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Nausea and Vomiting: Managing Chemo Nausea

Managing Nausea and Vomiting from Chemotherapy

Nausea and vomiting are two of the most feared chemo symptoms, and for good reason — not only do nausea and vomiting feel downright horrible, they can keep you from getting the nutrients and calories your body needs to help you heal during chemo.

While modern-day chemo patients are often given a list of anti-emetics (anti-nausea medications) a mile long, breakthrough nausea can still sometimes occur.

Read on to find out why chemo causes nausea and vomiting, tips and tricks for staying on top of the nausea, and what to do if you have breakthrough nausea or vomiting. 

Why does chemo cause nausea and vomiting?

Chemotherapy is typically given through the bloodstream, so why does it cause nausea or vomiting? According to the American Cancer Society, chemotherapy triggers an area of the brain that then sends signals to your esophagus, stomach, and intestines. This then activates a reflex pathway that causes nausea and vomiting. 

There are often other factors surrounding cancer treatment that can contribute to nausea, including anxiety, other medications, and the cancer itself. Some people will also experience anticipatory nausea or vomiting, which occurs when a person’s body reacts to a sight, smell, or experience where they’ve felt ill before. If your brain associates the chemo infusion room with nausea, you might feel ill just thinking about walking in the door. 

Who experiences chemo-induced nausea and vomiting?

Anyone undergoing chemotherapy might experience chemo-induced nausea and vomiting. According to the Mayo Clinic, there are some risk factors that may raise your chances of getting sick during or after chemo, including:

  • Being a woman
  • Being younger than 50
  • Having a history of motion sickness or nausea
  • Having anxiety
  • Previous experience with morning sickness during pregnancy
  • Having a history of not drinking alcohol

If any of these risk factors applies to you, you may need additional help controlling your nausea or vomiting during chemo.

The biggest and most known is nausea. After my first infusion and into my last, I would have about 72 hours of extreme nausea. This was day-consuming nausea. I would wake up with it, only able to eat a few things, but it did go away. Some people are not as fortunate to have that nausea go away naturally.

I was able to get back into full appetite and energy by about week two after each infusion.What helped me the most with my nausea was having some exercise. That seems counterintuitive, but it stimulates the appetite, gets you out in fresh air, and gives some movement for the body.

Nina L. (DLBCL, Stage 4) 

I would go home and rest, but I would feel great. In the middle of the night or the next day I would just get so nauseated, be so sick.

Jodi S. (Metastatic Ovarian Cancer)

How are nausea and vomiting treated?

Ever since chemotherapy usage became widespread in the 1960s and 1970s, doctors have been looking for ways to control the associated nausea and vomiting. One of the earliest drugs used to control nausea and vomiting in cancer patients was the steroid dexamethasone (nicknamed “dex”), which is still one of the most common prescribed anti-nausea drugs today. 

Every decade, researchers discover more and more drugs that can help cancer patients control nausea and vomiting. Some drugs, like Zofran (ondansetron), were specifically developed to treat nausea and vomiting in cancer patients. Other drugs, like Ativan (lorazepam), were developed for other uses and were later found to also be successful at keeping nausea at bay. You may have taken some of the drugs your doctor prescribes you to control nausea during chemo for other uses in the past. 

Before starting chemotherapy, your doctor should give you a list of drugs to have on hand to prevent nausea and vomiting. Many patients are prescribed a steroid like dexamethasone for a few days after each chemo session alongside other drugs like Zofran, Ativan, prochlorperazine, olanzapine, or medical cannabis. Your drug list may include instructions on the order in which you should take the drugs.

While some patients might be able to control their nausea with fewer medications, check with your doctor before cutting any medications out of your regimen. It is best if you stay ahead of the nausea and vomiting rather than under-medicate and then attempt to play catch-up with your medication after you’ve already started vomiting. 

While the nausea continued, it did get better as I began to take the anti-nausea meds more proactively. I also never had mouth sores again after she prescribed medication to prevent them. They weren’t a guarantee, but thankfully they worked for me! 

Stephanie C. (Primary Mediastinal B-Cell Lymphoma, Stage 3, Double Expressor)

They had given me anti-nausea medications, but I felt fine the day before, so I didn’t take them. I learned very quickly that even if you’re not feeling nauseous, you should still take the medicine. 

Stefanie H. (Invasive Ductal Carcinoma, Stage 3) 

My doctor kind of punched me in the arm, said, “Don’t be a cowboy. Take the [anti-nausea] medicine.” He’s right. I take it so you don’t have the symptoms, but you’d still have that feeling in your stomach.

Richard P. (Relapsed/Refractory DLBCL)

I really feel like I could take the anti-nausea medication and I learned after the first one, I’d just take it that night when I went to bed, take it when I wake up, just keep on that regimen. It really kept the nausea down.

I only threw up a few times during the whole process. After the first time I was in a lot of pain, I always just took the meds beforehand and just kept taking them until I felt noticeably better because it was so much easier to stay on top of it than to get behind.

Jodi S. (Metastatic Ovarian Cancer)

Anti-nausea drug regimens for chemo vary depending on the type of cancer, type of chemo, institution or doctor, and your individual tolerance. Always check with your doctor before combining medications or leaving a medication out of your daily regimen.

They’d start [my chemo] with anti-nausea medications. That would be for about a half-hour or so. Then an hour later they’d start the AC (Adriamycin, cyclophosphamide) which wasn’t very long, maybe two hours. 

The first couple of days I remember feeling pretty good. I would even go work out to keep up my exercise during treatments. But then during Day 2 or 3, little bit of nausea.

They give you anti-nausea medications that I took. I remember just mostly being in bed those two days. I was also working part-time during this time so I timed it, I was able to time it so I’d have the five days – they say you won’t feel well – off and then I’d go into work on Day 6 or 7.

The second week, you feel pretty good, pretty back to normal. And then you start again. So it was usually about five days where I felt stomach queasiness. I remember not feeling  like eating much. 

Margaret A. (Invasive Ductal Carcinoma [IDC] & Ductal Carcinoma In Situ [DCIS])

Beth A. describes her 3-medication regimen:

The first drug is Zofran… If you’re not feeling any better from that, and that usually does the trick for most people, then you take Compazine which is prochlorperazine… If you’re really still feeling sick and nauseous, the last one is Ativan which a lot of cancer patients are on and take anyway for anxiety and different things. It helps counteract some of the dexamethasone side effects as well.

Beth A. (Relapsed Refractory Multiple Myeloma)

I had nausea, but it was manageable. I had three different nausea medications running 24/7. That was a suggestion from some other people, and it helped so much. I want to be that for others. That’s why I want to be open about my experience.

Scott C. (Multiple Myeloma, IgG Lambda, Heavy Chain, Stage 3)

It was three days of rest and a little bit of nausea. I actually only threw up once before dinner one time. Then it was gone.

Other people have had different experiences, but my care team definitely prescribed me all the anti-nausea medicine and antacids.

I think I had 12 prescription bottles on my bedside table at one point. There are fixes for the worst side effects, which are nausea and sleeplessness.

CC W. (Hodgkin’s Lymphoma, Stage 3)

For nausea, an amazing new FDA approved drug called Varubi (rolapitant) that helped suppress much of my nausea. This drug was used by our cancer center and it was one of the best things because it probably kept my nausea suppressed to 10- to 20-percent, though I got nauseous at the end of two weeks.

Helicon K. (Hodgkin’s Lymphoma, Stage 2A)

I take Zofran, which is a pretty common nausea medication. They have stronger stuff if it really starts to affect you.

Evan L. (Acute Lymphoblastic Leukemia [ALL])

Some people, like Bobby J., have trouble with the medications. If your anti-nausea medication is causing you to feel depressed or anxious, talk to your doctor about alternatives.

The worst side effect from the nausea medicines was it basically put me in a depression. I lied in bed, did not want to get up. There were three different medications they gave me. I’m not sure what the three were, but it caused me to go into depression.

They just called it a cocktail, and it was three different anti-nausea medicines. In Cycles 2, 3 and 4, I did not take the anti-nausea cocktail. I believe I took some Ativan.

Bobby J. (Mantle Cell Lymphoma, Stage 4)

They do give you anti-nausea drugs, and they give what they call pre-meds. One of them is Zofran. Dexamethasone was also one of my pre-meds, and those drugs really did a great job of controlling my nausea to the point where I essentially had close to a nausea-free chemo.

Luis V. (DLBCL)

I was given some medication for discomfort. When my anti-nausea medication stopped working  (usually by Day 3 of chemo), I was given Ativan through an IV. Ativan helped with the nausea, but it made me not remember anything after I received the dose.

Donna S. (Primary Mediastinal B-Cell Lymphoma, Stage 1 to 2)

Are there any natural remedies for nausea or vomiting?

While you should make sure you’re taking your prescribed anti-nausea medication, there may be days when your anti-nausea medications don’t completely suppress your upset stomach. In those cases, natural anti-nausea remedies may help you control your nausea. 


According to the Mayo Clinic, ginger is clinically proven to reduce the severity of nausea for patients undergoing chemotherapy when taken in combination with standard anti-nausea medication. However, studies show that ginger taken alone doesn’t do much to help control nausea for patients undergoing chemotherapy. Ginger can interfere with some medications, so check with your doctor before adding this supplement to your diet.


Some patients find relief from nausea by smelling peppermint oil or sucking on a peppermint candy. Studies show that consuming peppermint can help with symptoms of irritable bowel syndrome, and that inhaling peppermint oil can help control nausea. Use an essential oil diffuser or roll-on for quick aromatherapy relief.

Cold liquids

Remember sipping Sprite when you were sick as a kid? Sipping a cold drink, such as ice water, Gatorade, or club soda, helps some patients control acute nausea. Cold liquids can help calm the nervous system, sooth the stomach, and prevent dehydration. Be sure to sip slowly if your stomach as bothering you to avoid triggering vomiting.


Fruits such as lemon and lime have been shown to help prevent nausea in some people. If you’re feeling sick, try smelling some lemon essential oil or squeezing a fresh lemon into your drink. Check with your doctor before using citrus — some fruits, such as grapefruit, can make your cancer medications less effective. 


You may find that your stomach may be more sensitive when it is empty. If you’re feeling ill, try having a carbohydrate-rich snack like pretzels or cereal. If you’re prone to early morning nausea on the days after chemo, keep a granola bar at your bedside in case you wake up feeling sick.


For me, when I was nauseous, I found that it was my body needing something. Either I was hungry and didn’t know I was hungry, or I was thirsty and didn’t know I was thirsty. Maybe I was even sleepy and didn’t know I was sleepy. You’re on all this medication, and it throws your body out of whack. When I would get nauseous and it was too much for my anti-nausea medicine, it was usually as simple as drinking a glass of water or taking a couple of bites of a sandwich.

Caitlin J. (Invasive Ductal Carcinoma, Stage 2B)

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Chemo Brain: What It Is and How To Cope

Chemo Brain: What It Is and How To Cope

Anyone who has been through chemotherapy can tell you that chemo drugs don’t just wreak havoc on your hair and stomach — they can mess with your head, too, leaving you feeling like your brain is stuck in a cloud. 

Maybe you’ve noticed yourself forgetting things you’ve always known, like the name of your sister’s dog or your best friend’s phone number. Or maybe you just feel like you’re thinking at half-speed, concentrating hard on the next thing to say while the conversation zooms by without you. Chemo brain is absolutely a real phenomenon, and it can leave cancer patients feeling hopeless and frustrated as they attempt to go to work, attend school, or interact with friends and family.

If you’re suffering from chemo brain, also known as chemotherapy brain fog, know you’re not alone. It affects people of all ages, diagnoses, and backgrounds. Read on to learn more about how chemo brain feels, how long it lasts, and how to combat it. 

What is chemo brain?

Cancer-related cognitive impairment, or “chemo brain,” is the mental confusion and fogginess that many patients experience before, during, and after cancer treatment. Patients experience chemo brain in different ways. Some people say that chemo brain makes them feel “scattered,” reduces their vocabulary, and hurts their focus

Up until recently, there wasn’t much research about the existence of chemo brain and its effect on patients. However, advances in cancer treatment mean that far more patients are living long, full lives, and doctors are placing greater emphasis on helping patients who experience this sometimes long-lasting side effect. 

Who gets chemo brain?

Chemo brain affects people who have gone through cancer treatment, but the condition isn’t specific to any particular type of cancer. According to Dr. Arash Asher at Cedars-Sinai, about 75% of cancer patients experience chemo brain during treatment and one-third of patients report symptoms of chemo brain after their treatment ends. Chemo brain is even reported by patients who don’t undergo chemotherapy. 

There are several aspects of cancer treatment that can cause brain fog and mental confusion, including:

There is no one cause of chemo brain.

What does chemo brain feel like?

People who experience chemo brain may feel a variety of different symptoms. Some people report forgetting words and names they’ve known for years. Others say the effects of treatment made it difficult to multitask or quickly perform tasks. Chemo brain symptoms range from mild forgetfulness to full-blown brain fog that can interfere with your life at work, home, and in social situations. 

Here’s how patients described their experience with chemo brain:
Samantha S. buzzed hair experienced chemo brain after her treatment.

Chemo brain is such a broad term that people use, but for me, it was always really a combination of severe sadness and difficulty functioning in everyday life, difficulty remembering things, difficulty doing what I would say, or executive functioning tasks. If I only have one thing to focus on, it’s fine. But when I’m going through an episode like that, give me a list of groceries to get at the store and it’s going to take me twice as long to find my way around. Can I cook a dish while my kids are talking to me? That would be really difficult.

Samantha S. (Relapsed Hodgkin’s Lymphoma)
Callie smiling

I definitely had some continuation of thought issues. I was very scattered.

Callie M. (Invasive Ductal Carcinoma, Stage 2B, Grade 2, ER+)
Wade looking out over a lawn

I already had a lot of focus issues before starting [treatment] and then I can’t focus on things. 

Wade W. (Hodgkin’s Lymphoma, Stage 2A)

Mila is a cervical cancer survivor who experienced chemo brain.

“…there was a fair amount of the chemo brain aspect of things where you can’t concentrate. I couldn’t think of the words that I wanted to use and that was really, for me, very frustrating because I had always prided myself on having a large vocabulary.

I work with people and have clients and so being able to express myself the way that I wanted to was always something that I was good at. That was kind of taken away from me in that time. Very frustrating.”

Mila L. (Cervical Cancer, Squamous Cell, Stage 1B1)
Nicole B. was diagnosed with Soft Tissue Sarcoma, Stage 3 and struggled with chemo brain.

I would repeat myself or be unable to recollect things – not only short term but long term too. I remember my mom bringing up memories we had, and I just could not get there.

In the game UNO, there was a green eight that was laid down. I would see it, look at my hand, and by the time I looked back I forgot what was down. I was struggling trying to process information in front of me. It was hard to even think straight trying to get through a game.

Nicole B. (Soft Tissue Sarcoma, Stage 3, Undifferentiated Pleomorphic Sarcoma) 
Barbara smiling

Once chemo was over I didn’t remember the station [HGTV] is on TV. I couldn’t read. People were dropping off books and I have to tell you that was a shock to me when I couldn’t read a book, I couldn’t focus enough.

I couldn’t watch movies. Movies required a lot of attention. I didn’t have an attention span for movies. But I could watch short shows. It was bizarre. I didn’t read magazines or books. It was these short little makeover shows. I wasn’t myself.

Barbara M. (Colon Cancer, Stage 3)
Melissa sitting in her car

This was the worst side effect for me. I felt like I was going crazy and I felt confusion. I didn’t start seeing this until later in the treatment and it probably lasted a year or so. I didn’t have issues with school memory… I had issues with small everyday decisions. For example, I watched my one-year old during the day and some days I would go to the pantry and not be able to think of how or what to make for lunch. Something about the multitude of choices and necessity of the action would fluster me. I would call my husband crying not knowing what to do. He would talk me down and give me simple instructions that I would follow.

Melissa H. (Invasive Ductal Carcinoma, Stage 2B, Triple Negative)
Rach on a beach

I remember when I still had my day job, I was typing. Then, I just couldn’t.

It was hard. I was holding a stack of binders, then I had to walk to my desk and it just dropped because I just didn’t have the strength or my wrist was hurting.

Then you also experience what they call chemo brain where things are just a little foggy and you can’t remember. Those are things that you can’t help. It gets very frustrating.

Rach D. (Invasive Ductal Carcinoma, Stage 2, Triple Positive)

How long does chemo brain last?

For some people, chemo brain ends soon after they finish treatment. However, others may find that its effects can last for months or even years. One recent study found that 36% of breast cancer survivors reported ongoing cognitive issues six months after their treatment ended. Although it may persist after treatment, most patients will find that their chemo brain resolves within a year or so of finishing cancer treatment. 

What can I do to help chemo brain?

At home

While there is no known cure for chemo brain, there are things you can do to help combat it.

  • Keep a pocket-sized notebook with you and write down everything. Make checklists throughout the day and check off tasks as you accomplish them, even if they’re simple things like “get the mail” or “text Mom back.”
  • Use technology to your advantage. If your phone has an option that allows you to keep track of where you parked your car, turn it on. Use the GPS function to set reminders that go off when you leave or enter the house. 
  • Play brain training games on your smartphone or computer. Puzzles, crosswords, and Sudoku puzzles are also good options.
  • Pick up a craft, like crochet, to keep your hands and mind busy. 
  • Take walks, stretch, or do yoga
  • Some patients find that stimulant medications like Modafinil can help. Talk to your doctor if you think a medication could help your chemo brain. 
  • Be gentle with yourself. You’re allowed to feel bad sometimes. You’re experiencing something nearly everyone around you isn’t.

I encourage trying to play games though. Do not get frustrated with yourself but try to engage your mind when you can or when you feel well enough. Try to keep yourself on your toes a little bit. We played a lot of board games and cards during treatment.

Nicole B. (Soft Tissue Sarcoma, Stage 3, Undifferentiated Pleomorphic Sarcoma) 
At work

Many adult cancer patients still participate full-time in the workforce. While it can be difficult to perform at full capacity while undergoing cancer treatment, there are strategies that can help you feel a bit more control over your work day.

  • Apps like ToDoist, Microsoft To-do, and Google Tasks are great for keeping track of tasks on your phone or computer.
  • Ask coworkers to send detailed instructions for tasks and to communicate their questions and needs in writing. It is easier to remember a task sent via email or messaging than it is to remember a task told to you over the phone. 
  • See if your company has a remote work or work-from-home policy. Many employers will understand that you may have a limited amount of energy each day, and that working from home can help you stay focused.
  • Request that all meetings be recorded if possible, and use a transcription app to keep a written record of what was said. Here are instructions for turning on transcription for some major video chat and meeting apps:

How can I help someone with chemo brain?

Chemo brain has only recently been seriously accepted by the medical community as a real phenomenon. Many people are uneducated about the mental effects of cancer treatment and may not understand the cognitive difficulties some cancer patients face. While it’s important to not treat your loved one like they are incapable, there are some things you can do to help while they go through this experience.

For everyone
  • Be patient. There are a lot of stressors that people experiencing cancer face that may affect their ability to remember things or perform tasks. Remember that they are not forgetting things or slowing down on purpose.
  • Don’t patronize them. A person experiencing chemo brain may be forgetful or slower to respond to you, but that doesn’t mean they don’t understand things or are incapable of making their own decisions.
  • Understand that it may take them a while to respond to text messages or phone calls. When you’re going through cancer, people are often flooding your phone with messages that can quickly become overwhelming. This doesn’t mean that they are trying to ignore you.
For loved ones
  • Help them take on a mental load. Offer to help them keep track of their appointments and medications or ask if there are tasks you can help with, like budgeting or sorting out health insurance claims.
  • Offer to attend doctor’s appointments or chemo sessions with them. Beyond providing emotional support, it’s important for cancer patients to have a clear-minded advocate who can speak up if something seems off. 
  • It’s important for patients to eat well, but it can be hard to plan meals. Schedule a meal drop-off, grocery delivery, or restaurant delivery meal card. Not having to think about what you’re going to eat for dinner or worry about cooking can be a huge relief.
For coworkers
  • If you are their coworker, make sure your questions and instructions are clear and concise. People undergoing cancer treatment may struggle with executive function — a vague email asking them to figure out how to do something may seem like an insurmountable task to a coworker suffering from chemo brain. 
  • Make sure all meetings are noted in an electronic calendar. Don’t ask them to remember things that aren’t explicitly written down.
  • Understand that they may be out of the office more than normal. Some days, even the difficulty of executing a morning routine is too much to handle. Allow them to work from home when possible.
  • If you are running a meeting, turn on transcription services and save a copy of the transcript in the project folder. 
  • Ask your coworker before sharing anything about their condition with clients or other coworkers. Although you may feel that you need to explain the situation to others, some cancer patients would rather not draw attention to their diagnosis. 

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