Treatment Side Effects - Nausea and Vomiting

Several treatments for blood cancer, including chemotherapy and targeted therapies, can cause nausea and vomiting as a side effect. Nausea is an unpleasant queasy sensation that may be felt in the stomach, abdomen or back of the throat and may or may not lead to the urge to vomit. Vomiting is throwing up the contents of the stomach through the mouth. Nausea and vomiting may have various causes, such as viral infections, bacteria in food, or as a side effect of cancer treatment.^1,2

Nausea and vomiting can be extremely unpleasant, and may also be serious side effects, with the potential to cause dehydration and weakening. Fortunately, there are medications that can help manage nausea and vomiting from blood cancer treatment.²

Why do nausea and vomiting occur after blood cancer treatments?

Chemotherapy drugs work by targeting rapidly dividing cells, such as cancer cells. Because chemotherapy drugs attack cells that are dividing quickly, they affect cancer cells as well as normal cells that divide quickly, such as cells in the bone marrow, the lining of the mouth and intestines, and hair follicles.¹

Targeted therapy focuses on key features present in cancer cells, which hopefully provides treatment with less effect on normal cells. However, targeted therapies still can cause side effects. Side effects are specific to the medication given, but numerous treatments can cause nausea and vomiting.²

Radiation therapy may also cause nausea and vomiting, particularly if the radiation therapy is directed to a point on the body where the digestive organs are also found.²

Some people may be more susceptible to experiencing nausea and vomiting from cancer treatment, including those who:

• Are female
• Are younger than 50 years of age
• Have had nausea and vomiting from chemotherapy in the past
• Have had a history of motion sickness
• Have had a history of morning sickness
• Are dehydrated or malnourished
• Have had recent surgery or radiation therapy²

Managing nausea and vomiting

Not everyone who receives treatment for blood cancer experiences nausea and vomiting, and the frequency and severity of these side effects can vary from person to person. In some cases, these side effects lessen or go away as the person’s body becomes more accustomed to their treatment.³

Anti-nausea medications can be given to patients undergoing cancer treatment to prevent nausea and vomiting. Some of these medications may be given prior to treatment, while others may be given following treatment to prevent delayed nausea and vomiting. Medications used to prevent nausea and vomiting include:

• Phenothiazines, such as prochlorperazine (brand names: Compro®, Compazine®)
• Butyrophenones, such as droperidol (brand name: Inapsine®) and haloperidol (brand name: Haldol®)
• Substituted benzamides, such as metoclopramide (brand name: Reglan®)
• Serotonin receptor antagonists, such as dolasetron (brand name: Anzemet®), granisetron (brand names: Kytril®, Sancuso®, Sustol®), ondansetron (brand name: Zofran®), and palonosetron (brand name: Aloxi®)
• Substance P/NK-1 receptor antagonists, such as aprepitant (brand names: Cinvanti™, Emend® capsules), fosaprepitant (Emend® injection). A combination product, netupitant/palonosetron (brand name: Akynzeo®), combines a substance P/NK-1 receptor antagonist with a serotonin receptor antagonist
• Corticosteroids, such as dexamethasone (brand names: Decadron®, Hexadrol®) and methylprednisolone (brand names: Medrol®, Solu-Medrol®)
• Benzodiazepines, such as alprazolam (brand names: Xanax®, Niravam®) and lorazepam (brand name: Ativan®)
• Antipsychotics, such as olanzapine (brand name: Zyprexa®)
• Cannabinoids, such as dronabinol (brand name: Marinol™) and nabilone (Cesamet®)²

In addition to medication, many patients find that complementary therapies can help ease or prevent nausea and vomiting, including acupuncture, acupressure, hypnosis, and relaxation techniques. There are several dietary modifications that may also help, such as drinking clear liquids (like ginger ale, apple juice, broth or tea), sucking on hard candies, and eating bland foods (like toast or crackers).^1-3