How to find an appetite when dealing with chemotherapy and nausea

Patient Expert

This is the fourth article in a series on how to beat cancer through diet and exercise from our Expert, Doctor Amy Thomas. You can read her first post here.

Nausea is a dreadful and dangerous complication of chemotherapy. Although everyone's response is different, the most common chemotherapeutic agents cause nausea in 60-90% of patients. Some people are more likely to experience nausea with chemotherapy, including women, patients less than 50 years of age, those with a history of motion sickness or morning sickness with pregnancy, and those who experienced nausea and vomiting related to previous chemotherapy.

Ending  nausea with medication

A myriad of drugs are available to help people with nausea**;** however, some prefer to minimize the number of medications taken. If you are experiencing nausea or vomiting related to cancer treatment, you should be aware of the medications available and alternative ways to prevent and control these symptoms_._ Treatment of nausea can help you maintain appropriate intake in order to avoid the risks of dehydration, electrolyte imbalance, and malnutrition.

Side effects of chemotherapy, including nausea, are often more difficult to control once they begin. For this reason, your oncologist may prescribe an anti-nausea (anti-emetic) pill for you to start taking prior to treatment and continue taking during the entire round of chemotherapy, regardless of your symptoms. This proactive approach helps patients avoid the nausea-related fatigue and anxiety they would likely experience otherwise. The agents available for nausea have improved significantly over the past 10 years, and can relieve symptoms as long as 1-7 days after treatment begins. Common anti-nausea medications include: Ondansetron (Zofran), Palonosetron (Aloxi), Dolasetron (Anzemet), Granisetron (Kytril), Dexamethasone (Decadron), Prochlorperazine, Metoclopramide, Haloperidol, and Lorazepam (Ativan). Talk to your doctor about the risks and benefits of these medications to decide if one is right for you.

Alternative ways to avoid nausea

While a number of effective medications are available, some patients prefer to manage their nausea without taking an additional pill. This can be difficult, but there are a few ways to minimize nausea naturally.

People with nausea from any cause often benefit from eating small frequent meals throughout the day rather than a few large, heavy ones. It helps to eat before you get very hungry. Dry foods including cereal, toast, crackers, and bagels are often gentler on your stomach and may be a good beginning to a light meal. Also, the spices ginger and peppermint have been used for years to treat nausea and vomiting. Studies to establish their effectiveness are currently under way, but meanwhile you can try a soothing herbal tea containing either spice.

After eating, avoid exercise, which can slow digestion and worsen nausea. You should also avoid lying flat, as this can cause regurgitation and trigger the vomiting reflex. Engage in a relaxing activity, such as reading a book or watching a movie, sitting in a semi-upright position. Wear comfortable, loose-fitting clothes that don't exert pressure on your abdomen, and avoid strong odors and unpleasant smells, such as perfumes or fried foods. You may request that no one cooks in your house when you are feeling bad.

Relaxation techniques have been used to fight nausea with some success. Guided imagery is a meditative practice in which you imagine a pleasant, relaxing place and focus on the sensations you would experience in this place. Imagining positive sensations, such as the bright blue sky, the sound of the ocean, and the feeling of warm sand under your feet, can help block your perception of the negative physical sensations responsible for nausea and vomiting.

When nothing works

Despite medications and techniques listed above, it is unlikely you will avoid nausea and vomiting entirely. If you do start vomiting, stop eating for 30 minutes to an hour. Once vomiting has subsided, advance your intake slowly. Start with sipping small amounts of clear liquids, such as broth, juice, sports drinks, or water, over a few hours. Then, advance to light, mild foods like applesauce, bananas, rice, or toast. Avoid jumping ahead to large, heavy meals, and avoid caffeine and smoking completely.

It is especially important to avoid dehydration, which can exacerbate nausea and is dangerous to your health. That being said, many chemotherapy patients experience the sensation of unease and discomfort in their stomach, even when just drinking water. Taking small sips throughout the day may help, and cool, lightly flavored beverages such as unsweetened tea or juice may be more tolerable than others. If even small sips are a problem, start with wetting your lips and mouth while sitting in a comfortable position in a relaxing environment. Sucking on hard candy, popsicles, and ice may help.

Although nausea is a common complication of chemotherapy, it's important for your care team to be aware of your symptoms so they can anticipate complications and work with you to determine the best treatment option. Remember to discuss your symptoms with your doctor at every visit.

  • Amy E. Thomas, MD

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