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What is nausea and vomiting?
Nausea and vomiting often happen at the same time, but can be
2 different problems.
Nausea
is an unpleasant feeling in the back of your throat and stomach that
may lead to vomiting. Some other ways people describe nausea are "sick
to my stomach," "queasy," or "upset stomach." Other symptoms that may
happen along with nausea are increased saliva (spit), dizziness,
light-headedness, trouble swallowing, skin temperature changes, and a
fast heart rate.
People often refer to vomiting as "throwing up." When you
vomit, your
stomach muscles contract (squeeze) and push the contents of
your stomach out through your mouth. You may or may not feel nauseated.
Sometimes people retch.
This is when you try to vomit without bringing anything up from your
stomach. Other words used to describe retching are "gagging" or "dry
heaves."
How common is nausea and vomiting in people
with cancer?
About 7 or 8 out of every 10 people treated for cancer have
bouts of nausea and vomiting. But there are many medicines that work
well to control nausea and vomiting, and you should not suffer.
Drugs used to control these side effects are
called as anti-nausea/vomiting
drugs. You may also hear them called anti-emetics. Every
person with cancer who is getting treatments that cause nausea or
vomiting can, and should, get medicines to
prevent them.
What problems can nausea and vomiting cause?
Nausea and vomiting are 2 of the most dreaded, unpleasant side
effects of cancer treatment, but they are seldom life-threatening.
Repeated vomiting can lead to dehydration, which is a lack of fluid and
minerals your body needs. This can become a serious problem very
quickly. Be sure to let your cancer team know right away if you can't
keep fluids down, if you can't take the medicines you need, or if your
vomiting lasts 24 hours or longer.
Vomiting can also cause tiredness (fatigue), trouble
concentrating, slow wound healing, weight loss, and loss of appetite.
It can interfere with your ability to take care of yourself and may
lead to changes in your treatment plan. When nausea and vomiting are
severe or long-lasting, and interfere with your normal daily
activities, the outcomes are even worse.
What do I need to know about nausea and
vomiting?
Ask your doctor or a member of your health care team these
questions:
- Is my cancer treatment likely to cause nausea and vomiting?
- Are there effective treatments to prevent or control my
nausea and vomiting?
- How will you decide which anti-nausea/vomiting treatment I
should use?
- Are there side effects to the anti-nausea/vomiting
treatments you want me to use?
- When and how often shoud I take each medicine?
- What else can be done if the treatment does not control my
nausea and vomiting?
You will also want to know in what situations your doctor
wants you to call. For example, some doctors want you to call them if
you are vomiting or if you can't keep down fluids or medicines. And
you'll want to know how to reach your cancer team on weekends or at
night if these problems happen.
Causes of nausea and vomiting in people with
cancer
Nausea and vomiting in the person with cancer can be caused by
many different things:
- chemotherapy, also called chemo
- radiation therapy
- the cancer itself
- certain other medicines
- bowel slow down (paresis)
or blockage (obstruction)
- inner ear problems
- an imbalance of minerals and salts (electrolytes) in
the blood
- infections
- axiety
- the expectation of vomiting due to earlier experiences (anticipatory
vomiting)
- other diseases or illnesses
This information is about the nausea and vomiting caused by
chemo or radiation therapy. Talk to your health care team about what
treatments you can use to keep from having nausea and vomiting.
How do nausea and vomiting happen?
Doctors think that vomiting is most likely controlled by the
part of the brain called the vomiting
center. Less is known about how nausea occurs. When you
are given chemo, 2 things happen:
- a certain area of the brain is triggered
- certain areas of the esophagus (the swallowing tube),
stomach, small intestine, and large intestine are triggered
Chemo is thought to cause vomiting in both of these ways.
How likely are you to have nausea and
vomiting with chemo?
How likely you are to have nausea and vomiting when you are
getting chemo is affected by many different things, including:
- the types of chemo drugs used
- the dose of the drugs (high doses of chemo are more likely
to cause nausea and vomiting)
- when and how often the drug is given; for example, if doses
of a chemo drug that causes nausea and vomiting are given close
together, there is less time for the person to recover from the nausea
and vomiting before the next treatment is given
- how the drugs are given; for instrance, chemo given
into a vein (intravenous, or by IV) may cause nausea and vomiting much
faster than a drug given by mouth, because the drug given by
IV
is absorbed faster
- individual differences, since not every person has the same
reaction to a dose or type of chemo
Some of the individual risk factors that may make you more likely to
have nausea and vomiting include:
- being female
- being younger than 50
- having had morning sickness during pregnancy
- being very anxious
- having ever had motion sickness
- being prone to vomiting when you are sick
- having been a light drinker (of alcohol)
Your doctor may consider all of these things when choosing the
anti-nausea/vomiting medicines to use with your cancer treatment.
Types of nausea and vomiting
There are different types of nausea and vomiting.
Chemo-related nausea and vomiting can be
- acute
- delayed
- anticipatory
- breakthrough
- refractory
Acute nausea
and vomiting usually happens a few minutes to hours after
the chemo is given. It goes away within the first 24 hours. The worst
vomiting most often happens 5 or 6 hours after chemo.
Delayed nausea
and vomiting starts more than 24 hours after chemo is
given. It is more likely with certain types of chemo, such as
cisplatin, carboplatin, cyclophosphamide, and doxorubicin. For example,
cisplatin-related vomiting is usually worst from 48 to 72 hours after
chemo and can last 6 to 7 days.
Anticipatory
nausea and vomiting is a learned response. It is usually
the result of previous unpleasant experiences with chemo that
led to
nausea and vomiting. It starts as you are getting ready for the next
treatment--before you even get the chemo. You anticipate or expect that
nausea and vomiting will happen like it did before. Most
people with this problem only feel nausea, but some vomit as well.
Breakthrough
nausea and vomiting occurs even though treatment is given
to prevent it. When this happens, you need more or different
anti-nausea/vomiting medicines. You will need to start taking
these medicines regularly during your chemo treatment to prevent
further nausea and vomiting.
Refractory
vomiting may happen after one, a few, or even several
chemo treatments. In this case, even though you are being treated to
prevent or control nausea and vomiting, the anti-nausea and vomiting
treatment is no longer working. Your nausea and vomiting have become
refractory (no longer
respond) to the medicines you are getting to prevent it. When this
happens
you will need more or different anti-nausea/vomiting medicines.
The risk of nausea and vomiting with
chemo
Some chemo drugs are more likely to cause nausea and vomiting
than others. Yo can describe the chance of chemo causing nausea and
vomiting when
effective anti-nausea/vomiting treatment is not given
by using these 4 risk groups:
- minimal
vomiting risk: these chemo drugs cause vomiting in less
than 10% of people who do not get effective anti-nausea and vomiting
treatment
- low vomiting
risk: these chemo drugs cause vomiting in 10% to 30% of
people who do not get effective anti-nausea and vomiting treatment
- moderate
vomiting risk: these chemo drugs cause vomiting in 30% to
90% of people who do not get effective anti-nausea and vomiting
treatment. Most of thse drugs can cause nausea and vomiting for at
least 4 days after the last dose.
- high vomiting
risk: these chemo drugs cause vomiting in more than 90%
of people who do not get effective anti-nausea and vomiting treatment.
Most of thse drugs can cause nausea and vomiting for at least 4 days
after the last dose.
Please remember that these percentages apply if no effective
nausea and vomiting treatment is given. Keep in mind that many of these
drugs can cause more nausea than vomiting. For example, 40% of the
people who take a drug may feel nausea, but only 20% vomit. So this
drug would appear on the low risk of vomiting list, even though the
risk of nausea is higher. Use these risk groups as a guide for
discussions between you and your doctor and nurse.
Chemo drugs by name and their risk of
nausea and vomiting
As noted before, chemo drugs are often grouped by how likely
they are to cause vomiting when they are given alone, without
anti-nausea/vomiting treatment:
Drugs with minimal risk (less than 10%) of
vomiting
- Alemtuzumab (Campath®)
- Asparaginase (Elspar®)
- Bevacizumab (Avastin®)
- Bleomycin (Blenoxane®)
- Busulfan (low-dose)
- Chlorambucil (by mouth) (Leukeran®)
- Cladribine (Leustatin®)
- Cytarabine (very low-dose) (ara-c, Cytosar®)
- Dasatinib (Sprycel®)
- Decitabine (Dacogen®)
- Denileukin diftitox (Ontak®)
- Dexrazoxane (Zinecard®)
- Erlotinib (Tarceva®)
- Fludarabine (Fludara®)
- Gefitinib (Iressa®)
- Gemtuzumab (Mylotarg®)
- Hydroxyurea (by mouth) (Hydrea®)
- Lenalidomide (Revlimid®)
- Melphalan (low-dose, by mouth) (Alkeran®)
- Mercaptopurine (Purinethol®)
- Methotrexate (low-dose)
- Nelarabine (Arranon®)
- Pegaspargase (Oncaspar®)
- Pentostatin (Nipent®)
- Rituximab (Rituxan®)
- Sorafenib (Nexavar®)
- Sunitinib (Sutent®)
- Temsirolimus (Torisel®)
- Thalidomide (Thalomid®)
- Thioguanine (by mouth)
- Valrubicin (Valstar®)
- Vinblastine (Velban®)
- Vincristine (Oncovin®)
- Vinorelbine (Navelbine®)
Drugs with a low risk (10% to 30%) of
vomiting
- Aldesleukin (low-dose)
- Amifostine (lower doses) (Ethyol®)
- Bexarotene (Targretin®)
- Bortezomib (Velcade®)
- Capecitabine (Xeloda®)
- Cetuximab (Erbitux®)
- Cytarabine (low-dose) (Cytosar®,
ara-c)
- Docetaxel (Taxotere®)
- Doxorubicin (liposomal) (Doxil®)
- Etoposide (Vepesid®, VP-16®)
- Everolimus (Afinitor®)
- Fludarabine (by mouth) (Fludara®)
- 5-Fluorouracil (5-FU®)
- Gemcitabine (Gemzar®)
- Imatinib (Gleevec®)
- Interferon alfa (moderate-dose) (IntronA®,
Roferon-A®)
- Ixabepilone
- Lapatinib (Tykerb®)
- Methotrexate (moderate-dose)
- Mitomycin (Mutamycin®)
- Mitoxantrone (Novantrone®)
- Nilotinib (Tasigna®)
- Paclitaxel (Taxol®)
- Paclitaxel-albumin (Abraxane®)
- Pemetrexed (Alimta®)
- Topotecan (Hycamtin®)
- Trastuzumab (Herceptin®)
- Vorinostat (Zolinza®)
Drugs with a moderate risk (30% to 90%) of
vomiting
- Aldesleukin (higher doses) (IL-2, Proleukin®)
- Amifostine (higher doses) (Ethyol®)
- Arsenic trioxide (Trisenox®)
- Azacitidine (Vidaza®)
- Bendamustine (Treanda®)
- Busulfan (high-dose)
- Carboplatin
- Carmustine (lower doses) (BCNU®)
- Cisplatin (lower doses)
- Clofarabine (Clolar®)
- Cyclophosphamide (lower doses) (Cytoxan®)
- Cyclophosphamide by mouth (Cytoxan®)
- Cytarabine (high-dose) (Cytosar®,
ara-c)
- Dactinomycin
- Daunorubicin
- Doxorubicin (Adriamycin®)
- Epirubicin (Ellence®)
- Etoposide by mouth (Vepesid®,
VP-16®)
- Idarubicin (Idamycin®)
- Ifosfamide (Ifex®)
- Irinotecan (Camptosar®)
- Lomustine (CeeNU®)
- Melphalan (higher doses) (Alkeran®)
- Methotrexate (high-dose)
- Oxaliplatin (Eloxatin®)
- Temozolomide (Temodar®)
Drugs with a high risk (greater than 90%)
of vomiting
- Altretamine (Hexalen®)
- Carmustine (high-dose) (BCNU®)
- Cisplatin (moderate- to high-dose)
- Cyclophosphamide (high-dose) (Cytoxan®)
- Dacarbazine (DTIC®)
- Doxorubicin (Adriamycin®) or
epirubicin (Ellence®) given with
cyclophosphamide (Cytoxan®)
- Mechlorethamine (Mustine®,
nitrogen mustard, Mustargen®)
- Procarbazine
- Streptozocin (Zanosar®)
So, for example, you can see that high doses of cisplatin and
cyclophosphamide cause nausea and vomiting in more than 90% of people
getting these drugs when no anti-nausea/vomiting treatment is given. On
the other hand, bleomycin or vincristine cause nausea and vomiting in
less than 10% of people who get these drugs and do not use
anti-nausea/vomiting medicines.
This grouping system is meant to help you when you are talking
to your doctor and nurse about your treatment plan. Use this list for
information on the chemo drugs you will be getting. In general, your
doctor should offer anti-nausea/vomiting treatment based on the drug
that is most likely to cause nausea and vomiting. This means that if at
least one drug on your chemo list is in the "high risk" group, you
should expect to get at least 2 or 3 different drugs to prevent nausea
and vomiting.
Radiation therapy and nausea and vomiting
Whether radiation therapy causes nausea and vomiting depends
on the part of the body being treated, the dose of radiation given,
and how often the treatment is given. When the area of the body being
treated includes a large part of the abdomen (belly) -- mainly the
small intestine (or small bowel) -- there is a greater chance of nausea
and vomiting.
About half of people with cancer who get standard doses (180
to 200 centiGray) of radiation to the abdomen have nausea and vomiting.
These problems can start 1 to 2 hours after treatment and can last for
hours. Of those being treated with total body radiation therapy (which
is used in bone marrow transplants), up to 9 of every 10 people have
nausea and vomiting if not given treatment to prevent it. These people
may also get high doses of chemo to prepare for the transplant. And the
combination of radiation therapy and chemo further raises the chance of
nausea and vomiting. People who get one large dose of radiation have a
greater chance of nausea and vomiting than those who get their
radiation
treatment in smaller doses.
How are nausea and vomiting prevented and
treated?
Today, many medicines can be used to prevent or control nausea
and vomiting and so there are many treatment options.
Radiation therapy and anti-nausea/vomiting
medicines
When radiation treatment is likely to cause nausea and
vomiting, your doctor will probably give you medicines to help prevent
it each day before you get your radiation treatment. The
anti-nausea/vomiting medicines may be given by mouth or into the vein,
or both. If you have nausea or vomiting, be sure to tell your doctor so
that it can be treated effectively.
Chemotherapy and anti-nausea/vomiting
medicines
No one drug can prevent or control nausea and vomiting 100% of
the time. This is because chemo drugs act on the body in different ways
and because each person responds to chemo differently. To choose the
best treatment plan, the doctor:
- considers how likely the chemo is to cause nausea and
vomiting if no anti-nausea/vomiting treatment is given
- selects anti-nausea/vomiting medicines based on how much
the chemo drugs are known to affect the vomiting center in the brain
- looks at your history of nausea and vomiting
- reviews how well any anti-nausea/vomiting medicines have
worked for you before
- looks at the side effects of the anti-nausea/vomiting
medicines
- uses the lowest effective dose of the anti-nausea/vomiting
medicine before chemo or radiation therapy is given
- uses medicines to try to prevent (not just control) the
nausea and vomiting
- carefully watches how you respond to the
anti-nausea/vomiting treatment
The goal is to prevent nausea and vomiting, because it's
easier to prevent it than it is to stop it once it starts. To help the
drugs work best against chemo-related nausea and vomiting:
- preventive treatment should start before the chemo is
given
- it should continue
for as long as the chemo is likely to cause vomiting, which can be up
to a week or even 10 days after the last dose
Anti-nausea/vomiting medicines are usually given on a regular
schedule around the clock. Sometimes you may be asked to take a
medicine on an "as needed" schedule -- you take the medicine at the
first sign of nausea to keep it from getting worse. Because nausea and
vomiting can happen for different reasons, different
anti-nausea/vomiting medicines may be used together. Two or more
medicines are often used. Be sure you know how to take each drug. And,
ask your doctor or nurse how long after the last dose of chemo you
should keep taking your medicine to prevent nausea and vomiting, so
that you don't stop taking it too soon.
Each time you start a new cycle of chemo, be sure to tell your
cancer team what did and didn't work the last time. This is a time to
get better control of your nausea and vomiting so that it isn't a
problem for the next round, and it is a chance for the doctor to be
sure that there aren't other factors besides the chemo adding to your
nausea and vomiting
Anti-nausea/vomiting medicines
There are many different anti-nausea/vomiting medicines.
These drugs work better in some people than in others.
You will get anti-nausea/vomiting medicines based on which
chemo drugs you are getting. For example, if you are getting a chemo
drug that is likely to cause nausea and vomiting, you should get the
anti-nausea/vomiting medicine that has proven to work best in other
people who got that same drug. If these medicines do not prevent your
nausea and vomiting, it is important to tell your doctor so you can get
different medicines. You might have to try a few different medicines to
find the ones that work best for you. Some of the most common
anti-nausea/vomiting medicines are listed below.
Commonly used anti-nausea/vomiting
medicines by generic and brand name:
| Generic
name |
Brand
name |
| Alprazolam |
Xanax® |
| Aprepitant |
Emend® |
| Dexamethasone |
Decadron® |
| Diphenhydramine |
Benadryl® |
| Dolasetron |
Anzemet® |
| Dronabinol |
Marinol® |
| Granisetron |
Kytril® |
| Haloperidol |
Haldol® |
| Lorazepam |
Ativan® |
| Metoclopramide |
Reglan® |
| Nabilone |
Cesamet® |
| Ondansetron |
Zofran® |
| Olanzapine |
Zyprexa® |
| Palonosetron |
Aloxi® |
| Prochlorperazine |
Compazine® |
| Promethazine |
Phenergan® |
Common anti-nausea/vomiting medicines and
how they are used:
Aprepitant:
Anti-nausea/vomiting medicine; works differently from all others; used
for acute and delayed nausea and vomiting
Dexamethasone:
A steroid used alone and with other anti-nausea medicines; given by
mouth or in the vein
Diphenhydramine:
An antihistamine that helps decrease side effects from
other anti-nausea medicines; used for low-risk chemo or when other
medicines do not work; given along with other medicines; does not work
well as an anti-nausea medicine when used alone
Dolasetron,
granisetron, ondansetron: Anti-nausea/vomiting medicines;
can be given by mouth or IV (into a vein), granisetron is also
available as a patch; each works equally well
Dronabinol,
nabilone: Used when other anti-nausea medicines do not
work; tetrahydrocannabinol (THC) is the active ingredient; younger
adults have fewer side effects
Haloperidol:
Also used as a tranquilizer, works as anti-nausea medicine when used
along with other medicines; used when other anti-nausea medicines don't
work
Lorazepam,
alprazolam: Used to reduce anxiety; often used with other
anti-nausea medicines; both have calming (tranquilizing) and
anti-nausea effects; can be used for anticipatory nausea and vomiting
Metoclopramide: Used
for low-risk chemo or when other agents do not work; may be used alone
or along with other medicines
Olanzapine: Sometimes
used when other medicines do not work; affects a number of message
carriers in the brain
Palonosetron: Anti-nausea/vomiting
medicine much like dolasetron, granisetron, ondansetron, but it is only
given by IV; works for both acute and delayed nausea and vomiting
Prochlorperazine:
Used for low-risk chemo or when other agents do not work;
may be used alone or along with other medicines
Promethazine: Used
when other medicines do not work
How are the anti-nausea/vomiting medicines
given?
Anti-nausea/vomiting medicines are given in different ways
based on
- how bad your nausea and vomiting is,
- the easiest way for you to take the medicine, and
- what you prefer
Taking pills by mouth is often the best and easiest way to
prevent nausea and vomiting. But if you are already vomiting, or you
can't swallow and keep things down, many of these medicines can be
given in other ways. Not all anti-nausea/vomiting drugs can be given in
all these ways, but talk with your doctor about other ways you can get
the medicine you need if you can't take it as a pill:
- Some can be given IV or intravenously (into a vein)
- Others come as suppositories that are put in the
rectum
- Some are made into tablets that are put under the
tongue (sublingual)
- A few of these medicines come as patches that stick
on the skin (transdermal)
How a medicine is given does not change how well it works to
prevent or control nausea and vomiting. But it often affects how
quickly it starts working. Drugs that are given into the vein or under
the tongue usually start working faster.
Other treatments for nausea and vomiting
Although anti-nausea/vomiting medicines are the main treatment
for nausea and vomiting, there are some non-drug treatments that can be
used. These non-drug treatments involve using your mind and body with
the help of a qualified therapist. If you would like to try one of
these methods, ask a member of your health care team to refer you to a
therapist trained in these techniques. Non-drug treatments may be used
alone for mild nausea or for anticipatory nausea and vomiting. When
taking chemo drugs that are likely to cause nausea and vomiting, they
may be used along with anti-nausea/vomiting medicines. All of these
methods try to decrease nausea and vomiting by helping to:
- relax you
- distract you from what's going on
- help you feel in control
- make you feel less helpless
Here are some non-drug treatments that have helped some
people. Most of these treatments have few or no side effects. And with
the
proper training, nearly anyone can use most of these.
Self-hypnosis
Self hypnosis was the first technique used to make behavior
changes to control nausea and vomiting. It involves creating a state of
intense attention, willingness, and readiness to accept an idea. It has
been shown to work very well with children and teens.
Progressive muscle relaxation
Progressive muscle relaxation (PMR) teaches a person to relax
by progressively tensing and releasing different muscle groups. It has
been used to decrease the nausea and vomiting caused by chemo. Patients
who learn PMR often go on to use this method as a way to cope with
other stresses too. It is also used to help with
nervousness, pain, anger, headaches, and depression.
Biofeedback
This is a technique that helps people reach a state of
relaxation. Using biofeedback, a person learns to control a certain
physical response of the body, such as nausea and vomiting. This is
done by tuning in to the moment-to-moment body changes that
are linked to the physical response. For example, biofeedback can be
used to prevent skin temperature changes, such as those that often
happen before nausea and vomiting starts. The use of biofeedback alone
for nausea and vomiting has not been found to work as well as the
combination of
biofeedback and PMR.
Guided imagery
Guided imagery allows people to remove themselves mentally
from the treatment center and imagine that they are in a place that is
relaxing for
them. The place can be a vacation spot, a room at home, or some other
safe or pleasant place. While trying to imagine what they usually feel,
hear, see, and taste in the pleasant place, some people can mentally
block the nausea and vomiting.
Systematic desensitization
Systematic desensitization helps people learn how to imagine
an anxiety-producing situation (such as nausea and vomiting) and reduce
the anxiety related to the situation. In most cases, what a person can
imagine without anxiety, he or she can then experience in the real
world without anxiety.
Music therapy
Specially trained health professionals use music to help
relieve symptoms. Music therapists may use different methods with each
person, depending on that person's needs and abilities. There is some
evidence that, when used with standard treatment, music therapy can
help to relieve nausea and vomiting due to chemo. It can lower heart
rate and blood pressure, relieve stress, and give a sense of
well-being.
Acupuncture or acupressure
Acupuncture is a traditional Chinese technique in which very
thin needles are put into the skin. There are a number of different
acupuncture techniques, including some that use pressure rather than
needles. Some clinical studies have found it may help treat nausea
caused by chemo.
Eating right can help you get through cancer
treatment
Nausea and vomiting can affect how much you eat and what you
eat. And good nutrition is key for people being treated for
cancer. Many factors related to the illness itself, as well as cancer
treatments, may affect appetite and the body's ability to
take in food and use nutrients. Your nutritional needs will vary during
cancer treatment. Your health care team can help you come up with
nutrition goals and find an approach to eating that meets your needs.
Eating healthy foods while going through cancer treatment can help you:
- feel better
- keep up your strength and energy level
- stay at a healthy weight
- keep up your body's store of nutrients
- better handle treatment-related side effects
- lower your risk of infection
- recover and heal as quickly as possible
Eating well means eating many different kinds of foods that
will give you the nutrients you need for healing.
Nutrition suggestions for people getting
chemo
Here are some suggestions that may help reduce nausea and
vomiting if you are getting chemo.
- On the days you get chemo, make sure you have had
something to eat. Most people find that a light meal or snack before
chemo is best.
- In most cases, chemo is given on an outpatient
basis, such as in an infusion center or a doctor’s office.
Getting chemo can take a few minutes or many hours. Plan ahead and
bring a light meal or snacks with you. Many treatment centers have
refrigerators and microwaves you can use.
- Fatigue (being tired or lacking energy) is very common when
getting chemo. Here are some things you can do to deal with fatigue:
save your energy, set priorities, pace yourself, ask others to do
chores, plan activities when you have the most energy, know your
limits, and eat balanced meals.
- Don't be too hard on yourself if side effects make
it hard to eat. Try eating small, frequent meals or snacks. Choose the
foods that appeal to you the most. Your taste can change on an
almost day-to-day basis when you are getting cancer treatment.
- Make the most of days when you feel well and your appetite
is good. Always try to eat regular meals and snacks but listen to your
body. Never force yourself to eat something that you don't want, or if
you feel full.
- Ask family and friends for help with shopping and
cooking. If you don't have help, think about having meals delivered to
your home or maybe having lunch at a local community or senior center.
Contact community assistance organizations, area churches, or your
local American Cancer Society office for more ideas.
- Most side effects are short-term and go away when
treatment is over. If symptoms last, you should tell your health
care team. Nutrition-related side effects should be dealt with right
away to help you keep up your weight and energy.
Nutrition suggestions for people getting
radiation therapy
The types of side effects you have during radiation therapy
depend on the part of your body getting radiation, the size of the area
being treated, the total dose of radiation, and the number of
treatments. The list below shows different parts of the body that may
be treated and the possible side effects that may make it hard to eat.
- Brain, spinal cord: nausea, vomiting
- Tongue, voice box, tonsils, salivary gland, nose,
throat (pharynx): sore mouth, trouble swallowing or pain with
swallowing, change in or loss of taste, sore throat, dry mouth, thick
saliva
- Lung, esophagus, breast: trouble swallowing,
heartburn
- Large or small intestine, prostate, uterus, cervix,
rectum, pancreas: loss of appetite, nausea, vomiting,
diarrhea, gas,
bloating
Eating well is important both during and after treatment. If
side effects develop or if the anti-nausea/vomiting medicines are not
working, talk to your health care team.
Some patients need to be treated at a center far from their
home, which may make it hard for them to eat well. Most treatment
centers have some type of kitchen space. Patients can use this area to
store and prepare frozen foods, soups, single servings of fruits,
puddings, gelatin, ice cream, or cereals. If there is no kitchen, bring
food items that do not need refrigeration, such as single serving packs
of canned fruit, gelatin, puddings, cheese or peanut butter crackers,
granola bars, or cereal. A nurse or social worker might be able to give
you ideas about places to stay and eat while you are getting treatment.
Here are some eating tips you can try if you are getting
radiation therapy:
- Try to eat something at least an hour before
treatment rather than going to treatment with an empty stomach.
- Bring foods or nutrition supplements to eat or
drink on the ride to and from treatment if you must travel a long
distance for treatment each day,
- Eat small, frequent meals. Ask friends and family
members to help prepare meals, do the shopping, and choose the foods
and drinks you enjoy the most.
- Do not expect to have the same side effects as
someone else being treated for cancer in another part of the body. Even
people with the exact same treatments have different degrees of side
effects.
- Get to know other cancer patients and talk with them about
their
experiences, or join a support group. Other patients can be a great
source of information and support.
Managing the side effects that make it hard
for you to eat right
If you are having trouble eating and/or you are on a special
diet (such as for diabetes or heart disease), your food restrictions
might be relaxed during cancer treatment. But you should speak with
your health care team before making any changes. Here are some things
you can do to try to eat as well as possible during treatment:
- Try to eat small frequent meals rather than 3 large
meals.
- Add extra calories and protein to foods. Liquid or powdered
nutrition supplements are handy and can be helpful during this time.
Try different brands and flavors to find out which ones taste best and
work best for you. Your doctor, nurse, or a dietitian may be able to
tell you more about types of products available and may have samples
you can try.
- Try eating most foods during the time of day when
you are best able to eat. Many people find that breakfast time is best.
- Let your health care team know if eating is a
problem. A dietitian can be consulted to give you more tips to help
with eating.
- Let your health care team know when
anti-nausea/vomiting medicines don't work.
There are also things you can do to help manage or reduce your
nausea and vomiting. Here are a few suggestions:
- Eat foods and drink beverages that are "easy on the
stomach" or made you feel better when you had the flu or morning
sickness. These are often things like ginger ale, bland foods, sour
candy, and dry crackers or toast.
- Do NOT force yourself to eat when you feel
nauseated.
- Limit your fluids while eating.
- Eat food cold or at room temperature.
- Have someone else make the meals if you have
nausea.
- Keep your mouth clean; clean your mouth each time after
vomiting.
- Wear loose fitting clothes.
- Get fresh air with a fan or open window.
- Limit sounds, sights, and smells that cause nausea
and vomiting.
- Call your doctor or nurse if your nausea or vomiting is not
prevented or controlled with the medicines you have.
You can get more information on eating during cancer treatment
in our booklet, Nutrition for the Person with
Cancer During Treatment:
A Guide for Patients and Families.
Nausea and vomiting can be an unpleasant side effect of cancer
treatment. But they should not be accepted as a part of cancer
treatment that can't be changed. Talk to your health care team if you
are having nausea and vomiting. Be willing to work with them to find
the right anti-nausea/vomiting medicines for you.
Additional resources
More information from your American Cancer
Society
We have selected some related information that may also be
helpful to you. These materials may be viewed on our Web site or
ordered from our toll-free number, 1-800-ACS-2345 (1-800-227-2345).
You can also get more information on each drug used to treat
cancer, as well as drugs used to treat nausea and vomiting, by calling
us or visiting our Web site.
The following books are available from the American Cancer
Society. Please call us to ask about costs or place your order:
National organizations and Web sites*
In addition to the American Cancer Society, other sources of
patient information and support include:
CancerCare
Toll-free number: 1-800-813-4673 (1-800-813-HOPE)
Web site: www.cancercare.org
Provides information and free professional support by phone and online
to people with cancer, their loved ones, and caregivers.
Meals on Wheels Association of America (MOWAA)
Telephone number: 703-548-5558
Web site: www.mowaa.org
A group of programs that provide home-delivered meals. Some programs
may provide other services such as transportation, education,
information, and case management.
National Cancer Institute
Toll-free number: 1-800-422-6237 (1-800-4-CANCER)
TTY: 1-800-332-8615
Web site: www.cancer.gov
Offers information on cancer treatments, symptoms, and coping. More on
nausea and vomiting can be found at: www.cancer.gov/cancertopics/pdq/supportivecare/nausea/Patient
*Inclusion on
this list does not imply endorsement by the
American Cancer Society.
No matter who you are, we can help. Contact us anytime, day or
night, for cancer-related information and support. Call us at 1-800-227-2345
or visit www.cancer.org.
References
Manufacturers' Product Information. Accessed directly from
companies and also online at:
www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm on September
10, 2009.
National Cancer Institute. Nausea and Vomiting PDQ®.
Accessed at:
www.cancer.gov/cancertopics/pdq/supportivecare/nausea/HealthProfessional/page1
on September 10, 2009.
National Comprehensive Cancer Network. Antiemesis. NCCN
Clinical Practice Guidelines
in Oncology – v.4.2009. Accessed at:
www.nccn.org/professionals/physician_gls/PDF/antiemesis.pdf on
September 9, 2009.
Schwartzberg LS. Chemotherapy-induced nausea and vomiting:
clinician and patient perspectives. J Support Oncol.
2007;5(2 Suppl
1):5-12.
Last Medical Review: 09/29/2009
Last Revised: 09/29/2009
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