A common side effect of both cancer itself and cancer treatments is nausea — sometimes to the point of vomiting. Nausea, no matter how severe, can interfere with your ability to eat and complete daily activities. Let’s explore some of the ways you can prevent and manage stomach upset to maximize your comfort during treatment. 

What is nausea? 

Nausea is the sensation that we experience when our stomach is upset and/or we get the urge to throw up. It is often described as a churning discomfort and can be pretty unpleasant, particularly when it interferes with your ability to eat and pass stool. This sensation can range from mildly uncomfortable to severe and can sometimes induce vomiting. 

What causes nausea? 

In patients with cancer, multiple factors can contribute to nausea: 

• Cancer treatments — including chemotherapy, radiation, and immunotherapy (you may see this being referred to as Chemotherapy-Induced Nausea and Vomiting, or CINV, in your medical notes) 

• The cancer itself, especially if it’s in or affecting the brain, liver, or gastrointestinal system 

• Other medicines that you may be taking 

• Constipation or other gastrointestinal issues 

• Inner ear problems or balance concerns 

• An imbalance of electrolytes such as sodium, potassium, and others 

• Infections 

• Anxiety 

• Thinking of or being in a place or situation that triggers feeling sick, because it happened in the past. (This is called anticipatory nausea.) 

• Other diseases or illnesses 

Preventing and treating nausea during cancer treatment 

There are a variety of different things you can do to prevent nausea and manage it if it does occur. There is no one-size-fits-all approach to nausea and vomiting, so we recommend trying a few different combinations of these tactics to see what makes you most comfortable. 

1. Take anti-nausea medication as prescribed by your oncology team, even if you feel well 

Some cancer treatments are known to cause nausea. If you will be receiving one of these treatments, you doctor may prescribe extra medicines to prevent nausea before it starts. These medicines can very often be helpful in preventing nausea associated with your treatment. If your doctor has already prescribed medicine for nausea, it is important to take it correctly. Taking your medication as prescribed (including time of day and how often to take your dose) can help keep your risk of nausea and vomiting to a minimum. If your doctor hasn’t already prescribed you an anti-nausea medication, and you start to feel nauseous after treatment, it is important you to call their office to see what they can do 

2. Tell your oncology team when you’re feeling sick 

There’s no need to suffer in silence — “toughing out” nausea is almost never the answer. As we describe, there are a variety of medicine options and other remedies that can be used to treat nausea and prevent it from becoming severe. Even if you are only experiencing mild nausea, you should let your doctor know. It is also possible that your options and needs might change with time if one medication stops working well.. 

3. Drink enough fluids 

Staying hydrated helps  Try to sip fluids consistently throughout the day, aiming for 10 full glasses total. If you’re feeling too full and it’s contributing to nausea, you can also try limiting your fluid intake to mealtimes. If you’re finding it hard to drink for taste reasons, remember that any fluid is helpful in meeting your hydration needs — it doesn’t need to be plain water to count! You can add lime, lemon, fresh mint or cranberry juice to water or try sparkling water to make it easier to drink consistently. You can also sip fruit teas, smoothies, broths, or juices which sometimes go down easier. Frozen or thickened fluids like popsicles or sorbet also count.  Foods that contain a lot of water like watermelon and grapes are a good option. If you do experience vomiting, make sure to include 2-3 glasses of electrolyte-rich beverages like Pedialyte or Gatorade per instance of vomiting to prevent electrolyte imbalances.  

4. Change your eating habits 

It is common for cancer patients to struggle with nausea when they feel full, which is why a change of eating habits can sometimes help. Choosing several smaller mini-meals throughout the day instead of three big meals can help with this. Eating a small meal or snack before chemotherapy is also a good way to get some extra calories and strength. There are a variety of foods that people feel more comfortable with. Cold foods can offer less of a smell, which can help to keep nausea at bay while you eat. Avoid foods that are off-putting or have extreme tastes. Various foods can make you feel heavy in your stomach and when not feeling your best, the priority is to eat as well as possible. It can be tricky to find a combination of foods that will work for you. Avoid extreme tastes or smells — anything fatty, fried, spicy or very sweet may trigger nausea and vomiting. You might also want to avoid eating any of your favorite foods in case you risk developing an aversion to them.  Pro tip: sometimes, people have success alleviating nausea when they incorporate ginger into their daily food intake. You can try candied ginger or ginger tea to start. Contrary to popular belief, most bottled ginger ales don’t contain natural ginger, though you might still find them useful in meeting your hydration needs. You may also find mint lozenges or tea helpful.   

5. Eat regularly 

While you may feel like eating is the last thing you want to do, leaving your stomach empty for too long can further aggravate nausea. Try to eat regularly throughout the day — even a few crackers or a slice of toast before moving around in the morning can be helpful. Continue to eat something small every two to three hours over the day and be sure to eat something in the morning on the day of any treatments, blood tests, scans, or other visits, if your doctor allows. After you’ve eaten, it’s helpful to stay upright (by standing or sitting) for at least 2 hours after to let your stomach settle. Often, relaxing in a quiet, calm environment after eating can help prevent nausea. 

Nutrition and nausea 

The foods we eat have a very large impact on our health and comfort. Some foods make us feel great, while others make us feel less comfortable. Being aware of how you can improve your diet with the right foods, like ginger, can help ensure you still receive key nutrients while prioritizing your comfort. Exploring what works for you so that you can eat enough and avoid excessive nausea may take some time — don’t be afraid to experiment and ask your team for help. And, of course, be kind to yourself on the hard days! They might happen, and that’s totally OK. 

When to call your doctor 

If you’re experiencing severe nausea or vomiting during your cancer treatment and you’re unable to get adequate nutrition, talk to your doctor. There may be medications or other natural remedies they can offer to help ease your symptoms. Since nausea and vomiting can be dangerous and lead to dehydration and/or malnutrition, your doctor needs to know about this symptom if it’s uncontrolled. Here’s when you should call your doctor’s office: 

• If you’re unable to keep any food or fluid in your stomach 

• If you’ve vomited more than 4 times in a 24-hour period 

• If you throw up the medications your doctor gives you to prevent nausea and vomiting 

• Have a fever of 100.4 degrees or higher 

The Iris Care Team is also here to help with symptom management and nutrition suggestions. Chat with a nurse now for additional support.