The American Society of ClinicalOncology (ASCO) is a nonprofitorganization representing more than14,000 cancer professionals world-wide. ASCO offers scientific andeducational programs along with manyother initiatives intended to foster theexchange of information about cancer. The central purpose of the Society is toimprove cancer care and prevention,and its primary goal is to ensure that allpatients with cancer have access to thehighest quality care.
Preventing and Treating Nausea andVomiting Caused by Cancer Treatment
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Nausea and Vomiting Caused by Chemotherapy . . . . . . . . . . . . . 4
Chemotherapy Drugs that Cause Nausea and Vomiting . . . . . . . 5
Prevention and Treatment of Nausea and Vomiting
Caused by Chemotherapy . . . . . . . . . . . . . . . . . . . . . . . . 6
Prevention and Treatment of Nausea and Vomiting
Caused by Radiation Therapy . . . . . . . . . . . . . . . . . . . . . 8
Side Effects of Antiemetic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . 9
Keeping Your Information Current . . . . . . . . . . . . . . . . . . . . . . . 9
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
2000 American Society of Clinical Oncology
Preventing and Treating Nausea and VomitingCaused by Cancer Treatment
Recommendations of the American Society of Clinical Oncology
The American Society of Clinical Oncology (ASCO) established apanel of specialists to develop guidelines for preventing and treating
nausea and vomiting caused by cancer treatment. These specialists
determined what medications have worked best and made recom-
mendations to help you and your doctors make decisions about your
continuing health care. It’s important to remember, however, that
every person who is treated for cancer is different, and these
guidelines are not meant to replace your or your doctors’ judgment.
The final decisions you and your doctors make will be based on your
The information in this booklet will help you to understand what
antiemetic drugs are and how they may be used as part of your cancer
treatment. Antiemetic drugs are used to help prevent emesis, otherwise
known as vomiting (throwing up), and to relieve nausea (the feeling of
being sick to your stomach). Nausea and vomiting is a common side
effect of chemotherapy and, sometimes, radiation therapy (radio- therapy). Many patients fear these side effects, which, up until now,
have been difficult to control. There are now newer drugs that help
patients feel better while they are being treated for cancer.
Words that appear in bold throughout the text are defined in the
Nausea and Vomiting Caused by Chemotherapy
Not every patient who has chemotherapy will have nausea and vomiting. Some patients are more likely than others to have this
symptom. For example, it is more common in women, young patients,
patients with a history of excessive alcohol use, and in patients who
have had chemotherapy before and had nausea and vomiting that
Chemotherapy Drugs that Cause Nausea and Vomiting
Usually, your doctor will prescribe an antiemetic drug before yourchemotherapy if you will be treated with a chemotherapy drug that
sometimes or often causes nausea and vomiting. If you will receive
a chemotherapy drug that rarely causes nausea and vomiting, your
doctor will probably prescribe an antiemetic drug to be taken only
if you become sick while you are being treated.
Some chemotherapy drugs often cause nausea and vomiting, while
others cause it less frequently or rarely, as outlined in the table below.
Nausea and Vomiting Nausea and Vomiting
Prevention and Treatment of Nausea and VomitingCaused by Chemotherapy
The following antiemetic drugs are recommended to preventvomiting after treatment with chemotherapy drugs.
These drugs can be given orally (by mouth) or intravenously
(through a vein in your arm), and your doctor will decide which
is best for you. Your doctor will probably suggest that you have
a dose of one or more of these drugs before your scheduled
treatment with chemotherapy. He or she may give you a
combination of different antiemetic drugs, but also may give
you just one. If you will be given high-dose chemotherapy,
your nausea and vomiting may be more difficult to control,
and your doctor will probably give you a higher dose of an
antiemetic drug to help you feel better.
If your doctor thinks you may have vomiting for more than a
day, he or she will probably suggest that you take a dose of one
or more of these drugs several times a day for 2 to 4 days after
Some patients may have anticipatory emesis or vomiting that begins before a chemotherapy treatment. This type of vomiting
occurs in patients who have felt sick during chemotherapy in the
past. Also, people who have motion sickness are more likely to have
If your doctor thinks you may have developed anticipatory emesis,
he or she might try to prevent it by prescribing an antiemetic drug
to be taken a few days before your scheduled treatment with
chemotherapy. If you still have anticipatory emesis, your doctor
may suggest alternative ways to overcome this symptom.
Be sure to tell your doctor if you continue to feel sick
to your stomach or throw up even after taking an
antiemetic drug. Your doctor can then adjust
your medication to help you feel better.
Prevention and Treatment of Nausea and VomitingCaused by Radiation Therapy
With radiation treatment for cancer, your body is exposed to only asmall dose of radiation for a very short time. Because of this, nausea
and vomiting does not occur as often after radiation therapy as it does
after chemotherapy. However, nausea and vomiting can be more likely
after radiation treatment to certain areas on your body.
Your doctor will probably prescribe an antiemetic drug if you will
have total-body irradiation (radiation treatment of your entire body), hemibody irradiation (radiation treatment of half your body), or cranial radiosurgery (an operation in which radiation is used to
destroy a tumor within the brain). You also may be given an
antiemetic drug if you will have radiation treatment of the following
Nausea and vomiting is not usually caused by radiation treatment
of your skull (only), head and neck, breast, chest, arms or legs, or
pelvis. Your doctor will probably prescribe an antiemetic drug to
be taken only if you become sick after receiving radiation treatment
The doses of antiemetic drugs given during chemotherapy or radiationtherapy sometimes cause side effects. Symptoms that have been
associated with some of these drugs are slight headache, constipation,
trouble sleeping, restlessness, involuntary movements of the muscles
and tongue, and sedation. Be sure to tell your doctor if you have any
of these symptoms or if you are at risk for hyperglycemia (high level
ASCO evaluates new treatments as they are developed. To be sure thatthe information you have is current, please call ASCO at (888) 651-3038
ASCO OnLine, at www.asco.org. anticipatory emesis: vomiting that occurs before a chemotherapy
treatment; usually occurs in patients who have felt sick during
antiemetic drug: a drug that prevents or relieves nausea and chemotherapy: treatment with chemicals (drugs) to kill cancer cells
by stopping them from growing or multiplying
constipation: inability to have a bowel movement cranial radiosurgery: the use of radiation to destroy tumors in the
brain that are not reachable by a conventional operation
dose: a specified amount of a drug (medication) emesis: vomiting (throwing up) hemibody irradiation: treatment of half of the body with radiation high-dose chemotherapy: treatment with high doses of a
chemotherapy drug, or combination of drugs, usually given to
patients who are having bone marrow or stem-cell transplantation
hyperglycemia: excess of glucose (a sugar formed by the body) nausea and vomiting: a sick feeling in the stomach (nausea) and the radiation therapy (radiotherapy): treatment with radiation to kill
tumors or cancer cells or damage them so that they cannot grow
or spread; the radiation waves are targeted to the specific area of
sedation: a state of feeling sleepy or at rest total-body irradiation: treatment of the whole body with radiation
Just as important as your physical health is your emotional health. There are many organizations that offer support to patients withcancer and their families. Ask your doctor or call your local hospitalto find out about such groups in your community. In addition, thefollowing organizations can provide you with more information oreducational materials about cancer. American Cancer Society (ACS) National Office 1599 Clifton Road, NE Atlanta, GA 30329 (800) ACS-2345 www.cancer.org American Society of Clinical Oncology (ASCO) 225 Reinekers Lane, Suite 650 Alexandria, VA 22314 (888) 651-3038 or (703) 299-0150 www.asco.org Cancer Care, Inc. 275 Seventh Avenue New York, NY 10001 (800) 813-HOPE www.cancercare.org National Cancer Institute (NCI) National Institutes of Health Office of Cancer Communication Building 31, Room 10A24 9000 Rockville Pike Bethesda, MD 20892 (800) 4-CANCER www.nci.nih.gov National Coalition for Cancer Survivorship 1010 Wayne Avenue, Suite 595 Silver Spring, MD 20910 (301) 650-8868
Supporting Clinical Cancer Research andEducation Around the World
The ASCO Foundation is a nonprofit corporation based inAlexandria, Virginia, dedicated to furthering clinical cancer research
and education. The Foundation provides an added mechanism for
private fund-raising in support of the broad range of ASCO programs,
with special emphasis on the advancement of careers in clinical
cancer research through the Society’s Fellowship Grants Program.
The Foundation’s ultimate goal is to support the development of the
next generation’s leaders in the field of clinical oncology.
The ASCO Foundation has received a generous contribution from its
charter sponsor, Ortho Biotech Inc., but it still needs your help to
fund these important research and education programs.
For more information, or to make a contribution to the ASCO
American Society of Clinical Oncology ASCO Foundation American Society of Clinical Oncology
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The American Society of ClinicalOncology (ASCO) is a nonprofitorganization representing more than14,000 cancer professionals world-wide. ASCO offers scientific andeducational programs along with manyother initiatives intended to foster theexchange of information about cancer.
Preventing and Treating Nausea and VomitingCaused by Cancer Treatment
Recommendations of the American Society of Clinical Oncology
The American Society of Clinical Oncology (ASCO) established apanel of specialists to develop guidelines for preventing and treating
nausea and vomiting caused by cancer treatment. These specialists
determined what medications have worked best and made recom-
mendations to help you and your doctors make decisions about your
continuing health care. It’s important to remember, however, that
every person who is treated for cancer is different, and these
guidelines are not meant to replace your or your doctors’ judgment.
Nausea and Vomiting Caused by Chemotherapy
Not every patient who has chemotherapy will have nausea and
Some patients may have anticipatory emesis or vomiting that
Prevention and Treatment of Nausea and VomitingCaused by Radiation Therapy
With radiation treatment for cancer, your body is exposed to only asmall dose of radiation for a very short time. Because of this, nausea
and vomiting does not occur as often after radiation therapy as it does
after chemotherapy. However, nausea and vomiting can be more likely
after radiation treatment to certain areas on your body.
The doses of antiemetic drugs given during chemotherapy or radiationtherapy sometimes cause side effects. Symptoms that have been
associated with some of these drugs are slight headache, constipation,
anticipatory emesis: vomiting that occurs before a chemotherapy