What is nausea and when does it occur during cancer treatment?
Of all the feared side effects from cancer and chemotherapy, nausea sits at the top of the list. Nausea and vomiting from cancer treatment can be one of the most difficult side effects to manage — for both the patient and their caregivers. Unfortunately, the effects of nausea and vomiting can be so severe, it can sideline normal everyday activities such as working, cooking, exercising, and even resting. Prolonged nausea can lead to weight loss, dehydration (especially if vomiting), loss of lean muscle tissue, and even cause your chemotherapy treatments to be interrupted.
The different types of nausea
There are several different kinds of nausea. You may have heard of chemotherapy-induced nausea and vomiting, also known as CIVN, while anticipatory nausea, acute or delayed nausea, may be unfamiliar. The type of nausea varies with different chemotherapy treatments and how these chemotherapy treatments interact with your body.
Anticipatory nausea occurs prior to the chemotherapy itself, most often occurs on the day of chemo when you wake, on your way to your treatment center, or when you walk in the door of your cancer center. Anticipatory nausea can be so severe that many people will also vomit from it. You can decrease this feeling with relaxation techniques — a great topic to discuss with your healthcare team. Many hospitals and cancer organizations, such as Gilda’s Club, organize free meditation or gentle yoga programs for cancer patients. Consider joining a support group, too, as it helps to hear others’ experiences and to share your own. The group members will understand what you’re feeling, and you can speak with an openness that you cannot have with friends and family. It really will help and you’ll get great tips and info there, too.
Acute nausea usually occurs 24 hours after your chemotherapy treatment and can also become so severe that you may vomit. Acute nausea can last hours to days. If the chemotherapy treatment puts you at risk for acute nausea, be sure to take the anti-nausea medications on schedule to prevent it. Acute nausea is common with chemotherapy drugs like cisplatin, carboplatin, cyclophosphamide, and doxorubicin.
Delayed nausea occurs 1 to 7 days after treatment and is most intense between the 45 to 72 hours following treatment. It is especially important to take your anti-nausea medications on time and not to skip doses if you experience delayed nausea.
Be sure to monitor the food your eating and your weight, and to reach out to your medical team if you are unable to stop vomiting, your urine becomes dark brown (a sign of dehydration), or you are losing weight.
Tips for managing treatment-related nausea:
- If you experience nausea, don’t suffer in silence — speak to your medical team about anti-nausea drugs. There are some good ones you can take pre-and-post chemo that can really cut the misery, but unless your insurance pays for them they can be expensive. Make sure to follow the instructions for your drugs correctly to get the full benefits and to time your meals for when your medications will work their best.
- Speaking of being prepared, when you are feeling well, cook and freeze some of your favorite meals ahead of time and/or the meals you know you tolerate well when feeling unwell. Or if you can, have someone else prepare and bring your food to you, so that you avoid the smells of cooking. Cooking odors can cause real distress. It’s important to stay nourished so never be afraid to ask caregivers or friends for what you need. They won’t know unless you tell them. Make sure they know what you like and are sensitive to your needs.
- Remember the BRAT diet. It is often recommended for nausea. BRAT is the acronym for Banana, Rice, Applesauce, Toast — all foods known to help nauseous patients so make sure you have these ingredients in the house. If you feel queasy when you wake up, keep dry crackers near your bed to snack on to settle your stomach before getting up.
- Consider avoiding your favorite foods. This may seem counterintuitive, but trying to eat a favorite food when you feel nauseous can turn it into something repulsive, a feeling which can stay with you long after treatment is over which can spoil your enjoyment of it for good. Instead, try to stick with foods that are mild, and especially avoid spicy foods.
- Forget the idea of three square meals per day. It can be too much when you don’t feel well. Instead, focus on having 6-8 small, calorie-dense meals or snacks throughout the day. Try to avoid getting too hungry or too full, both of which can make you feel more nauseous. Check out our Small Plates for Small Appetites collection of recipes. Try sitting upright while you eat and for an hour or more after eating. This will take pressure off your stomach and allow your body to digest your food more easily.
- Eat foods which are cold or at room temperature, such as chilled soup or sandwiches. Hot foods can give off more pungent smells that can worsen nausea. If this seems like too much, nibble on plain foods like crackers, noodles, yogurt, oatmeal, or ice chips.
- Try drinking cold liquids, sipped slowly. If you are having taste issues, try adding additional flavors like mint or make lemon and ginger lemonade, ginger tea, ginger hibiscus tea, turmeric tea, or fennel tea which will be refreshing to your taste buds and easy on the stomach. Keep a supply ready in the fridge to make it easy to consume these beverages. Be sure to separate your liquids from your mealtimes.
- Try to avoid foods with strong odors, and heavy, fatty, greasy foods. Use different cooking methods such as poaching or baking in parchment paper to reduce smells that may aggravate your nausea. Both of the recipes linked above use fish, but you can also use these cooking methods to make wonderfully juicy chicken, which will provide your body with protein for recovery.
- Don’t forget mouth care. Be sure to rinse your mouth often to get rid of nasty tastes. Here is a quick and easy mouth rinse you can make ahead of time: Mix 1 teaspoon salt and 1 teaspoon baking soda in 4 cups of water. Shake well before swishing and spitting.
- On a more practical level, nausea can be worsened by strong-smelling lotions, soaps, perfumes, and air fresheners and it is best to avoid these during treatment and ask others around you to avoid these as well.
- If you are experiencing vomiting due to severe nausea, be sure to consume electrolyte-rich beverages to stay hydrated. Monitor your urine closely and increase the volume of fluids and, as stated above, contact your medical team if your urine becomes dark yellow or brownish.
Sidelining The Side Effects: Nausea
Our founder, Ann Ogden Gaffney, put together this list of her favorite foods she kept on standby to help her during treatment — although she does stress — eat or drink whatever makes you feel better!