How to manage nausea from cancer treatment

One of the most common side effects of cancer treatment is nausea. It can be caused by chemotherapy, radiation therapy and even anesthesia. Dehydration or constipation can play a part, too.

Several medications are available now to help patients manage nausea. But what other strategies can you use to control this uncomfortable side effect?

We spoke with Tricia Rosemond, a clinical dietitian, for details.

Why do chemotherapy and radiation therapy cause nausea in cancer patients?

Chemotherapy is a systemic treatment, which means it affects the whole body. And many chemotherapy drugs are designed to attack fast-growing cells, like cancer. But some types of healthy cells grow just as quickly as cancerous ones do. One of those lines the entire gastrointestinal tract. And when that system becomes irritated or inflamed, nausea can be the result.

Radiation therapy is a site-specific treatment, meaning it tends to only affect the area being irradiated. But when the central nervous system gets involved, that can cause nausea, too. That’s why patients who are being treated with radiation therapy for brain and spine tumors are most likely to see nausea as a side effect.

What else can make cancer patients feel nauseous?

A lot of people don’t realize that dehydration and constipation can contribute to nausea — and that one can lead to the other, or even amplify it. So, staying adequately hydrated is essential.

When your body doesn’t get enough water, the bowels slow down. This causes stools to become firmer and harder to pass. If your body isn’t eliminating solid waste regularly, you can start to feel “backed up,” because nothing is moving or going out. So, whenever you eat, it can feel like there’s no room for anything new, and that can trigger nausea — and even vomiting.

Sometimes, constipation can be a side effect of pain medicine or anti-nausea medication. So, it’s important to discuss these issues with your care team as soon as you notice them. That way, they can suggest alternatives.

What methods are available to help manage nausea?

There are several medications that can help control nausea. The main one — and probably the most frequently prescribed — is ondansetron (Zofran). But if it doesn’t work on its own, or a patient just can’t tolerate it, doctors may add or substitute an additional medication, such as prochlorperazine (Compazine) or promethazine (Phenergan).

Another way to control nausea without medication is acupuncture. This traditional form of Chinese medicine uses tiny needles to stimulate certain parts of the body. It can be effective against nausea as well as other side effects, such as pain, neuropathy and even fatigue.

Can you give cancer patients any other tips to manage their nausea?

Yes, there are several small changes you can make that can make a big difference:

1. Eat small, frequent meals throughout the day. They put less strain on your stomach than trying to finish a big meal if it’s already feeling unsettled.

2. Stay hydrated. Drinking an adequate amount of fluid doesn’t just help fight nausea. It also counteracts fatigue, kidney damage, and other side effects.

3. Try tart foods, such as lemons or pickles. These can be especially useful when patients experience changes in the way food and beverages taste. Some patients squeeze lemon juice in their water to make it more palatable. Others suck on the lemon wedge itself.

4. Use ginger root. Ginger has been used as a natural remedy to settle upset stomachs for years. It has a very distinct and potent flavor, though, so some people can’t tolerate it. If you like the taste, there are many ways you can use it. You can chew candied ginger, or add some sliced, fresh ginger root to a vegetable stir fry. You can also peel and cut a piece about the size of your thumb into slivers and then boil it in water for a few minutes or add it to your tea and let it steep alongside the leaves.

5. Drink flat, clear soft drinks. Carbonated beverages, such as ginger ale and lemon-lime-flavored soda, can sometimes help settle an upset stomach. To reduce burping, open the can or bottle and let it sit out on the counter for about 10 minutes before drinking it. This will release some of the carbonation. Avoid the darker cola drinks, though; many contain caffeine, which is an irritant to the gastrointestinal tract.

6. Try cold foods. The smell of certain foods can be enough to make some cancer patients feel queasy. So, if food or cooking odors trigger a gag response in you, consider eating more cold foods, or not heating up leftovers before you eat them.

7. Avoid spicy, fried, or greasy foods. Fat takes longer to digest than protein and carbohydrates, so anything containing a lot of added fat will sit in your stomach for longer. If you’re already nauseous, the slower transit time can make you more prone to vomit.

8. Consider meal replacement shakes. We prefer patients to get as much of their nourishment as possible from real food, but if your appetite is poor, you’re losing a lot of weight, or you’re having a hard time swallowing, meal replacement shakes might make sense for you. You can add flavor or texture by blending in fresh fruits, yogurt, ice cream or even ice cubes.

Don’t hesitate to ask for help

If you need guidance in maintaining a balanced diet, ask your care team and ask for a referral to a clinical nutritionist or a clinical dietician. They might be able to recommend additional methods or solutions that will work for your specific case.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.