On Nausea & Chemotherapy

By Steven Grunberg, MD
Professor of Medicine
University of Vermont Comprehensive Cancer Center
Burlington, Vermont

Question:
Are there new ways to control nausea caused by chemotherapy?

Answer:
Nausea and vomiting have always rated high among the side effects most feared by patients receiving chemotherapy. Fortunately‚ there has been a great deal of progress in the prevention and control of these gastrointestinal side effects. In times past‚ patients receiving many chemotherapy drugs had a high likelihood of being nauseated and/or vomiting several times within the first 24 hours after chemotherapy.

With newer antiemetic (antinausea) medicines‚ more than half of the patients receiving chemotherapy that has a high potential to cause nausea or vomiting will have minimal‚ if any‚ problems. If you receive this type of chemotherapy‚ your doctor will give you several antiemetic medications before chemotherapy and additional medications to take at home over the next several days.

It is important that you take these medications as directed even if you are never sick or if any nausea or vomiting you experienced has ended. There may be a continuing risk of nausea or vomiting for several days after chemotherapy because‚ even though most chemotherapy drugs are rapidly eliminated from the body‚ a chain of events is set in motion that results in both the beneficial effects and possible side effects as well.

If the antiemetic medications are not effective‚ or if you have side effects from these medications‚ you should inform your doctor immediately since there are alternative medications that can be substituted. If you experience more nausea or vomiting than you expected or experienced on previous doses of the same chemotherapy‚ or if nausea or vomiting begins more than a week after chemotherapy‚ you should also contact your doctor immediately because there might be other causes for these side effects besides the chemotherapy.

Patients should maintain a diet that is as close to normal as possible. However‚ it is probably better not to have heavy meals‚ spicy foods‚ or alcohol around the time of chemotherapy. It is also important to remember that dehydration can be extremely dangerous for a person receiving chemotherapy‚ and it can exacerbate nausea or vomiting.

If you must choose between full meals and a large amount of liquids for a few days after chemotherapy‚ take the liquids and avoid dehydration. New medicines to control nausea continue to be developed. Zofran® (ondansetron)‚ Kytril® (granis–etron)‚ and Anzemet® (dolasetron) are examples of such medicines that are currently available‚ and more are on the way.

Finally‚ communication is always important. Be certain your doctors and nurses know exactly how you are doing so they can use these advances to your best advantage. While each person reacts differently to a given treatment‚ most of the common (and feared) chemotherapy side effects can be minimized.