"In the past, there were people who simply would not get their chemotherapy because of nausea and vomiting," says Philip Bierman, MD, associate professor of oncology and hematology at the Eppley Cancer Center at the University of Nebraska Medical Center. UNMC is one of 18 institutions that make up the NCCN. "These guidelines let people know that there has been significant progress. In most cases, nausea and vomiting can be eliminated or brought under control."

The guidelines divide chemotherapy agents into five levels, based on how likely the drugs are to bring on nausea and vomiting. Level 1 agents such as bleomycin or vincristine cause nausea and vomiting in less than 10% of patients, even when anti-nausea medications are not used. Level 5 agents, such as high-dose cisplatin or cyclophosphamide, cause nausea and vomiting in more than 90% of patients who do not get anti-nausea drugs.

Patients who are receiving Level 1 drugs usually do not need anti-nausea medication.

Those who are being treated with Level 2 – 5 chemotherapy drugs usually receive anti-nausea drugs before chemotherapy begins; the guidelines note that prevention is the best and most effective treatment.

"It’s no fun to throw up," says Terri Ades, RN, MS, AOCN, director of health content for ACS. "The message from these guidelines is that nausea and vomiting can be treated. Because we have found newer, very effective medications, patients are realizing that nausea and vomiting are not something they have to put up with."

The guidelines list more than a dozen medicines used to treat nausea and vomiting, some in use for many years and others newly approved by the Food and Drug Administration. As new anti-nausea drugs are developed and evaluated, Bierman says, they will be added to the list. The guidelines also include decision trees to help patients and doctors design the most effective anti-nausea treatment for each individual.

Non-drug treatments can also help reduce anticipatory nausea and vomiting. This occurs when patients become sick just thinking about getting their chemotherapy. Self-hypnosis can be especially successful with children and adolescents. Progressive muscle relaxation, biofeedback, and guided imagery can help patients of all ages. The most effective treatment program may combine several drug and non-drug elements.

Ades says the guidelines were originally developed to help physicians understand the wide range of treatment options available to control the nausea and vomiting that follows chemotherapy and radiation therapy. The ACS translated the technical guidelines into everyday language to help patients communicate more effectively with their doctors to get relief from these unpleasant side effects.

The NCCN Nausea and Vomiting Treatment Guidelines for Patients with Cancer can be obtained by calling the ACS toll-free at 1-800-ACS-2345 (1-800-227-2345) or by calling the NCCN at 1-888-909-NCCN (1-888-909-6226), or by clicking on the linke above, or by visiting the NCCN web site. The guidelines can also be requested by email to patientinformation@nccn.org. Other guidelines written for patients by ACS and NCCN covering recommended treatments for breast, prostate, and colorectal cancers and for cancer pain, all based on expert evaluation of scientific and clinical evidence, are available through the same channels.