How to reduce gastrointestinal reactions during chemotherapy?

1. Is the probability of nausea and vomiting during chemotherapy high? How to define and classify it?

1. Nausea and vomiting are common adverse reactions to cancer drug treatment, with an incidence rate of over 70% in cancer patients.

2. Nausea refers to a state characterized by nausea and/or the urgent need to vomit.

3. Vomiting refers to a reflex action of spitting out stomach contents through the mouth.

4. According to the Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 5.0, nausea is divided into 3 levels:

Grade 1: decreased appetite without changes in eating habits;

Grade 2: Decreased oral intake without significant weight loss, dehydration or malnutrition;

Grade 3: Insufficient oral energy and water intake, requiring nasogastric feeding, total parenteral nutrition or hospitalization.

5. According to the Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 5.0, vomiting is divided into 5 levels:

Grade 1: No intervention required;

Grade 2: Outpatient intravenous rehydration, medical intervention required;

Grade 3: requiring nasogastric feeding, total parenteral nutrition, or hospitalization;

Grade 4: life-threatening, requiring urgent treatment;

Level 5: Death.

2. What are the methods to reduce nausea and vomiting during chemotherapy?

1. Clinicians will use antiemetic drugs (such as dexamethasone, tropisetron, aprepitant, etc.) to prevent and treat the occurrence of nausea and vomiting according to the risk and severity of nausea and vomiting caused by chemotherapy drugs.

2. Patients can reduce gastrointestinal reactions caused by chemotherapy, such as nausea, vomiting, loss of appetite, abdominal distension, diarrhea, constipation, etc., by optimizing their lifestyle management methods.

3. First, let’s get to know our stomach

1) The stomach is located in the left hypochondrium and is the largest part of the digestive tract.

2) The capacity of an adult’s stomach is 1-2L

3) It has the function of storing and initially digesting food

4) Pure gastric juice is a colorless acidic liquid

5) Daily secretion 1.5-2.5L

6) Digestive function of the stomach: digestion by gastric juice + grinding by gastric motility

7) Gastric wall: mucosal layer, submucosal layer, muscular layer, serosa layer

4. Avoid factors that cause gastric mucosal damage:

1) Stress: trauma, surgery, mental stress, etc.

2) Overeating, overheated food, spicy food, strong alcohol, etc. The Yellow Emperor's Classic of Internal Medicine warns: "When eating and drinking, do not eat too hot or too cold. The right amount of cold and warm should be maintained, so that the Qi will be maintained and you will not suffer from evil."

3) Helicobacter pylori infection (HP infection)

5. How to prevent Helicobacter pylori infection?

If you experience recurring stomach discomfort, such as acid reflux, heartburn, etc., you can go to the hospital for Helicobacter pylori testing. If the Helicobacter pylori test is positive, you need to receive timely eradication treatment.

6. How to optimize lifestyle management to reduce stomach discomfort during chemotherapy?

1. Dietary tips during chemotherapy:

1) Ensure good nutrition and adequate calorie intake

2) Eat warm, soft foods and avoid eating raw, cold, spicy and other irritating foods and hard foods

3) Limit high-fat foods, especially animal products

4) Avoid overeating and eat small and frequent meals - prepare snacks throughout the day, such as yogurt, cereal, fruit (it is recommended to be cooked or steamed before eating), juice, dried fruit, biscuits, bread, mashed potatoes, lotus root starch, etc.

2. Maintain proper exercise:

1) Healthy adults aged 18-64: After physical recovery, it is recommended to do moderate-intensity exercise for 30 minutes (preferably 45-60 minutes) at a time, at least 5 days a week, including at least 2 days of strength training

2) Moderate-intensity physical exercise under the guidance of a professional coach: reach 55%-75% of the maximum heart rate, maximum heart rate = 220-age (for example, for a 40-year-old, the maximum heart rate is 180 beats/minute, and the moderate intensity requires 99-135 beats/minute)

3) Note: If cancer patients are malnourished and have poor physical strength, they need to perform appropriate exercise while receiving nutritional treatment (ensuring the intake of protein/amino acids and energy). During this stage, due to the consumption caused by the disease itself and anti-tumor treatment, nutritional treatment can be appropriately strengthened and exercise intensity can be reduced. High-intensity exercise should be avoided when physical fitness is poor. Choose appropriate exercise methods and amounts according to your own situation, such as walking every day, or moderate-intensity physical exercise under the guidance of a professional coach, 3-5 times a week, 10-60 minutes each time.

7. Optional recipes to relieve digestive tract reactions after chemotherapy

1) Loss of appetite: The color, aroma and taste of food can stimulate appetite; choose food that aids digestion and increases appetite; keep a happy mood

Ginger and Sugar Drink: 10g ginger, 15g maltose, drink with boiling water. It has the effects of dispelling cold, strengthening the spleen and stimulating appetite.

Lotus root powder: beneficial to blood, regulating the middle, and appetizing

Hawthorn cake: Enhances the activity of pepsin and fat decomposition, eliminates food stagnation and promotes appetite

2) Nausea and vomiting: Avoid spicy food, seafood and food with special smell. Eat light and easily digestible food.

Candied radish: Wash and dice 500g fresh white radish, blanch in boiling water for a while, take out, squeeze out the water and dry in the sun for 6 hours; put it in a pot, add 150g honey and boil over low heat, mix well and eat after cooling.

Ginger juice: mash the ginger to extract the juice, add a small amount of boiled water and drink it.

3) Abdominal bloating: high-fiber vegetables, digestive fruits, digestive and bloating-relieving foods, and limit gas-producing foods

Limit gas-producing foods: such as milk, soda, beans, sweet potatoes, potatoes, etc.

High dietary fiber vegetables: such as celery, Chinese cabbage, spinach, cabbage, etc.

Digestive aid fruits: hawthorn, tangerines, oranges, plums, etc.

Digestive food: Cereals such as malt, malt, and roasted barley, etc., soaked in water and drunk as tea

Digestive and bloating-relieving foods: radish, tangerine peel, orange peel, etc.

4) Constipation: Drink more water, eat foods that moisturize the intestines and promote bowel movements

Drink warm water, light salt soup, vegetable soup, soy milk, fruit juice, etc. every morning

Take appropriate amounts of foods that have a laxative effect, such as sesame seeds, honey, etc.

Eat more vegetable oils such as sesame oil, peanut oil, corn oil, rapeseed oil, etc., which have a laxative effect and break down to produce fatty acids to stimulate intestinal peristalsis.

Eating gas-producing foods such as soybeans, sweet potatoes, and potatoes can promote intestinal peristalsis.

Spinach salad: 250g spinach, boiled in water, seasoned with sesame oil, twice a day, suitable for constipation caused by dryness and heat, and qi stagnation

Radish juice: Wash the white radish with cold water, chop and mash it, squeeze the juice into sterilized gauze, add an equal amount of honey, 4-5 spoons each time

5) Diarrhea: Eat a light, low-fat, low-residue diet, and gradually resume eating. In severe cases, temporarily withhold food and water, and give intravenous fluids.

Control your diet and pay attention to replenishing water. Oral rehydration salt solution can be used. In severe cases, you may need to temporarily stop drinking water and give intravenous fluids.

Light, low-fat, low-residue diet, such as egg white water, rice soup, soft noodles, lotus root starch, thin noodles

Avoid gas-producing foods such as milk and sucrose in the early stages

After the diarrhea has basically stopped, eat a low-fat, low-residue semi-liquid diet or soft rice, small meals, such as noodles, porridge, steamed buns, lean meat paste

Chinese Yam, Tangerine Peel and Jujube Soup: Peel 10g of fresh Chinese yam, slice it, put it into a pot with tangerine peel and jujube, add appropriate amount of water and simmer it into a soup. You can add a small amount of sugar. It has the function of strengthening the spleen and stopping diarrhea, and promoting appetite. It is suitable for those who lack appetite and have loose stools.

VII. Summary

Gastrointestinal reactions caused by chemotherapy are common adverse reactions, including nausea and vomiting, loss of appetite, abdominal distension, diarrhea, constipation, etc., which affect the daily quality of life of patients. Many patients are often afraid of chemotherapy due to the gastrointestinal reactions caused by chemotherapy. This popular science content focuses on how to reduce gastrointestinal reactions during chemotherapy, and focuses on how to reduce gastrointestinal reactions during chemotherapy by optimizing lifestyle management and adjusting daily diet, hoping to help more cancer patients.

Reference books:

1. Cai Donglian et al., Practical Nutritionist Handbook [M], People's Medical Publishing House, December 2009

2. CSCO Guidelines for Nutritional Therapy in Patients with Malignant Tumors (2021)

3. Expert consensus on the prevention and treatment of nausea and vomiting associated with cancer drug therapy in China (2022 edition)

4. Physiology, 9th edition [M], People's Medical Publishing House; Systematic Anatomy, 9th edition [M], People's Medical Publishing House

About the Author:

Physician of breast, head and neck tumors at the First Affiliated Hospital of Jinzhou Medical University, Master of Oncology, Secretary of the Professional Committee of Oncology, Cardiology and Cell Biology Research of Liaoning Cell Biology Society.

Since practicing medicine, he has been adhering to the department's philosophy of "keeping healthy people healthy and making sick people healthier" and actively participated in a series of health education activities for cancer patients.