Ask the Nurse: Myeloma, nausea, vomiting and loss of appetite

Nausea, vomiting and loss of appetite are common experiences for myeloma patients. Whatever the cause, nausea, vomiting and/or loss of appetite can make it difficult to stay hydrated, eat well, and maintain a healthy diet – all of which are important to help you feel as well as possible and support you during your treatment.

In this month’s blog, we answer some of the questions you ask our Myeloma Infoline team about nausea, vomiting and loss of appetite.

What are nausea and vomiting?

Vomiting is the process of throwing up or being sick. Nausea is an unpleasant sensation (queasiness) in the stomach, paired with the urge to be sick – although nausea does not always result in being sick.

Symptoms of nausea and vomiting include:

• Feeling like being sick, or being sick.
• Queasiness.
• Dizziness.
• Excessive sweating and feeling clammy.
• Dry mouth.

If you have severe or persistent vomiting, it can lead to dehydration, stomach pain and in some cases, damage to the throat. If you take oral (by mouth) treatments, vomiting may also affect how well your medication is absorbed.

This means it is important that if you experience unexpected or prolonged symptoms, you let your healthcare team know. They can support you and explore the cause.

Do myeloma treatments cause nausea and/or vomiting?

There are several reasons myeloma patients commonly experience nausea and/or vomiting, but myeloma treatment is a common cause. Many treatments can cause these side effects including:

• Chemotherapy treatments like cyclophosphamide and melphalan.
• Other anti-myeloma drugs like bortezomib (Velcade^®), ixazomib and panobinostat (Farydak^®).
• Supportive treatments including radiotherapy, antibiotics and some painkillers.

Your healthcare team can advise you and make sure you have the appropriate supportive treatments to stop or reduce nausea and/or vomiting.

What else can cause nausea and/or vomiting with myeloma?

Other possible causes of nausea and/or vomiting include:

Infection

Due to having a weakened immune system, myeloma patients are more likely to develop infections like gastroenteritis and food poisoning. You can read about how to minimise infection risk in our Infection and myeloma Infosheet.

Stress and anxiety

Feeling stressed, anxious or nervous can make you feel unwell, including nausea and vomiting. This is known as anticipatory nausea and vomiting. Relaxation techniques and breathing exercises for stress can help you to feel calmer and reduce stress-related symptoms.

Pain

Pain, and some supportive treatments used to treat pain, can cause nausea and/or vomiting. Your healthcare team may be able to suggest changes to your treatment to manage your symptoms better. Read more about ways to cope with pain in our Pain and myeloma Infoguide.

Hypercalcaemia

Myeloma can cause the bones to be broken down more quickly than they are repaired, releasing high levels of calcium into the blood (hypercalcaemia). Hypercalcaemia causes a variety of symptoms, including nausea, vomiting and loss of appetite.

Myeloma treatments and supportive treatments help to control the breakdown of bone and reduce the chances of hypercalcaemia and associated nausea and vomiting. Our Myeloma bone disease Infoguide provides information about hypercalcaemia, it’s causes and how it can be managed.

What treatments can help my nausea and/or vomiting?

The best way to treat nausea and/or vomiting depends on the cause and so it is important to mention these symptoms and side effects to your healthcare team. They can prescribe supportive treatment and offer advice on managing the nausea and/or vomiting.

Your doctor may prescribe anti-sickness (anti-emetic) drugs to prevent or minimise the side effects.

 It’s important to take anti-sickness drugs according to instructions from your doctor, and on time, even if you feel well. This can help prevent symptoms such as nausea and vomiting before they occur.  

There are many different anti-sickness drugs, so if the ones you have been given don’t work, talk to your healthcare team about trying a different one.

Whilst it is possible to buy some anti-sickness drugs without a prescription (‘over the counter’), always check with your doctor before taking any new treatments. They can make sure the anti-sickness drugs are suitable for you and do not interact with your prescribed treatments. 

What can I do myself to manage my nausea and/or vomiting?

There are things that you can do to prevent, reduce or manage nausea and vomiting symptoms:

• Take small sips of water or fizzy drinks to prevent dehydration.
• Eat little and often. Plain, cold snacks or high-calorie drinks may be easier than hot meals.
• Strong smells can worsen nausea. Try keeping windows open when cooking and using lightly perfumed handkerchiefs to mask smells. Some scents like lavender can calm nausea.
• Fresh air can ease nausea and vomiting. Consider sitting outside or by a window.
• Some people find that ginger or peppermint can help settle their stomach. Try peppermint or ginger tea, ginger biscuits, non-alcoholic ginger beer, mints or chewing gum.

Why have I lost my appetite?

There are many reasons why you might lose your appetite. Some complications of myeloma, such as damage to kidneys or hypercalcaemia can cause a loss of appetite. In these cases, treating myeloma and the complications can resolve appetite loss.

Some supportive treatments and anti-myeloma treatments, such as melphalan, can affect your appetite directly or change your sense of taste and smell resulting in a loss of appetite. People with myeloma are also more prone to mouth problems like mucositis, which can be painful and make eating and drinking difficult. Read more in our Mouth care Infosheet.

Feeling unwell because of treatment, nausea and/or vomiting or infections can reduce your interest in eating too, as can low mood or anxiety. Experiencing diarrhoea or constipation can also reduce appetite – read more in our Gastrointestinal disturbances Infosheet.

It might feel uncomfortable to talk about some of these things with your healthcare team, but they are there to support you and are used to these conversations.

What can I do to make sure I keep eating well?

It is important to keep eating, even if you don’t feel like it. Many people find that eating little and often is easier. It’s ok to plan meals and snacks around the times you feel hungry, even if that is not your usual mealtimes.

If you are struggling to eat, you can help to keep your energy up by choosing high calorie but low volume foods like butter, oils, cream or cheese, and high-protein meals.

 If you are not able to eat and drink as you normally would, these tips may be helpful: 

• If you lack interest in eating, try exploring different drinks and foods.
• If your sense of smell or taste is reduced, try seasoning your food with spices and herbs, marinading food before cooking and using strongly flavoured sauces.
• If altered sense of taste makes your food taste metallic, try using plastic cutlery.
• If water is unappealing, try drinking sugar-free flavoured drinks.
• Try rinsing your mouth before and after eating.
• Distract yourself while eating by watching TV, reading a book, or having a conversation.
• Cold foods are often more palatable than hot foods e.g. fruit, biscuits, dry toast, yoghurt, jelly or cereals.
• Sharp or strong-tasting foods such as fresh fruit, fruit juices and sour, boiled, or mint sweets can be refreshing and leave a pleasant taste in the mouth.

Your healthcare team may be able to resolve the underlying cause of your loss of appetite and/or refer you to a dietician who can offer you advice tailored specifically to your needs.

Read more about eating a healthy well-balanced diet in our Infopack for living well with myeloma (section 6) and the Diet and exercise section of our website.

You can read more about nausea, vomiting and loss of appetite, alongside other gut problems like diarrhoea and constipation in our Gastrointestinal disturbances Infosheet or watch the recording from our Infoday session. 

If you have any further questions or need support, contact us through the Myeloma Infoline at 0800 980 3332 (UK) or 1800 937 773 (Ireland) or use our Ask the Nurse email service.