Nausea and vomiting in palliative care

Nausea and vomiting are common symptoms in people living with a terminal illness. They can cause distress in some patients and reduce their quality of life. Anti-sickness medicines (antiemetics) can treat nausea and vomiting, and there are practical things you can do to help your patients.

On this page:

What are nausea and vomiting?

Nausea is the unpleasant feeling of needing to be sick. It often happens alongside other symptoms, such as sweating, feeling cold, looking pale, or having a fast heart rate (tachycardia).

Vomiting is the act of being sick, which means the contents of the stomach being forced out through the mouth. Nausea and vomiting often happen together but they can happen individually.

Causes of nausea and vomiting

Physical and psychological factors can contribute to nausea and vomiting. Common causes in patients with a terminal illness include:

• medicines, including opioids and non-steroidal anti-inflammatory drugs (NSAIDs)
• chemotherapy
• metabolic causes, for example, hypercalcaemia (high calcium blood level) and kidney failure
• stomach not emptying properly (gastric stasis)
• constipation
• inflammation or ulcers in the stomach
• ascites (fluid build-up in the abdomen)
• enlarged liver (hepatomegaly)
• infection
• bowel obstruction
• illness affecting the brain such as metastases
• stress and anxiety. 

Assessing nausea and vomiting

Taking a history, physical examination and blood and urine tests can all help to assess someone with nausea and vomiting, work out what’s causing it, and decide on the best treatment.

Check whether the patient wants a physical examination. If they don't, make a note and share it with their wider healthcare team. This could also be included in their advance care plan.

Read more about advance care plans.

Ask the patient and anyone supporting them:

• how often they feel sick or are being sick, and how long it lasts for
• whether it happens at a certain time of day (like first thing in the morning or after a meal)
• if anything makes it better or worse
• how long they’ve been experiencing nausea or vomiting
• what medicines they’re taking
• what their bowel habit is like
• how much they're managing to eat and drink
• if they have any worries or concerns making them anxious.

Managing nausea and vomiting

After an assessment, the patient’s GP or specialist nurse can work out a treatment plan with the patient. Their care plan might include a combination of medicines, non-medical treatments and practical tips.

Practical tips

All patients are individual, so what works for one patient may not work for others. You could:

• make sure they have a large bowl, tissues and water nearby in case they vomit
• encourage eating small snacks often, rather than large meals
• offer cool fizzy drinks or flavoured water rather than hot drinks
• strong smells can make people feel sick, so suggest eating cold food instead of hot food
• avoid greasy or spicy food
• suggest that if the patient usually cooks at home, someone else prepares food instead, as cooking smells can be a trigger
• avoid wearing perfume or other strong scents around the patient
• provide a calm and reassuring environment
• make sure the patient is positioned comfortably - sometimes lying flat can make nausea worse
• sudden movements like sitting up quickly can make nausea worse - encourage the patient to move gently when they’re sitting up or getting out of bed
• help patients to join in relaxing activities such as listening to music or doing breathing exercises.

Certain foods and drinks can be easier to eat and can help with feeling sick. They include:

• fizzy or flavoured water
• plain-tasting foods, like mashed potato or rice pudding
• dry biscuits, crackers or toast
• food and drink containing ginger, like ginger ale or ginger biscuits
• boiled sweets and mints, or ice lollies if the patient has difficulty swallowing
• cold foods
• salty foods like crisps or salted nuts.

It’s important to be guided by the patient and which foods appeal to them.

Non-medical treatments

Complementary therapies like acupuncture can help with nausea and vomiting. These may be available through patient’s GP or local hospice.

Pressure bands worn around the wrists can help too. Patients can buy these from most pharmacies.

Feeling worried, stressed or anxious can make nausea and vomiting worse. Talk to your patient about any worries or concerns they have. If anxiety is a major factor in their nausea and vomiting, talking to a counsellor or psychological therapy may be helpful.

If the patient has concerns about practical issues, speaking to someone who can help, such as an occupational therapist or social worker, might help to lessen their worry and improve their symptoms.

Medicines

There are lots of different types of  antiemetics (anti-sickness medicines). Your patient may need more than one type and it make take a while to find the best one for them.

Antiemetics can be taken orally (such as tablets), as injections or through a syringe pump (also called syringe driver). Antiemetics should be taken regularly, not just as required. They can be stopped if the cause of the nausea has been resolved.

Read more about syringe pumps.

Doing a medicine review

Some medicines can make patients nauseous or sick. Ask their medical team or specialist nurse to review their medicines to see if they can stop taking any.

Do not stop any medicines before speaking with the medical team, GP or specialist nurse.

When to ask for help

Contact the patient’s GP, district nurse or specialist nurse if their symptoms aren’t improving.

Nausea and vomiting can cause serious complications if they aren't being managed, including dehydration, altered blood electrolyte levels and emotional distress.

Ask for help if the patient can’t take their usual medicines by mouth as they might need injections or a syringe pump.

Useful resources

NICE Clinical Knowledge Summary: Palliative Care – nausea and vomiting  

Scottish Palliative Care Guidelines: Nausea and vomiting