Will Chemo Make You Sick? A Comprehensive Patient Guide to Nausea and Vomiting Associated with Chemotherapy

Casey Jones, ASN, RN

The first thing that comes to mind when your doctor explains you will be receiving chemotherapy is likely, "Will it make me sick?". The fear of nausea and vomiting while going through chemotherapy is widespread. Nausea and vomiting are among many chemotherapy drugs' most common side effects. The good news is that cancer doctors have come a long way in preventing nausea and vomiting. There are many great anti-nausea drugs to treat you before chemo and to use as needed at home. So do not fear the "sick" feeling you may have heard your grandma talk about eons ago when she went through chemo.

What Causes Nausea and Vomiting after Chemo?

What causes nausea and vomiting associated with chemo is not as simple as you might think. The type of chemotherapy drug(s) that you are on will determine much of your nausea and vomiting risk. Other than the specific chemo regimen you are on, your risk of having nausea with chemo can also be from:

anxiety
tumor location
type of cancer
radiation treatments
age - if less than 50 years old
gender - female gender has a higher chance of nausea
previous history of alcohol use
history of morning sickness during pregnancy

As you can see, many things can cause nausea and vomiting during cancer treatment. Your unique nausea treatment plan will depend on your situation and history.

Chemotherapy Drugs

Certain chemotherapy drugs make you more likely to feel nauseous than others. Each chemotherapy drug falls into a high, moderate, or low-risk nausea category. If your chemotherapy drug is at high or moderate risk for causing nausea, you may be pre-treated with anti-nausea medication(s).

Often, you will get a combination of nausea medications through your IV catheter about 30 minutes before chemo. You may get a mix of anti-nausea drugs that are both short- and long-acting. Short-acting drugs, like ondansetron (Zofran), take effect within a few minutes and last several hours. A long-acting drug, like fosaprepitant (Emend), lasts several days and is for delayed onset nausea and vomiting. Certain chemo drugs cause delayed onset nausea and vomiting - nausea that happens >24 hours after chemotherapy has finished. Long-acting nausea drugs are helpful if you take a chemo drug that causes delayed nausea and vomiting.

It is good to remember that not every chemotherapy drug causes nausea, so you may not have any nausea treatment before chemo. What you are pre-treated with will depend on the chemotherapy drug(s) you are receiving. Your doctor will determine your regimen based on your chemo drugs and history.

Anxiety and Anticipatory Nausea from Chemotherapy

Nausea can also be from a history of anxiety. Many people have nausea from the anticipation of receiving chemotherapy. This type of nausea is a conditioned response called anticipatory nausea. If you have anticipatory nausea, you may get nauseous as soon as you walk into the lobby of the cancer center or sit down in the infusion room. According to the National Cancer Institute, anticipatory nausea affects 1 in 3 cancer patients. It can help to take an anti-anxiety medication before arriving at the cancer center. Discuss this with your doctor if it becomes an issue - it is more of a problem than many clinicians realize. Some cancer patients believe the doctor will think it's "all in their head," but this is not true. Anticipatory nausea is natural and can make your experience miserable if you try and go at it alone.

Other than pharmaceutical interventions, there are beneficial alternative therapies, including:

Guided imagery
Muscle relaxation
Distraction methods, such as watching TV or listening to music
Hypnosis
Putting a lemon or peppermint hard candy in your mouth before a bad taste or smell (often associated with the saline flush that goes in the patient's IV)

How to Treat Nausea and Vomiting at Home

Now that you know what causes nausea and vomiting related to chemo, you must know what to do about it once you get home. Your doctor will likely prescribe you different anti-nausea pills to take if you need them. Taking your nausea medication as soon as you feel nauseous is essential instead of trying to "wait it out." Take your nausea pills everywhere so you always have them, even if you are not at home. Taking an anti-nausea medication about 30 minutes to 1 hour before eating can also be helpful if food makes you nauseous.

Some doctors recommend you take your nausea pills on a schedule for a few days after chemo, while others suggest only taking them as needed. Please consult your healthcare team to determine how they want you to take your nausea pills. Some chemotherapy drugs are so likely to cause nausea that the doctor will prescribe a steroid pill for you to take the day before, the day of, and the day after chemo. There is no "one way fits all" method for nausea prevention. You must find what works for you and follow your doctor's guidance.

How to Eat when Nauseous after Chemo

When choosing what to eat after chemo, it can help to eat small, frequent meals to prevent nausea. Choose bland foods that have no foul smells and are cold or at room temperature. If you get nauseated when your stomach is empty, it can help to snack often so you don't get too hungry. Now is not the time to be on a diet. Eat whatever sounds good to you, and feel free to add in high-calorie items like:

ice cream/milkshakes
sauces and syrups
gravy
butter/oil

If you are having trouble maintaining your weight, it can help to focus on high-calorie and high-fat foods. Foods like broth, soup, popsicles, saltines, toast, bananas, and white rice are easier to eat. Try sipping on liquids throughout the day to stay hydrated. Water, tea, lemonade, Ensure, protein shakes, and ginger ale are great options for staying hydrated. These are a few tips to help prevent nausea and vomiting while going through cancer treatment. For more info, reach out to your cancer center's registered dietician.

When Nausea and Vomiting are a Problem after Chemo

Dehydration can lead to electrolyte imbalances, dizziness, weakness, confusion, and weight loss. If you haven't been able to eat for 48 hours, have vomited 5-6 times in 24 hours, or if your nausea medications are not working - call your doctor. If you struggle, your healthcare team can help you find a better nausea plan. The goal is to keep you free from nausea and vomiting while going through your chemotherapy journey.

Key Takeaways

Not all cancer treatments cause nausea and vomiting.
There is a nausea risk scale that doctors use to determine the potential for nausea and vomiting associated with your chemotherapy.
Your nausea treatment will depend on how high or low the risk is.
You should have at-home anti-nausea pills to take either on a schedule or as needed - always keep them with you.
Try eating bland, cold, or room temperature foods, and those that sound good to you.
Do not let yourself get too hungry, as this can lead to nausea. Eat small, frequent meals.
Call your doctor if you cannot eat or drink over 48 hours or have vomited 5-6 times daily.

References/Resources

Prevention of chemotherapy-induced nausea and vomiting in adults: UpToDate

Nausea and Vomiting Caused by Cancer Treatment: American Cancer Society

Managing Nausea and Vomiting at Home: American Cancer Society

Nausea and Vomiting Related to Cancer Treatment (PDQ®)–Health Professional Version: National Cancer Institute: National Institutes of Health