Types of Nausea and Vomiting

There are different types of nausea and vomiting. Chemotherapy-related nausea and vomiting can be either acute, delayed, anticipatory, breakthrough, or refractory.

Acute nausea and vomiting usually occurs a few minutes to several hours after the chemotherapy is given and goes away within the first 24 hours. The worst vomiting is usually 5 or 6 hours after chemotherapy.

Delayed vomiting develops more than 24 hours after chemotherapy is given. It might occur with certain types of chemotherapy, such as cisplatin, carboplatin, cyclophosphamide, and doxorubicin. For example, cisplatin-related vomiting is usually worst from 48 to 72 hours after chemotherapy and can last 6 to 7 days.

Anticipatory nausea/vomiting is learned from previous experiences with vomiting. Anticipatory nausea and vomiting occurs as a result of a previous unpleasant experience with chemotherapy. It occurs as the person is preparing for the next dose of chemotherapy. The person anticipates that nausea and vomiting will occur as it did before.

Breakthrough vomiting occurs despite treatment to prevent it. It requires more or different anti-nausea/vomiting treatment.

Refractory vomiting occurs after one, a few, or several chemotherapy treatments, even though the person is being treated to prevent or control nausea and vomiting. The anti-nausea and vomiting treatment is no longer effective. The person has become “refractory” (no longer responding) to treatment to prevent nausea and vomiting.

Chemotherapy and Nausea and Vomiting

Some chemotherapy medicines are more likely to cause nausea and vomiting than others. The likelihood of chemotherapy medicines causing nausea and vomiting when effective anti-nausea/vomiting treatment is not given can be put into four groups. Chemotherapy with a high risk for vomiting is most likely to cause nausea and vomiting when no effective treatment is given; chemotherapy with a minimal risk for vomiting is the least likely to cause nausea and vomiting (see Table 1). Individual chemotherapy agents are grouped using this level 1 to 5 classification system (see Table 2).

As an example, you can see in the table that high-dose cisplatin and cyclophosphamide, which both have a high risk for vomiting, cause nausea and vomiting in greater than 9 out of every 10 people receiving these drugs when no anti-nausea/vomiting treatment is given. Bleomycin or vincristine, which both have a minimal risk for vomiting, cause nausea and vomiting in less than 1 out of every 10 people who receive these drugs and do not use effective anti-nausea/vomiting medicines. This classification system is meant to help you when discussing your treatment plan with your doctor. Please refer to Table 2 for information on the specific chemotherapy agents you will be receiving.

Radiation Therapy and Nausea and Vomiting

Whether radiation therapy causes nausea and vomiting depends on the part of the body being treated, the amount of radiation given, and how often the treatment is given. When the area of the body being treated includes a large part of the abdomen—specifically, the small intestine (or small bowel)—there is a greater chance of nausea and vomiting occurring. About 50% of people with cancer who receive standard doses (180 to 200 centiGray) of radiation to their abdomen have nausea and vomiting. These symptoms can occur 1 to 2 hours after treatment and can last for several hours. Of those being treated with total body radiation therapy (which is used in bone marrow transplants), about 6 to 9 out of every 10 people develop nausea and vomiting if not given prevention treatment. These people may also receive high doses of chemotherapy to prepare for the transplant. The combination of radiation therapy and chemotherapy increases the chance of nausea and vomiting. People who receive one large dose of radiation therapy have a greater chance of nausea and vomiting than those who receive radiation therapy in smaller doses.

CAUSES OF NAUSEA AND VOMITING

TREATMENT OF NAUSEA AND VOMITING

For more information on these treatment guidelines, or on cancer in general, call the NCCN at 1-888-909-NCCN or the American Cancer Society at 1-800-ACS-2345. Or you can visit these organizations’ web sites at www.cancer.org (ACS) and www.nccn.org (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.