Nausea and vomiting

Nausea is a feeling of sickness or discomfort in the stomach that may come with an urge to vomit. It's a common side effect of some types of breast cancer treatment.

When you vomit, you throw up some or all of the contents of your stomach through your mouth. Vomiting usually results from nausea.

It’s important to know that not all breast cancer treatments cause nausea and vomiting. For the treatments that do cause nausea and vomiting, not every person taking that treatment experiences them.

There are many medicines available that can prevent or lessen nausea and vomiting during cancer treatment. Before treatment begins, your care team will talk with you about options.

What causes nausea and vomiting?

Nausea and vomiting can be caused by many breast cancer treatments, including:

• Chemotherapy
• Immunotherapy
• Radiation therapy
• Targeted therapy
• Hormonal therapy

These treatments can sometimes trigger nausea and vomiting. While not everyone will experience nausea and vomiting with every treatment, a combination of these treatments can increase the risk.

There are three types of treatment-related nausea:

• Acute nausea happens within the first 24 hours of a treatment.
• Delayed nausea happens a few days after a treatment and can last for days or weeks.
• Anticipatory nausea happens just before a treatment appointment or because of a trigger, such as a certain odor you associate with your treatment.

Ask your care team ahead of time whether your treatment is likely to cause these side effects. If so, they can prescribe medicines to control and prevent nausea and vomiting.

Nausea and vomiting can also be caused by:

• Some pain medicines
• Antibiotics
• Other medicines not related to cancer treatment
• The cancer itself
• Other side effects of breast cancer treatment, such as dehydration and constipation
• Ovarian suppression medicines such as goserelin (Zoladex), leuprolide (Lupron), and triptorelin (Trelstar)
• Bisphosphonates (bone-strengthening medicines)
• Anxiety
• Infections
• Eating something that upsets your stomach
• Bacteria in food
• Other diseases or illnesses
• An imbalance of electrolytes, salts, or minerals in your blood

How can I prevent or lessen nausea and vomiting?

Medicines called antiemetics are available to prevent and control nausea and vomiting. Examples include:

• Aprepitant (Emend)
• Dexamethasone (DexPak)
• Ondansetron (Zofran)
• Prochlorperazine (Compazine)

There are also many other anti-nausea medicine options. Talk with your care team about which anti-nausea treatment may be most effective for you.

It’s common for doctors to treat nausea and vomiting ahead of time, before a treatment is given. For example, if you are having a chemotherapy treatment, your care team may give you preventive anti-nausea medicine through the chemotherapy IV line first. In many cases, you can take medicines to prevent nausea and vomiting before you get treatment, while you’re getting it, and in the days after treatment.

It's very important to take any anti-nausea medicines your care team recommends, even if you aren't experiencing nausea or vomiting. It's much easier to prevent nausea than it is to treat it once symptoms start. If one anti-nausea medicine doesn’t work, ask for another.

You can also keep a side effect journal to track your symptoms. Write down times when nausea and vomiting happen, how long it lasts, how severe it is, and how well anti-nausea medicine is working. Be as specific as possible, and share the information with your care team.

Diet and lifestyle changes can also help. Here are some things to try:

• Eat more frequent, smaller meals. Eating a lot all at once can make nausea worse. It helps to eat small meals or snacks throughout the day rather than three large meals.
• Eat at the time or times of day when you feel best. If nausea tends to strike in the mornings, eat less — or eat nothing — and wait until later. If you know you tend to get more nauseated at dinnertime, try to eat more in the earlier hours of the day.
• Avoid spicy, citric, and high-fat foods. Bland choices such as rice, plain pasta, bananas, and crackers can be easier on your stomach. Foods with ginger, such as gingersnaps, can be soothing.
• Choose your environment. Avoid places with strong smells, including the kitchen when meals are being cooked. Eat in a cool room with fresh air. Eat slowly and chew your food well.
• Drink cold, clear liquids and sip them slowly. Ginger or peppermint tea may help, as well as flat soda or ginger ale.
• Mindfulness-Based Stress Reduction and guided imagery can help with anticipatory nausea.
• You can also take your mind off how you are feeling with activities such as soothing music, games, reading, walking, or talking with a friend.

Nausea and vomiting and metastatic breast cancer treatment

In metastatic breast cancer and treatment, nausea and vomiting can have many causes. These include:

• Breast cancer treatments such as chemotherapy, targeted therapy, immunotherapy, radiation therapy, or hormonal therapy
• Medicines to manage pain, such as opioids; examples include:
  • Oxycodone (Oxycontin, Percocet)
  • Hydrocodone (Vicodin)
• The cancer itself, especially with metastasis to the brain or digestive system

With ongoing treatment, there is a higher risk of nausea and vomiting. Receiving a combination of treatments also increases the risk. If your anti-nausea medicine isn’t working well enough, talk with your care team about trying a different one.

If you experience severe nausea and vomiting, contact your care team right away. Severe nausea and vomiting can affect your nutrition, increase pain, and reduce your quality of life. Symptoms such as dehydration can sometimes require a hospital stay.

Other ways your care team can help you manage nausea and vomiting include:

• Lowering the dose of your treatment
• Delaying your treatment by an extra week
• Temporarily pausing treatment

It can help to know that most treatments have built-in recommendations to lower the dose or change the timing of the treatment if side effects are difficult to manage. With many treatments, even if the dose is lowered or changed, the treatment will still be effective against the cancer.

Although one goal of your treatment is to keep the cancer under control for as long as possible, a second, equally important goal is to allow you to have a good quality of life. Remember, your needs are an important part of your treatment plan. You and your care team will decide together whether it’s best to continue with a certain treatment or try a different one.