Nausea (the feeling of needing to vomit) and vomiting (being sick) can be side effects of treatment for lymphoma. The treatments most likely to cause sickness are chemotherapy, radiotherapy, and some biological therapies. Some people also experience retching – an automatic movement of the abdominal (stomach) muscles. Retching is a reflex action that happens when you are about to vomit but do not actually do so.
We use the word ‘sickness’ to mean both nausea and vomiting throughout this information. Speak to a member of your medical team if sickness affects you so that they can help you to manage it.
Chemotherapy can activate the vomiting centre in your brain, which controls feelings of nausea and vomiting.
When chemotherapy is present in your bloodstream, your body makes certain chemicals. These chemicals are then detected by the vomiting centre, which makes you feel sick.
Some chemotherapy drugs are more likely to cause sickness than others. These include cisplatin, carboplatin, cyclophosphamide and doxorubicin. Ask your medical team whether sickness is a likely side effect of your chemotherapy drugs.
Chemotherapy treatment is given in cycles. Each cycle is usually several weeks long. The chemotherapy is given on certain days of the cycle and the remaining time allows your body to recover before the next cycle begins. Generally, any sickness starts when you are given a dose of chemotherapy and stops within a day or 2, although it could go on for longer.
Few people who have radiotherapy experience sickness. Whether you do depends largely on the dose of radiotherapy you have and which areas of your body receive radiation. Radiotherapy to the abdomen (stomach), bowel, chest or pelvic area can trigger signals to the vomiting centre and make sickness more likely.
Sickness is also more likely if you’re treated with fewer larger doses of radiotherapy compared to many smaller doses. Other factors that influence whether you feel sick include your age, general health, anxiety levels, and whether you are also receiving chemotherapy (in which case the likelihood is higher).
How soon sickness starts varies from person to person and depends which part of your body receives radiotherapy. It may start within a few hours of a treatment session and usually lasts up to a couple of weeks. Tell your doctor if you’re feeling sick. They might offer you antiemetics to help manage it.
If you are treated with a biological therapy, you may have sickness. Speak to your medical team about whether this is likely to affect you.
There are different types of treatment-related sickness depending on when it occurs and how long it lasts. You may hear it referred to as acute (short-lived), anticipatory, or delayed.
Acute nausea and vomiting
Sickness that starts within 24 hours of a dose of treatment is known as ‘acute’. It may start within minutes or hours of a treatment session and usually passes within a day.
Anticipatory nausea and vomiting
If you experience sickness after your treatment, you might worry that it will happen again after your next treatment. This can lead to anticipatory sickness, which is feeling or being sick as you wait for your treatment, before you actually have it.
If chemotherapy makes you sick and your sickness is not well-controlled early on, you might find yourself vomiting before your next appointment. This can happen when you automatically (without conscious thought) connect treatment with feeling sick. You might make other links too, for example, with the smell of the hospital or the sight of chemotherapy drugs, which can then make you feel sick. Research suggests that certain groups of people are more likely to have anticipatory sickness than others. This includes those who are under the age of 50, those who suffer from travel sickness, and those who are prone to anxiety.
Speak to your medical team if you experience anticipatory nausea and vomiting. A drug treatment such as lorazepam (Ativan®) could help in the short-term. Anticipatory vomiting is based on expectations, though, so non-drug, psychological interventions may be more effective in the longer-term.
Delayed nausea and vomiting
Sickness that occurs over 24 hours after you receive chemotherapy is known as ‘delayed’. It usually goes on for about a week. Delayed sickness is more common with some chemotherapy drugs than with others. This applies to cisplatin, carboplatin, cyclophosphamide and doxorubicin. You might be given antiemetics to help prevent or control your sickness, particularly if the drugs you are having are likely to make you unwell.
To prevent or manage treatment-related sickness, your doctor may prescribe medicines. There are also various psychological (non-drug) interventions that can help.
Antiemetics are medicines that help to control sickness. Your doctor may prescribe antiemetics if the treatment you are having is expected to cause sickness.
Antiemetics tend to be most effective when they are used prophylactically (before you start to feel sick rather than after). If you find that the antiemetics you’re taking aren't helping, tell a member of your medical team. Many types of antiemetics are available and each works in a different way so even if a particular type doesn’t work for you, another one could be very effective.
You may 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, usually it can be reduced. Steroids, most commonly dexamethasone (Decadron®, Hexadrol®, Dexasone®), are often given together with antiemetics to help ease sickness.
Note: Your doctor will talk to you about the possible side effects of any medicines they give you. Take any medicines you are given exactly as prescribed.
Psychological interventions are non-drug treatments. Cognitive (thinking) exercises are a type of psychological intervention that can help to reduce feelings of nausea. These exercises aim to modify any thoughts and behaviours that influence you in a negative way. Examples of cognitive exercises are:
- Distraction – Becoming absorbed in, or distracted by, something can take your attention away from feeling sick. Guided imagery techniques 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. Similarly, for children, storytelling, especially where they are involved as a hero, can be a good distraction technique.
- 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, ie you become desensitised to them. You start by imagining something that causes you a small amount of anxiety (eg 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 – Restructuring (changing or modifying) attitudes and beliefs that add to your distress can reduce your anxiety. Cognitive restructuring is a type of cognitive behavioural therapy. It involves talking through your thoughts, feelings and beliefs about your treatment or medical procedures with a trained professional. The aim is to identify those that cause you distress. You are then encouraged to adapt or restructure the distressing thoughts, attitudes or beliefs by considering different ways of processing (thinking about and responding to) them.
Evidence shows that psychological interventions can help with anticipatory nausea and vomiting. There is currently little research into their effectiveness with post-treatment sickness. Different people find different approaches helpful so speak to your medical team to find out what might work best for you.
You may find that food or drink worsen your sickness, in which case the following simple steps might help. If you are unable to keep food or drink down, seek advice from your medical team.
Controlling food smells
If the smell of food makes you feel nauseous, you might 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 such as spicy or very sweet foods.
Meals and snacks
- Add ginger (which may reduce nausea) to your diet, for example, ginger beer, ginger tea, ginger biscuits, or root ginger.
- Choose plain-tasting carbohydrates, such as toast, crackers, breadsticks, pretzels, rice, pasta, potatoes or noodles. These can be easier to tolerate than greasy or very full-flavoured foods.
- Eat a cracker or a dry biscuit before you get up if you feel sick in the mornings.
- Frequency of meals and snacks
- Eat little and often. Hunger can make nausea worse and a large and full plate may feel overwhelming.
If you are having treatment with chemotherapy or radiotherapy, you may temporarily have a sore mouth or unpleasant taste in your mouth – people often describe this as 'metallic'. If this happens, refresh your mouth between meals by cleaning your teeth or using a mild, alcohol free mouthwash. Sucking a sugar free mint 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.
While you are having treatment, your medical team will advise you to drink plenty. Keeping your fluid intake up is especially important if you are vomiting. It helps to prevent dehydration in order for your body to function well.
- 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 taste. Doing so will bypass some of your taste buds.
Drink plenty of water between your meals. A lot of fluid all in one go with a meal can cause bloating and discomfort.
Below are a few suggestions to help manage your sickness. You may also like to visit our online forums to share your experiences and to find out what others have found helpful.
Identify what makes you nauseous
Certain foods, smells, activities or surroundings can trigger nausea. Noticing when you feel nauseous can help to identify possible triggers. You can then consider how you could avoid or minimise contact with them. Strong perfumes and aftershaves are examples of common triggers. If this is the case for you, try fragrance-free products. Mention to people you live and work with that these smells can make you feel sick so that they know to avoid using strong fragrances too.
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.
You could also speak to your nurse specialist about complementary therapies. These are used in addition to your hospital treatment, not instead of it. They aim to improve mental and physical wellbeing and may help you to relax if you feel anxious and unsettled by your sickness.
Wear loose-fitting clothes
Tight clothing can make you feel uncomfortable and make the feeling of nausea worse.
Experiment with 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.