# Anticipatory nausea and vomiting before chemotherapy: prevention and treatment

Source: https://onco.cc/protocols/anticipatory-nausea-and-vomiting/  
OnCo record `anticipatory-nausea-and-vomiting` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Some people feel sick, or are sick, before a chemotherapy session, set off by the hospital or a smell: a learned reaction to sickness in earlier cycles. The best protection is good anti-sickness medicine from the first cycle. If it happens, tell your team: relaxation training helps, and a calming tablet such as lorazepam the night before and on the morning of treatment can be offered.

## Summary

Anticipatory nausea and vomiting is a conditioned response that follows poorly controlled nausea in earlier cycles. MASCC/ESMO (2016, unchanged from 2009 and still the latest statement) recommend preventing it by optimal control of acute and delayed chemotherapy-induced nausea and vomiting, and treating it with benzodiazepines and behavioural therapies, in particular progressive muscle relaxation, systematic desensitisation and hypnosis; their 2016 search found no new trial meeting its criteria. eviQ (reviewed 2024) gives lorazepam 0.5 to 1 mg orally the night before and 1 to 2 hours before treatment. A 2024 meta-analysis for the Japanese antiemesis guideline found that systematic desensitisation reduced anticipatory nausea (risk ratio 0.60) and vomiting (0.54) in a few small, mostly high-risk-of-bias studies. In a randomised trial of 474 people, 20-minute nurse-delivered mindfulness relaxation or relaxing music reduced anticipatory nausea at the midpoint of chemotherapy but not at the end. The 2023 MASCC/ESMO update suggests progressive muscle relaxation, alone or with guided imagery, as an adjunct for chemotherapy-induced nausea generally [II, B].

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: anticipatory nausea; ANV; conditioned nausea before chemotherapy; anticipatory emesis; feeling sick before chemotherapy
- Tags: protocol; nausea-and-vomiting; supportive-care

## Connected records

- protocols: [Antiemetic prophylaxis for chemotherapy by emetic risk](https://onco.cc/protocols/antiemetic-prophylaxis-by-emetic-risk/), [Nausea and vomiting in advanced cancer not caused by cancer treatment](https://onco.cc/protocols/nausea-and-vomiting-in-advanced-cancer/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Antiemetics for chemotherapy-induced nausea and vomiting](https://onco.cc/technologies/antiemetic-therapy/), [Clinical hypnosis for procedures, pain and hot flushes](https://onco.cc/technologies/hypnosis-cancer-care/), [Relaxation training and guided imagery](https://onco.cc/technologies/relaxation-guided-imagery/)
- institutions: [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/), [Multinational Association of Supportive Care in Cancer](https://onco.cc/institutions/mascc/)

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