Nausea and Vomiting in Childhood Cancer
Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.
Nausea (feeling the urge to vomit, or throw up) and vomiting are probably the most common side effects of many cancer treatments, especially during cycles of chemotherapy treatment. Nausea and/or vomiting can sometimes last for several days after the chemotherapy treatment stops.
Some children may become extremely anxious when they are about to have chemotherapy or other treatments for cancer, which may cause them to vomit even before chemotherapy is given and/or may cause vomiting to last longer after treatment. Children affected in this way can become so upset by clinic visits and treatments that even the smell of the clinic or hospital can make them feel ill enough to begin vomiting.
The effects of chemotherapy vary with each child and the dose given. A medicine that makes one child very ill often has no effect on another child. Because the effects are so variable, the management of nausea and vomiting must be worked out for each child’s individual needs.
For individuals with cancer, nausea and vomiting may be caused by the following:
- Blocked Intestines, also called bowel obstruction
- Cancer that has spread to the brain
- Electrolyte Imbalance – the loss of minerals such as potassium and sodium in the body
- Heart Disease
- Infections or Bleeding – in the gastrointestinal (stomach and intestines) system
- Other Medications
- Radiation Therapy: Especially to the brain, spinal cord, abdomen, and pelvis. Individuals who receive Total Body Radiation Therapy (usually prior to a stem cell/bone marrow transplant), have the highest risk.
Individuals who are more likely to experience nausea and vomiting from chemotherapy include the following:
- Those who have previously vomited after cancer treatment
- Individuals who often have motion sickness
- Individuals who are anxious before cancer treatment
- Those younger than 50, especially women
Mild nausea and vomiting can be rather uncomfortable, but do not generally cause serious problems.
Severe vomiting (vomiting a lot and often), can cause dehydration, electrolyte imbalance, weight loss, and depression. Severe vomiting may also cause some patients to stop cancer treatment.
Relieving side effects is an important part of total cancer care and treatment, which is why you should discuss any symptoms your child is experiencing, new symptoms and changes in symptoms with their Oncology Team so that they can work out a regimen of palliative or supportive care for them.
There are various methods to treat nausea/vomiting:
- Your child’s doctor may prescribe medicines called anti-emetics that effectively reduce nausea and vomiting. Anti-emetics are given either orally (by mouth), or intravenously (into a vein). Medication that is given orally may be used at home if nausea and vomiting continue.
- Many individuals find that behavioural treatments such as Hypnotherapy can help control nausea and vomiting, and if your child is experiencing nausea or vomiting, this could help them too. Ask your child’s healthcare team for a recommendation for a therapist.
- Distraction, Relaxation Techniques, Meditation, and Positive/Guided Imagery can help change the expectation and fear of the cancer treatment or the nausea and vomiting.
- Massage Therapy may also help to reduce the incidences as well as the severity/length of the nausea
In some situations, your child’s doctor may be able to recommend another treatment plan that is less likely to cause vomiting.
There are various ways in which you can help your child if they are experiencing nausea or vomiting as a result of their cancer treatments:
- If your child is vomiting persistently, do not force them to eat; rather give them sips of fluid every 30 minutes;
- The best fluids to give your child when they are vomiting are flat lemonade, and commercial glucose drinks such as Lucozade;
- If your child is vomiting three or more times in a two-hour period, or they have not been able to drink during this time, you should contact your child’s doctor or healthcare team;
- If your child is able to drink fluids without vomiting, try giving them small amounts of foods that they like. Yoghurt, cooked pureed fruit and breakfast cereal are generally well-tolerated;
- If your child has stopped vomiting but still feels nauseated, try diluting any drinks you give them with water.
There may still be times when nausea and vomiting affect your child’s desire and ability to eat and drink, but they need to keep their strength up and their immune system strong to fight the cancer, so here are some ideas you can try to help on these occasions:
- Give your child small, frequent snacks every few hours; don’t let their stomach become too full or too empty;
- Give your child sips of drinks throughout the day;
- Use cups with lids and straws to make smells less noticeable;
- Try giving your child cold foods that don’t have much smell; jelly, fruit juice, biscuits, sandwiches and desserts for instance;
- Try giving your child dry foods such as crackers and plain biscuits;
- Try ice cubes, ice blocks, peppermints or barley sugars;
- Avoid giving your child fatty and spicy foods such as chips, pizza, fried foods and chocolate until the nausea has gone;
- Keep your child distracted by playing games with them or giving them fun tasks to do
You can read more about Nutrition in Childhood Cancer on the following posts: