Ginger

Ginger

PEP Topic 
Chemotherapy-Induced Nausea and Vomiting
Description 

Ginger is a plant herb used in traditional Chinese and Indian medicine for the treatment of nausea and vomiting. Ginger has aromatic, spasmolytic, carminative, and absorbent properties that suggest direct effects on the gastrointestinal tract. Ginger has been evaluated for management of chemotherapy-induced nausea and vomiting (CINV).

Effectiveness Not Established

Systematic Review/Meta-Analysis

Ernst, E., & Pittler, M.H. (2000). Efficacy of ginger for nausea and vomiting: A systematic review of randomized clinical trials. British Journal of Anaesthesia, 84, 367-71.

doi: 10.1093/oxfordjournals.bja.a013442
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Search Strategy:

  • Databases searched were MEDLINE, Embase, Biosis, CISCOM, and Cochrane Library.
  • Searched keywords were ginger, herbal remedy, nausea, and vomiting.

Literature Evaluated:

The review identified three studies on postoperative nausea, one for seasickness, one for morning sickness, and one for chemotherapy-induced nausea and vomiting (CINV). Studies were performed in the United States and in Denmark.

Sample Characteristics:

The total number of participants in the studies was 288 for postoperative nausea, 30 for morning sickness, 80 for seasickness, and 41 for CINV.

Conclusions:

Clinical data was insufficient to draw a firm conclusion on the benefits of ginger for nausea and vomiting.

Nursing Implications:

Although no adverse events were reported in these studies, ginger may have an adverse effect. A German monograph reported that ginger may be mutagenic in pregnancy.

Lee, J., & Oh, H. (2013). Ginger as an antiemetic modality for chemotherapy-induced nausea and vomiting: a systematic review and meta-analysis. Oncology Nursing Forum, 40, 163-170.

doi: 10.1188/13.ONF.163-170
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Purpose:

To review and evaluate the evidence on the effect of ginger as a modality for management of chemotherapy-induced nausea and vomiting (CINV)


 

Search Strategy:

Databases searched were MEDINE, CINAHL, Embase, Cochrane central register, Korean Studies information service system, and dissertation central.

Search keywords were chemotherapy, nausea, vomiting, chemotherapy induced nausea and vomiting, ginger, ginger extract and Zingiver officinale.

The reference lists of retrieved articles also were reviewed.

The inclusion criteria were not specifically stated, but all studies were double blind randomized controlled trials (RCTs).

The exclusion criteria were not stated. However, specific studies that combined ginger with another treatment, did not include sufficient information about the sample and intervention, and examined outcomes per episode of chemotherapy rather than by patient were excluded.

Literature Evaluated:

  • A total of 11 RCTs were initially identified.
  • Reviewers used the Jadad scale to evaluate study quality.

 

Sample Characteristics:

  • Five studies were included in the final review.
  • Study samples ranged from 17-576 patients.
  • Studies involved various cancer types and various chemotherapy emetic potentials.

Phase of Care and Clinical Applications:

All patients were in active antitumor treatment.

Results:

Three of the studies compared ginger to placebo, and two compared it to metoclopramide or ondansetron. Most of the trials did not use an NK1 in the antiemetic regimen, which is the current recommended guideline. Side effects reported with ginger included drowsiness, sleepiness, dry mouth, thirst, heartburn or restlessness. One study reported bruising, flushing, or rash. Meta-analyses concluded that ginger had no significant effect on control of acute or delayed nausea or vomiting.

Conclusions:

Results do not support the use of ginger and did not show an antiemetic effect of ginger for management of CINV.

Limitations:

  • The number of studies included in the review was limited.
  • The meta analysis had high heterogeneity. 
  • Not all studies specified the chemotherapy used and one study combined use with low, moderate, and high emetogenic chemotherapy regimens. 
  • Most antiemetic regimens used with ginger did not incorporate current treatment guidelines for CINV.

Nursing Implications:

Ginger does not appear to be effective for the management of CINV.

Marx, W.M., Teleni, L., McCarthy, A.L., Vitetta, L., McKavanagh, D., Thomson, D., & Isenring, E. (2013). Ginger (Zingiber officinale) and chemotherapy-induced nausea and vomiting: A systematic literature review. Nutrition Reviews, 71, 245-254.

doi:10.1111/nure.12016
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Purpose:

To review the current published research from randomized controlled trials (RCTs) and crossover trials evaluating the efficacy of ginger for prevention of chemotherapy-induced nausea and vomiting (CINV)

Search Strategy:

Databases searched were PubMed, CINAHL, and Cochrane library.

Search keywords were ginger, cancer , chemotherapy, nausea, emesis, vomiting, and CINV.

Studies were included in the review if they

  • Were RCTs or crossover trials.
  • Involved ginger as the main intervention.
  • Were in English language.

Study exclusions were not reported.

Literature Evaluated:

  • A total of 27 references were initially retrieved.
  • Studies were rated using the National Health and Medical Research Council hierarchy of evidence. 
  • The overall body of evidence was rated according to the American Dietetic Association quality criteria checklist.

Sample Characteristics:

  • Seven studies were included in the final review.
  • Sample sizes ranged from 36-576 patients in each trial for a total of 1,013 patients across all studies.
  • One study was of children. Samples included male and female participants.

Phase of Care and Clinical Applications:

  • All patients were in active antitumor treatment.
  • The report has applications for pediatrics.

Results:

  • Four studies reported positive results with ginger, and three showed no benefit. 
  • Varied ginger doses were used, and various comparisons were used.
  • Only one study involved use of a 5-HT3 or other recommended CINV treatment in the regimen. 
  • All studies were rated as level II (with level I as the highest level); however, not all studies reported how CINV was measured, and one involved multiple emetogenicity levels.

Conclusions:

At best, findings show mixed results for use of ginger.  Overall body of evidence was rated as “C’ in which “D” was the lowest possible level.

Limitations:

  • The number of studies was limited.
  • The quality rating method used was questionable, because all studies were highly rated for quality but some did not even define the method of CINV measurement. 
  • The review did not take into account what treatments were used for control comparisons, and many did not include recommended treatments.

Nursing Implications:

This review does not support the use of ginger for CINV prevention.

Research Evidence Summaries

Levine, M.E., Gillis, M.G., Koch, S.Y., Voss, A.C., Stern, R.M., & Koch, K.L. (2008). Protein and ginger for the treatment of chemotherapy-induced delayed nausea. Journal of Alternative and Complementary Medicine, 14, 545–551.

doi:10.1089/acm.2007.0817
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Study Purpose:

To determine the extent to which protein meals along with ginger, when used as adjuvant therapies for standard antiemetic treatment, reduce delayed nausea

Intervention Characteristics/Basic Study Process:

Patients were assigned randomly to 1 of 3 experimental groups. The Protein (P) and High Protein (HP) Groups received test meals of varying protein content and dried powdered ginger root in addition to standard antiemetic medication; the Control Group received only standard antiemetic medication.

The P and HP Groups were asked to consume two test meals daily for three days beginning 24 hours after their first chemotherapy session. Patients in the Control Group consumed their normal diet.

Patients completed daily diaries during the three-day study. Investigators called patients daily to monitor for adverse events, answer questions, remind patients to eat the test meals, and remind them to complete diaries.

Sample Characteristics:

  • The study consisted of 28 participants.
  • Patient ages ranged from 29–83 years with a mean of 54.3 years.
  • The majority of patients were female (75%).
  • Cancer diagnoses were breast, Hodgkin and non-Hodgkin lymphoma, bladder, lung, gastric, and prostate.
  • Patients were treated with 13 different chemotherapy regimens using six different types of antiemetics.
  • Patients were receiving their first chemotherapy treatment with moderately emetogenic chemotherapy (MEC) or highly emetogenic chemotherapy (HEC).

Setting:

The setting was not reported.

Phase of Care and Clinical Applications:

All patients were in active treatment.

Study Design:

This was a randomized controlled trial, non-blinded study.

Measurement Instruments/Methods:

An Electrogastrogram Symptom Diary was used to report nausea symptoms incidence, frequency, and intensity. Patients also recorded use of as-needed antiemetics.

Results:

  • Reports of nausea, frequent nausea, and bothersome nausea were significantly less common (p < 0.01) among the HP Group patients than among the Control and P Group patients.
  • Significantly fewer patients in the HP Group used antiemetic medication (p < 0.05). The differences between the P and Control groups were not statistically significant.
  • In the five patients who had tests of gastric myeoelectrical activity performed, a significant decrease in gastric dysrhythmia occurred after ingestion of the protein and ginger (p <  0.05).

Conclusions:

High-protein meals with ginger reduced delayed nausea associated with chemotherapy and use of antiemetic medications.

Limitations:

  • The sample size was small.
  • A standardized measurement tool for report of nausea was not used.
  • Conclusions cannot be drawn on the role of ginger in reducing nausea because of possible interactions between ginger and high doses of protein.
  • Samples were widely variable in terms of cancer types, cytotoxic agents, and prescribed antiemetic medications.
  • The study lacked an adequate control group for the ginger component of the test meals and a placebo meal that contained neither ginger nor protein.
  • Daily phone calls to patients from investigators may have skewed results.

Nursing Implications:

The limitations of this study limit the ability to draw conclusions for nursing practice.

Manusirivithaya, S., Sripramote, M., Tangjitgamol, S., Sheanakul, C., Leelahakorn, S., Thavaramara, T., et al. (2004). Antiemetic effect of ginger in gynecologic oncology patients receiving cisplatin. International Journal of Gynecologic Cancer, 14, 1063-1069.

doi: 10.1111/j.1048-891X.2004.14603.x
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Study Purpose:

To determine the potential antiemetic effect of ginger in cisplatin-induced emesis

Intervention Characteristics/Basic Study Process:

Patients were randomized to one of two groups. In regimen A, patients received 1 g of ginger per day for five days starting on the first day of chemotherapy. In regimen B, patients received a placebo on day one and metoclopramide on days two through five.

Sample Characteristics:

  • The study consisted of 48 patients.
  • All patients were female.
  • All patients were being treated for gynecologic cancers and were receiving cisplatin chemotherapy.

Setting:

The study was conducted in Bangkok, Thailand.

Measurement Instruments/Methods:

Investigators assessed nausea and vomiting on day one. On days 2-5, patients recorded the presence and intensity of emetic episodes on diary cards.

Results:

In regimen A, no effect was found in acute or delayed treatment. In regimen B, ginger had the same control as 40 mg metoclopramide for delayed nausea.

Limitations:

  • The sample size was small.
  • Comparing antiemetics was difficult because the study did not use 5-HT3 antiemetics.

Panahi, Y., Saadat, A., Sahebkar, A., Hashemian, F., Taghikhani, M., & Abolhasani, E. (2012). Effect of ginger on acute and delayed chemotherapy-induced nausea and vomiting: A pilot, randomized, open-label clinical trial. Integrative Cancer Therapies, 11, 204-211.

doi:10.1177/1534735411433201
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Study Purpose:

To evaluate the effects of ginger on acute and delayed chemotherapy-induced nausea and vomiting (CINV) in women being treated for breast cancer

Intervention Characteristics/Basic Study Process:

Consecutive patients were alternatively assigned to the treatment or control group. Those in the treatment group were given 1.5 g ginger per day in addition to a standard antimetic regimen. The standard regimen consisted of graniestron plus dexamethasone. Treatment was given for four days.

Sample Characteristics:

  • The study consisted of 78 patients.
  • The mean age of patients was not reported.
  • All of the patients were female.
  • All of the patients had been diagnosed with  breast cancer; the majority were receiving docetaxel, epirubicin, and cyclophosphamide.

Setting:

The study was conducted at a single site in Iran.

Phase of Care and Clinical Applications:

All patients were in active antitumor treatment.

Study Design:

This was a randomized, open-label comparison.

Measurement Instruments/Methods:

The Rhodes index of nausea, vomiting, and retching was used to measure CINV.

Results:

The authors reported that patients in the treatment group had significantly less nausea in the first six hours of the study; however, no differences were found between groups at any other time point, and no differences were found between groups in terms of vomiting.

Conclusions:

No significant differences were found between groups in CINV other than less nausea in the first six hours after chemotherapy with ginger.

Limitations:

  • The sample size was small with fewer than 100 participants.
  • A risk of bias exists because no blinding or random assignment was used.
  • The measurement methods were not well described. The timing and exact use of CINV measurement was not described. 
  • The randomization of group assignment was questionable.
  • No demographic information was reported. Evaluation of demographic differences between the groups, which could have influenced CINV, was not included.
  • The authors suggested that ginger had positive effects, despite the lack of major significant findings, suggesting study bias. 
  • The study period was short.
  • Patient experience with previous chemotherapy courses or prior CINV was not reported.

Nursing Implications:

These findings did not provide strong support for the efficacy of ginger in the management or prevention of acute or delayed CINV in patients receiving moderately emetogenic chemotherapy.

Pillai, A.K., Sharma, K.K., Gupta, Y.K., & Bakhshi, S. (2010). Anti-emetic effect of ginger powder versus placebo as an add-on therapy in children and young adults receiving high emetogenic chemotherapy. Pediatric Blood and Cancer, 56, 234–238.

doi: /10.1002/pbc.22778
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Study Purpose:

To evaluate the efficacy of ginger powder in reducing chemotherapy-induced nausea and vomiting (CINV) in children and young adults

Intervention Characteristics/Basic Study Process:

Participants were randomly assigned to receive either ginger powder tablets or placebo tablets to be taken daily at night during the first three days of chemotherapy and then three times daily for the next two days after chemotherapy was completed. The total dose of ginger powder was 1,000–2,000 mg per day, based on body weight. Ondansetron and dexamethasone were used as standard antiemetics.

Randomization was done for each cycle of chemotherapy. Data were analyzed according to treatment cycle grouping. Patients received a follow-up telephone call on the seventh and tenth days of chemotherapy to reinforce diary use.

Sample Characteristics:

  • The sample consisted of 32 patients who were studied over a total of 60 chemotherapy cycles.
  • Patient ages ranged from 8–21 years old.
  • Data was reported by chemotherapy cycle, not known in patient sample.
  • All patients had been newly diagnosed with bone sarcoma.

Phase of Care and Clinical Applications:

All participants were pediatric patients in active treatment.

Study Design:

This was a randomized, double-blind, placebo-controlled trial.

Measurement Instruments/Methods:

  • The Edmonton Symptom Assessment Scale (ESAS) and National Cancer Institute guidelines for grading of nausea and vomiting were used to measure symptoms.
  • Patients or guardians were instructed to complete daily diaries recording of emesis episodes and questions related to grading of nausea and vomiting.

Results:

  • Incidence of acute nausea in both study groups was 100%. In the control group, acute moderate-to-severe nausea was 93.3% compared to 55.6% in those receiving ginger (p < 0.003).
  • Complete absence of vomiting was reported in 3.3% of controls, compared to 14.81% in the experimental group.
  • Moderate to severe delayed nausea was seen in 73.3% of control cycles compared to 25% in the experimental group (p < 0.001).
  • Moderate to severe delayed-phase vomiting was seen in 46.7% of controls and 14.8% of those who received ginger (p = 0.022).
  • No adverse effects were seen with ginger or the placebo.

Conclusions:

Ginger powder may have a positive impact in reducing acute and delayed nausea as an adjunct to standard antiemetic treatment in children and young adults, and it was not associated with any adverse effects.

Limitations:

  • The sample was small with less than 100 participants.
  • Patients may have received either ginger or placebo during different chemotherapy cycles; however, the study design was not done as an actual crossover design. This is a substantial design flaw in this study.
  • Results showed that there was a complete absence of vomiting in the control cycles for the acute phase; however the authors did not discuss or explain this observation, since all other observations suggested reduction in CINV with ginger. 
  • No discussion of compliance with diary documentation of nausea grading was provided.
  • Analysis of subgroups according to the cycle of chemotherapy was not possible, and anticipatory CINV was not measured.
  • Gender distribution between control and experimental groups was significantly different with more males in the experimental group. Known gender differences occur in adults in response to antiemetic therapies. It is not clear if this is also the case in pediatric patients.

Nursing Implications:

Ginger may be helpful in mitigation of CINV symptoms for younger patients; however, effectiveness remains unclear.

Ryan, J.L., Heckler, C.E., Roscoe, J.A., Dakhil, S.R., Kirshner, J., Flynn, P.J., … Morrow, G.R. (2012). Ginger (Zingiber officinale) reduces acute chemotherapy-induced nausea: A URCC CCOP study of 576 patients. Supportive Care in Cancer, 20, 1479-1489.

doi: 10.1007/s00520-011-1236-3
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Study Purpose:

To determine the dose and efficacy of ginger at reducing the severity of chemotherapy-induced nausea (CIN) on day one of chemotherapy

Intervention Characteristics/Basic Study Process:

Patients were randomly assigned to four arms.

  • Placebo
  • 0.5 g ginger
  • 1.0 g ginger
  • 1.5 g ginger

Nausea occurrence and severity were assessed at a baseline cycle and the two following cycles during which patients were taking their assigned study medication. All patients received a 5-HT3 receptor antagonist antiemetic on day one of all cycles. Patients took three capsules of ginger (250 mg) or placebo twice daily for six days starting three days before the first day of chemotherapy. Patients reported the severity of nausea for days 1–4 of each cycle, four times daily.  Compliance was determined by pill counts.

Sample Characteristics:

  • The sample consisted of 576 patients.
  • Mean age was 53 years.
  • The sample was 91% female.
  • All participants had been diagnosed with cancer and were receiving chemotherapy.
  • All patients had to have experienced nausea in a previous chemotherapy cycle and be scheduled to receive a 5-HT3 plus dexamethasone for antiemetic management. 
  • Baseline values showed that more than 50% of the sample had had previous chemotherapy. Baseline nausea ranged from 2.2–2.5.

Setting:

This was a multisite study conducted at 23 private practice oncology groups  affiliated with the University of Rochester.

Phase of Care and Clinical Applications:

  • Patients were in mutliple phases of care.
  • Applications exist for palliative care.

Study Design:

This was a phase II/III randomized, double blind, placebo-controlled clinical trial.

Measurement Instruments/Methods:

  • Nausea and emesis were measured on a 7-point scale using a modified four-day patient report diary developed by Burish and Carey.
  • A 13-item Symptom Inventory was used to assess potential side effects of ginger, as well as anticipatory nausea, on an 11-point scale.
  • Anticipatory nausea was analyzed using the nausea item on the Symptom Inventory completed prior to chemotherapy.
  • Quality of life was assessed using the 27-item Functional Assessment of Chronic Illness Therapy-General (FACIT-G) at baseline and follow-up assessments .

Results:

  • No significant differences were found between the treatment arms in regard to the use of antiemetics.
  • The mixed model analyses across both study cycles 2 and 3 revealed that all doses of ginger significantly reduced acute CIN in both study cycles compared to placebo (p = 0.013, 0.003). Differences in the least-squares means showed that 0.5 g and 1.0 g daily ginger were the most effective at reducing acute nausea.
  • Data suggested that patients reported more severe delayed nausea compared to acute nausea, and no differences were found between groups in delayed nausea.
  • Overall, no significant differences were observed in vomiting or quality of life between the three ginger arms and placebo.
  • The majority of patients did not report episodes of vomiting (mean incidence = 0.5). 
  • Analysis revealed that anticipatory nausea (p < 0.0001) was a factor in acute CIN.
  • A total of 24 adverse events were reported during the course of the study. Only nine of the reported adverse advents were considered to be related to study drug.

Conclusions:

Ginger given at 0.5 g-1.0 g daily, may aid in the reduction of acute-phase CIN in patients receiving standard antiemetics. The ability to clearly interpret results is difficult because of lack of information on chemotherapy agents involved and differences in antiemetic regimens used.

Limitations:

  • The chemotherapy agents used were not described, so the emetogenicity of the treatment or potential differences between groups, which could have affected results, are not known. 
  • No discussion was provided regarding use or non-use of rescue medications or any other management strategies that may have been used.
  • The antiemetic regimens used were varied, and it is known that different regimens have different levels of effect. 
  • Though inclusion criteria identified use of 5-HT3 medication, results reported show that four different types of regimens were actually employed.

Nursing Implications:

This study showed that ginger significantly reduced nausea in these patients during the acute phase but had no apparent effect on delayed nausea. Studies in the use of ginger have had mixed results, and meta analysis have shown no effect, in contrast to this study. Here, only nausea was examined, which may partially explain differences. Application of these findings is difficult, because the chemotherapy regimens used are not described, so emetogenicity or differences in regimens between groups cannot be evaluated. Also, the antiemetic medications used were varied and subgroup analysis was not done; how this influenced findings is not clear. Even with maximum current pharmacologic management of chemotherapy-induced nausea and vomiting, control of nausea, as opposed to vomiting, has remained problematic. Further research in approaches to effectively manage nausea, as well as emesis is needed.

Yekta, Z.P., Ebrahimi, S.M., Hosseini, M., Nasrabadi, A.N., Sedighi, S., Surmaghi, M.H., & Madani, H. (2012). Ginger as a miracle against chemotherapy-induced vomiting. Iranian Journal of Nursing and Midwifery Research, 17(5), 325–329.

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Study Purpose:

To evaluate the effect of the ginger plant on chemotherapy-induced vomiting

Intervention Characteristics/Basic Study Process:

The intervention persisted for six days starting three days before the chemotherapy session. During this period, all participants took four 250 mg capsules (Zintoma) at six-hour intervals (1 g per day) complemented by the routine antiemetic regimen, including Kytril, or granisetron hydrochloride tablets, (1 mg per day) and dexamethasone ampoules (8 mg per day). A self-made, two-part, self-reporting instrument was used to measure the number of vomiting cases in both the groups. Vomiting times were recorded in the instruments each night just before sleep. 

Sample Characteristics:

  • N = 80
  • AVERAGE AGE = (placebo group) 45.1 +/– 10 years; (intervention group) 41.8 +/– 8.4 years        
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Breast cancer

Setting:

  • SITE: Single site  
  • SETTING TYPE: Inpatient  
  • LOCATION: Tehran, Iran

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Active antitumor treatment
  • APPLICATIONS: Palliative care

Study Design:

Randomized, double-blind, placebo-controlled clinical trial

Measurement Instruments/Methods:

A self-made, two-part, self-reporting instrument was used to measure the number of vomiting cases in both the groups. This instrument was a reliable standard table that has been used in various studies.

Results:

Vomiting cases were meaningfully lower in the ginger group in the anticipatory (p = 0.04), acute (p = 0.04), and delayed (p = 0.003) phases, and after a total sum of six days (p = 0.002). The only stated side effect during the study was heartburn. However, there were no significant differences between the two groups at the anticipatory (p = 0.2), acute (p = 0.06), and delayed (p = 0.5) phases.

Conclusions:

The results of this randomized, controlled trial showed that ginger alleviated nausea and vomiting in patients in the ginger arm compared to the placebo group. Ginger could be a promising antiemetic herbal remedy; however, its positive effects could be dose-related or specific agent-related. Therefore, we need further evidence, including multiagent chemotherapy with different types of cancers.

Limitations:

  • The paper stated that participants received single-day chemotherapy. Although the prescribed antiemetics (e.g., Kytril,  Zofran, and dexamethasone) were clearly identified, this paper lacked information regarding the names of the chemotherapy agents. According to Table 1, the researchers considered chemotherapy agents to be low to moderately emetogenic, and refer the reader to check the American Society of Clinical Oncology's guidelines.
  • Small sample (< 100)
  • Key sample group differences that could influence results
  • Other limitations/explanation: This study was only done on women with breast cancer undergoing single-day courses of chemotherapy. Results were only connected with and applicable for patients with breast cancer and, consequently, cannot be generalized to other types of cancers.

Nursing Implications:

The nursing implication was confined to teaching patients and their families about the ginger capsules.

Zick, S.M., Ruffin, M.T., Lee, J., Normolle, D.P., Siden, R., Alrawi, S., & Brenner, D.E. (2009). Phase II trial of encapsulated ginger as a treatment for chemotherapy-induced nausea and vomiting. Supportive Care in Cancer, 17, 563–572.

doi: 10.1007/s00520-008-0528-8
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Study Purpose:

To evaluate the efficacy of ginger in relief of delayed chemotherapy-induced nausea and vomiting (CINV)

Intervention Characteristics/Basic Study Process:

Patients with cancer who had experienced CINV during at least one previous round of chemotherapy were asked to participate. All participants were receiving a 5-HT3 receptor antagonist or aprepitant as part of their standard antiemetic regimen. Patients were randomized to receive either 1.0 g of ginger, 2.0 g of ginger, or matching placebo daily for three days.

Sample Characteristics:

  • The study consisted of 162 participants.
  • The mean age was 55.7 years.
  • The majority of the participants was female.
  • Specific diagnoses were not stated.
  • Patients were receiving a variety of chemotherapy drugs of low, moderate, and high emetogenic risk.

Setting:

The study was conducted at multiple outpatient settings in Ann Arbor, MI.

Phase of Care and Clinical Applications:

All patients were in active treatment.

Study Design:

This was a randomized double-blind, placebo-controlled trial.

Measurement Instruments/Methods:

The Morrow Assessment of Nausea and Emesis (MANE) and the National Cancer Institute (NCI) Common Toxicity Criteria version 3.0 for Adverse Events were used.

Results:

  • More than half (58%) of study participants reported experiencing both acute and delayed nausea; 30.9% reported acute vomiting or retching; and 24.7% reported delayed vomiting or retching.
  • No significant difference was found between either of the ginger doses compared to placebo in the terms of acute or delayed nausea or vomiting. This was consistent when participants were stratified by whether  aprepitant was prescribed as part of their CINV treatment.
  • Participants who received the higher dose of ginger (2.0 g) reported having significantly more severe episodes of delayed nausea compared to both placebo and low-dose ginger.

Conclusions:

  • Ginger extract provided no benefit in reducing prevalence of delayed nausea and vomiting when added to standard contemporary antiemetic therapy.
  • When ginger was taken with aprepitant, prevalence of delayed vomiting was higher (although this did not reach statistical significance).

Limitations:

  • The study lacked an adequate sample size.
  • Participants reported that they knew if they were randomized to either of the ginger treatment arms based on the taste of the capsule.

Nursing Implications:

Ginger extract provides no clinical benefit at the doses evaluated when given in addition to standard, evidence-based medical therapy to prevent CINV. Ginger extract may have a negative effect on severity of nausea when taken with aprepitant.


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