Nausea and Vomiting

What is nausea and vomiting?

Nausea is a feeling of sickness in the stomach that may lead to vomiting. Vomiting is the emptying of the stomach contents through the mouth.

The purpose of this pamphlet is to help you prevent and reduce nausea and vomiting that may be caused by the cancer treatment.

What causes nausea and vomiting?

Nausea and vomiting may be caused by the chemotherapy or radiation treatment you are getting. The cancer itself, or some other disease may also cause nausea and vomiting. It is not pleasant, but it is a common side effect of cancer treatment. Feelings of nausea are usually worse right after your chemo¬therapy treatment and they may last for a few days. Some people may feel sick even before the treatment starts. Everyone has a different experience.

What medications are used to treat and prevent nausea and vomiting?

You will get medicine that you will take on a schedule to prevent nausea and vomiting. These may include Ondansetron® and Dexamethasone®. You may also be given Stemetil®, which you can take 'as needed' when you feel sick.

In some rare cases, these medicines will not work as well as they should. If this happens, your doctor will prescribe other medicine to help control your nausea and vomiting.

Suppositories will be prescribed if you are not able to keep pills down.

How is nausea and vomiting managed?

At the time of your chemotherapy, you will be given anti-nausea medicine. This should prevent nausea and vomiting for 8 to 12 hours. To help make this medication more effective:

• Use your anti-nausea medicine regularly for the first day (24 hours) after your treatment. In some cases you should continue using the medicine for up to 3 to 5 days.

• Lie down or rest in a chair. Sometimes nausea can get worse if you are active.
• Take the anti-nausea medicine even if you don’t feel sick. It is harder to treat nausea once it starts.

Most anti-nausea medication taken by mouth takes 30 to 60 minutes to start working. If vomiting does occur, drink plenty of fluids (8 to 10 cups a day) so that you avoid dehydration.

What should I eat or drink to help me control nausea?

Choosing the following foods and fluids may help you control nausea. Start with small amounts. As the nausea settles, introduce a variety of fluids, foods, and increase your portion sizes.

Fluids:

• Sip small amounts of fluids often. Fluids help to keep you well hydrated and will help settle your stomach. Some suggested fluids include:
  • Clear and cool fluids;
  • Flat pops and sodas with no caffeine, like ginger ale, Sprite® and 7-up®;
  • Clear soup broth that is low in sodium (salt).

Foods:

• Eat foods with a high fluid content, such as Jell-O®, popsicles and sherbert.
• Try eating dry, starchy foods such as soda crackers, dry cereal, plain rice and toast. You may find it helpful to have a cracker about 10 minutes before getting out of bed in the morning.
• Snack often. You may feel better with a small amount of solid food in your stomach.
• Avoid spicy foods, fried foods, and foods with strong smells.
• Enjoy foods that are cold or at room temperature.

Are there other things that I can do to control nausea and vomiting?

Besides taking the medicine to control these side effects, it is helpful to relax during your cancer treatments. You can do things like:

• Take frequent naps and rest often during your chemotherapy treatments;
• Sit and relax after you eat, but do not lie down;
• Try relaxation exercises such as deep breathing;
• Walk outside in the fresh air;
• Focus on the TV, or watch a movie;
• Change your position when you start to feel sick.

What do I do if the vomiting is severe?

Vomiting is severe if it happens more than three times in a day. It is important to drink plenty of fluids, in small amounts and often, to keep you hydrated. Here are some tips to help you control the vomiting:

• If you cannot keep your pills down, ask your doctor for suppositories;
• Ask your doctor for different medicine to control the vomiting.

When do I need to call for help?

Call your family doctor or the LRCP Telephone Triage Nurse if you have any of the following:

• You are weak and you cannot eat or keep fluids down;
• You have vomited more than 3 times in the day and it lasts more than 24 hours;
• Your nausea is longer than 48 hours.

The Telephone Triage Nurse (TTN) is available Monday to Friday between 8:30 a.m. and 4:00 p.m. Call 519-685-8600 and press option '3'.

If you live outside of London, call the TTN, family physician, or go to your nearest Emergency Department. Your family doctor or treating physician can call LRCP for more information or advice if needed.

If you call after hours or on weekends, ask for the on-call oncologist.

Helpful Links:

Nausea and Vomiting - Canadian Cancer Society