What is Nausea and Vomiting?
What is nausea and vomiting?
Nausea is the uneasy feeling in the stomach that suggests that you may need to throw up. People often describe it as feeling “sick to the stomach” or “queasy.” Vomiting is when the stomach forcefully pushes its contents up and out through the mouth. A person can have nausea without vomiting, vomiting without much warning, or both.
What does nausea and vomiting look like?
Nausea may cause a person to look pale, sweaty, uncomfortable, or less interested in food. They may have a bad taste in their mouth, or certain smells may make them feel worse. Vomiting may happen once or repeatedly. Some people also have gagging, retching, stomach cramps, dizziness, or trouble keeping food and drinks down. If vomiting continues, the body can lose too much fluid, and the person can become dehydrated.
Who gets nausea and vomiting?
Anyone getting chemotherapy can have nausea or vomiting, but the chance is not the same for every treatment. Cancer treatments are grouped into different risk levels for nausea, which means how likely a drug or treatment regimen is to cause vomiting if no anti-nausea medicine is given. In general, high-risk chemotherapy causes vomiting in more than 90% of patients without prevention, moderate-risk causes it in 30% to 90%, low-risk in 10% to 30%, and minimal-risk in less than 10%. The risk level helps the care team choose how strong the prevention plan should be.
A person’s own body can also affect risk. Some people are simply more likely to feel sick from treatment than others. Prior problems with nausea, motion sickness, pregnancy-related nausea, or poor nausea control during an earlier chemotherapy cycle can all increase the risk of experiencing nausea/vomiting during treatment.
How do you prevent nausea and vomiting?
The main goal is to prevent nausea and vomiting because once symptoms begin, they can be harder to control. The timing of prevention also matters. Nausea risk can mainly be in the first 24 hours after chemotherapy, while some therapies can potentially cause nausea up to 5 days after treatment. This is why some anti-nausea medicines are given right before chemotherapy, while others may be continued for a few more days at home.
The medicines used most often belong to a few main groups:
- 5-HT3 blockers
- Ondansetron (Zofran®)
- Palonosetron (Aloxi®)
- Dolasetron (Anzemet®)
- Granisetron (Sancuso®, Kytril®)
- Dexamethasone (Decadron®)
- NK1 blockers
- Aprepitant (Emend®, Cinvanti®, Aponvie®)
- Fosaprepitant (Emend®, Focinvez®)
- Rolapitant (Varubi®)
- Netupitant (Akynzeo®)
- Fosnetupitant (Akynzeo®)
- Olanzapine (Zyprexa®)
For high-risk chemotherapy, prevention usually consists of a 3 or 4-drug plan. This often includes a combination of a 5-HT3 blocker, dexamethasone, NK1 blocker, and/or olanzapine. For moderate-risk chemotherapy, prevention is usually a 2-drug plan for many regimens; however, some patients may need a 3-drug regimen. For low-risk chemotherapy, patients often receive just one medicine before treatment, such as dexamethasone or ondansetron. For minimal-risk chemotherapy, routine prevention medicine is often not needed, though rescue medicine may still be available if symptoms happen.
How is nausea and vomiting treated?
Even with good prevention, some patients still develop nausea or vomiting. When that happens, doctors often use a breakthrough treatment plan. “Breakthrough” means symptoms happen even though preventive medicine was already given. Commonly used medications for breakthrough symptoms include:
- Olanzapine (Zyprexa®)
- Cannabinoids
- Dopamine blockers
- Haloperidol (Haldol®)
- Metoclopramide (Reglan®)
- Prochlorperazine (Compazine®)
- Histamine blockers
- Promethazine (Phenergan®)
- Scopolamine
- 5-HT3 blockers
- Ondansetron (Zofran®)
- Dolasetron (Anzemet®)
- Granisetron (Sancuso®, Kytril®)
- Dexamethasone (Decadron®)
- Lorazepam (Ativan®)
If nausea and vomiting keep happening over repeated cycles, the treatment plan may be changed for the next chemotherapy cycle. For example, the team may add olanzapine, add an NK1 blocker, switch the 5-HT3 blocker, or extend how long medicine is continued after treatment.
NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.
What is a CBC?
A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.
Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.
2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.
3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.
What is a CMP?
A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status, 2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.
Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride
Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)
Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein
Blood sugar:
13) Serum glucose
Calcium:
14) Serum calcium
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