Cancer : Nausea and Vomiting, Part 2

by National Cancer Institute

(Page 2 of 2)

Delayed Nausea and Vomiting

Delayed nausea and vomiting occurs more than 24 hours after chemotherapy. It is more likely to occur in patients who:

• Are receiving high-dose chemotherapy regimens.
• Have experienced acute nausea and vomiting with chemotherapy.
• Are female.
• Drink little or no alcohol.
• Are young.

Drugs to prevent nausea and vomiting may be given alone or in combinations to patients who are receiving chemotherapy.

Nausea and Vomiting in Advanced Cancer

Patients who have advanced cancer commonly experience chronic nausea and vomiting, which can significantly impair quality of life. Nausea and vomiting related to advanced cancer may be caused by the following:

• Use of opioids, antidepressants, and other pain medications.
• Constipation (a common side effect of opioid use).
• Brain and colon tumors.
• Abnormal levels of certain substances in the blood.
• Dehydration.
• Stomach ulcers.

Radiation Therapy and Nausea and Vomiting

Radiation therapy may also cause nausea and vomiting, especially in patients who are undergoing radiation to the GI tract (particularly the small intestine and stomach) or brain. The risk for nausea and vomiting increases as the dose of radiation and area being irradiated increase. Nausea and vomiting associated with radiation therapy usually occurs one-half hour to several hours after treatment. Symptoms may improve on days the patient does not undergo radiation therapy.

Treatment

Anticipatory Nausea and Vomiting

Treatment of anticipatory nausea and vomiting is more likely to be successful when symptoms are recognized and treated early. Although antinausea drugs do not seem to be effective, the following may reduce symptoms:

• Guided imagery.
• Hypnosis.
• Relaxation.
• Behavioral modification techniques.
• Distraction (such as playing video games).

Acute/Delayed Nausea and Vomiting

Acute and delayed nausea and vomiting are most commonly treated with antinausea drugs. Some drugs last only a short time in the body, and need to be given more often; others last a long time and are given less frequently. Blood levels of the drug(s) must be kept constant to control nausea and vomiting effectively.

The following drugs are commonly given alone or in combinations to treat nausea and vomiting:

• prochlorperazine
• droperidol, haloperidol
• metoclopramide
• ondansetron, granisetron, dolasetron, palonosetron
• aprepitant
• dexamethasone, methylprednisolone
• dronabinol
• lorazepam, midazolam, alprazolam
• olanzapine

Nausea and Vomiting Related to Constipation and Bowel Obstruction in Advanced Cancer

In patients with advanced cancer, constipation is one of the most common causes of nausea. To prevent constipation and decrease the risk for nausea and vomiting, it is important that a regular bowel routine be followed, even if the patient isn't eating. High-fiber diets and bulk-forming laxatives with psyllium or cellulose require large amounts of fluid, however, and are not well tolerated by patients with advanced cancer. Laxatives that soften the stool or stimulate the bowel may be prescribed to prevent constipation, especially if the patient is being treated with opioids for cancer pain. The use of enemas and rectal suppositories is limited to short-term, severe episodes of constipation. Patients who have a loss of bowel function because of nerve damage (such as a tumor pressing on the spinal cord) may require suppositories for regular bowel emptying. Enemas and rectal suppositories should not be used in patients who have damage to the bowel wall. Severe constipation may result in bowel obstruction.

Malignant Bowel Obstruction

Patients who have advanced cancer may develop a bowel obstruction that cannot be removed with surgery. The doctor may insert a nasogastric tube through the nose and esophagus into the stomach to temporarily relieve a partial obstruction. If the obstruction completely blocks the bowel, the doctor may insert a gastrostomy tube through the wall of the abdomen directly into the stomach to relieve fluid and air build-up. A gastrostomy tube also allows medications and liquids to be given directly into the stomach by pouring them down the tube. Sometimes, the doctor may create an ileostomy or colostomy by bringing part of the small intestine or colon through the abdominal wall to form an opening; or an expandable metal tube called a stent may be inserted into the bowel to open the blocked area. Injections or infusions of medications may be prescribed to relieve pain and/or nausea and vomiting. Alternative Therapies for Nausea and Vomiting

Nausea and vomiting may be controlled without using drugs. The following may be helpful in relieving symptoms, especially for anticipatory nausea and vomiting, and may improve the effectiveness of antinausea drugs.

• Nutrition
• Hypnosis.
• Acupuncture
• Acupressure.
• Guided imagery.

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