Inability to enjoy or retain food because of nausea and vomiting is one of the most upsetting problems faced by people with cancer. It is a common side effect of both chemotherapy and radiation therapy, but it is by no means universal. Many people never experience nausea or vomiting.
Fortunately, most people can be helped by medications called antiemetics, which combat nausea and vomiting. For maximum benefit these drugs should be given before the first chemotherapy session, for the following reason: people tend to associate nausea with specific situations. A person who develops nausea and vomiting after eating a particular food in a restaurant may avoid that food—and the restaurant—for years or a lifetime. Similarly, after experiencing nausea or vomiting after one or more chemotherapy treatments, some people develop nausea or vomiting or both immediately before the therapy is given. This is called anticipatory or conditioned nausea and vomiting.
Antiemetics are usually prescribed six to twelve hours prior to chemotherapy. They are continued every four to six hours for at least twelve to twenty-four hours, or as long as the nausea persists. To maintain enough drug concentration in the body to prevent the onset of nausea and vomiting, the medication often must be taken every few hours around the clock during chemotherapy treatment. Sometimes the most effective antiemetic, dose, and frequency must be established by trial and error.
There are many other means besides drugs to prevent or alleviate nausea and vomiting. Finding the best ones may also require experimentation. Methods that have worked for many patients include:
- Recalling strategies that were successful during pregnancy, illness or other times of stress. For example, some people find that eating a few bland crackers or sipping on a flat cola drink before getting out of bed in the morning helps.
- Eating foods that are cold or served at room temperature, such as sandwiches, cottage cheese, cereals, and desserts. These foods are usually better tolerated than warm or hot foods, since the odors of hot foods often aggravate the feeling of nausea.
- Using a clear liquid diet that includes apple juice, cranberry juice, lemonade, broth, ginger ale, cola or lemon-lime drinks, popsicles, gelatin, tea, or Gatorade.
- Experimenting with sour foods such as lemons, sour pickles, sour hard candy, or lemon sherbet. Rinsing the mouth with water mixed with a little lemon juice may also help, if there are no mouth sores.
- Avoiding sweet, fatty, highly salted, and spicy foods, as well as food with strong odors, such as cheese or salami. Bland foods like mashed potatoes, applesauce, sherbet, crackers, toast, and cottage cheese are usually better tolerated.
- Avoiding sights, sounds, and smells that can stimulate nausea—cooking odors, strong perfume, or other people vomiting.
- Eating various kinds of candy during chemotherapy administration. Some that have helped decrease the unpleasant metallic taste are hard or soft mints and sour candy.
- Experimenting with various eating patterns. For example, some patients avoid eating or drinking for one to two hours before and after chemotherapy administration, while others have a large meal three or four hours before, and then light meals for the rest of the day. Some patients do better with a liquid diet up to twelve hours before and twenty-four hours after chemotherapy. Others are able to eat solid food if they have frequent but small meals every five to six hours.
- Getting fresh air from an open window or by taking a walk outside.
- Using relaxation techniques or positive imagery, or self-hypnosis, which can be learned from a qualified therapist or a specially trained nurse.
- Using distraction, such as music, television, or movies, video games, crafts, games, and conversation.
- Sleeping during episodes of nausea or when it is anticipated. If nausea is present when the patient awakes, it may help to take the prescribed antiemetic and rest in bed for another thirty minutes to an hour.
If vomiting occurs, the patient should note the amount and character to report to the nurse or doctor. If the episodes are frequent, he or she should refrain from eating or drinking for four to eight hours, or twenty-four if necessary, but rinse the mouth with a mixture of water and lemon juice after each episode. When the vomiting has subsided, the patient can suck on ice cubes or sip small quantities of liquid slowly. Broth, Gatorade, ginger ale, cola, lemonade, tea, and gelatin are usually easily tolerated.
In the past, marijuana as a preventive for nausea and vomiting has gained a good deal of media attention. Some physicians have recommended marijuana for this purpose, but this is seldom done today since the antiemetic drugs are more effective and predictable.