While chemotherapy can successfully treat many types of cancer, it can also leave patients with serious side effects.

Accounting for chemo

Chemotherapy-induced nausea and vomiting (CINV) can cause mental changes, loss of appetite—even a torn esophagus or broken bones. It can also prevent patients from keeping down medication, food and liquids, leading to dehydration, malnutrition and fatigue.

CINV can also cause patients to have higher health care costs, due to longer hospital stays, lost work hours, a need for assistance performing everyday tasks and depression.

Clearly, controlling CINV is important for reasons beyond discomfort. But many patients hesitate to talk about it with their doctors in the belief they can't be helped.

Fortunately, that isn't the case.

“While anti-nausea drugs may help other types of CINV, they are usually ineffective in stopping anticipatory nausea and vomiting.”

Solving nausea

Nausea and vomiting, while related, are not interchangeable. Nausea is controlled by the central nervous system, while vomiting is a reflex controlled by a different part of the brain. Vomiting can be triggered by everything from smells, tastes, poor blood flow and even anxiety or changes to the body caused by inflammation. 

Both anticipatory nausea and vomiting can occur in some patients after several courses of chemotherapy, and it is more common in women and people under age 50. It can sometimes be triggered by odors in the therapy room, even when the patient experiences them elsewhere.

The more chemotherapy sessions a patient has, the more likely CINV is to occur. While anti-nausea drugs may help other types of CINV, they are usually ineffective in stopping anticipatory nausea and vomiting. 

Psychologists and other mental health professionals can help curb this specific side effect. Some methods that have helped include muscle relaxation with guided imagery, hypnosis, biofeedback and even distractions like playing video games. 

Prescribing anti-nausea

Acute and delayed CINV are more successfully treated with anti-nausea drugs. Usually administered prior to treatment. But medical professionals are finding that non-drug treatments can either relieve CINV on their own or help anti-nausea drugs work more effectively. Changes in a patient's nutrition, acupuncture and acupressure, and relaxation methods including guided imagery and hypnosis have been found to help some patients.

While patients may feel embarrassed discussing CINV with their doctors, it's vitally important to do so. Preventing CINV is easier than trying to control symptoms after they start, and doctors need to consider how best to address it by assessing the side effects of some anti-nausea drugs, a patient's personal history of nausea and vomiting and even make drug changes to prevent future CINV. While no method is 100 percent effective all the time, no one has to suffer in silence with this unpleasant side effect.