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Nausea and vomiting after chemotherapy

9 August 2005

What you can do about it

We’ve come a long way since the days when nausea and vomiting were inevitable side effects of chemotherapy. Today, we know much more about how and why chemotherapy causes nausea and vomiting-and we have more medicines available to help prevent these unpleasant side effects.

How chemotherapy causes nausea and vomiting
Chemotherapy destroys cancer cells by stopping them from growing and multiplying. But in the process, chemotherapy can affect other cells in your body. When certain cells that grow in your stomach lining are injured during chemotherapy, they send signals to your brain that start the vomiting process. That’s one way chemotherapy causes nausea and vomiting. However, some chemotherapy medicines may send signals directly to your brain, without involving the stomach cells at all.

How today’s medicines help
“Antiemetics” (anti-e-MEH-tix) are medicines used to prevent or control nausea and vomiting. Some stop the stomach’s cells from signaling the brain. Others stop the “receiver cells”(called receptors), preventing the brain from receiving “vomit signals.” Today, newer antiemetic medications allow more and more patients to help avoid nausea and vomiting after chemotherapy.

How antiemetics are chosen for you
All chemotherapies work differently, and each one carries a distinct set of side effects. For example, some chemotherapies cause more nausea and vomiting than others, and some cause very little or no nausea or vomiting. Some cause vomiting within the first few hours after you get chemotherapy (acute nausea and vomiting). Others cause nausea and vomiting a day or more after treatment has been given (delayed nausea and vomiting).

Guidelines have been written that make recommendations about which antiemetics should be used with different chemotherapies. According to these guidelines, many people will need more than one antiemetic during a chemotherapy cycle. Some antiemetics are given on the day of chemotherapy to prevent acute nausea and vomiting; others are taken at home to prevent delayed nausea and vomiting. And some antiemetics prevent both acute and delayed nausea and vomiting, and are taken on the day of chemotherapy and for a few days after.

Why every person’s response is individual
Although we know which chemotherapies are more likely to cause nausea and vomiting, and we know which antiemetics work best with different types of chemotherapy, every person has an individual response to the chemotherapy… and to the antiemetic!

For example, we now know that when two chemotherapy medications are used together, they may be more likely to cause nausea and vomiting than when either one is used alone. We also know that women are more likely to develop nausea and vomiting after chemotherapy than men. In addition, if you are under age 50 or prone to motion sickness, you may be at greater risk for nausea and vomiting after chemotherapy than people who are not.

To complicate matters further, no one antiemetic works 100% of the time in all people. So you might have to try different regimens to find the one that works best for your individual needs.

What you can do to reduce the occurrence of nausea and vomiting
The most important thing you can do to reduce the occurrence of nausea and vomiting after chemotherapy is to speak to your doctor, nurse, or other oncology practitioner about the antiemetics they have prescribed.
Tell them whether or not the medicines worked well enough and whether or not you were satisfied with your treatment.

You may not think that discussing side effects is as important as discussing your overall progress, but it really is. Your health-care team wants you to feel as good as possible after chemotherapy.
But the only way they can help achieve that goal is with your help. All it takes is for you to speak up… and let your health- care team help.

The booklet can be downloaded below...

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  By Merck Sharp & Dohme Malaysia Branch (A community public education programme)  

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