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Nausea and Vomiting Related to Cancer Treatment (PDQ)

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General Information
Causes
Anticipatory Nausea and Vomiting
Acute or Delayed Nausea and Vomiting
Treating Nausea and Vomiting Without Drugs
Treatment-Related Nausea and Vomiting in Children
About This PDQ Summary

General Information

Nausea and vomiting are serious side effects of cancer therapy.

Nausea and vomiting are side effects of cancer therapy and affect most patients who have chemotherapy. Radiation therapy to the brain, gastrointestinal tract, or liver also cause nausea and vomiting.

Nausea is an unpleasant feeling in the back of the throat and/or stomach that may come and go in waves. It may occur before vomiting. Vomiting is throwing up the contents of the stomach through the mouth. Retching is the movement of the stomach and esophagus without vomiting and is also called dry heaves. Although treatments for nausea and vomiting have improved, nausea and vomiting are still serious side effects of cancer therapy because they cause the patient distress and may cause other health problems. Patients may have nausea more than vomiting.

Nausea is controlled by a part of the autonomic nervous system which controls involuntary body functions (such as breathing or digestion). Vomiting is a reflex controlled in part by a vomiting center in the brain. Vomiting can be triggered by smell, taste, anxiety, pain, motion, or changes in the body caused by inflammation, poor blood flow, or irritation to the stomach.

It is important that nausea and vomiting are controlled so that the patient can continue treatment and have a better quality of life.

It is very important to prevent and control nausea and vomiting in patients with cancer, so that they can continue treatment and perform activities of daily life. Nausea and vomiting that are not controlled can cause the following:

Different types of nausea and vomiting are caused by chemotherapy, radiation therapy, and other conditions.

Nausea and vomiting can occur before, during, or after treatment.

The types of nausea and vomiting include:

Causes

Many factors increase the risk of nausea and vomiting with chemotherapy.

Nausea and vomiting with chemotherapy are more likely if the patient:

Patients who drank large amounts of alcohol over time have a lower risk of nausea and vomiting after being treated with chemotherapy.

Radiation therapy may also cause nausea and vomiting.

The following treatment factors may affect the risk of nausea and vomiting:

The following patient factors may cause nausea and vomiting with radiation therapy if the patient:

Patients who drank large amounts of alcohol over time have a lower risk of nausea and vomiting after being treated with radiation therapy.

Other conditions may also increase the risk of nausea and vomiting in patients with advanced cancer.

Nausea and vomiting may also be caused by other conditions. In patients with advanced cancer, chronic nausea and vomiting may be caused by the following:

Anticipatory Nausea and Vomiting

Anticipatory nausea and vomiting may occur after several chemotherapy treatments.

In some patients, after they have had several courses of treatment, nausea and vomiting may occur before a treatment session. This is called anticipatory nausea and vomiting. It is caused by triggers, such as odors in the therapy room. For example, a person who begins chemotherapy and smells an alcohol swab at the same time may later have nausea and vomiting at the smell of an alcohol swab. The more chemotherapy sessions a patient has, the more likely it is that anticipatory nausea and vomiting will occur.

Having three or more of the following may make anticipatory nausea and vomiting more likely:

Other factors that may make anticipatory nausea and vomiting more likely include:

The earlier that anticipatory nausea and vomiting is identified, the more effective treatment may be.

When symptoms of anticipatory nausea and vomiting are diagnosed early, treatment is more likely to work.

Psychologists and other mental health professionals with special training can often help patients with anticipatory nausea and vomiting. The following types of treatment may be used:

Antinausea drugs given for anticipatory nausea and vomiting do not seem to help.

Acute or Delayed Nausea and Vomiting

Acute and delayed nausea and vomiting are common in patients being treated with chemotherapy.

Chemotherapy is the most common cause of nausea and vomiting that is related to cancer treatment.

How often nausea and vomiting occur and how severe they are may be affected by the following:

The following may make acute or delayed nausea and vomiting with chemotherapy more likely if the patient:

Patients who have acute nausea and vomiting with chemotherapy are more likely to have delayed nausea and vomiting as well.

Acute and delayed nausea and vomiting with chemotherapy or radiation therapy are usually treated with drugs.

Drugs may be given before each treatment, to prevent nausea and vomiting. After chemotherapy, drugs may be given to prevent delayed vomiting. Patients who are given chemotherapy several days in a row may need treatment for both acute and delayed nausea and vomiting. Some drugs last only a short time in the body and need to be given more often. Others last a long time and are given less often.

The following table shows drugs that are commonly used to prevent nausea and vomiting caused by chemotherapy and the type of drug.

Drugs Used to Prevent Nausea and Vomiting Caused by Chemotherapy

Drug NameType of Drug
Chlorpromazine, prochlorperazine, promethazinePhenothiazines
Droperidol, haloperidolButyrophenones
Metoclopramide, trimethobenzamideSubstituted benzamides
Dolasetron, granisetron, ondansetron, palonosetronSerotonin receptor antagonists
Aprepitant, fosaprepitant, netupitant, rolapitantSubstance P/NK-1 antagonists
Dexamethasone, methylprednisoloneCorticosteroids
Alprazolam, lorazepamBenzodiazepines
OlanzapineAntipsychotic/monoamine antagonists
Cannabis, dronabinol, ginger, nabiloneOther

The following table shows drugs that are commonly used to prevent nausea and vomiting caused by radiation therapy and the type of drug:

Drugs Used to Prevent Nausea and Vomiting Caused by Radiation Therapy

Drug NameType of Drug
Dolasetron, granisetron, ondansetron, palonosetronSerotonin receptor antagonists
DexamethasoneCorticosteroids
Metoclopramide, prochlorperazineDopamine receptor antagonists

It is not known whether it is best to give antinausea medicine for the first 5 days of radiation treatment or for the full treatment course. Talk with your doctor about the treatment plan that is best for you.

Treating Nausea and Vomiting Without Drugs

Treatment without drugs is sometimes used to control nausea and vomiting.

Non-drug treatments may help relieve nausea and vomiting, and may help antinausea drugs work better. These treatments include:

Treatment-Related Nausea and Vomiting in Children

Nausea and vomiting in children treated with chemotherapy is a serious problem.

Like adults, nausea in children receiving chemotherapy is more of a problem than vomiting. Children may have anticipatory, acute, and/or delayed nausea and vomiting.

Anticipatory nausea and vomiting may occur in children.

Children who have nausea and vomiting after a chemotherapy treatment may have the same symptoms before their next treatment when the child sees, smells, or hears sounds from the treatment room. This is called anticipatory nausea and vomiting.

When the child’s nausea and vomiting is well controlled during and after a chemotherapy treatment, the child may have less anxiety before the next treatment and less chance of having anticipatory symptoms.

Health professionals caring for children who have anticipatory nausea and vomiting have found that children may benefit from:

In children, acute nausea and vomiting is usually treated with drugs and other methods.

Drugs may be given before each treatment to prevent nausea and vomiting. After chemotherapy, drugs may be given to prevent delayed vomiting. Patients who are given chemotherapy several days in a row may need treatment for both acute and delayed nausea and vomiting. Some drugs last only a short time in the body and need to be given more often. Others last a long time and are given less often.

The following table shows drugs that are commonly used to prevent nausea and vomiting caused by chemotherapy and the type of drug. Different types of drugs may be given together to treat acute and delayed nausea and vomiting.

Drugs Used to Prevent Nausea and Vomiting Caused by Chemotherapy

Drug NameType of Drug
Chlorpromazine, prochlorperazine, promethazinePhenothiazines
MetoclopramideSubstituted benzamides
Granisetron, ondansetron, palonosetronSerotonin receptor antagonists
Aprepitant, fosaprepitant Substance P/NK-1 antagonists
Dexamethasone, methylprednisoloneCorticosteroids
LorazepamBenzodiazepines
OlanzapineAtypical antipsychotic
Dronabinol, nabiloneOther drugs

Non-drug treatments may help relieve nausea and vomiting, and may help antinausea drugs work better in children. These treatments include:

Dietary support may include:

Delayed nausea may be hard to detect in children.

Unlike in adults, delayed nausea and vomiting in children may be harder for parents and caregivers to see. A change in the child’s eating pattern may be the only sign of a problem. In addition, most chemotherapy treatments for children are scheduled over several days. This makes the timing and risk of delayed nausea unclear.

Studies on the prevention of delayed nausea and vomiting in children are limited. Children are usually treated the same way as adults, with doses of drugs that prevent nausea adjusted for age.

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about the causes and treatment of nausea and vomiting (emesis) (N&V). It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Supportive and Palliative Care Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials are listed in PDQ and can be found online at NCI's website. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).

Permission to Use This Summary

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The best way to cite this PDQ summary is:

PDQ Supportive and Palliative Care Editorial Board. PDQ Nausea and Vomiting Related to Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/about-cancer/treatment/side-effects/nausea/nausea-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389289]

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Disclaimer

The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

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Physicians version: CDR0000062747
Date last modified: 2017-06-06

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Dr. G. Quade
This page was last modified on Tuesday, 21-Nov-2017 11:57:13 CET
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