Nausea and Vomiting Caused by Cancer Treatment

Cancer treatments, such as chemotherapy or radiation therapy can cause nausea and vomiting. Some other drugs, such as targeted therapy and immunotherapy can cause nausea and vomiting too. There many different kinds of each type of treatment. Some can make you have nausea and/or vomiting while others might not. Sometimes the type of cancer you have can make you have nausea and vomiting too.

How likely you are to have nausea and vomiting while getting treatment depends on many things. Some of these are:

  • The types of treatment used. Drugs that travel through the body are more likely to cause nausea and vomiting than treatment that only affects one area of the body, such as radiation therapy. And, some drugs are more likely than others to cause nausea and vomiting
  • The dose of the drugs (higher doses can be more likely to cause nausea and vomiting, especially certain chemo drugs)
  • 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’s less time for the person to recover from the effects of the last dose before the next one is given.
  • How the drugs are given. For instance, chemo given through a vein (intravenous, or by IV) may cause nausea and vomiting much faster than a drug given by mouth. This is because the drug given by IV is absorbed faster.
  • Individual differences – not every person will have the same response to a dose or type of treatment.
  • Having a tumor in the brain, liver, or gastrointestinal tract may increase the risk for nausea and vomiting.
  • Other drugs (such as pain medicines) that may cause or worsen nausea and/or vomiting.

Some personal risk factors that may make you more likely to have nausea and vomiting include:

  • Being female
  • Being younger
  • Having had morning sickness during pregnancy
  • Being very anxious or nervous
  • Having ever had motion sickness
  • Being prone to vomiting when you are sick
  • Having been a non-drinker or light drinker (of alcohol)
  • Having had chemo in the past

There’s no way to know for sure if you will have nausea and vomiting, but your doctor will consider these things when choosing anti-nausea and vomiting medicines to use with your cancer treatment.

Nausea and vomiting due to chemo and other drugs that treat cancer

You may hear treatment-related nausea and vomiting also referred to as chemotherapy-induced nausea and vomiting (CINV). If you're getting a drug to treat cancer, be sure to talk to your cancer care team about what kind of drug it is and how likely it is to cause nausea and vomiting.

There are different types of nausea and vomiting, depending on when they happen.

Acute nausea and vomiting usually happens within minutes to hours after treatment is given, and usually within the first 24 hours. This is more common when treatment is given by IV infusion or when taken by mouth.

Delayed nausea and vomiting usually starts more than 24 hours after treatment and can last up to a few days after treatment ends. It’s more likely with certain types of chemo or other drug to treat cancer. Ask your doctor if the treatment you’re getting is known to cause delayed nausea and vomiting.

Anticipatory nausea and vomiting is a learned or conditioned response. It appears to be the result of previous experiences with treatment that led to nausea and vomiting, in which the brain pairs some parts of the treatment such as the sights, sounds, and smells of the treatment area with vomiting. Anticipatory nausea and/or vomiting can happen before or during treatment is given.

Breakthrough nausea and vomiting happens even though treatment has been given to try to prevent it. When this happens, you may need more or different medicines to help prevent further nausea and vomiting.

Refractory vomiting is when you’re getting medicines to prevent or control nausea and vomiting, but the drugs are not working. Your nausea and vomiting have become refractory (no longer respond) to the medicines you’re getting to prevent it. This means you may need more or different medicines to stop the nausea and/or vomiting. Refractory vomiting may happen after a few or even after several chemo treatments.

Anti-nausea and vomiting medicines used for drugs used to treat cancer

Medication to treat nausea and vomiting is called anti-emetic therapy. What medication is given and how often you take it is based on how likely the chemo or other drug is expected to cause nausea and vomiting. It’s easier to prevent nausea and vomiting than it is to stop it once it starts. No one drug can prevent or control treatment-related nausea and vomiting 100% of the time. This is because treatments act on the body in different ways and each person responds to chemo and to anti-nausea and vomiting drugs differently.

To choose the best treatment plan for you, the doctor will:

  • Consider how likely your treatment is to cause nausea and vomiting
  • Look at current research and guidelines that tell the doctor what anti-nausea medicines work best for the treatment you're receiving
  • Select medicines based on whether the treatment for cancer is known to affect the vomiting center in the brain
  • Ask about your history of nausea and vomiting
  • Ask how well any anti-nausea medicines have worked for you before
  • Consider side effects of the anti-nausea medicines
  • Prescribe the lowest effective dose of the anti-nausea medicine before treatment is given
  • Make changes as needed to help keep you from having nausea and vomiting

Anti-nausea and vomiting medicines are often given on a regular schedule around the clock. Your doctor might encourage you to take them on a schedule even if you don't have any nausea or vomiting. Sometimes, you may take the medicine on an "as needed" schedule. This means you take the medicine at the first sign of nausea to keep it from getting worse. Ask your cancer care team how you should take these drugs.

  • Preventive medication should start before the treatment is given.
  • Medication should continue for as long as the cancer treatment is likely to cause vomiting, which may be different for different people based on the type of chemo drug given.

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.

Nausea and vomiting due to radiation therapy

Nausea and vomiting can be caused by radiation therapy based on:

The part of the body being treated. The risk is greatest when the brain is treated, or the area of the body being treated includes a large part of the upper abdomen (belly) – mainly the small intestine (or small bowel) and/or the liver.

Total body irradiation (used in stem cell transplants) is linked to a high risk of nausea and vomiting if treatment is not given to prevent it. Patients may also get high doses of chemo to prepare for transplant, which further raises the chance of nausea and vomiting.

The dose of radiation given. The bigger the dose of radiation given, the higher the risk for nausea and vomiting.

How often the treatment is given. People who get one large dose of radiation have a greater chance of nausea and vomiting than those who get radiation that is spread out over smaller doses.

If chemotherapy or another drug to treat cancer is given along with the radiation. When radiation is given along with chemo, the anti-emetic treatment used is based on the nausea and vomiting risk of the chemo drugs given.

Anti-nausea and vomiting medicines used for radiation therapy

If your 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 radiation. Anti-nausea and vomiting medicines may be given by mouth or into a vein, or both.

To choose the best treatment plan, the doctor will:

  • Consider how likely the radiation is to cause nausea and vomiting
  • Ask about your history of nausea and vomiting
  • Ask how well any anti-nausea medicines have worked for you before
  • Consider side effects of the anti-nausea medicines
  • Prescribe the lowest effective dose of the anti-nausea medicine before radiation therapy is given
  • Make drug changes as needed to help keep you from having nausea and vomiting

Anti-nausea and vomiting medicines are often given on a regular schedule around the clock. your doctor may encourage you to take them on a schedule even if you don’t have any nausea or vomiting. Sometimes you may take the medicine “as needed.” This means you take the medicine at the first sign of nausea to keep it from getting worse. Ask your cancer care team how you should take your anti-nausea and vomiting medicines.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Blanchard EM, Hesketh PJ. Nausea and vomiting. In DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2019:2078-2085. 

Brant JM, Stringer LH. Chemotherapy-induced nausea and vomiting. In Brown CG, ed. A Guide to Oncology Symptom
Management.
 2nd ed. Pittsburgh, PA: Oncology Nursing Society; 2015:171-196.

Cancer.Net. Nausea and vomiting. 2018. Accessed at https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing -physical-side-effects/nausea-and-vomiting on September 5, 2019.

Hainsworth JD. Nausea and vomiting. In Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:599-606.e3.

Hesketh PJ et al. Antiemetics: ASCO guideline update. Journal of Clinical Oncology. 2020;38(24). Accessed at https://ascopubs.org/doi/10.1200/JCO.20.01296 on September 10, 2020. 

National Cancer Institute (NIH). Treatment-related nausea and vomiting (PDQ®)- Health Professional Version. 2018. Accessed at https://www.cancer.gov/about-cancer-treatment/side-effects/nausea/nausea-hp-pdq on September 6, 2019.

National Comprehensive Cancer Network (NCCN). Antiemesis. 2019. Version 1.2019. Accessed at https:// www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf on September 9, 2019.

References

Blanchard EM, Hesketh PJ. Nausea and vomiting. In DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2019:2078-2085. 

Brant JM, Stringer LH. Chemotherapy-induced nausea and vomiting. In Brown CG, ed. A Guide to Oncology Symptom
Management.
 2nd ed. Pittsburgh, PA: Oncology Nursing Society; 2015:171-196.

Cancer.Net. Nausea and vomiting. 2018. Accessed at https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing -physical-side-effects/nausea-and-vomiting on September 5, 2019.

Hainsworth JD. Nausea and vomiting. In Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:599-606.e3.

Hesketh PJ et al. Antiemetics: ASCO guideline update. Journal of Clinical Oncology. 2020;38(24). Accessed at https://ascopubs.org/doi/10.1200/JCO.20.01296 on September 10, 2020. 

National Cancer Institute (NIH). Treatment-related nausea and vomiting (PDQ®)- Health Professional Version. 2018. Accessed at https://www.cancer.gov/about-cancer-treatment/side-effects/nausea/nausea-hp-pdq on September 6, 2019.

National Comprehensive Cancer Network (NCCN). Antiemesis. 2019. Version 1.2019. Accessed at https:// www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf on September 9, 2019.

Last Revised: September 10, 2020

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