Medical Oncologist
Nausea and sickness
A written sickness plan for chemotherapy
Four things: which medicines to take and exactly when, what to do if sickness breaks through anyway, the point at which you call the helpline, and the point at which you go straight to hospital. On one sheet, where the whole household can see it. Most people leave the clinic with the tablets but without those four answers written down, and then decide at eleven at night from memory.
NG
Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
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The short answer
What should a sickness plan actually contain?
Four things: which medicines to take and exactly when, what to do if sickness breaks through anyway, the point at which you call the helpline, and the point at which you go straight to hospital. Written on one sheet, stuck where the whole household can see it.
Most people leave the clinic with the tablets but without those four answers written down, and then make decisions at eleven at night from memory. A plan on paper is what turns a bad evening into a manageable one.
Why it has to be written
Because the person who needs it at midnight may not be the person who was at the appointment. A son arriving from another city, a neighbour helping out, or the patient themselves when they are drowsy and unwell — none of them can rely on what was said three weeks earlier.
Fill this in with your nurse at the next visit rather than guessing. It takes five minutes of their time.The sheet
What to write down, section by section
Copy these headings onto one sheet and get your team to fill in the details for your own treatment.
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Before and on treatment day
Anything to take the night before or the morning of treatment, and what is given in the unit. Note whether to eat beforehand, and what to take with you.
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The days straight after
Which tablets, at what times, and for how many days — including the days you feel well. This is the part most often taken wrongly, and it is the part that matters most.
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If sickness breaks through
What to take as a rescue, how soon it can be repeated, and what to do if a tablet comes back up. Write the maximum clearly so nobody has to guess in the middle of the night.
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Call the helpline when
The specific thresholds your team gives you — how many episodes, how long without keeping fluids down, how many days without a motion. Write their numbers, not general ones.
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Go to hospital when
A fever, nothing staying down for most of a day, blood in the vomit, severe stomach pain, no urine since the morning, drowsiness or confusion. Write which hospital, and how you would get there at night.
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The daily record
A few columns at the bottom: date, how sick, anything vomited, what was taken, temperature, what was drunk. One line a day, taken to every appointment.
Not sure whether this applies to you?
Ask an oncologistQuestions to get answered
What to ask so the sheet can be filled in
- Which tablets do I take on treatment day, and at what time?
- Which do I take afterwards, for how many days, and on days I feel well?
- What do I take if I still feel sick despite them?
- What do I do if a tablet comes back up?
- At what point should I telephone rather than wait?
- At what point should I go straight to an emergency department?
- Which of these medicines must I not miss, and which are optional?
- Is there anything I should avoid taking alongside these?
- Which number do I call at night and at weekends?
!
These go on the sheet as "go now"
A fever · nothing staying down for most of a day · vomit containing blood or looking like coffee grounds · severe stomach pain, or a swollen hard stomach · very little or no urine since the morning · drowsy, confused, or dizzy standing up. Go to the nearest emergency department and say clearly that the person is on chemotherapy. Do not give paracetamol to bring a temperature down before being seen.
Making it work
Where to put it, and how to keep it useful
Stick it where decisions actually get made — on the fridge, or beside the bed if the person is not moving much. Take a photograph of it on every family member's phone, so whoever is present at a difficult moment has it.
Set alarms rather than relying on memory
The commonest reason an anti-sickness plan fails is doses taken late or missed on days someone felt well. Phone alarms for each dose, for the full number of days, fix most of that without any change to the medicine.
Update it after every cycle
If the plan changed at the last appointment, rewrite the sheet rather than amending it in the margin. An out-of-date sheet is worse than none, because people follow it confidently. Note the date on it.
Take the record to every appointment
The bottom section — how sick, for how many days, what was taken, whether it helped — is what allows the plan to be tuned. Teams respond to specifics far better than to "it was difficult", and the record is where the specifics live.
If a plan is changed, ask what is different and why, and check the new boxes against the old ones before leaving.Leave a number, we will call you
One field. No form to fill in, and no charge for the call.
Being straight with you
What this page cannot tell you
It cannot fill in the plan for you. The medicines, the timings, the number of days and the thresholds for calling all depend on which chemotherapy you are having and how strongly it causes sickness. A plan copied from a page would be wrong for most people, and dangerous for some.
It also cannot replace the conversation. What this gives you is the set of questions to ask and the shape of the answers, so that you leave the clinic with something written rather than something remembered.
What to do next
Copy the headings onto a sheet before your next appointment and take it with you. Ask the nurse to fill it in with you. Stick it on the fridge, photograph it on every phone in the family, and set the alarms. Then start the daily record from the next cycle.
Questions we are asked
Common questions about a sickness plan
Is there a ready-made chart we can download?
The version that works is the one filled in for your own treatment, because the medicines, timings and thresholds are individual. Copy the headings onto a sheet, take it to the appointment, and ask your nurse to complete it with you. That takes about five minutes of their time.
Do I really need to take tablets on days I feel fine?
Usually yes, and this is the most important line on the sheet. Most anti-sickness medicines work preventively, for a set number of days after each cycle, whether or not sickness has appeared. Stopping early because you feel well is the commonest reason a plan seems to fail.
What should we do if a tablet is vomited back up?
Ask your team for their instruction and write it on the sheet, because the answer differs between medicines. Do not keep swallowing and bringing up tablets — if nothing is staying down, that is a reason to contact the team, since medicine can be given by injection instead.
Who should have a copy?
Everyone who might be present at a bad moment. Stick it on the fridge and photograph it on every family member's phone, including anyone who visits or stays overnight. The person who needs it at midnight is often not the one who was at the appointment.
What if the plan changes?
Rewrite the whole sheet rather than amending it, and put the date on it. An out-of-date sheet is worse than none, because people follow it confidently. Check the new medicine boxes against the old ones before leaving the hospital so nothing gets taken on the wrong schedule.
Should the daily record be shown to the patient?
Keep it factual and keep it for the clinic rather than using it as a running commentary. Reading out how little someone has eaten or how many times they were sick adds pressure at exactly the wrong moment. Its value is at the appointment, not at the bedside.
How long should we keep the record going?
Through the whole course, at one line a day. Once the plan is tuned and cycles become predictable, it takes seconds. It is also what shows a pattern if things start getting worse, which is when it becomes most valuable.
What if we cannot reach anyone on the helpline?
Write on the sheet which hospital you would go to at night and how you would get there, decided in advance while things are calm. If any of the "go now" signs are present, do not spend time trying to reach someone — go, and say clearly that the person is on chemotherapy.
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Sources
- National Cancer Institute — Nausea and Vomiting Related to Cancer Treatment (PDQ)
- Cancer Research UK — Sickness and cancer drugs
- Macmillan Cancer Support — Feeling sick and being sick
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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