Managing Nausea and Vomiting

Nausea is an unpleasant feeling in the stomach that usually precedes vomiting (throwing up). Nausea and vomiting may occur during, or a few hours after your treatment (acute) or much later (delayed). It is natural to be concerned, but keep in mind that there has been great progress made in both the medications that prevent/control nausea and vomiting and in cancer treatments. Please note: Nausea and vomiting is not always a side effect of cancer treatments. Many people will have no nausea or vomiting at all.

Nausea may occur in people who:

  • have had general anesthesia (for surgery)
  • are taking certain medications
  • are receiving chemotherapy
  • are getting radiation treatments

Some chemotherapy works by attacking cancer cells because they reproduce very quickly. The cells that line your digestive tract also reproduce rapidly and can be damaged or destroyed by these medications. The good news is when treatment is over, your body will replace these cells with new, healthy cells. In the meantime, however, you may experience nausea and/or vomiting. Other medications or treatments may cause nausea by irritating your mouth, esophagus, or stomach, or affecting your sense of balance.

Medications

It is important that you keep in contact with your doctors and nurses about how you are feeling. In addition to the helpful tips in this brochure, there are medications your doctor can prescribe that can prevent, lessen, or treat the nausea and vomiting associated with cancer treatments. These medications are called anti-nausea drugs or anti-emetics. Anti- nausea medications can be taken by mouth, through an IV (intravenously) or intramuscular injection, by wearing a patch, by using a rectal suppository, or by placing a dissolvable strip under your tongue or inside your cheek. Follow your doctor’s instructions on when and how to take your medications very carefully, such as which medications to take first or whether or not to take a medication with food.

The following table lists some common medications used to prevent and/or treat nausea and vomiting. Work with your doctor to find the one (or combination) that will provide you with maximum relief and minimum side effects.

Helpful Foods

The following foods and liquids are generally well-tolerated.

  • Ice pops
  • Clear soups, clear sodas such as ginger ale (drink flat soda or stir it well before drinking to get rid of the carbonation), Kool-Aid®, and Gatorade®
  • Weak tea, fruit juices, and nectars (avoid citrus and acidic juices)
  • White rice, cooked potatoes, noodles, and pasta
  • White bread, creamed rice or wheat cereals, crackers, and dry toast
  • Bananas, applesauce, and cooked fruits
  • Yogurt, pudding, and cottage cheese
  • Baby food
  • Scrambled or soft-boiled eggs
  • Smooth peanut butter
  • Cooked chicken or turkey (no skin), lean beef, and fish (not fried)
  • Liquid supplements, such as Ensure®

Foods to Avoid

The following foods and liquids are generally not well-tolerated.

  • Greasy, fried, and fatty foods
  • Spicy foods
  • Acidic foods and drinks
  • Coffee, tea, drinks, and candies (including chocolate) that contain caffeine
  • Alcohol
  • High fiber foods: bran, oatmeal, fresh fruits, whole-grain breads, broccoli, corn, and beans

What Else Can I Do?

  • If your nausea only lasts an hour or two, you may want to avoid eating and just take a few sips of water or (weak) juice or tea to prevent becoming dehydrated (excessive loss of fluids from your body). If nausea lasts longer, you will need to find ways to get the nutrients and fluids your body needs.
  • Try eating small meals or snacks frequently, rather than large meals.
  • Eat and drink foods at room temperature, rather than hot or freezing.
  • Eat bland foods.
  • If you cannot eat or drink very much, try a salty, bland food (such as pretzels), as the salt will help you retain body fluids.
  • Drink most of your fluids between meals; only drink enough with meals to keep food moist.
  • If you are vomiting, wait an hour or so and then try clear liquids. If you do not vomit, try a small amount of a food from the Helpful list.
  • Nibble on dry crackers throughout the day.
  • Rinse your mouth frequently to rid your mouth of unpleasant tastes.
  • Avoid foods with strong or unpleasant odors (including during cooking).
  • Rest often.
  • Distract yourself with calm activities, such as reading, or a hobby.
  • Try taking a slow walk; the fresh air may decrease your nausea.
  • Avoid clothes that press against your stomach and throat areas.
  • If you are having difficulty eating or drinking enough to meet your nutritional needs, ask your nurse for a referral to a dietitian, who can work with you to design a food plan that meets your needs.

When Should I Call My Doctor?

If you have nausea and/or vomiting, it is very important to stay hydrated. This will help avoid dehydration or electrolyte imbalances. Dehydration can result in kidney failure, neurological symptoms, arthritis, skin problems, confusion, and disorientation. Severe dehydration leads to changes in the body's chemistry, such as electrolyte imbalances, which may become life-threatening.

Call your doctor or nurse right away if you have any of the following:

  • Nausea that lasts more than 2 days and is interfering with your daily activities.
  • Severe stomach pain.
  • Blood in your vomit (may appear red or black).
  • Cannot keep food, liquid, or anti-nausea medication in your stomach.
  • Vomiting 3 or more times per hour for more than 8 hours, projectile vomiting (vomiting with extreme force), or vomiting with dizziness or confusion.
  • Weight loss of 2 lbs or more in 1 day due to vomiting.
  • Signs or symptoms of dehydration (excess loss of body fluids): increased thirst, dry mucus membranes (dry mouth and nose), thick mucus, lack of saliva, dry skin, skin that “tents” (retains a tent shape after you pinch it up and then let go), weakness, lightheadedness (particularly if it gets worse when you stand), dark urine, infrequent urination, and/or small amounts or no urine when you try to urinate.