Why might my child feel sick on treatment?
Professor Bob Phillips, Consultant Paediatric Oncologist and Contact’s medical adviser
The biggest factors are the effects of treatment directly, and the anticipation of feeling sick from previous experience. The drugs, and to some extent radiotherapy, can affect the lining cells in the gut, leading to feeling sick. Some of the chemo can directly affect cells in the ’vomiting centre’ of the brain too, as can anaesthetics and some other medicines. If the gut gets slowed down, with drugs or the effects of tumours, surgery or infection, it can lead to the stomach being fuller, and vomiting from this, too.
How can feeling sick or the anti-sickness drugs affect appetite?
Sometimes, chemo can just stop children and young people wanting to eat, while the anti-sickness drugs can also sometimes reduce appetite - some through slowing the movement in the guts, some through making the child or teen feel sleepy. Conversely, some, like steroids and nabilone, can have the opposite effect and increase appetite.
What can help my child feel less sick?
Anti-sickness drugs given as prescribed can be helpful. Each type of drug acts on the signalling systems which tell the body to vomit in different ways. If they don’t seem to be working, please let your medical team know as they may be able to alter the medications to use a different way to reduce the nausea signals. Overall, the drugs don’t really work any better if given intravenously, orally or by patch, though we know that some children develop a strong vomiting response to some tastes or tablets. When chemo is finished, it’s rarely of value to keep on giving anti-sickness regularly, but occasional doses may be needed, while for some drugs, a longer course is required.
Another, less talked about aspect of care is how managing constipation can reduce vomiting. Trying to help keep nice, soft poo coming out daily will make it less likely that there’ll be big problems with sickness. This is one of the reasons why carrying on giving anti-sickness drugs, like ondansetron, can be counterproductive, as one of its side effects is increased chances of constipation.
When a child is receiving chemotherapy, it can also be helpful to not ask about feeling sick too frequently. This can raise an expectation that it’s going to happen and can start the feeling of nausea. Providing plenty of things to distract from the chemo going on can be helpful. Some respond to scents of home or a calm and relaxing place – though for others, this could be unhelpful as it then makes home remind them of times spent in hospital. Occasionally, the ’travel bands’ acupressure devices can help, and some find foods with ginger useful.
My child feels sick the evening before chemo, would it help to give them more anti-sickness drugs in the days before?
For nearly all anti-sickness drugs, the answer to this is ’no’. The nausea which develops before chemotherapy isn’t caused by the drug in the system, but instead by anticipation and the brain and body getting worried about the nausea which might be coming. In fact, we know that children who do get given extra are more likely to feel sick. This type of nausea is a ’conditioned response’. We know good control of nausea and vomiting can help, as can some relaxation/distraction/hypnosis approaches. Your hospital play specialists and/or psychologists are happy to advise on these type of
approaches to help.
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From Contact magazine issue 101 - Winter 2023
