Sickness and poor appetite

 
 

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Anti-sickness medication (anti-emetics) should only be prescribed when the causes of the nausea and vomiting is known. Nausea in cancer patients can be caused either by the disease itself or drugs prescribed to treat the cancer.

Cancer related causes:

  • Cancer of the bowel or cancer which had spread to the bowel can interfere with the flow of contents running through it. This commonly causes nausea particularly if this is the upper part of the bowel (stomach or small bowel).
  • Cancer interfering with the function of the Liver or Kidney's.
  • Cancer in the brain causing increased pressure.
  • Cancer causing an increase in blood calcium either by damaging the bones or releasing a chemical into the blood stream.

Treatment related causes:

  • Chemotherapy commonly causes nausea
  • Pain killers - particularly morphine based drugs but others containing codeine can also cause nausea.
  • Other drugs - Anti-inflammatory drugs can cause mild nausea by themselves or more commonly by irritating the lining of the stomach wall.
  • Hormone therapies - It is not uncommon to experience some nausea for a few weeks  when treated with hormone especially for breast cancer.
  • Some anti-biotics particularly erythromycin or ciprofloxicicn can cause nausea
  • Radiotherapy can causes nausea especially if a large area of the body it being treated particularly if this includes the abdomen.

Other factors which can add to the risks of nausea (particularly after surgery or during chemotherapy):

  • High drug doses
  • Chemotherapy drugs which have a high risk of nausea - cisplatin, cyclophosphamide, decarbazine, streptozocin, adriamycin, epirubicicn)
  • Prior history of chemotherapy induced nausea and vomiting (CINV)
  • History of travel sickness
  • Younger female patients
  • Anxiety
  • Low alcohol intake
  • High tumour burden poor performance status
  • Given with other drugs - painkillers etc

Treatments and advice:

Remove the causes. First and foremost. Always mention poor appetite and sickness to the supervising medical team.

General lifestyle tips if feeling sick or have a poor appetite:

  • Donít force yourself to eat when you feel sick but keep up the fluid intake
  • Avoid dehydration
  • It is important to keep your fluid intake up to prevent dehydration
  • Clear, cold drinks may be better tolerated
  • Try sipping fizzy drinks such as soda water, ginger beer or lemonade
  • Sip these slowly, using a straw may help
  • Solid fluids such as sorbet or jelly may be easier to manage
  • Herbal, ginger or peppermint tea may soothe an upset stomach
  • Eat slowly and relax afterwards, but avoid lying flat
  • Nausea may become worse when the stomach is empty so try to take regular snacks
  • If possible, a short walk before eating may help.
  • Fresh air also helps to stimulate your appetite.
  • Avoid wearing tight fitting clothes
  • Try to relax and eat slowly in a well ventilated room.

Eating with a poor appetite or feeling sick:

  • Start with small frequent meals and snacks
  • Try to make your food and drinks as nourishing as possible.
  • Highly spiced or rich or fatty foods can make nausea worse - avoid them if they do
  • Your appetite may come and go, so it is important to make the most of the times when you feel like eating.
  • Experiment with different foods. You may find you like things you donít usually eat.
  • If the smell of cooking makes you sick you could try eating cold food
  • Donít worry if you donít feel like cooking, cold meals can be as nutritious as hot ones
  • Donít worry if it isnít Ďnormalí foods at Ďnormalí times - if you fancy cereal at midnight, enjoy it!
  • A small glass of wine, beer or your favourite drink may boost your appetite. Check with your doctor first.
  • Avoid drinking with meals as this may fill you up and spoil your appetite.
  • Convenience foods are a useful standby and can be just as nourishing.
  • Accept offers from friends and relatives to help with cooking and shopping.

Drug therapy. If nausea is severe and associated with vomiting medications are given intravenously (into a vein). Alternatively, in this situation they can be injected or infused into the fat under the skin (subcutaneously) either as a single injection or   infused slowly via an infusion pump. If patients are not vomiting oral tablets are usually suitable. There are also a variety of other routes of administration ranging from suppository (inserted into the back passage) and transdermally (a plaster stuck to the skin), Buccally (a tablet left between the lip and gum - like the cowboy used to chew tobacco). Listed below are the commonly used anti-sickness medications used in patients with cancer.

  • Act via the chemoreceptor trigger zone - Domperidone ( Motilium), Prochlorperazine (Stemetil, Buccastem), chlorpromazine
  • Acts directly on the gastrointestinal track - Metochlopramide (Maxolon)
  • Act via antihistamine or motion sickness route - Cyclizine (Valoid), Hyoscine (Scopoderm TTS)
  • Sedatives - lorazepam, haloperidol
  • Act by blocking the H3T receptor in the stomach Granisetron (Kytril), Ondansetron (Zofran), Tropisetron, Palonestron
  • Dexamethasone - given to enhance the effect of the main drugs
  • Synthetic cannabis - Nabilone
  • Substance P inhibition (Emend) a new antiemetic acting on a specific receptor in the brain neurokinin 1-receptor antagonist (NK-1 antagonist)

Other therapies - Many patients obtain a great deal of benefit from supportive and complementary therapies. This may be because they genuinely have a direct benefit or they have psychological benefit (placebo). Either way, if patients have a benefit and do not experience side effect from them, then they have useful role. Listed below are the more commonly available remedies which have been used in patients with cancer.

Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.


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