Nausea and Vomiting
Nausea and vomiting (NV) is one of the most distressing side effects that people with cancer experience. Unmanaged NV can lead to dehydration, serious electrolyte imbalance, weight loss and anticipatory nausea and vomiting.
Causes of Nausea and Vomiting
Most common causes:
- Certain chemotherapy and targeted immunotherapy regimens
- Other medications
- Radiation therapy to the whole body or certain parts of the body (such as the abdominal area or the brain’s vomiting center).
- Cancer in the brain
- Electrolyte imbalances
- Blocked intestines
- Bleeding in the stomach or intestines
Managing Nausea and Vomiting
Many effective antiemetic regimens are available for specific types of cancer treatment. Some of the drugs have been formulated to dissolve under your tongue for quicker effect and to reduce its risk of being vomited. The American Society of Clinical Oncology (ASCO)’s Cancer.Net webpage on Nausea and Vomiting provides an excellent listing and summary of various specific antiemetic regimens, as well as questions to ask your healthcare team about NV.
Taking your pre- and post-treatment antiemetic and anti-anxiety medication as prescribed is important for best effect. Tell your doctor of any of these situations:
- You miss a dose
- You can’t keep the medication down
- It isn’t working
- It causes unpleasant or serious side effects
A number of complementary approaches can enhance your antiemetic regimen and improve your comfort. The National Cancer Institute (NCI) suggests that deep breathing, guided imagery, hypnosis, and other relaxation techniques such as listening to music, reading a book, or meditating may help some people. NCI also suggests a number of dietary and eating tips that are often helpful: Nausea and Vomiting in People with Cancer.
In his book Life Over Cancer, Dr. Keith Block provides information on using the following complementary approaches in managing NV:2
- Acupuncture, acupressure and electroacupuncture
- Ginger tea and some herbal teas
- Mild exercise
- Eating appropriately
- Mind-body approaches including imagery and relaxation strategies
- Systematic desensitization
Some studies have found that massage may help to alleviate nausea.
Clinical Practice Guidelines
Clinical practice guidelines from the Society for Integrative Oncology (SIO) list the following integrative approaches as helpful for controlling chemotherapy induced NV in people with breast cancer:4
- These therapies can be considered as an addition to antiemetic drugs
- Glutamine should not be recommended for improving nausea and vomiting during chemotherapy.
SIO’s evidence-based clinical practice guidelines for integrative oncology cite evidence to consider the following integrative therapies for NV:5
- Acupuncture when nausea and vomiting associated with chemotherapy or surgical anesthesia are poorly controlled
- Mind-body approaches including music therapy, hypnosis and yoga
SIO guidelines for complementary therapies to manage nausea and vomiting in lung cancer patients include these:6
- In lung cancer patients experiencing the side effects, mind-body modalities are suggested as part of a multidisciplinary approach to reduce anticipatory chemotherapy-induced nausea and vomiting.
- In patients having nausea and vomiting from either chemotherapy or radiation therapy, acupuncture or related techniques is suggested as an adjunct treatment option.
ASCO’s Cancer.Net cautions:
“Some herbal products, like ginger, may help with nausea. However, you should discuss your plans with your healthcare team before starting any alternative or complementary treatments. These options should not be used as a replacement to medical treatments such as the ones listed [on the ASCO webpage]. There is not enough evidence to recommend a cannabinoid such as medical marijuana to prevent or treat nausea and vomiting from chemotherapy or radiation therapy. However, the FDA-approved cannabinoids dronabinol (Marinol, Syndros) or nabilone (Cesamet) are recommended to treat nausea and vomiting that does not improve with the standard antiemetics discussed above.”7