Managing Side Effects - Nausea and Vomiting - Patient Education ...

Cancer Therapy: Managing Side
Effects - Nausea and Vomiting
Nausea is a sick, uncomfortable feeling in your stomach that often
comes before you vomit, or “throw up.” Nausea and vomiting are
possible side effects of the medicines used for cancer treatments. This
can be chemotherapy and/or biotherapy. Chemotherapy and biotherapy
drugs can irritate your stomach or stimulate the vomiting center in your
brain. The severity of stomach upset and how long it lasts depend on
the drug and the dose you take. Not all chemotherapy and biotherapy
drugs cause nausea and vomiting.
Radiation therapy also may cause nausea and vomiting. This is more
likely to happen when you are receiving radiation to your chest,
stomach or back. Radiation treatment to other parts of your body
should not cause nausea and vomiting.
Nausea and vomiting from these treatments are usually temporary.
Call your doctor right away any time you are too nauseated to
drink fluids or any time you have more than one or two episodes
of vomiting in a 24-hour period.
Other causes of nausea and vomiting may include: your disease,
infection, constipation, high blood sugar levels, low sodium (salt)
levels, high calcium levels, and various medicines.
© Copyright 2009 - November 16, 2010. James Cancer Hospital &
Solove Research Institute, The Ohio State University Medical Center
- Upon request all patient education handouts are available in other
formats for people with special hearing, vision and language needs,
call (614) 293-3191.
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Ways to Reduce Nausea and Vomiting
Foods and liquids
• You may need to limit what you eat on the day you get
chemotherapy, biotherapy, or radiation therapy, or any time your
stomach is upset. Talk to you nurse if you have questions about
eating immediately before or after your treatment.
• Eat small amounts often during the day, instead of three large
meals. Eat slowly, in a pleasant place. Give yourself plenty of time
to eat. Eat whenever your feel like eating.
• Do not drink liquids with meals. Wait 30 to 60 minutes after
eating. Clear cool liquids are often tolerated well, especially fluids
like Gatorade TM , and Exceed TM . Try weak tea, ginger tea, clear
soups, gelatin, or popsicles. Try ice cubes made from a favorite
non-alcoholic beverage, 7-UP TM , ginger ale, or cola.
Caution: Ginger tea may not be used with some health
conditions. Ask your doctor or nurse.
• Eat bland dry foods, such as unbuttered toast with jelly, saltine
crackers, dry popcorn, or boiled/baked potatoes.
• Foods that digest easily include: skim milk, cereal, sherbet, fruit,
and plain vegetables.
• Eat foods that are cool or at room temperature. Do not allow
refrigerated foods to sit at room temperature more than 30 minutes
before you eat them.
• Avoid spicy “hot” foods, such as chili, hot peppers or barbecue
sauces. Do not eat fatty, fried or greasy foods such as French fries,
cheeses, butter, oil, cream, margarine, or red meats. Many patients
do not like foods that are sweet.
• If foods with strong odors bother you, go into another room while
these foods are cooking.
• Avoid your favorite foods during times of severe stomach upset.
That way you will not connect them in your mind with nausea and
vomiting.
• Sucking on hard candy such as lemon drops may relieve a metallic
taste in your mouth. Use plastic utensils whenever possible. If you

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do not have a sore mouth or throat, try citrus juice. Pickles, relish
or cranberry juice may also be helpful.
• Family members should not coax, bribe or threaten you about food.
They can help best by cooking the foods for you so you will not
have to smell the cooking odors.
Anti-emetic Medicine (anti = against, emetic = vomiting)
• Take anti-emetic medicine as it is ordered, about one half hour
before eating. Take the medicine a day before treatment or for
several hours before treatment, even if you feel fine. You may
need to continue it regularly for a few days after treatment.
• If pills do not stay down, most anti-emetic medicines can be given
in another form, such as injections, suppositories, or under the
tongue.
• If your anti-emetic medicine does not seem to be working, tell your
doctor or nurse. There are many anti-emetic medicines and/or other
drugs that may work better.
• Antacids such as Maalox TM or Mylanta TM may help mild nausea or
heartburn.
• If you are weak, dizzy, or sleepy from the anti-emetic medicine,
ask someone to stay with you and help you.
Other Ways to Help
• Rest before and after meals, but do not lie down for 2 hours after
eating. Sit in a comfortable chair with your feet up.
• Slow, deep breathing through your mouth or swallowing will
sometimes help the feeling of nausea to pass.
• Avoid unpleasant sights, sounds and smells that might trigger
nausea.
• Do mouth care after every meal and before meals if you have a bad
taste in your mouth.

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• A bad taste in your mouth may be taken away by rinsing your
mouth removing and cleaning dentures, brushing your teeth, or
sucking on hard candy such as peppermint.
• Open a window to get fresh air.
• Avoid strenuous exercise and sudden movements that may
interfere with your sense of balance.
• Distract yourself by talking, reading, listening to music, playing
games, doing handwork, watching TV, or working on a hobby.
• Learn how to do relaxation and guided imagery techniques (ask
your nurse to teach you).
• Try to rest or take a nap during the nausea.
• To increase calories and maintain or gain weight, ask for the
booklet Eating Hints from the National Cancer Institute. See your
nurse or dietitian for this booklet or for more information or you
may call 1-800-4-CANCER and request a copy, free of charge.
• Even if you cannot eat foods, try to drink at least 1 to 2 quarts of
fluid a day to avoid dehydration. Consider taking vitamins and
nutritional supplements.
• If you have mouth pain:
Try blended, smooth, creamy foods (eggs, soup, cheese cake,
ice cream, pudding
Try shakes made from oral nutritional supplements such as
Carnation Instant Breakfast®, Ensure®, or Boost®
Avoid hot foods
Avoid acidic foods
• Take a mild laxative if you are constipated. Sometimes
constipation can cause or add to your nausea. Do not take a
laxative if you are having belly pain. Call your doctor or nurse.
• Take medicines to keep pain under control.
• Provide comfort after nausea and vomiting by placing a cool cloth
to the forehead or back of neck and by resting.

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• Sit up or turn on your side when vomiting so you will not get any
of it into your lungs.
When to call your doctor or nurse:
• Call your doctor or nurse if vomiting lasts longer than 2 days.
• Be prepared to answer these questions:
How often do you have nausea and vomiting?
About how much is coming up?
Does the vomit ever have blood or coffee ground looking stuff
in it?
Is the nausea and vomiting related to activity, food, medicines,
pain or coughing?
Do you feel better after vomiting?
Are your bowels moving? Are you passing water as usual?
What have you tried to decrease the nausea and vomiting?
What usually works best to control your nausea and vomiting?
Can you keep any food or fluid down?
• Weigh yourself once a week. Report a loss of more than 5
pounds in a week or 10 pounds in a month.
• Report any of these signs of too much water loss (dehydration):
Dry eyes
Cracked lips/dry mouth
Dry, limp skin
Dizziness, especially when you stand up
Talk to your doctor or others on your health care team if you
have any questions. You may request more written
information from the Library for Health Information at (614)
293-3703 or email: health-info@osu.edu.