Nausea and Vomiting During Cancer Treatment

Nausea and vomiting are common side effects of cancer and cancer treatments. These symptoms can vary from mild to severe. They may happen before, during, or after treatment. Childhood cancer patients and families often say that nausea is one of the side effects that bothers them most.

If nausea and vomiting are not managed, they have a negative effect on your child’s quality of life. They can affect emotional well-being, treatment plans, and daily activities. These side effects can also lead to poor nutrition, weight loss, and other health problems.

For most children with cancer, there are ways to reduce nausea and vomiting. These include medications, changes in diet, and coping strategies such as deep breathing and distraction. Complementary therapies such as acupuncture, aromatherapy, and hypnosis may also help.

Causes of nausea and vomiting during cancer

Chemotherapy is a main cause of nausea in children with cancer. However, radiation therapy and other medicines can also cause nausea. Some children have nausea because of cancer itself or because of other health problems.

Children with brain tumors may have a build-up of fluid in the brain. The increased pressure in their head can press on nerves and cause vomiting. Health problems such as illness and infection, pain, or hormone changes can also trigger nausea and vomiting in children with cancer.

Nausea and vomiting with chemotherapy

Up to 70% of children who get chemotherapy have nausea at some point during treatment. Symptoms vary from mild stomach upset to severe vomiting. 

The connection between nausea and vomiting with chemotherapy is not fully understood. But chemotherapy may cause the release of certain chemical messengers that control nausea and vomiting. Some anti-nausea medicines act on these chemical systems to block the signals.

Three types of nausea and vomiting are related to chemotherapy:

• Acute nausea and vomiting: Symptoms happen during the first 24 hours after chemotherapy. The nausea usually begins 1–2 hours after chemotherapy and starts to get better after 4–6 hours.
• Delayed nausea and vomiting: Symptoms start 1 day or more after chemotherapy. Usually, delayed vomiting is most severe 2–4 days after chemotherapy. Then it gets better over the next few days.
• Anticipatory nausea and vomiting: Symptoms can start before chemotherapy. Anticipatory nausea and vomiting are brought on by triggers that the person connects with chemotherapy. This is a learned response. It is most common in patients who had severe nausea and vomiting with past treatments.

Cancer medicines with higher risk of nausea

Certain chemotherapy medicines are more likely to cause nausea and vomiting. These medicines can be grouped by how likely they are to cause symptoms of nausea and vomiting:

• High risk: more than 90% risk 
• Moderate risk: 30–90% risk
• Low risk: 10–30% risk
• Minimal risk: less than 10% risk

These groups are based on the likelihood of symptoms if no anti-nausea medicines are given. Children who get chemotherapy with high or moderate risk of vomiting are usually given medicines to prevent nausea and vomiting before symptoms occur. Talk to your health care team about how the medicine will affect your child. Find out which group the medicine is in. If it is in a higher risk group, talk about ways you can manage your child’s symptoms.

Medicines for nausea and vomiting

Anti-nausea medicines (antiemetics) may be used to prevent and treat nausea and vomiting. Some people get a combination of medicines. Your child may get anti-nausea medicines before the start of chemotherapy. Or your child may get medicines as needed for nausea. Talk with your care team so that any side effects can be managed in the best way possible.

Common medicines used in pediatric cancer patients include:

• Ondansetron (Zofran®)
• Granisetron (Kytril®)
• Lorazepam (Ativan®)
• Diphenhydramine (Benadryl®)
• Dexamethasone (Decadron®, Dexamethasone Intensol®, Dexpak®)
• Aprepitant (Emend®)
• Metoclopramide (Reglan®)
• Olanzapine (Zyprexa®)
• Scopolamine (Transderm Scop®)

Many of the medicines used to reduce nausea and vomiting have other uses. Talk to your health care provider to learn about the purpose and instructions for each medicine your child takes.

Diet changes and nutrition support

Certain foods and smells may make nausea worse. Your child may lose their appetite, or their food preferences may change during cancer treatment. It may take some time to find what meals and snacks work best for your child. A dietitian can help you with nutritional challenges due to chemotherapy or other treatments.

Find nutrition tips for patients with nausea and vomiting.

If your child has severe nausea and vomiting, they might need to have a feeding tube (enteral nutrition) or to get IV nutrition (parenteral nutrition). These are important to make sure your child has good nutrition and enough fluids to prevent dehydration. 

Learn more about clinical nutrition support.

Complementary therapies and coping strategies

Complementary therapies and coping strategies may help with nausea and vomiting. These include:

• Acupuncture or acupressure
• Aromatherapy and essential oils
• Biofeedback
• Deep breathing and relaxation techniques
• Hypnosis
• Herbal supplements, like ginger
• Distraction (playing video games, art, music) 
• Exercise

Talk with your care team before trying any complementary therapy to make sure that it is safe for your child. Your care team can also help you decide what treatments may work best to manage symptoms.

Questions to ask your care team

• Is my child at risk for nausea and vomiting because of their cancer treatment?
• Will the side effects likely happen right away or later?
• How long does nausea and vomiting usually last?
• Will you prescribe medicines to help with nausea and vomiting?
• What are ways to help manage nausea and vomiting?
• When should I call the care team?
  

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