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About Lymphoma

Nausea and vomiting

Nausea (feeling sick) is a common side effect that many people get when having treatment for lymphoma. In some cases, nausea can be a symptom of lymphoma or other illness, and can cause vomiting. However, nausea can be managed so it does not get too bad.

As with many things, prevention of nausea is better than treatment, so this will page will provide practical tips on how to prevent nausea and vomiting, and what to do if you can’t prevent it.

On this page:
"You don't need to suffer with nausea and vomiting as your health care team have wonder drugs to help with this"
Ben

What causes nausea and vomiting?

Many anti-cancer treatments can cause nausea which can lead to vomiting if not managed well. Some treatments that can cause nausea include some chemotherapies, surgery, radiotherapy and some immunotherapies. 

Triggers for vomiting

Vomiting is triggered from a part of your brain called the vomiting centre. There are several signals that can trigger the vomiting  centre.

These may include signals from:

  • an area in your brain called the chemo-receptor trigger zone that reacts to chemicals or medicines in your blood.
  • your brain cortex and limbic system that reacts to sight, taste, and smell, as well as to emotions and pain.
  • some other organs and nerves that respond to disease or irritation. Trigger zones in your stomach, oesophagus and intestines can be activated by chemotherapy.

Why is it important to prevent nausea & vomiting?

Preventing nausea and vomiting is important because they can lead to other complications.

During treatment for lymphoma, you need to maintain a good diet and drink 2-3 litres of water (or other non-alcohol, non-caffeine drinks) each day. This helps flush the medicine out of your body to prevent too many side-effects. It is also how your body gets the energy to replace your healthy cells that have been damaged by your treatment, and to continue to fight the lymphoma.

Additionally, if you are unable to eat and drink well, you increase your risk of becoming malnourished and dehydrated. This can lead to:

  • problems with your kidneys 
  • increased risk of falling as your blood pressure can drop, and you can become dizzy and lightheaded.
  • severe headaches
  • worse nausea and vomiting
  • delayed healing from any wounds
  • changes in your blood results
  • longer recovery from treatment
  • changes to your blood sugar levels
  • severe fatigue, weakness, and drowsiness.

Preventing nausea and vomiting

Nausea and vomiting can happen at any time when you have treatment for lymphoma. It usually starts several hours after treatment, but can also be after several days. 

If you’ve had severe nausea from treatment in the past, you may wake up with nausea on the day of, or before treatment. This type of nausea is called anticipatory nausea, and affects about 1 in 3 people who’ve had severe nausea in the past. This is another reason to manage the nausea early and prevent it getting worse right from the start.  

Treatment day

Make sure you eat and drink before your appointment. Having an empty stomach can increase your chances of feeling sick, so having something before treatment can help you feel better during treatment.  

If your treatment is known to cause nausea, or you have severe nausea from treatments in the past, your doctor will prescribe (order) you anti-nausea medicine. These are often given intravenously (into your blood stream through a cannula or central line) by your nurse before you start treatment.  Medicine given intravenously works more quickly than taking it by tablet. 

After you are given the anti-nausea medication, your nurse will wait some time (usually 30-60 minutes) to make sure the medicine takes affect, before they give you the treatment. You may also be given medicine to take home.

Oral therapy to treat lymphoma or CLL is taken by mouth as a tablet or capsule.
Oral therapy to treat lymphoma or CLL is taken by mouth as a tablet or capsule.

Anti-nausea medicine at home

You may be given anti-nausea tablets that you can take home. Take these as the pharmacist tells you even you are not feeling sick. They are to prevent you feeling sick later on, and help you to eat and drink well. 

Some medicines need to be taken before each meal, and some only every 3 days. Others may only be taken if you are feeling sick (nauseaous). Make sure you ask your nurse, pharmacist or doctor to explain how to take the medicine you have been prescribed.

 

 

Questions to ask about your anti-nausea medicine

It is very important to take your anti-nausea medications the way they are prescribed. Asking questions is the best way to make sure you get the information you need to take care of yourself once you go home. 

Questions you may like to ask your doctor, nurse or pharmacist about your medications include:

  1. When should I take this medication?
  2. Do I need to have it with food, or can I have it before I eat?
  3. How often should I take this medication?
  4. Should I still take this medication if I don’t feel sick?
  5. What are the side-effects of this medication?
  6. What should I do if I vomit soon after taking this medication?
  7. When should I stop taking this medication?
  8. What should I do if I still feel sick after taking this medication?
  9. Who can I contact if I have more questions about this medication, and what are there contact details?

Types of anti-nausea medications

You may be given one or several different types of anti-nausea medications to help manage your nausea. The table below provides an overview of different types of anti-nausea medications you may be offered, or can ask your doctor about.
 

Type of Medication

Information

Corticosteroids 

 

Our body naturally makes a hormone called cortisol. Corticosteroids are similar to this natural hormone and are often used to help prevent nausea.

An example of a common corticosteroid is dexamethasone.

Serotonin antagonists (also called 5HT3 antagonists)

 

Serotonin is a hormone our bodies naturally produce, and they can affect our mood, sleep and appetite. It also can sends signals to our brain to tell us to vomit. Serotonin antagonists prevent these signals from getting to our brain. 

Examples of these medications include palonosetron (Aloxi), ondansetron (Zofran) and granisetron.

Gastrointestinal stimulants

 

Some medications work by emptying your stomach and bowels more quickly so whatever is in there cannot make you feel sick anymore. 

An example of this is metoclopramide (Maxalon or Pramin).

Dopamine antagonists

 

Dopamine receptors are present in different areas of our body including the vomiting centre of our brain. When triggered, they send signals to feel sick and vomit. 

Dopamine antagonists attach to these receptors to prevent the “feel sick” signals getting through.

An example is prochlorperazine (Stemetil).

NK-1 Inhibitors

 

These medications bind to NK-1 receptors in your brain to prevent them receiving messages that can trigger nausea and vomiting.

Examples include aprepitant (Emend) and fosapreptitant.

Anti-anxiety medications
 

These can be very effective at preventing anticipatory nausea (more information on this is below)

Examples include lorazepam (Ativan) and diazepam (Valium).

Cannabinoids 

 

These medications include tetrahydrocannabinol (THC) and cannabidiol (CBD). They are sometimes called medicinal cannabis or medicinal marijuana. They work by blocking certain signals that can cause nausea and vomiting. 

You may not be able to drive while taking these medications so talk to your doctor about the benefits and risks. These are newer medications and may work for some people with nausea.

Cannabinoids are not the same as illegal marijuana.

If you have been given anti-nausea medication but you’re still feeling sick, tell your doctor as you may benefit from a different type of medication.

Practical tips to manage nausea and vomiting

Everyone is different in what works for them to help manage nausea. Make sure you take anti-nausea medication as prescribed. But in addition, you may find some of the below practical tips may also work well to manage your nausea and prevent or lessen any vomiting. 

Do:

  • eat a light and bland diet
  • eat small amounts of food throughout the day
  • try foods or drinks with ginger in them such as ginger ale or ginger beer, ginger cookies or lollies (make sure it has real ginger and is not just ginger flavoured)
  • drink plenty of fluid. Avoid hot drinks. Drink through a straw so the taste buds are bypassed. Fizzy drinks such as ginger ale can help settle the stomach
  • suck on hard lollies, ice blocks or ice during chemotherapy
  • if possible, keep cool but not cold
  • identify and avoid triggers that make you sick.
  • relax before and after treatment. Try things such as meditation and gentle breathing exercises
  • wear loose-fitting clothes.
Don’t:
  • eat heavy, high fat and greasy meals
  • use foods or sprays with strong smells including perfumes, sprays, meat cooking
  • have drinks with caffeine or alcohol
  • smoke (If you would like help giving up smoking, talk to your doctor about it)

Tip

If you are struggling to drink enough water each day, try to increase your fluids by adding some of the below into your diet.

Fruits and vegetable
Drinks
Other foods

Cucumber

Watermelon

Celery

Strawberries

Cantaloupe or rockmelon

Peaches

Oranges

Lettuce

Zucchini

Tomato

Capsicum

Cabbage

Cauliflower

Apples

Watercress

 

Water  (can be flavoured with ginger, cordial, juice, lemon, lime cucumber if you prefer)

Fruit juice

Decaffeinated tea or coffee

Sports drinks

Lucozade

Coconut water

Ginger ale

 

 

 

Ice cream

Jelly

Watery Soup and broth

Plain yoghurt

Anticipatory nausea

Many patients who experience nausea and vomiting after chemotherapy develop anticipatory symptoms in the chemotherapy cycles that follow. This means you may feel nauseous or vomit before coming into the hospital for treatment, or once you get there even before treatment begins. 

Anticipatory nausea is quite common and can affect around 1 in every 3 patients having treatment. It is more common if you have had bad nausea with previous treatments. 

Cause of anticipatory nausea

Starting treatmentAnticipatory nausea and vomiting is thought to be a result of classical psychological conditioning. The sights sounds and smells of hospitals or clinics can create a learned response that links these experiences to nausea and vomiting. As a result, experiencing these same smells and noises or other triggers can make your body remember that they caused nausea previously, and make you feel nauseous again. This becomes a pattern. 

Anticipatory nausea can affect anyone, however it is more common in people who are:

  • less than 50 years old
  • have experienced nausea and vomiting after a previous anti-cancer treatments
  • have had previous anxiety or panic attacks
  • get travel sickness
  • have had severe morning sickness during pregnancy.

Prevention and treatment

Anticipatory nausea does not improve with standard anti-nausea medicines.

Prevent nausea and vomiting from the first cycle is the best way to prevent anticipatory nausea developing on later cycles of treatment. However, if this hasn’t happened, anticipatory nausea may be improved with relaxation techniques, distractions to take your mind off the sights and smells, or anti-anxiety medications such as lorazepam or diazepam. 

If you have any of the above risk factors, or your current anti-nausea medications are not working ask your doctor if these medications may be suitable for you.

Other practical things that can help with anticipatory nausea include:

  • distractions – keep your attention on something other than your surroundings such as colouring in, reading, watching a movie, craft, sewing or having conversations with those around you.
  • relaxation – ask if there is a quieter area where you can wait for your appointment or have treatment (if possible), concentrate on your breathing and how it feels as your breath fills and leaves your lungs. Download and listen to visualisation apps on your phone.
  • bring some cloth, tissue, a pillow or something you can spray with a calming essential oil to minimise other smells.

 

Video - Diet & Nutrition

Video - Complimentary and Alternative treatment

Summary

  • Medicine to prevent or improve nausea and vomiting may be called anti-sickness, anti-nausea or anti-emetic medicine.
  • Nausea is a common side-effect of many anti-cancer treatments.
  • You do not need to “put up” with nausea, there are many ways to manage this to lessen nausea and prevent vomiting.
  • Prevention is better than cure so take your mediction as prescribed.
  • Nausea can lead to vomiting, which can cause many problems. Talk to your doctor if your medication is not working – there are other options that may work better for you.
  • Practical tips listed above can help improve nausea and make you feel better.
  • If you have any questions or concerns about nausea or vomiting, please call our Lymphoma Care Nurses. click on the Contact Us button at the bottom of the screen for there details.

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