Christina L. DiSegna, MS, RD, CSO, CNSC, LDN
Senior Clinical Dietitian
Dana-Farber/Brigham and Women’s Cancer Center
One of the most common side effects of cancer treatment is nausea. Nausea is a feeling of sickness or distress in the stomach leading to a feeling of vomiting or regurgitation. It may also manifest as a queasy or unsettled feeling in the stomach accompanied by food distaste. Chemotherapy, immunotherapy and radiation therapy all have the potential to cause nausea. The likelihood of developing nausea with treatment depends on a lot of factors including, but not limited to: the type of treatment, dose given, frequency of administration, type of cancer, and other individual factors such as age, being prone to vomiting, having had morning sickness or motion sickness. Nausea is classified based on the timeframe for onset: anticipatory (prior to treatment), acute (within 24 hours of treatment), delayed (one to seven days after treatment). Nausea may also be classified as breakthrough (occurring despite prophylactic medication) or refractory (not responding to any medication). Complications of nausea and subsequent vomiting during treatment include: dehydration, electrolyte imbalances, inadequate nutritional intake, weight loss, malnutrition, and could lead to delays in treatment or inability to complete treatment.
Nausea is often managed with a combination of medications, nutrition interventions and complementary therapies. Because nausea and vomiting are triggered by different pathways in the body, there are groups of anti-nausea medications that work on the various pathways to help control symptoms. Often, multiple medications may be needed to be most effective. Because it is easier to prevent nausea than improve it once it starts, medications are often given before starting treatment and on a schedule for as long as nausea is anticipated to occur. Other medications can be taken “as needed” at the first sign of feeling nauseated. If certain medications are not effectively controlling symptoms, different combinations can be tried or doses adjusted.
In addition to medical management, there are a variety of nutritional interventions that may help manage nausea and ensure adequate nutrition and hydration.
- Aim for small, frequent eating opportunities throughout the day. Time eating when nausea medications are most effective.
- Avoid skipping meals and snacks. Nausea can be worse on an empty stomach.
- Focus on hydration. Try drinking liquids in between meals rather than with meals.
- Choose bland, starchy foods. Aim to include protein at each eating opportunity.
- Avoid high-fat or highly seasoned foods.
- Try cold or room-temperature foods to decrease food smells.
- Avoid food/cooking odors by using fans, opening windows, and avoiding food preparation areas.
- Avoid lying down for 30 minutes after eating.
- Avoid strong-smelling perfumes, lotions, soaps, etc.
- Rinse your mouth often to eliminate bad tastes.
- Add lemon to food and drink. Lemons contain neutralizing acids that help soothe an upset stomach.
- Try ginger. The properties of ginger help to improve digestion, which may decrease nausea. Ginger ale and ginger tea are two common uses. Crystallized ginger or ginger hard candies may also help manage nausea.
Lastly, complementary therapies have proven effective for some patients, especially those with anticipatory nausea. These include acupressure bracelets, acupuncture, relaxation and meditation techniques, and massage. Aromatherapy with lemon or ginger may also help to manage nausea.
