Anticipatory Nausea and Vomiting
Acute Nausea and Vomiting
Delayed Nausea and Vomiting
        Nausea and Vomiting in Advanced Cancer
        Radiation Therapy and Nausea and Vomiting

Nausea is controlled by a part of the central nervous system that controls involuntary bodily functions. Vomiting is a reflex controlled by a vomiting center in the brain. Vomiting can be stimulated by various triggers, such as smell, taste, anxiety, pain, motion, poor blood flow, irritation, or changes in the body caused by inflammation.

The most common causes of nausea and vomiting are:

• Chemotherapy drugs.
• Radiation therapy directed at the gastrointestinal (GI) tract, liver, or brain.

Nausea and vomiting are more likely to occur if the patient:

• Experienced severe episodes of nausea and vomiting after past chemotherapy sessions.



• Is female.



• Is younger than 50 years.



• Has a fluid and/or electrolyte imbalance (hypercalcemia, dehydration, or an excess of fluid in the body's tissues).



• Has a tumor in the GI tract, liver, or brain.



• Has constipation.



• Is receiving certain drugs.



• Has an infection or blood poisoning.



• Has kidney disease.



• Experiences anxiety.

Anticipatory nausea and vomiting occur after the patient has undergone several cancer treatments. It occurs in response to triggers, such as odors in the therapy room. For example, a person who begins chemotherapy and smells an alcohol swab at the same time, may later experience nausea and vomiting at the smell of alcohol alone. Patients usually do not experience nausea and/or vomiting before or during chemotherapy until after they have received several courses of treatment. The following factors may help predict which patients are more likely to experience anticipatory nausea and vomiting:

• Being younger than 50 years.



• Being female.



• The severity of nausea and vomiting after the last chemotherapy session.



• Feeling warm or hot after the last chemotherapy session.



• A history of motion sickness.



• Feeling dizzy or lightheaded after chemotherapy.



• Sweating after the last chemotherapy session.



• Experiencing weakness after the last chemotherapy session.



• Having a high level of anxiety.



• The type of chemotherapy (some are more likely to cause nausea and vomiting).



• Having morning sickness during pregnancy.

Chemotherapy is the most common treatment-related cause of nausea and vomiting. The drug, dose, schedule of administration, route, and factors that are unique to the patient all determine how often nausea occurs and how severe it will be. Usually, these symptoms can be prevented or controlled.

Acute nausea and vomiting are more likely to occur in patients who:

• Have experienced nausea and vomiting after previous chemotherapy sessions.



• Are female.



• Drink little or no alcohol.



• Are young.

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.

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 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.

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