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Efficacy of Ginger in Control of Chemotherapy Induced Nausea and Vomiting in Breast Cancer Patients Receiving Doxorubicin-Based Chemotherapy

  • Ansari, Mansour (Breast Diseases Research Center, Shiraz University of Medical Sciences) ;
  • Porouhan, Pezhman (Breast Diseases Research Center, Shiraz University of Medical Sciences) ;
  • Mohammadianpanah, Mohammad (Colorectal Research Center) ;
  • Omidvari, Shapour (Breast Diseases Research Center, Shiraz University of Medical Sciences) ;
  • Mosalaei, Ahmad (Radiation Oncology, Shiraz Institute for Cancer Research) ;
  • Ahmadloo, Niloofar (Breast Diseases Research Center, Shiraz University of Medical Sciences) ;
  • Nasrollahi, Hamid (Breast Diseases Research Center, Shiraz University of Medical Sciences) ;
  • Hamedi, Seyed Hasan (Breast Diseases Research Center, Shiraz University of Medical Sciences)
  • Published : 2016.08.01

Abstract

Nausea and vomiting are among the most serious side effects of chemotherapy, in some cases leading to treatment interruption or chemotherapy dose reduction. Ginger has long been known as an antiemetic drug, used for conditions such as motion sickness, nausea-vomiting in pregnancy, and post-operation side effects. One hundred and fifty female patients with breast cancer entered this prospective study and were randomized to receive ginger (500 mg ginger powder, twice a day for 3 days) or placebo. One hundred and nineteen patients completed the study: 57 of them received ginger and 62 received ginger for the first 3 chemotherapy cycles. Mean age in all patients was 48.6 (25-79) years. After 1st chemotherapy, mean nausea in the ginger and control arms were 1.36 (${\pm}1.31$) and 1.46 (${\pm}1.28$) with no statistically significant difference. After the $2^{nd}$ chemotherapy session, nausea score was slightly more in the ginger group (1.36 versus 1.32). After $3^{rd}$ chemotherapy, mean nausea severity in control group was less than ginger group [1.37 (${\pm}1.14$), versus 1.42 (${\pm}1.30$)]. Considering all patients, nausea was slightly more severe in ginger arm. In ginger arm mean nausea score was 1.42 (${\pm}0.96$) and in control arm it was 1.40 (${\pm}0.92$). Mean vomiting scores after chemotherapy in ginger arm were 0.719 (${\pm}1.03$), 0.68 (${\pm}1.00$) and 0.77 (${\pm}1.18$). In control arm, mean vomiting was 0.983 (${\pm}1.23$), 1.03 (${\pm}1.22$) and 1.15 (${\pm}1.27$). In all sessions, ginger decreased vomiting severity from 1.4 (${\pm}1.04$) to 0.71 (${\pm}0.86$). None of the differences were significant. In those patients who received the AC regimen, vomiting was less severe ($0.64{\pm}0.87$) comparing to those who received placebo ($1.13{\pm}1.12$), which was statistically significant (p-Value <0.05). Further and larger studies are needed to draw conclusions.

Keywords

Chemotherapy;nausea;vomiting;ginger

Acknowledgement

Supported by : Shiraz University of Medical Sciences

References

  1. Chaiyakunapruk N, Kitikannakorn N, Nathisuwan S, et al (2006). The efficacy of ginger for the prevention of postoperative nausea and vomiting: a meta-analysis. Am J Obstet Gynecol, 194, 95-9. https://doi.org/10.1016/j.ajog.2005.06.046
  2. Chrubasik S, Pittler MH, Roufogalis BD (2005). Zingiberis rhizoma: a comprehensive review on the ginger effect and efficacy profiles. Phytomedicine, 12, 684-701. https://doi.org/10.1016/j.phymed.2004.07.009
  3. Ernst E, Pittler MH (2000). Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials. Br J Anaesth, 84, 367-71. https://doi.org/10.1093/oxfordjournals.bja.a013442
  4. Fahimi F, Khodadad K, Amini S, et al (2011). Evaluating the effect of Zingiber officinalis on nausea and vomiting in patients receiving cisplatin based regimens. Iranian J Pharmaceutical Res, 10, 379.
  5. Giacosa A, Morazzoni P, Bombardelli E, et al (2015). Can nausea and vomiting be treated with ginger extract? Eur Rev Med Pharmacol Sci, 19, 1291-6.
  6. Manusirivithaya S, Sripramote M, Tangjitgamol S, et al (2004). Antiemetic effect of ginger in gynecologic oncology patients receiving cisplatin. Int J Gynecological Cancer, 14, 1063-9. https://doi.org/10.1111/j.1048-891X.2004.14603.x
  7. Marx W, McCarthy AL, Ried K, et al (2014). Can ginger ameliorate chemotherapy-induced nausea? Protocol of a randomized double blind, placebo-controlled trial. BMC Complement Altern Med, 14, 134. https://doi.org/10.1186/1472-6882-14-134
  8. Marx WM, Teleni L, McCarthy AL, et al (2013). Ginger (Zingiber officinale) and chemotherapy-induced nausea and vomiting: a systematic literature review. Nutr Rev, 71, 245-54. https://doi.org/10.1111/nure.12016
  9. Navari RM, Aapro M (2016). Antiemetic Prophylaxis for Chemotherapy-Induced Nausea and Vomiting. N Engl J Med, 374, 1356-67. https://doi.org/10.1056/NEJMra1515442
  10. Palatty PL, Haniadka R, Valder B, et al (2013). Ginger in the prevention of nausea and vomiting: a review. Crit Rev Food Sci Nutr, 53, 659-69. https://doi.org/10.1080/10408398.2011.553751
  11. Panahi Y, Saadat A, Sahebkar A, et al (2012). Effect of ginger on acute and delayed chemotherapy-induced nausea and vomiting: a pilot, randomized, open-label clinical trial. Integr Cancer Ther, 11, 204-11.
  12. Pillai AK, Sharma KK, Gupta YK, et al (2011). Anti-emetic effect of ginger powder versus placebo as an add-on therapy in children and young adults receiving high emetogenic chemotherapy. Pediatric Blood Cancer, 56, 234-8. https://doi.org/10.1002/pbc.22778
  13. Ryan JL, Heckler CE, Roscoe JA, et al (2012). Ginger (Zingiber officinale) reduces acute chemotherapy-induced nausea: a URCC CCOP study of 576 patients. Support Care Cancer, 20, 1479-89. https://doi.org/10.1007/s00520-011-1236-3
  14. Shankar A, Roy S, Malik A, et al (2015). Prevention of chemotherapy-induced nausea and vomiting in cancer patients. Asian Pac J Cancer Prev, 16, 6207-13. https://doi.org/10.7314/APJCP.2015.16.15.6207
  15. Sharma SS, Gupta YK (1998). Reversal of cisplatin-induced delay in gastric emptying in rats by ginger (Zingiber officinale). J Ethnopharmacol, 62, 49-55. https://doi.org/10.1016/S0378-8741(98)00053-1
  16. Sontakke S, Thawani V, Naik M (2003). Ginger as an antiemetic in nausea and vomiting induced by chemotherapy: a randomized, cross-over, double blind study. Indian J Pharmacology, 35, 32-6.
  17. Wang SY, Yang ZJ, Zhang L (2014a). Olanzapine for preventing nausea and vomiting induced by moderately and highly emetogenic chemotherapy. Asian Pac J Cancer Prev, 15, 9587-92. https://doi.org/10.7314/APJCP.2014.15.22.9587
  18. Wang SY, Yang ZJ, Zhang Z, et al (2014b). Aprepitant in the prevention of vomiting induced by moderately and highly emetogenic chemotherapy. Asian Pac J Cancer Prev, 15, 10045-51.
  19. Weimer K, Schulte J, Maichle A, et al (2012). Effects of ginger and expectations on symptoms of nausea in a balanced placebo design. PLoS One, 7, 49031. https://doi.org/10.1371/journal.pone.0049031