ADDITIONAL INFORMATION ABOUT THE FOLLOWING SUBJECTS IS IN OTHER SECTIONS OF THIS ARTICLE

Chemotherapy can cause nausea and vomiting. 

• Nausea is a feeling of queasiness in the stomach.
• Vomiting (also called throwing up, emesis, and informally, barfing) is the forceful expulsion of the contents of one's stomach through the mouth and sometimes through the nose.

If, and when, nausea and vomiting will occur is individual to each of us, although it may be more common with some chemotherapies than others.

• Nausea and vomiting can occur before treatment such as the day before or upon entering the health care faclility where chemotherapy is administered (anticipatory nausea/vomiting). Anticipatory nausea is very real even though it occurs before chemotherapy infusion.
• A reaction can be experienced within minutes after adminstration of treatment or 4-6 hours after treatment or as much as 12 or even 24 hours later.  Some patients feel flu-like symptoms which can include nausea around the third day after treatment. Most people feel fine for the first hours after a treatment and find this is a good time to eat a meal.
• Nausea and vomiting which occurs soon after administration of treatment may last a few hours. It usually resolves within 24 hours.  Nausea has been known to last 6 - 7 days. 

Tell your doctor or nurse if you are very nauseated, if you have been vomiting for more than a day, or if your nausea is so bad that you cannot keep liquids down. Anti-nausea medicines are very effective in relieving or preventing nausea and vomiting. Non-drug techniques also help with nausea. For example,

• Rinse your mouth often to eliminate any bad taste.
• Distract yourself with activities that you enjoy.
• Avoid strongly scented foods.
• Before chemo appointments, drink fluids and eat a light meal in addition to taking an anti-nausea drug.
• For additional  tips for reducing the effects of nausea, click. here.

Consider carrying a bag with you "just in case" you get nauseous while outside the home.

Keep track of your symptoms to make a discussion with your doctor or other health care provider more useful. Survivorship A to Z provides a symptoms diary to help you keep track. When you are ready to see a doctor, a click of a button changes your diary into an easy to read graph. For information, see "To Learn More."    

Last, but not least, do what you can to increase your appetite.

For more information, see:

• Why Chemotherapy Drugs Can Cause Nausea and Vomiting   
• Definition of Nausea, Retching, Vomiting, Anticipatory Vomiting  
  
• Drugs Which Are More Likely To Cause Nausea And Vomiting  
  
• Factors Which Are More Likely To Cause Nausea And Vomiting  
  
• Methods For Preventing Anticipatory Vomiting    
  
• Non-Drug Methods For Preventing Or Reducing Nausea and Vomiting   
  
• Drugs Which Can Be Used To Prevent Nausea And Vomiting   
  
• What To Do And No Do If You Just Had A Bout Of Vomiting    
  
• A Bag To Carry "Just In Case"
  
• Foods and Drinks That May Be Easier On The System   
  
• Foods To Avoid When Feeling Nauseous   

NOTE: Get a prescription for anti-nausea medication from your doctor and get it filled. Keep the medication with you when possible. It is better to stop nausea early than allow it to become vomiting. If payment for drugs is difficult, click here.

Chemotherapy drugs cause nausea and vomiting for a variety of reasons.

• One reason is they irritate the lining of the stomach and duodenum (the first section of the small intestine). This stimulates certain nerves that activate the vomiting center (VC) and the chemoreceptor trigger zone (CTZ) in the brain which leads to vomiting.
• Another way these areas of the brain can be activated is through obstruction (intestinal blockage), delayed gastric emptying, or inflammation -- all possible effects of chemotherapy.

Nausea is an unpleasant wavelike sensation in the stomach and back of throat. It can be accompanied by symptoms such as sweating, light-headedness, dizziness, increased salivation, and weakness. It can lead to retching, vomiting, or both.

Retching is a rhythmic movement of the diaphragm and stomach muscles that are controlled by the vomiting center.

Vomiting is a process controlled by the vomiting center that causes the contents of the stomach to be forced out through the mouth. Vomiting can happen right after chemotherapy, or later. If it happens within minutes to hours after chemotherapy, it is called acute vomiting. If it develops or continues for 24 hours or more after chemotherapy, it is called delayed vomiting or delayed emesis. This type sometimes lasts for days.

Anticipatory vomiting can happen when you have had a bad experience with nausea and vomiting in the past that was not treated. This conditioned response can be stimulated by sights, sounds, or odors. As a result, you develop nausea and vomiting when placed in the same situation (for example, before receiving the next chemotherapy treatment). There are some types of treatment that may help this after it has started, but prevention is best.

Although it is not possible to predict the onset, severity, or duration of nausea and vomiting for any one person, certain chemotherapy drugs are more likely to cause nausea and vomiting. Some examples of these are:

• Cisplatin
• Dacarbazine
• Mechlorethamine
• Melphalan
• Daunorubicin
• Cytarabine (high doses)
• Streptozocin
• Carmustine
• Etoposide (high doses)
• Cyclophosphamide
• Procarbazine
• Lomustine
• Dactinomycin

Other factors that may affect the amount and severity of nausea and vomiting include:

• Prior experiences with motion sickness.
• Previous bad experience with nausea and vomiting.
• Fatigue.
• Anxiety during treatment.
• Heavy alcohol intake (currently or in the past).
• Being a woman of menstrual age (at greatest risk for severe and long-lasting nausea and vomiting).

Anticipatory nausea and vomiting is a conditioned or learned response that occurs after a negative past experience in which nausea and vomiting was not controlled.

Behavorial therapies such as relaxation, hypnosis, guided imagery and acupuncture may be effective. For information about these therapies, see the documents in  "To Learn More."

Behavorial therapies can be used along with anti-nausea medications such as benzodiazepines (Xanax or Ativan). 

Some experts suggest that on the day of treatment:

• Eliminate offending odors. For example, open a window or put in a fan to expell smells from the kitchen.
• Leave thehouse if the weather is nice and there are smells that may offend.
• Eat room termperature foods. They have less odor than hot foods.
• Avoid spicy, gresay foods.
• Have dry food such as saltine crackers before getting out of bed to have something in your stomach to soak up extra fluids.

The following non-drug methods help with nausea and vomiting:

• Meals
  • Avoid big meals so your stomach won't feel too full. 
  • Eat frequent, small meals 6 - 8 times throughout the day instead of 1, 2, or 3 large meals.
  • Prepare and freeze meals in advance.
• Drink liquids at least an hour before or after mealtime instead of with your meals.
• Eat and drink slowly.
• Chew your food well for better digestion
• After eating, rest in a chair. Do not lie flat for at least 2 hours after you've finished your meal.
• Stay away from sweet, fried, or fatty foods.
• Eat foods cold or at room temperature (warm) so you won't be bothered by strong smells.
• If nausea is a problem in the morning, try eating dry foods, such as cereal, toast, or crackers, before getting up. 
  • Keep them by the bed so you can eat them before getting up. 
  • Don't try this if you have mouth or throat sores or are troubled by a dry mouth.
• Drinks
  • Drink at least an hour before or after meals - instead of drinking with meals.
  • Drink cool, clear liquids, such as apple juice, tea, or ginger ale that has lost its fizz.
  • Avoid fizzy drinks and acid juices (such as orange juice).
  • Avoid caffeinated drinks such as tea, coffee, and many sodas.
• Suck on ice cubes, mints, or tart candies to get liquids or if you have a dry mouth. 
  • Juice popsicles are an alternative to drinking.
  • Do not eat tart candies if you have mouth or throat sores.
• Try to avoid odors or any smell that bothers you, such as cooking smells, smoke, or perfume.
• Wear loose-fitting clothes.
• Breathe deeply and slowly when you feel nauseated.
• Distract yourself by talking with friends or family members, or watching a movie or TV show.
• Use relaxation techniques, including relaxation exercises and guided imagery. For information about these techniques, see the documents in "To Learn More".
• Acupuncture. 
• Getting a massage.
• Listen to soothing music.
• Consume ginger in tablets or in flat ginger ale.
• (Ed. note): Consider using the following products which have helped many people with nausea and vomiting due to treatment.
  • Queasy Pops and Queasy Drops
  • Spearmint Gum 

The American Cancer Society also suggests listening to music. You can use music therapy either under the guidance of a certified music therapist or on your own. There is no downside to music therapy.

• To do music therapy on your own, listed to your favorite soothing music in a relaxed setting.
• To find a certified music therapist, ask at your treatment center or look at the web site of the organization known as The Certification Board for Music Therapists,www.cbmt..or g. Click on "Find a Board Certified Music Therapist" or call 800.765.2268.

NOTE: A large National Cancer Institute (NCI) funded study found that:

• One-quarter of a teaspoon of ginger daily for three days before chemotherapy, eliminated nausea by 40 percent. 
• A larger dose did not work as well as the small dose.
• The study also found that taking ginger with anti-vomiting drugs worked better to control nausea than taking the drugs alone.

The key to effective control of nausea and vomiting is to prevent it before it occurs whenever possible. That is why medicines for nausea and vomiting are started before the chemotherapy is given. Many drugs are used alone or in combination to prevent or decrease nausea and vomiting. Drugs used in this way are called anti-emetics. They include:

• Lorazepam (Ativan ')
• Prochlorperazine (Compazine ')
• Promethazine (Phenergan ')
• Metoclopramide (Reglan ')
• Corticosteroids such as dexamethasone (Decadron ')
• Ondansetron (Zofran ')
• Granisetron (Kytril ')
• Dolasetron (Anzemet ')
• Palonosetron (Aloxi ')
• Aprepitant (Emend ')

Survivorship A to Z note: Some anti nausea drugs make you vulnerable to sunburn and heatstroke. Ask you doctor about these as other potential side effects to watch for.

Consider the following helpful tips. If you have additional tips, please share the information at Survivorship A to Z

• After about an hour after vomiting, help settle your stomach and rehydrating by taking small sips of clear liquids such as broth or apple juice. You can also suck on ice chips.
• Eat mild foods such as crackers or toast.
• Use relaxation techniques such as:
  • Deep Breathing
  • Meditation
  • Techniques For Coping With Stress
  • Visualization
• Once you have gone at least 8 hours without vomiting, you can start eating solid foods. It is recommended that you start with one food at a time and that you eat small amounts to get started. For foods that are easier to eat, click here.   For foods to avoid, click here. 

It is helpful to carry a vomit bag with you 24/7 “just in case.”  

A gallon size plastic baggie will do. If you want more elegant solutions, consider the following ideas:

• A bag from an airplane
• Chick sick sacks from www.chemochicks.com
• A sporty bag at www.redebag.com
• Convenience bags from Walgreens (www.walgreens.com )
• A no frills bag at www.SickSaver.com

NOTE: Also carry a List of Medications in case of emergency. Emergency personnel need to know what medications you are currently taking and have recently taken. We provide a form to use that you can store and change as necessary. See "To Learn More." 

According to the National Cancer Institute, following is a list of full liquid foods that are easier during periods of nausea and vomiting. Below is a list of foods that are easy on the stomach.

FULL LIQUID FOODS

FOODS AND LIQUIDS THAT ARE EASY ON THE STOMACH

Avoid:

• Greasy and processed foods, and foods that contain a lot of salt. Some of these are white breads, pastries, doughnuts, sausage, fast-food burgers, fried foods, chips, and many canned foods.
• Foods with strong smells.
• Caffeine, alcohol, and carbonated drinks.
• Very spicy foods.