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.

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

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.

• 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).

The setting was not reported.

All patients were in active treatment.

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

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

• 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).

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

• 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.

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