Nausea and vomiting

Your lymphoma treatment might make you feel sick or be sick. This page offers practical advice to help you cope with these side effects.

On this page

Coping with sickness

Will I experience sickness?

Types of sickness

Managing sickness

The cannabis controversy

Nausea (feeling sick) and vomiting (being sick) can be side effects of treatment for lymphoma. Some people also experience retching, or dry heaves – automatic movements of the abdominal (stomach) muscles that happen when you vomit, without actually being sick. We use the word ‘sickness’ to mean both nausea and vomiting throughout this information.

The lymphoma treatments most likely to cause sickness are chemotherapy, radiotherapy, and some targeted drugs. It is important to remember that effective treatments are available that can prevent sickness in many people.

This page offers practical advice on coping with sickness. There is also information on why it happens and how it is treated for people who are interested in learning more.


Coping with sickness

Effective treatments for sickness are available and can prevent or manage sickness in many people even on high-risk therapy. However, if you experience sickness, it can be distressing and disabling. Here, we list some practical suggestions that might help you cope.

Tips to help with eating and drinking

You may find that eating or drinking makes your sickness worse. If so, the following tips might help.

Tell your medical team if you can’t keep food or drink down.

Controlling food smells

If the smell of food makes you feel sick, you could try the following suggestions:

  • Ask friends or family members to prepare your meals for you.
  • Cook food in a microwave to minimise food smells.
  • Eat foods served at room temperature. Hot foods tend to produce stronger smells.
  • Limit or avoid foods that have particularly strong smells.

Meals and snacks

  • Plan the best times for you to eat and drink.
  • Eat food you fancy but avoid your favourite foods in case you start to associate them with being sick.
  • Plain-tasting carbohydrates, such as toast, crackers, breadsticks, pretzels, rice, pasta, potatoes or noodles, can be easier to tolerate than greasy or very full-flavoured foods.
  • Don’t force yourself to eat anything that makes you feel sick.
  • Avoid food that’s too hot or too cold.
  • Try adding ginger to your diet – for example, ginger beer, ginger tea, ginger biscuits, ginger cake or root ginger. This may reduce sickness.
  • Eat a cracker or a dry biscuit before you get up if you feel sick in the mornings.
  • Don’t skip meals or snacks. Hunger can make sickness worse.
  • Try eating five or six small meals a day instead of three large meals. A full plate can feel overwhelming.
  • Avoid lying down for 1 hour after eating.

If you are having treatment with chemotherapy or radiotherapy, you may temporarily have a sore mouth or an unpleasant taste in your mouth – people often describe this as 'metallic'. If this happens, try cleaning your teeth or rinsing your mouth with a mild, alcohol free mouthwash between meals. Sucking sugar free mints or lemon sweets can help too. There are simple things you can do that might help if you have a sore mouth. Talk to your medical team for more advice.

Drinks

It is important to drink plenty of fluid, especially if you are vomiting. It helps to prevent dehydration so your body can function well and cope better with your treatment.

  • Drink slowly throughout the day.
  • Carry a bottle of drink with you when you are out and about.
  • Choose cool, citrus flavoured, fizzy drinks. These tend to be more soothing than still or hot drinks and can help to settle your stomach.
  • Sip drinks slowly through a straw if your treatment affects your sense of taste. This bypasses some of your taste buds.
  • Only drink small amounts at mealtimes to avoid feeling too full.

Other practical suggestions

Below are a few suggestions to help manage your sickness. You could also visit our online forum to share your experiences and to find out what others have found helpful.

Take your medicines

It is very important to take all your antiemetic medicines exactly as they’re prescribed, even if you’re not feeling sick. It is much easier to prevent sickness than to treat it once it starts.

Speak to your medical team

Your medical team can advise you on how to manage sickness and may be able to prescribe antiemetics. Make a note of how often you are sick and contact a member of your medical team if the situation does not get better.

Identify what makes you feel sick

Certain foods, smells, activities or surroundings can trigger nausea. Noticing when you feel sick can help you identify possible triggers. You can then work out how to avoid or minimise contact with them. You might find it helpful to keep a symptom diary.

Strong perfumes and aftershaves are common triggers. If this is the case for you, try fragrance-free products. Tell people you live and work with that these smells can make you feel sick so that they know to avoid using strong fragrances too.

Ask a friend or family member to go with you to your treatment 

They can support you emotionally and can help distract you from how you’re feeling.

Tell people how you’re feeling

Tell your friends and family how you’re feeling. As well as emotional support, they can help you in practical ways, such as doing your food shopping or making you a meal so you don’t have to cope with cooking smells.

Relax before each cancer treatment

Being anxious can make sickness more likely. Try to find a relaxation technique that works for you. Some people find breathing exercises, meditation or mindfulness helpful.

Wear loose-fitting clothes

Tight clothing can make you feel uncomfortable and make the feeling of nausea worse.

Try acupressure bands

Acupressure bands are travel sickness bands that you wear on your wrists. They may help to ease nausea. You can buy acupressure bands from pharmacies and health shops.

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Will I experience sickness?

Whether or not you experience sickness depends on lots of factors. These include:

  • what treatment you are having
  • where your lymphoma is: sickness is more common if you have cancer affecting your digestive tract, liver or central nervous system
  • how old you are: sickness affects younger people (under 50) more than older people
  • what sex you are: women are more likely than men to experience sickness
  • whether you are prone to sickness (for example, if you suffer from motion sickness, if you’ve had sickness during previous rounds of chemotherapy, or, for women who have been pregnant, if you experienced morning sickness)
  • if you have any other illnesses
  • if you take any other medication.

Sickness as a side effect of chemotherapy

Chemotherapy can activate a part of your brain called the vomiting centre, which controls feelings of nausea and vomiting. It can also trigger reflexes in your gut. Together, this can cause sickness.

Generally, the sickness starts when you are given your dose of chemotherapy and reaches a peak after 5 to 6 hours. It usually stops within 24 hours, although it can go on for longer.

Anti-sickness treatment is more effective the earlier it is started, so tell your medical team straight away if you are feeling sick. There are lots of antiemetics (anti-sickness medications) they can give you to help.

Some chemotherapy drugs are more likely to cause sickness than others. Your likelihood of experiencing sickness also depends on the dose you have, how often you have it and what other drugs it’s combined with, as well as lots of individual factors.

The lists below outline the chance of experiencing sickness for some of the chemotherapy drugs commonly used to treat lymphoma. These are general figures only and they do not tell you your individual chance of experiencing sickness. Your medical team will talk to you about your individual treatment, and what they can do to help prevent sickness.

It is important to remember that the risk of sickness listed here is without anti-sickness treatment. Effective treatment is available and can prevent sickness in many people even on high-risk chemotherapy drugs.


High risk of sickness (affects more than 9 in 10 people):

  • regimens containing cyclophosphamide and doxorubicin together
  • high-dose cyclophosphamide
  • carmustine
  • cisplatin.

Medium risk of sickness (affects between 3 and 9 in every 10 people):

  • bendamustine
  • carboplatin
  • low-dose cyclophosphamide
  • high-dose cytarabine
  • doxorubicin
  • ifosfamide
  • oxaliplatin.

Low risk of sickness (affects between 1 and 3 in every 10 people):

  • low-dose cytarabine
  • etoposide
  • gemcitabine
  • methotrexate
  • mitoxantrone.

Minimal risk of sickness (affects less than 1 in every 10 people):

  • bleomycin
  • fludarabine
  • vinblastine
  • vincristine.

Sickness as a side effect of radiotherapy

Radiotherapy can trigger signals to the vomiting centre in your brain, causing sickness. Nobody knows exactly why this happens.

How soon sickness starts varies from person to person and depends on which part of your body is treated. It can start within a few hours of radiotherapy but it may not start until a few days afterwards. It usually lasts up to a couple of weeks.

Tell your medical team if you’re feeling sick. They can prescribe medicines to help manage it.

In general, sickness affects around 1 in 3 people having radiotherapy. Your individual chance of experiencing sickness depends on many things, including:

  • your dose of radiotherapy
  • where in your body it is targeted
  • how often you have it
  • whether you are also having chemotherapy
  • lots of individual factors.

The sections below list the chance of experiencing sickness based on which part of your body receives radiotherapy. These are general figures only and they do not tell you your individual chance of experiencing sickness. Your medical team will talk to you about your individual treatment, and what they can do to help prevent sickness.

It is important to remember that the risk of sickness listed here is without anti-sickness treatment. Effective treatment is available and can prevent sickness in many people.


High risk of sickness (affects more than 9 in 10 people):

  • whole body radiotherapy (also called total body irradiation, or TBI).

Medium risk of sickness (affects between 6 and 9 in every 10 people):

  • radiotherapy to the upper abdomen (tummy)
  • radiotherapy to the brain or spine.

Low risk of sickness (affects between 3 and 6 in every 10 people):

  • radiotherapy to the head and neck
  • radiotherapy to the chest
  • radiotherapy to the pelvis.

Minimal risk of sickness (affects less than 3 in every 10 people):

  • radiotherapy to the breast(s)
  • radiotherapy to the arms or legs.

Sickness as a side effect of targeted drugs

Targeted drugs are less likely to cause sickness than chemotherapy or radiotherapy but some people may be affected.

Your medical team will talk to you about your individual chance of experiencing sickness.

The sections below list the chance of experiencing sickness for some of the targeted drugs that may be used to treat lymphoma. This page uses the generic (non-branded) names of the drugs, not brand names. You can find more information on our targeted drugs section.

These are general figures only and they do not tell you your individual risk. Your medical team will talk to you about your individual treatment, and what they can do to help prevent sickness.

It is important to remember that the risk of sickness listed here is without anti-sickness treatment. Effective treatment is available and can prevent sickness in many people.


Low risk of sickness (affects between 1 and 3 in every 10 people):

  • brentuximab vedotin
  • belinostat
  • bortezomib
  • temsirolimus.

Minimal risk of sickness (affects less than 1 in every 10 people):

  • rituximab
  • nivolumab
  • obinutuzumab
  • ofatumumab
  • pembrolizumab.

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Types of sickness

There are different types of treatment-related sickness depending on when it occurs and how long it lasts.

Acute sickness

Sickness that starts within 24 hours of a dose of treatment is known as ‘acute’ sickness. It may start within minutes or hours of a treatment session and usually passes within a day.

Delayed sickness

Sickness that starts more than 24 hours after you have chemotherapy is known as ‘delayed’. It usually reaches its peak after 2 to 3 days and lasts about a week.

Delayed sickness is more likely to affect people on chemotherapy regimens containing cisplatin, cyclophosphamide, ifosfamide or doxorubicin.

If you are at risk of delayed sickness, your medical team will prescribe medicine to help prevent it.

Anticipatory sickness

 
Despite the anti-sickness drugs, I found myself vomiting. It gradually declined and my nurse explained that it was psychological.
Reem, diagnosed with Hodgkin lymphoma in 2006

Anticipatory sickness is sickness that happens before your treatment starts. It affects people who experienced sickness during previous treatment cycles and it usually starts after three or four cycles.

Anticipatory sickness is a subconscious reaction to the sights and smells of the chemotherapy unit, which your brain associates with the sick feeling you experienced before. This can activate the vomiting centre in your brain, making you feel sick again.

Anticipatory sickness affects around 1 in 10 people on chemotherapy. You are more likely to be affected if you are younger (less than 50), anxious, and experienced moderate or severe sickness in previous cycles.

Anticipatory sickness can be difficult to treat with medicines but there are behavioural strategies that may help. Some people find complementary therapy helpful, but ask your medical team if it is safe for you before booking an appointment.

Breakthrough sickness

Breakthrough sickness is sickness that occurs within 5 days of chemotherapy despite being given medicines to prevent it. It is usually treated with higher doses of different antiemetic medicines.

Refractory sickness

Sickness that doesn’t respond to treatment is known as ‘refractory’. It can be difficult to manage but behavioural strategies and complementary therapy may help.

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Managing sickness

To prevent or manage treatment-related sickness, your doctor may prescribe medicines. There are also various psychological (non-drug) interventions that can help.

Antiemetics (anti-sickness medicines)

Antiemetics are medicines that help to control sickness. Your doctor may prescribe antiemetics if the treatment you are having is expected to cause sickness.

Antiemetic treatment is more effective the sooner it is started. Many types of antiemetics are available and each works in a different way. Even if a particular type hasn’t worked for you, another one could be very effective.

Preventing sickness

The best way to manage sickness is prevention. Before you start treatment, your medical team looks at how likely you are to experience sickness based on the lymphoma treatment you’re having and your individual factors. They use this information to decide if you need any antiemetics (anti-sickness medicine) and, if so, what is most likely to work for you. Steroids (for example, dexamethasone) can also reduce sickness.

The anti-sickness medicine you have depends on your risk of experiencing sickness. In general:

  • High risk of sickness: three to four anti-sickness medicines before treatment and for up to 4 days afterwards.
  • Medium risk of sickness: two to three anti-sickness medicines before treatment and for up to 4 days afterwards.
  • Low risk of sickness: one anti-sickness medicine before treatment.
  • Minimal risk of sickness: no anti-sickness medicine.

However, treatment is always tailored to your individual needs. Sometimes one, stronger medicine may be more effective for you than several, less potent medicines.

Your doctor should talk to you about the possible side effects of any medicines you have.

It is important to take all your medicines exactly as they’re prescribed. This will help prevent acute or delayed sickness during your current treatment cycle, as well as preventing anticipatory sickness during any future treatment cycles.

Breakthrough sickness

If you experience any sickness at all, tell a member of your medical team straight away.

You might find it helps to keep a diary of when you’re feeling sick. You could show it to your doctor to help them tailor your medication to suit your needs. Although it is not always possible to stop sickness completely, it can usually be reduced.

If you are being sick and you can’t keep pills or tablets down, your doctor could prescribe medicine as an injection, a drip or a suppository (a tablet that you put into your bottom).

Behavioural strategies

Behavioural strategies are non-drug treatments. Cognitive (thinking) exercises are a type of behavioural strategy that can help to reduce feelings of sickness. These exercises aim to modify any thoughts and behaviours that influence you in a negative way. Examples of cognitive exercises include:

  • Distraction – Becoming absorbed in, or distracted by, something can take your attention away from feeling sick. Guided imagery techniques (sometimes called ‘guided meditation’) can help achieve this. For example, picture yourself walking on a beach, focusing on the sights and sounds you would experience. You might hear seagulls calling and the waves lapping the shore. You may feel the warm sand beneath your feet. Concentrating on these images can make you feel less sick. If you’re not sure where to start, you might find it helpful to use a guided imagery CD, audio download, online video or app. There are many available to choose from.
    Some people find that playing video games is a useful distraction technique. For others, doing something absorbing that helps them remember good times, such as organising family photographs, is effective. For children, storytelling can be helpful, especially where they are involved as a hero.
    Some Maggie’s centres offer workshops that cover distraction techniques.
  • Systematic desensitisation – Becoming desensitised (getting used) to the things that cause you anxiety can help relieve anxiety-related sickness. You may have come across this in relation to phobias such as fear of flying. During a systematic desensitisation session, you are asked to imagine the things that make you feel anxious, working from the least to the most anxiety-provoking items. Over time, your anxiety response to these triggers should lessen – in other words, you become desensitised to them. You start by imagining something that causes you a small amount of anxiety (for example, a needle). Once you become more comfortable with this image, you gradually build up to things that cause you higher levels of anxiety, such as the hospital ward or your chemotherapy drugs. In vivo (‘living’) systematic desensitisation works in the same way but you see or do the things that cause you anxiety, instead of imagining them.
  • Relaxation training – Reaching a state of deep relaxation can reduce your anxiety and make distraction more effective. Relaxation techniques can help achieve this. An example is focused imagery, where you concentrate on calming imagery such as a landscape of hills and meadows. Learning to tense and relax muscle groups is another technique that can help you relieve stress and tension and lower anxiety. You might find that going for walks and getting fresh air also helps.
  • Cognitive restructuring – Cognitive restructuring is a type of cognitive behavioural therapy. It involves talking through your thoughts, feelings and beliefs about your treatment with a trained therapist. The aim is to identify the ones that cause you distress. You are then encouraged to adapt, or ‘restructure’, the distressing thoughts, attitudes or beliefs by thinking about them and responding to them in different ways. You can find more information about cognitive behavioural therapy on the NHS Choices website.

Behavioural strategies can be particularly helpful for anticipatory sickness. Different people find different approaches effective so speak to your medical team to find out what might work best for you.

Complementary therapies

Some people find that complementary therapies, such as hypnosis, massage, acupuncture or acupressure, help reduce feelings of sickness.

Complementary therapies are used in addition to your hospital treatment, not instead of it. They aim to improve your mental and physical wellbeing and can help you to relax if you feel anxious and unsettled by your sickness.

Speak to your medical team before trying a complementary therapy. They may be able to advise you on therapies that are suitable for you and any you should avoid.

Other strategies

For some people, having a visit from a therapy pet is helpful. Your medical team might be able to tell you if there is a suitable scheme in your area, and if your hospital allows it.

Other people find strength in their religious beliefs.

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The cannabis controversy

You may have heard that cannabis, and products derived from cannabis (for example, cannabis oil), may help with sickness due to chemotherapy. Although there is some evidence to support this, in the UK, cannabis and medicines made from cannabis are not currently licensed for this purpose. 

The UK government has recently reviewed the benefits and harms of medicinal cannabis. Although it is not officially licensed, from 1st November 2018, medicinal cannabis can be prescribed by specialist doctors for people who have no other licensed treatment option.

The government review did not reclassify the legal status of cannabis (marijuana). It is illegal to take, carry, grow or sell cannabis in the UK.

Home-grown cannabis and cannabis bought illegally contain lots of active chemicals in unpredictable amounts. It is not safe to use instead of medicinal cannabis because you can’t control the dose you’re getting and it could be contaminated with other chemicals.

Nabilone, a medicine sometimes used to treat breakthrough sickness or refractory sickness, is a man-made chemical similar to cannabis extract. It is not made from the cannabis plant. In the UK, nabilone is licensed to treat sickness due to chemotherapy in people who haven’t responded to other antiemetics.

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Further reading

Related content

Buddy service

Our Buddy service can connect you with other people who have a personal experience of lymphoma.

Community forum

Our online community forum is a safe space where you can share your emotions and experiences, ask questions and connect with others.