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    Control Chemotherapy Nausea & Vomiting

    New drugs and alternative therapies can help reduce -- or eliminate -- chemotherapy side effects.

    Anticipatory Nausea -- Expecting to Get Sick

    After starting treatment, about one out of three people in chemotherapy develop anticipatory, or conditioned, nausea. You may find that anything which reminds you of getting chemotherapy -- the smell of the doctor's office, the freeway exit that takes you to your clinic -- triggers queasiness. About one out of ten develop anticipatory vomiting.

    "People are sometimes embarrassed of this," says Syrjala. "They think it's a sign of weakness to get sick before you actually get treatment." But that's not the case.

    Syrjala says this is simply the body's natural response to anything that makes it sick. It happens for the same reason you might still have a strong aversion to a food that gave you food poisoning -- even if it happened decades ago. "Your body is just trying to protect you," she says.

    While this connection can be broken after it's already been established, Syrjala says the best strategy is to prevent it. She recommends people at high risk of developing nausea take antinausea medicines before they start treatment. Changes in your behavior can help as well.

    "One of the best things you can do is distract yourself," says Syrjala. For example, before and during chemotherapy, concentrate on something besides your treatment. An intense conversation, video games, or books-on-tape are all ways to do this.

    New Antinausea Drugs

    Chemotherapy drugs cause nausea in different ways. Some stimulate the nausea centers in the brain, says Russell, while others may stimulate parts of the esophagus, stomach, or intestines. Most antinausea drugs block the chemical stimulation of the nausea receptors.

    Experts say that a treatment breakthrough came in the early 1990s, with the introduction of 5HT3 antagonists. "Those drugs were a huge step forward," says Russell. They include Anzemet (dolasetron), Kytril (granisetron), and Zofran (ondansetron.)

    Russell says two new drugs are also helping. They are Emend (aprepitant) and Aloxi (palonosetron), a second generation 5HT3 antagonist. Both are given intravenously. Sancuso (granisetron), another 5HT3 antagonist, is a skin patch that is indicated for the prevention of chemotherapy-induced nausea and vomitin., Other types of drugs are also available.

    Improvements in medications have made a big difference for patients. "Fifteen years ago, the drugs we had to control nausea just weren't that effective," says Escalante. "Many people had to be hospitalized during chemotherapy. The nausea and vomiting was that bad."

    But now, most chemotherapy is done on an outpatient basis. That's partly due to the success of new antiemetics, Escalante says.

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