Solutions for Chemotherapy-Related Nausea and Vomiting

Nausea and vomiting are among the most dreaded side effects of undergoing chemotherapy for cancer. Both reactions not only drain energy and sap appetite but also can dehydrate and weaken people to the point that low blood pressure, dizziness, and falling become serious risks — tempting some to stop following their prescribed regimens altogether.

Times have changed, however, says Memorial Sloan Kettering Nurse Leader Corey Russell, who has helped patients manage chemotherapy side effects for more than a decade.

Since arriving at MSK in 2007, Mr. Russell has taken part in the hospital’s efforts to implement standards for preventing chemotherapy-related nausea and vomiting established by the National Comprehensive Cancer Network, the American Society for Clinical Oncology, and other organizations.

“In the past, few medications were available to treat nausea,” he explains. “Now we better understand the mechanisms that trigger nausea and vomiting, as well as the risk of these side effects with specific agents. These insights enable clinicians to differentiate between different types of nausea.”

In other words, “there is no longer a need for most people to suffer.” According to Mr. Russell, “we can prevent as much as 70 to 80 percent of chemotherapy-induced nausea and vomiting by using the right medicine at the right time.”

Greater Insight, Better Solutions

With today’s more nuanced understanding of chemotherapy agents, says Mr. Russell, “We are able to prescribe drugs that target certain receptors in the body and specifically address the three primary types of chemotherapy-related nausea: anticipatory, acute, and delayed.”

Preventing Anticipatory Nausea

More psychosomatic than actual, this type of nausea often relates to what people anticipate might happen based on what they’ve seen or heard. Sometimes, says Mr. Russell, the reaction occurs because a person’s nausea was previously not well controlled.

To treat it, the antianxiety drug lorazepam (Ativan^®) can help. For many people, reassurance and coaching on ways to create a calming environment through diversion techniques such as music therapy and meditation can also help.

Preventing Acute, Fast-Acting Nausea

Triggered by the use of specific chemotherapy agents, acute nausea — which tends to start within 24 hours of receiving the agent — can often be alleviated with customized, fast-acting drugs such as ondansetron (Zofran^®) and dexamethasone (Decadron^®). These are the most commonly used treatments for acute nausea today, Mr. Russell says, but others are continuously being introduced.

Preventing Delayed Nausea

For nausea occurring 24 hours to several days after receiving chemotherapy or in reaction to the combination of multiple medicines and radiation, pre-chemotherapy agents such as fosaprepitant (Emend^®) have been found to be effective.

Timing Is Key

Another breakthrough in recent years is that doctors and nurses recognize how important it is to stay ahead of the nausea.

“We try to educate patients about identifying that sense of uneasiness or early nausea coming on, and do something about it right away,” Mr. Russell says. Chemotherapy nurses give patients this information before they begin their regimen, as well as at various intervals along the way.

“We make it a point to check in with each patient after he or she has received their first dose of a chemotherapy drug, or if they are switching drugs,” he explains, “so we can reinforce techniques for managing any symptoms or side effects immediately. With quick action, we can avoid the scenario of a patient being at home with uncontrolled nausea needing to come to the hospital for more complex and intensive interventions.”

Other Key Measures

Mr. Russell urges people to remember that when and what you eat and drink can make a big difference in how you feel following chemotherapy. Opting for small, frequent meals, drinking plenty of liquids but in measured amounts, and avoiding certain types of foods are just a few of the ways to help to minimize or prevent nausea and vomiting.