• Approximately 50% of patients who vomited during cancer treatment at the time of their cannabis certification report the severity of vomiting was lowered by more than 30 percent over the four months following the first time they purchased cannabis.
• Marijuana has been shown through various clinical trials to be an effective drug for treating nausea/vomiting as well as dealing with pain caused by cancer treatment. Marijuana can also help to stimulate a person’s appetite during cancer treatment.
• Evidence does not exist, however, that marijuana is the best medication available for achieving these goals. Many studies have revealed that cannabinoids are more effective than older medications in treating these side effects of cancer treatment. Marijuana, however, appears to be less effective than treating these side effects than newer medications.
• Evidence suggests that cannabinoids produced naturally in the body act to suppress nausea in normal circumstances and taking in cannabinoids from medical marijuana during nausea episodes can also effectively reduce the symptoms of nausea.
• Inhaled medical marijuana appears to offer better results in reducing the side effects of nausea when compared to synthetic alternatives. The body absorbs medical marijuana because it is similar to cannabinoids that the body produces naturally. More cannabinoids are absorbed when inhaled as compared to ingested.
• If medication does not seem to be working, you should consider asking your medical team to prescribe medical marijuana. The active ingredient in marijuana is tetrahydrocannabinol, which has been shown to combat nausea and stimulate appetite in people who receive chemotherapy. Your medical provider can also prescribe a medication that contains tetrahydrocannabinol besides marijuana.

What You Can Do to Reduce Nausea Symptoms

Fortunately, various methods exist to reduce the nausea symptoms that you experience. Some of these helpful strategies to limit symptoms include:

• Consuming small and frequent meals during the day. This way your stomach does not end up feeling too full. For some people, nausea only happens between meals, and keeping something in their stomach at all times helps to avoid nausea.
• Eating foods that are cold or at room temperature. Avoid foods that are sweet, fried, fatty, and/or strong tasting.
• Eating meals slowly and consuming fluids at least one hour before or after meals instead of alongside meals.
• Eating only foods that you like and that are good for you.
• Not skipping meals or snacks. In many cases if your stomach is empty, your nausea is more likely to be worse.
• If you are nauseous, eat mild foods.
• If you eat your favorite foods when nauseous, you might end up finding them unappealing after treatment has ended because you associate them with being sick.
• On days that you receive chemotherapy, eating a small meal or snack.
• Eating ginger. Recent studies have shown that ginger can prove helpful in controlling nausea. You might want to consider adding ginger to your list of strategies to limit nausea.
• Staying away from strong smells including those scents associated with cooking or perfume.
• Using relaxation techniques, watching television, or listening to music while eating and during rest periods.
• Wearing loose and non-binding clothing.
• Sipping on liquids slowly during the day. You might find it easier to tolerate cold and clear liquids. Clear liquids include those that you can see through.
• Eating gelatin or popsicles as well as sucking on hard candies with pleasant tastes to remove bad tastes from your mouth.
• Eating small amounts of food that are high in calories and easy to eat.
• Use things that you put on food including oils, sauces, butter, and syrups to raise the caloric content of foods.
• Provided you do not have mouth sores, tart or sour foods are sometimes easier to keep down.
• Rest quietly while remaining upright for at least one hour following each meal.
• Tell your medical team about the nausea that you experience so that they can prescribe medications that will help you deal with the condition.
• Taking anti-nausea medications at the first indicator of nausea to avoid vomiting.

The Role of Alternative Treatments for Nausea and Vomiting

 Medications are the primary method of treating both nausea and vomiting, but some non-medication options can also be utilized. These options involve using both your mind and body with the assistance of a qualified medical professional.

Non-drug treatments might be used on their own to treat nausea, but are most often helpful in combination with medication. These techniques can be utilized with anti-nausea and vomiting medications for individuals whose treatment for cancer is likely to result in both nausea and vomiting. If you’re interested in using one or more of these methods, you should ask a member of your medical team if the methods are safe for you. These alternative methods help to combat nausea by helping you feel relaxed, distracting you from your surroundings, helping you feel like you remain in control of your situation, and making you feel less helpless.

It helps to review some non-medication options that have helped many cancer patients reduce the feeling of nausea. Many of these techniques have few or even no side effects. Before utilizing any of these treatments, however, you should check with your medical team to make sure that they are safe for you. Some of the non-medication options that you might consider include:

• Hypnosis can be utilized to make changes to control nausea as well as vomiting. Hypnosis creates a mood of attention as well as cooperation in accepting an idea.
• Meditation and other relaxation techniques including meditation, breathing, or muscle relaxation can help to reduce both nausea and vomiting.
• Biofeedback helps people obtain a relaxed state and relies on monitoring to help individuals gain conscious control over physical processes that are often automatically controlled. Utilizing biofeedback, a person discovers how to control the physical response of their body. This is performed by tuning into the moment-to-moment changes that are connected to physical response. Biofeedback has not been discovered to work as well for nausea and vomiting.
• Guided imagery helps people remove themselves from the treatment center and picture that they are in a place that’s relaxing for them. The spot can be a spot where they vacation, rest, or have pleasant memories. While attempting to imagine what they experience.
• Systematic desensitization helps individuals discover how to imagine anxiety-producing situations and lower the anxiety that they feel in situations. In many cases, what an individual imagines without anxiety can also be experienced in the real world in a non-anxious way.
• Acupuncture is a traditional Chinese method where small needles are placed into a person’s skin. Various types of acupuncture methods exist including some strategies that use pressure instead of needles.
• Specifically trained professionals who utilize music can help to promote healing. Music therapists sometimes use different methods with each person based on that individual’s needs and abilities. Some evidence exists that when used in combination with standard treatment, music therapy can help to reduce a person’s likelihood of experiencing nausea.

When to Call Your Medical Team

There are some cases where you should consider contacting your medical team immediately after you vomit. Some of these cases include:

• If you inhaled some of the material you vomited.
• If you are vomiting over days.
• If you are vomiting material that resembles coffee grounds.
• If you are unable to hold down medications.
• If you lose 2 or more pounds in 1 to 2 days.