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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 symptoms can also lead to poor nutrition, weight loss, and other health complications.
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.
Nausea is the feeling of sickness or discomfort that a person feels with the urge to vomit. Nausea usually involves unpleasant sensations in the throat or stomach. Other sensations a person may relate to nausea are dizziness, trouble swallowing, sweating, and feeling chilled or flushed.
Vomiting, or throwing up, happens when muscles contract and push what is in the stomach up and out the mouth. Common causes of nausea and vomiting are illness, motion sickness, and medication side effects.
You may see or hear the term emesis during cancer care. Emesis is the clinical name for vomiting. Antiemetic drugs are medicines that treat nausea and vomiting.
Nausea and vomiting are related, but you may experience one without the other.
Chemotherapy is a main cause of nausea in children with cancer. However, radiation therapy and other medications can also cause nausea. Some children have nausea because of cancer itself or because of other health problems. Children with brain tumors may have hydrocephalus, a build-up of fluid in the brain. The increased pressure in their head can press on nerves and cause vomiting.
Common causes of nausea and vomiting in children with cancer include:
The connection between nausea and vomiting with chemotherapy is not fully understood. However, 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.
Up to 70% of children who get chemotherapy have nausea at some point during treatment. Symptoms vary from mild stomach upset to severe vomiting. There are 3 types of nausea and vomiting related to chemotherapy:
Certain chemotherapy medicines are more likely to cause nausea and vomiting. These medicines can be grouped by how likely they are to cause symptoms:
These groups are based on the likelihood of symptoms if no anti-nausea medicines are given. Children receiving 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 what category your child’s medicine is in. If it is in a higher risk group, talk about ways you can manage your child’s symptoms.
|Chemotherapy with High Risk of Nausea and Vomiting
||Chemotherapy with Moderate Risk of Nausea and Vomiting|
|Cyclophosphamide (high dose)||Cyclophosphamide (low dose)|
|Cytarabine (high dose)||Cytarabine (moderate dose)|
|Methotrexate (high dose)||Doxorubicin (low dose)|
|Doxorubicin (high dose)||Imatinib|
|Cytarabine + Etoposide or Teniposide||Intrathecal chemotherapy|
|Doxorubicin + Ifosfamide||Methotrexate (low dose)|
|Etoposide + Ifosfamide||Temozolomide|
|Cyclophosphamide + doxorubicin, epirubicin, or etoposide|
There are several ways to help manage nausea and vomiting during cancer treatment. Work with your care team to make sure that your child’s symptoms are managed.
Nausea medicines (antiemetics) may be used to prevent and treat nausea and vomiting. Common medicines used in pediatric cancer patients include:
Some people get a combination of medicines. Many of the medicines used to reduce nausea and vomiting have other uses. Talk to your doctor or pharmacist to learn about the purpose and instructions for each medicine your child is taking.
Health care providers prescribe nausea medicines based on the chemotherapy plan, age of the child, type of cancer, and other factors. Some people will be prescribed medicine before the start of chemotherapy. However, nausea medicines are also prescribed as needed. It is very important that you discuss symptoms with your care team so any side effects can be managed in the best way possible.
Certain foods and smells may make nausea worse. Many people lose their appetite during cancer treatment. Your child’s appetite and food preferences may change. It may take some time to find what works best. Some general tips are:
Find more nutrition tips for patients with nausea and vomiting.
Dietitians are important members of the care team. They can help children struggling with nausea and vomiting. A dietitian can help you with nutrition challenges. If your child has severe nausea and vomiting, they might need to have a feeding tube (enteral nutrition) or to receive IV nutrition (parenteral nutrition). These are important to make sure your child has good nutrition and enough fluids. Learn more about nutrition in pediatric cancer care.
A variety of strategies and complementary therapies may help with nausea and vomiting. These include:
Talk with your care team before trying any complementary therapy to make sure that it is safe. Your care team can also help you decide what treatments work best to manage symptoms.
Talk to your care team about nausea and vomiting. There are medicines and other strategies that can help.
Keep a record of symptoms. Write down when nausea occurs, what makes it worse, what makes it better. Note any other symptoms such as pain, loss of appetite, diarrhea, or constipation. This can help you and your care team understand your child’s symptoms and develop a plan.
Together does not endorse any branded product mentioned in this article.
Reviewed: October 2022