Grape Juice

Grape Juice

PEP Topic 
Chemotherapy-Induced Nausea and Vomiting
Description 

Juice from grapes is rich in flavonoids, which have antioxidant properties and act as scavengers of free radicals. This may inhibit related damage to cells. The effect of grape juice ingestion as an adjunct to antiemetics was tested in patients with cancer for management of chemotherapy-induced nausea and vomiting (CINV). Flavonoids were hypothesized to reduce the severity of chemotherapy-related cell damage, thereby reducing one of the possible stimuli for CINV.

Effectiveness Not Established

Research Evidence Summaries

Ingersoll, G.L., Wasilewski, A., Haller, M., Pandya, K., Bennett, J., He, H., … Berry, C. (2010). Effect of Concord grape juice on chemotherapy-induced nausea and vomiting: Results of a pilot study. Oncology Nursing Forum, 37, 213–221. 

doi: 10.1188/10.ONF.213-221
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Study Purpose:

To determine the feasibility of administering a flavonoid-rich adjunctive treatment (Concord grape juice) for the management of chemotherapy-induced nausea and vomiting (CINV)

Intervention Characteristics/Basic Study Process:

Eligible patients were randomized to either the experimental group, which received Concord grape juice, or the control group, which received a placebo composed of water, sweeteners, food-grade acids, natural grape essence, and food coloring (but no fruit juice).

Both groups drank 4 oz. of the grape juice or placebo beginning the evening of the treatment day and 30 minutes prior to meals for seven days following each of four chemotherapy treatments; an additional 4 oz. could be taken as needed for nausea. All patients received standard medical management of CINV.

Sample Characteristics:

  • The sample consisted of 77 participants.
  • In the experimental group, the median age was 54.1 years (SD = 12.4 years); in the control group, the median age was 54.5 years (SD 12.7).
  • The experimental group was 80% female, and the control group was 81% female.
  • Diagnoses included breast (70%), lung cancer (6%), lymphoma (6%), non-Hodgkin lymphoma (NHL) (5%), colon (3%), and prostate (3%).

Setting:

The study was conducted at a single outpatient setting in northeastern United States.

Phase of Care and Clinical Applications:

All patients were in active treatment.

Study Design:

This pilot study was a double-blind, randomized clinical trial.

Measurement Instruments/Methods:

  • Patients recorded the amount of grape juice or placebo consumed and usual and weekly food intake in daily logs.
  • Patients measured CINV daily using the Rhodes’ Revised Index of Nausea and Vomiting (INV-R).
  • They also used the Multiple Affect Adjective Checklist, Revised (MAACL-R) and the 16-item McGill Quality-of-Life Questionnaire (MQOL).
  • A self-report instrument using a Likert-type format was used to measure perceived control over decision making at baseline and the cancer treatment experience at the end of the data collection period.

Results:

  • Nausea and vomiting frequency, duration, and distress were lower for experimental group members, although a high attrition rate (50%) resulted in insufficient power to detect statistically significant differences over time.
  • Dropout rates suggested that the intervention was undesirable or participation in the study was too much of a burden.
  • A few participants commented on the sweetness of the juice or placebo which they reported was difficult to drink when nauseated.
  • Greater levels of anxiety, depression, and hostility at baseline were related to nausea and vomiting, quality of life, and perceived control over decision making.

Conclusions:

This study did not show any benefit of grape juice flavonoids for management of CINV.

Limitations:

  • The sample was small sample, with fewer than 100 participants.
  • Initial analyses of clinical outcomes showed some differences over time; however, because of the limited sample size and the attrition rate, statistically significant differences were not seen for the majority of outcomes.
  • The reliance of the self-report measures may have contributed to over- or underreporting of symptoms.

Nursing Implications:

The effect of grape juice flavonoids on CINV should be investigated further with a larger sample to determine whether preliminary findings are supported. Use may be limited because of intolerance of very sweet juice.


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