Nausea and vomiting and cancer
Nausea and vomiting are common symptoms experienced by cancer patients, often resulting from cancer treatments like chemotherapy and radiation therapy, as well as the cancer itself. Nausea is characterized by a queasy feeling in the stomach, while vomiting involves the expulsion of stomach contents. Approximately 70 to 80 percent of cancer patients report these symptoms during treatment or as their disease progresses. The severity and frequency of nausea and vomiting can depend on various factors, including the type of treatment, the individual’s medical history, and even psychological responses to certain environments.
Management typically begins with identifying the underlying cause, as successful treatment of the cause can alleviate these symptoms. Anti-emetic medications are commonly used to control nausea and vomiting, along with dietary adjustments and alternative therapies like acupressure and ginger. While most people can recover from nausea and vomiting by addressing the underlying reasons, persistent symptoms may require medical intervention to prevent dehydration and other complications. Awareness and education about these symptoms can empower patients to seek appropriate care and support.
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Nausea and vomiting and cancer
ALSO KNOWN AS: Emesis, retching, heaving, gagging, throwing up, dry heaves
RELATED CONDITIONS: Chemotherapy, radiation therapy, inner ear syndrome, infections, brain cancer, constipation
DEFINITION: Nausea is the uneasy sensation that one is about to vomit, expelling stomach contents or undigested food through the mouth. Nausea can sometimes result in dry heaves when the stomach is empty.
Risk factors: Because nausea and vomiting are symptoms of many disorders as well as cancer therapies, the risk depends on the individual patient’s medical condition and circumstances. Patients with advanced cancer may experience chronic nausea caused by brain tumors, colon tumors, stomach ulcers, or radiation treatment, chemotherapy, and nonchemotherapeutic medications.
Etiology and the disease process: Nausea and vomiting are not diseases but symptoms—a sign that something is wrong in the body. Nausea and vomiting are complex bodily functions coordinated by the vomiting center in the brain stem of the central nervous system. Retching usually occurs after nausea and before vomiting as the body prepares to expel the stomach contents.
Nausea and vomiting can occur as a reaction to many promptsovereating, ingesting too much alcohol or sugar, infections, viruses, inner ear disorders, irritation of the throat or stomach lining, food poisoning, migraine headaches, unpleasant smells or sights, stress, severe anxiety or emotional circumstances, medications, or cancer treatments. A person experiencing a heart attack, appendicitis, or head injury with increased pressure on the brain may have nausea and vomiting. Determining the cause is critical to finding the appropriate treatment and correcting the problem.
Cancer patients may experience nausea and vomiting for several reasons. Some chemotherapy treatments cause nausea and vomiting ranging from low to severe. Factors such as the amount of the drug used or the route of administration can affect the incidence of nausea and vomiting. The characteristics of the person receiving chemotherapy—their age, gender, or history of motion sickness—can influence the occurrence of nausea and vomiting. Sometimes, nausea and vomiting will happen when patients enter an environment where they have received chemotherapy because of odors or a mental association with the setting (called anticipatory nausea and vomiting).
Cancer patients may also have nausea and vomiting as an extension of their disease. The tumor may have spread to the gastrointestinal tract, liver, or brain. Also, high-dose radiation treatments given for certain types of cancer can cause nausea and vomiting in the hours following therapy. Other causes of nausea and vomiting in cancer patients include bowel obstructions and constipation, infections, anxiety, and certain medicines.
Usually, the side effects of treatment can be controlled with antiemetic medication, but if they are uncontrolled, they can result in serious metabolic dysfunction, malnutrition, loss of appetite and the development of food aversions, dehydration, and a significant decline in the patient's quality of life.
Incidence: Approximately 70 to 80 percent of all cancer patients have nausea and vomiting during their treatment or as their disease progresses. Certain chemotherapeutic drugs are more likely to cause nausea and vomiting than others. The American Cancer Society's Guide to Cancer Drugs categorizes chemotherapeutic drugs into four risk groups based on the percentage of patients who experience nausea and vomiting while taking that drug without receiving antiemetic treatment. Drugs with a minimal risk cause vomiting in less than 10 percent of patients, drugs with a low risk cause vomiting in 10 to 30 percent of patients, drugs with a moderate risk cause vomiting in 30 to 90 percent of patients, and drugs with a high risk cause vomiting in more than 90 percent of patients.
Symptoms: Nausea produces a queasy feeling in the stomach and increased salivation in the mouth. Sometimes a stomachache or headache will occur before the nausea occurs. The person may experience dizziness, a fast heart rate, skin temperature changes (either feeling chilled or hot and flushed), and difficulty swallowing with nausea. Retching usually precedes vomiting as the body prepares to push out the stomach contents. However, sometimes vomiting occurs without nausea. Loss of fluids and electrolytes can leave the patient feeling drained and fatigued.
Screening and diagnosis: The severity, duration, and frequency of nausea and vomiting will determine the healthcare provider's need for further assessment and intervention. The key to screening and diagnosing nausea and vomiting is finding the underlying cause. Patients who are not undergoing cancer treatments should review any health conditions they have that might contribute to nausea and vomiting, such as migraine headaches or pregnancy (morning sickness).
Healthcare providers can prepare cancer patients for the likely possibility of nausea and vomiting during their treatment process. The degree to which nausea and vomiting affect the patient depends on many factors. Extension of cancer with metastatic disease to vital organs can increase the incidence of nausea and vomiting.
Treatment and therapy: Nausea and vomiting do not necessarily need treatment unless they continue for extended periods, as can occur with several types of radiation and chemotherapy. The first approach to treatment is determining the cause. The nausea and vomiting will subside if the cause can be defined and treated successfully.
Some people successfully use ginger ale, cola, or crackers to decrease the nausea. Vomiting will often relieve nausea, but nausea may return. Simple nausea and vomiting usually respond to limiting the intake of food and fluids. Gradually, patients may take clear liquids, then small amounts of dry toast or crackers. If this is well tolerated without more nausea and vomiting, patients can return to a regular diet.
If the nausea and vomiting continue uncontrolled, further examination is necessary to remove or treat the cause. Over time, patients with uncontrolled nausea and vomiting will become dehydrated and may suffer an electrolyte imbalance, which can be severe or even life-threatening. Patients with continuous nausea and vomiting may need antiemetics—medications that suppress these symptoms. These medications include those that block serotonin, dopamine, or the NK-1 receptor, including ondansetron (Zofran), metoclopramide (Reglan), or fosaprepitant (Emend), respectively. Doctors also may prescribe steroids like methylprednisolone (Medrol), benzodiazepines like lorazepam (Ativan), antipsychotics like olanzapine (Zyprexa), or cannabinoids containing THC like dronabinol (Marinol). If severe dehydration occurs, patients may need intravenous fluids.
Alternative or complementary therapies may help control or minimize nausea and vomiting. Nonpharmacologic therapies include biofeedback, guided imagery, attentional distraction, massage, and hypnosis. Behavior therapy, such as desensitization, may be useful for anticipatory nausea and vomiting. Ginger, an herb used to decrease nausea and vomiting, can be used in food or taken in capsules. Acupressure may help some patients. Dietary approaches such as eating food with minimal smell (either cold or at room temperature) while having chemotherapy may decrease nausea and vomiting. Avoiding certain foods, such as high-fat, spicy, or salty foods, helps some patients.
Prognosis, prevention, and outcomes: Most people experience uncomplicated nausea and vomiting at some point in their lives but can regain their health by addressing the cause and allowing the body time to heal. However, a healthcare provider should be notified if nausea and vomiting continue for longer than forty-eight hours or if they experience extreme dizziness, vomit blood, or are unable to retain fluids within twenty-four hours.
Patients should notify their healthcare provider if they plan to begin a new medication or supplement for nausea and vomiting. The doctor may change the drug or its dosage to help limit these symptoms and can advise the patient on the safest drug or supplement to improve symptoms. Patients should consult a healthcare provider if they have yellowing of the skin or eyes, difficulty swallowing, mental confusion, dehydration, extreme thirst, trouble urinating, or constant or sharp pain in the chest or lower abdomen. Certain conditions accompanied by nausea and vomiting may indicate a medical emergency, such as diabetic shock, severe headache, consistent chest pain, difficulty breathing, profuse sweating, or exposure to a known allergen.
More than half of all cancer patients experience nausea and vomiting at some point in their treatment. Using antiemetics or complementary therapies such as relaxation, massage, or meditation can sometimes produce a better outcome. Education and knowledge are important in helping patients help themselves.
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