Nausea and vomiting are two of the most common and distressing side‐effects of chemotherapy (Schulmeister [224]). Approximately 70–80% of all cancer patients receiving chemotherapy experience vomiting (Weinstein and Hagle [265]). Chemotherapy‐induced nausea and vomiting can be described as acute (occurring within 2 hours and lasting up to 24 hours), delayed (occurring 24 hours after chemotherapy administration) and anticipatory (happening before and during chemotherapy administration, often as a result of conditioning from stimuli associated with the chemotherapy process or environment) (Dougherty and Bailey [61]). Factors predisposing to nausea and vomiting include age and gender: younger patients experience more nausea and vomiting than older patients, and females more than males.

The emetic potential of chemotherapy drugs can be classified as low, moderate or high (MASCC [145], NCCN [165]). Guidelines on the use of antiemetic drugs to control chemotherapy‐induced nausea should be used to prevent, treat and manage patients’ symptoms (London Cancer New Drugs Group [142]). When choosing the antiemetic medication consideration needs to be given to the emetogenic potential of the individual drugs within the regimen; treatment may include corticosteroids and 5‐HT3 inhibitors.

Successful management of nausea and vomiting combines pharmacological intervention with non‐pharmacological strategies. Antiemetic guidelines are available in most treatment centres, and antiemetics should be commenced prior to treatment and continued throughout the emetic activity of the chemotherapy drug used (Weinstein and Hagle [265]). Non‐pharmacological interventions such as acupressure have been reported to relieve nausea. Acupressure works on the principle of pressure being applied to the P6 (pericardium) pressure point. The pressure point is located on the inner aspect of the wrist and the pressure band disc is placed three fingers’ width from the wrist crease between the two tendons (Figure 23.11). Although it has been suggested that nausea can be relieved within the first 24 hours following chemotherapy, the pressure bands do not appear to have any impact upon vomiting (Dougherty and Bailey [61]).

Patients receiving chemotherapy can experience changes in taste as well as loss of appetite. Foods that the patient is used to eating can taste very different following chemotherapy (Weinstein and Hagle [265]). It is therefore important to ensure that a nutritional assessment forms part of the patient's care plan and that strategies are adopted to maximize nutritional well‐being. Many patients complain of a bitter or metallic taste and can be advised to experiment with different flavours and spices, the aim of which is to stimulate the taste buds, making the mouth feel more comfortable (Schulmeister [224]). Plastic utensils can help reduce the metallic taste. Generally, patients find that cold food as opposed to hot is more palatable and that having meals served on glass rather than plastic helps reduce odours (Bernhardson et al. [11]).

Odours from cooking can have a negative impact upon the desire to eat; advise the patient to avoid areas where food is being prepared. Appetite stimulants can be prescribed if necessary in an attempt to maintain a healthy diet. Nutritional supplements such as protein drinks, protein powders and soft foods may be required (Schulmeister [224]).

Constipation is the passing of hard, dry stools, causing difficulty in defaecation (Weinstein and Hagle [265]). The severity of the problem can range from mild discomfort to paralytic ileus (Schulmeister [224]). There are many causes of constipation including side‐effects of medication, hypercalcaemia, dehydration, immobility and dietary deficiencies. Chemotherapy agents such as vinca alkaloids (vincristine, vinblastine) commonly cause constipation secondary to autonomic nerve dysfunction (Dougherty and Bailey [61]).

Prevention of constipation should be part of the medical and nursing assessment of the patient, and prophylactic laxatives, lubricants or stimulants should be used. Education about prevention interventions is important and the patient should be instructed to increase their dietary intake of fresh fruits, vegetables and fibre. Patients should be encouraged to drink 2–3 litres of fluid a day and to avoid cheese, eggs and starches (Weinstein and Hagle [265]). Physical activity stimulates peristalsis, so patients can be encouraged to be as mobile as possible. They should also be encouraged to defaecate immediately upon feeling the urge to do so and not to wait (Weinstein and Hagle [265]). See Chapter c26, Acute oncology.

The function of the colon is to absorb fluid. When this does not happen, diarrhoea ensues. Diarrhoea is the abnormal passage of three or more loose or watery stools in a 24‐hour period and is often accompanied by abdominal cramps (Schulmeister [224]). There are many causes of diarrhoea including post‐operative intestinal resection, Clostridium difficile and other intestinal infections. Chemotherapy agents such as 5‐FU, capecitabine, docetaxel, doxorubicin and methotrexate can cause diarrhoea (Dougherty and Bailey [61]).

Nursing interventions should focus on the early detection of the problem and patients should be encouraged to report symptoms promptly. Normal bowel activity should be assessed as well as the frequency of the diarrhoea and the patient's oral intake over a 24‐hour period. Patients require a minimum of 2 litres of fluid in a 24‐hour period because electrolytes are lost as a consequence of diarrhoea (Schulmeister [224]). Potassium is the most significant electrolyte to be reduced and the patient should be encouraged to eat potassium‐rich foods (Weinstein and Hagle [265]). Intravenous fluid replacement as well as antimotility agents can be used in severe cases. A high‐calorie, high‐protein and low‐residue diet is recommended (Dougherty and Bailey [61]). See Chapter c26, Acute oncology. Other agents such as EGFR tyrosine kinase inhibitors (e.g. erlotinib, gefitinib and lapatinib) are associated with severe diarrhoea (Camp‐Sorrell [27]). The diarrhoea is the result of the inhibitor activating on T‐cell immune response in which many different effects can occur including colitis (Camp‐Sorrell [27]).