What Causes CINV?

When chemotherapy drugs enter the body, an area of the brain receives signals, either directly or indirectly, which can trigger nausea and/or vomiting. For example, nausea may result when chemotherapy drugs damage the cells that line the gastrointestinal tract. In addition, certain other triggers, such as sights, smells, taste, motion, anxiety, or pain can also stimulate nausea and/or vomiting.

While each individual reacts differently to chemotherapy, nausea and/or vomiting may be more likely to occur if you have certain risk factors. The following are some common risk factors for CINV:

• Nausea and/or vomiting from previous chemotherapy treatments
• History of motion sickness and/or morning sickness
• Anxiety or nervousness before cancer treatment
• Cancer of the brain, liver, colon, or stomach
• Certain chemotherapy drugs
• Use of two or more chemotherapy drugs in combination
• A high-dose chemotherapy regime
• Fluid and/or electrolyte imbalance
• Constipation
• Certain pain medications
• Being under age 50 or female

Types of CINV

The type and severity of CINV varies depending on the type of chemotherapy drug used, as well as the dosage, frequency, method of administration, and other factors unique to your situation. Three types of chemotherapy-induced nausea and vomiting include acute, delayed and anticipatory CINV.

Acute CINV occurs within the first 24 hours after beginning treatment. It is generally most severe about five or six hours after treatment and usually ends within a day. Delayed CINV generally occurs one to five days after treatment. It tends to be most severe about two or three days after treatment and may last for up to a week.

Anticipatory CINV occurs before a new cycle of chemotherapy has begun. It is a conditioned response to previous treatments. For instance, the smells, sights and sounds associated with past treatments can trigger nausea. In addition, anxiety, worry or emotional distress prior to receiving chemotherapy can also cause nausea.

Methods Used to Control CINV

Although CINV is a common side effect of chemotherapy, there are medications and other measures you can take to help prevent and/or alleviate symptoms.

There are several medications you can take, alone or in combination, prior to receiving chemotherapy (e.g., pre-medications) and after treatment. Typically, the strength of the medication should match the intensity of the chemotherapy. Antiemetics are commonly used drugs to control nausea or stop vomiting before and/or after chemotherapy.

Even if you are receiving the same chemotherapy treatment as another person, your antinausea regime will vary. Thus, it is important to find the right combination of the right medications for you. In addition, other methods, such as distraction, relaxation, guided imagery, and acupuncture may help control nausea and/or vomiting.

Why is it Important to Control CINV?

You should be able to fight cancer without having to deal with unpleasant side effects, like nausea and/or vomiting, along the way. Uncontrolled CINV can result in dehydration, malnutrition, fatigue, loss of appetite, difficulty concentrating, sleep disturbances, and emotional distress. CINV can even disrupt your treatment regime.

Therefore, finding ways to control CINV is important not only to your quality of life, but also to ensuring that your treatment regime goes uninterrupted. Controlling nausea and/or vomiting can help you to sleep better, cope better with cancer and its treatment, stay active, eat healthy, and spend time with family and friends.

NOTE: THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS REPORT ANY SYMPTOMS OF CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING TO YOUR PHYSICIAN IMMEDIATELY.

Tips for Managing Chemotherapy-Induced Nausea

• Be proactive.The more you understand about CINV, the better able you will be to prevent this side effect and/or reduce its symptoms. Before you start treatment, talk with your doctor about the type of chemotherapy drugs you will receive, your risk of nausea and/or vomiting, and medications and other measures you can take to prevent and/or reduce nausea and vomiting.
• Track your symptoms.By tracking your symptoms, you can help determine how to prevent and/or reduce side effects like nausea. During treatment, keep track of when nausea and/or vomiting occur and the severity. Share this information with your health care team so they can work to find the right combination of medications and other supportive therapies for you.
• Speak up. As you undergo treatment, you may be hesitant to talk about symptoms like nausea and/or vomiting. However, to prevent interruptions to your treatment plan, it is important to speak up about any side effects you experience with your health care team. The following are examples of questions to ask your health care team:
• Should I expect nausea and/or vomiting with treatment? If so, how long will it last?
• What medications can I take to prevent and/or reduce nausea and/or vomiting?
• What other measures can I take to prevent or reduce nausea and/or vomiting?
• Should I contact you if I experience nausea and/or vomiting at home?
• Stay hydrated. Cancer and its treatment can make you dehydrated, which can lead to nausea and other complications (e.g., constipation) that can contribute to nausea. Prior to chemotherapy and throughout your treatment, drink plenty of fluids, such as water, unsweetened juice, ginger ale, and sports drinks. You can also try sucking on ice chips.
• Eat smart. Nausea and/or vomiting associated with chemotherapy can prevent you from eating properly and maintaining proper nutrition. Although eating may be the last thing on your mind, good nutrition may help prevent fatigue, minimize side effects, and decrease treatment interruptions. The following are tips for eating smart during chemotherapy:
• Plan ahead. Establish a pattern of eating meals and snacks at the same time each day. It may help to prepare meals ahead of time and freeze dishes into individual portions. Your doctor may suggest that you take a nausea medication before meals.
• Try several small meals. Instead of large meals, try to eat several small meals and snacks throughout the day. Take your time during meals, chewing slowly and thoroughly. Following treatment, wait at least one hour before you eat or drink anything.
• Sit upright during meals. Eat in a seated or upright position. If you need to rest after you eat, do not lie down. Sit up or recline with your head raised for at least one to two hours after a meal.
• Create a comfortable environrment. Make the atmosphere pleasant during mealtime. Avoid eating in a room that is warm and try to get some fresh air. Wear loose-fitting clothing and try keep yourself distracted. Background music may help.
• Avoid strong smells. Chemotherapy can change your sense of smell and taste, sometimes from day to day. Unpleasant odors may trigger nausea. It helps to eat foods that are cool or at room temperature. Stay away from foods with strong smells, such as coffee, onions, garlic, and foods that are cooking.
• Eat bland foods. To accommodate taste changes, try soft, bland, easy-to-digest foods, such as plain crackers, toast, dry cereals, plain yogurt, chicken noodle soup, cottage cheese, pudding, sherbet, and gelatin. Avoid foods that are hot, greasy, fried, spicy, fatty, or high in sugar. If foods have a metallic taste, try eating with plastic forks/spoons.
• Choose healthy options. Protein can help keep up your strength and rebuild body tissue. Some high-protein snacks include peanut butter and crackers, cheese and crackers, and nuts. Stay away from alcohol and tobacco. A registered dietitian can help you plan nutritious, well-balanced meals.
• Practice good mouth care. Rinse your mouth often to keep it clean and remove any bad tastes or odors. It also helps to suck on sugar-free mints to get rid of a bad taste in your mouth.
• Don't force yourself to eat. Eat what appeals to you whenever you can. If you can’t eat solid foods, try liquid or powdered meal replacements and shakes. Take advantage of days when you have a good appetite.
• Snack often. Keep a variety of nutritious snacks available. If your appetite is better in the morning, try to eat earlier in the day. If you feel nauseated in the morning, try snacking on crackers or toast before you get out of bed.
• Breathe. Breathing can help you relax and relieve nausea. When nausea hits, breathe deeply and slowly, in through your nose and out through your mouth. It also helps to get fresh air.
• Distract yourself. The night before your chemotherapy treatment, do something pleasurable, such as watching a movie or taking a walk. During your chemotherapy treatment, use simple distractions, such as listening to a relaxation tape or soft music, drawing, knitting, reading, or doing crossword puzzles.
• Try complementary medicine therapies. Many behavioral strategies may help you cope better with nausea and/or vomiting. A mind-body therapist can help suggest relaxation and guided imagery techniques. A naturopathic clinician can help suggest supplements to help curb nausea. A rehabilitation therapist can help you stay active to improve your mood and sense of well-being. A spiritual counselor can help you find peace of mind.
• Accept help. Remember, it's important to take care of yourself at this time so you can focus on healing. Let friends and family members help you. Support groups can also help you understand that you are not going through this alone.
• Be open with loved ones. Socializing with family and friends can be difficult during chemotherapy, particularly if it means going out for a meal. If you aren't up for eating out, let them know. Suggest another activity, such as a movie or even a short visit at home.

NOTE: THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTHCARE PROVIDER REGARDING CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING.

At Cancer Treatment Centers of America (CTCA), we understand potential side effects of chemotherapy, like nausea, can influence your ability to tolerate treatment, maintain a healthy diet, stay active, and enjoy a good quality of life.

Your multidisciplinary care team at CTCA will be as proactive as possible in anticipating and controlling nausea and/or vomiting. Depending on your treatment plan, prior to receiving chemotherapy, your medical oncologist may prescribe pre-medications to help prevent and/or reduce these side effects.

In addition, throughout your care, your multidisciplinary care team will provide a combination of complementary medicine therapies to ease nausea and/or vomiting, such as the following:

• Nutrition therapy: Our nutrition team will work closely with you to develop an individualized nutrition plan to fortify your body and help relieve nausea.
• Naturopathic medicine: Our naturopathic medicine team will recommend specific supplements and natural therapies before and after chemotherapy to help ease nausea.
• Pain management: Our pain management team will use various pain management techniques to help control your pain which can, in turn, help relieve nausea.
• Mind-body medicine: Our mind-body medicine team will provide techniques like guided imagery, deep breathing, and relaxation therapies to help alleviate nausea.
• Oncology rehabilitation: Our oncology rehabilitation team will provide a personalized exercise program to help you stay active and promote your overall well being.
• Spiritual support: Our pastoral care team will help nurture your spiritual well-being so that you feel more empowered throughout your journey.

At CTCA, we understand CINV can interfere with your ability to lead a productive, fulfilling life. Our cancer experts will use an integrative approach to help prevent and/or relieve nausea so you feel strong, optimistic and empowered as you heal from cancer.

I hope this information has helped you in some way. I will check in with you again next month. In the meantime, stay strong and hopeful.