Nausea and Vomiting

Nausea refers to the uncomfortable feeling of wanting to vomit, while vomiting is the act of throwing up stomach contents through the mouth. One of the most common side effects of cancer and certain anticancer treatments is nausea and vomiting, but not all patients with the same condition and/or treatments will experience it the same way. The severity of nausea and vomiting ranges from mild to severe in different people. It can occur before, during or after treatment, but there are also some people who do not experience it at all.

Causes of Nausea and Vomiting

An area in our brain called the “vomiting centre” controls vomiting. Various factors can cause nausea and vomiting by triggering the vomiting centre. These include:

Anticancer drugs. Certain chemotherapy (e.g. cisplatin, doxorubicin, cyclophosphamide) are more likely to cause nausea and vomiting than others.
Radiation therapy, especially to the brain / abdominal / pelvic areas, or total body radiation therapy
Certain medications (e.g. antibiotics, opioids)
Cancer that is within or has spread to the brain
Cancer affecting e.g. blocking the gullet, stomach or intestines
Abnormal body salt or mineral levels
Other factors that may be unrelated to cancer or its treatment (e.g. indigestion, infections, constipation, motion sickness, food poisoning)

What you need to look out for

Uncontrolled nausea and vomiting can lead to more serious issues like dehydration and other problems from the loss of body salts. It is important to look out for the following symptoms and if present, to see your doctor or nurse early to be assessed.

Feeling of wanting to vomit that lasts for more than 2 days
Throwing up for more than twice a day, for more than 2 days
Difficulty eating or drinking due to nausea and/or vomiting

How it can be treated

Your doctor will ask you further questions (e.g. when it started, associated symptoms) and conduct a physical examination, to determine the cause of your nausea or vomiting. Your doctor may also order for further investigations (e.g. blood tests, scans) if needed. As the treatment for nausea or vomiting depends on its cause, your healthcare team will be able to advise you in detail on the management plan that is most suited to your condition.

Some common treatment approaches include:

Prescribing anti-vomiting medications that prevents or treats nausea / vomiting
Treating the condition that causes the nausea / vomiting. For instance, administering an enema to help you pass motion can help relieve nausea / vomiting caused by constipation.

What you can do

The following are some of the do’s and don’ts to help you to manage your nausea and vomiting better:

To prevent nausea / vomiting:

Take your anti-vomiting medication(s) as prescribed by your doctor

Take clear, non-carbonated and non-caffeinated drinks (e.g. apple juice) frequently and in small amounts, as tolerated

Drink and eat slowly

Take small frequent meals throughout the day, instead of three large meals

Wear loose fitting clothes especially when eating

Keep your mouth clean by brushing your teeth at least twice a day and rinsing your mouth before and after meals

Avoid taking drinks together with meals as it might cause you to feel bloated more easily

Avoid going for treatment with full stomach after eating, if nausea usually occurs during treatment

Avoid lying flat after meals to prevent reflux. Rest in a seated position for at least 1-2 hours after meals

If your nausea / vomiting is worsened by smells from food or other sources:

Eat your food when it has cooled down, to avoid smells from hot foods

Keep windows open and ensure good ventilation in your home, especially the kitchen

If you are nauseated from food smells and are unable to cook, get someone else to help with the cooking or prepare and freeze meals in advance

Avoid the odours that bother you (e.g. cigarette smoke, perfumes)

If you feel nauseated:

Take “comfort foods” that made you feel better when you had nausea previously (e.g. sour candy, mints, bland porridge)

Distract yourself by chatting with family or friends, or doing activities that you like

Use relaxation techniques (e.g. deep breathing), or using positive imagery (e.g. focus your mind on a happy scene) to help you feel less anxious and decrease the feeling of nausea

Some people find herbal products like ginger helpful. Discuss with your doctor before using these products, to ensure that there is no interaction with any other medications you are taking

Acupuncture may be helpful. Check with your doctor if acupuncture is safe for you, before going for it

Avoid fatty, oily, fried, or spicy foods

Avoid foods with strong odour

When to call your cancer care team

Please inform your doctor or nurse if you experience any nausea and / or vomiting, or if you experience any of the following that can indicate worsening or complications of your condition:

Nausea / vomiting that does not improve despite anti-vomiting medications
Signs of dehydration, including weight loss, feeling thirsty or having dry mouth, passing darker / less urine, feeling light-headed, dizzy or confused
Signs of bleeding in your stomach or intestines, including having vomitus that looks like coffee ground, or has blood in it
Signs of blockage in your intestines, including inability to pass motion or gas

If you have any questions regarding the above, please call the Cancer Helpline at +65 6225 5655 or approach your doctor or nurse for further details.

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The above contents are made available as part of TEMASEK FOUNDATION-ACCESS (Accessible Cancer Care to Enable Support for Survivors) PROGRAMME, a holistic care programme to support cancer patients during their care and recovery journey.

The contents have been approved by the Cancer Education Information Service, National Cancer Centre Singapore (NCCS), for people with cancer and their families and caregivers. However, this information serves only as a guide and should not be used as a substitute for medical diagnosis, treatment or advice. For specific medical conditions, please seek expert medical advice from your healthcare team.

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