Nausea and Vomiting Treatment Guidelines for Patients with Cancer – Version IV, June 2007

Introduction

With this report, patients have information about how nausea and vomiting is treated at the nation’s leading cancer centers. Originally developed for cancer specialists by the National Comprehensive Cancer Network (NCCN), these treatment guidelines have now been written for the general public by the American Cancer Society (ACS). To obtain another copy of these guidelines, call the ACS at 1-800-ACS-2345, or the NCCN at 1-888-909-NCCN, or visit these organizations’ Web sites at www.cancer.org (ACS) and www.nccn.org (NCCN).

These patient guidelines should help you better understand nausea/vomiting treatment and your doctor’s advice. On the pages following general information about nausea and vomiting, you’ll find decision trees which are also referred to as flow charts. These charts represent different types of nausea and vomiting. Each one depicts step-by-step how you and your doctor decide which choices you can make to control this side effect. We urge you to discuss these guidelines with your doctor or nurse and ask the following questions:

• Is my cancer treatment likely to cause nausea and vomiting?
• Are there effective treatments to prevent or control my nausea and vomiting?
• How do you decide which anti-nausea/ vomiting treatment I should receive?
• What can be done if the treatment does not control my nausea and vomiting?
• What are the likely side effects of the recommended anti-nausea/vomiting treatments?

Before cancer treatment starts, most people are concerned about whether they will have side effects and, if so, what they will be like. They may find themselves overwhelmed by the wide range of possible side effects. Please remember that people do not experience every side effect, and some people have no side effects at all. In this report we will discuss nausea and vomiting as a side effect of cancer treatment. We have also provided a glossary. Words in blue italics are defined in the glossary; you can access their definitions in a small pop-up window by clicking on them.

Nausea and vomiting is one of the most dreaded, unpleasant side effects of cancer treatment, however, it is usually not life threatening. About 7 or 8 out of every 10 people treated for cancer experience nausea and vomiting. Today with newer and more effective medicines to control nausea and vomiting, people do not have to suffer. Drugs used to control these side affects are most commonly referred to as anti-nausea/vomiting drugs, but may also be called antiemetics. Every person being treated for cancer can, and should, receive treatment to prevent nausea and vomiting with these drugs.

Nausea and vomiting can lead to dehydration (lack of fluid and minerals needed by the body), fatigue, difficulty concentrating, slow wound healing, and loss of appetite. These negative effects are greatest when nausea and vomiting is severe or long-lasting, and when it interferes with the activities patients would like to do.

What Is Nausea and Vomiting?

Nausea and vomiting often occur together but can be separate conditions. Nausea is an unpleasant feeling in the back of the throat and stomach that may result in vomiting. Some terms commonly used to describe nausea are “sick to my stomach,” “queasy,” or “butterflies.” Increased saliva, dizziness, light-headedness, difficulty swallowing, skin temperature changes, and fast heart rate are other symptoms that may occur during nausea.

People frequently refer to vomiting as “throwing up.” Vomiting, also called emesis, is a forceful contraction of the stomach muscles that causes the contents of the stomach to come up through the mouth. Nausea may or may not be present.

Sometimes people experience retching. It is the attempt to vomit without bringing anything up from the stomach. Other words used to describe retching are “gagging” or “dry heaves.”

The entire report is also available as a PDF file:

NCCN_Nausea_Guidelines.pdf 297 k

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CAUSES OF NAUSEA AND VOMITING

The mutual goal of the National Comprehensive Cancer Network® (NCCN®) and the American Cancer Society (ACS) partnership is to provide patients and the general public with state-of-the-art cancer treatment information in understandable language. This information, based on the NCCN's Clinical Practice Guidelines, is intended to assist you in the dialogue with your physician. These guidelines do not replace the expertise and clinical judgment of your physician. Each patient's situation must be evaluated individually. It is important to discuss the guidelines and all information regarding treatment options with your physician. To ensure that you have the most up-to-date version of the guidelines, consult the web sites of the ACS (www.cancer.org) or NCCN (www.nccn.org). You may also call the NCCN at 1-888-909-NCCN or the ACS at 1-800-ACS-2345 for the most recent information.

NCCN Clinical Practice Guidelines were developed by a diverse panel of experts. The guidelines are a statement of consensus of its authors regarding the scientific evidence and their views of currently accepted approaches to treatment. The NCCN guidelines are updated as new significant data become available. The Patient Information version will be updated accordingly and will be available on-line through the NCCN and the ACS web sites. To ensure you have the most recent version, you may contact the ACS or the NCCN.

© 2007 by the National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS). All rights reserved. The information herein may not be reproduced in any form for commercial purposes or downloaded and stored in any information-retrieval system without the express written permission of the NCCN and the ACS. Single copies of each page may be printed out for personal, noncommercial use only.