Supportive Care in Cancer

, Volume 20, Issue 7, pp 1479–1489

Ginger (Zingiber officinale) reduces acute chemotherapy-induced nausea: a URCC CCOP study of 576 patients

  • Julie L. Ryan
  • Charles E. Heckler
  • Joseph A. Roscoe
  • Shaker R. Dakhil
  • Jeffrey Kirshner
  • Patrick J. Flynn
  • Jane T. Hickok
  • Gary R. Morrow
Original Article

Abstract

Purpose

Despite the widespread use of antiemetics, nausea continues to be reported by over 70% of patients receiving chemotherapy.

Methods

In this double blind, multicenter trial, we randomly assigned 744 cancer patients to four arms: 1) placebo, 2) 0.5 g ginger, 3) 1.0 g ginger, or 4) 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 1 of all cycles. Patients took three capsules of ginger (250 mg) or placebo twice daily for 6 days starting 3 days before the first day of chemotherapy. Patients reported the severity of nausea on a 7-point rating scale (“1” = “Not at all Nauseated” and “7” = “Extremely Nauseated”) for Days 1–4 of each cycle. The primary outcomes were to determine the dose and efficacy of ginger at reducing the severity of chemotherapy-induced nausea on Day 1 of chemotherapy.

Results

A total of 576 patients were included in final analysis (91% female, mean age = 53). Mixed model analyses demonstrated that all doses of ginger significantly reduced acute nausea severity compared to placebo on Day 1 of chemotherapy (p = 0.003). The largest reduction in nausea intensity occurred with 0.5 g and 1.0 g of ginger (p = 0.017 and p = 0.036, respectively). Anticipatory nausea was a key factor in acute chemotherapy-induced nausea (p < 0.0001).

Conclusions

Ginger supplementation at a daily dose of 0.5 g–1.0 g significantly aids in reduction of the severity of acute chemotherapy-induced nausea in adult cancer patients.

Keywords

Chemotherapy Cancer Nausea Ginger 

References

  1. 1.
    Aapro M (2005) 5-HT(3)-receptor antagonists in the management of nausea and vomiting in cancer and cancer treatment. Oncology 69:97–109PubMedCrossRefGoogle Scholar
  2. 2.
    Arfeen Z, Owen H, Plummer JL, Ilsley AH, Sorby-Adams RA, Doecke CJ (1995) A double-blind randomized controlled trial of ginger for the prevention of postoperative nausea and vomiting. Anaesth Intensive Care 23:449–452PubMedGoogle Scholar
  3. 3.
    Bone ME, Wilkinson DJ, Young JR, McNeil J, Charlton S (1990) Ginger root—a new antiemetic. The effect of ginger root on postoperative nausea and vomiting after major gynaecological surgery. Anaesthesia 45:669–671PubMedCrossRefGoogle Scholar
  4. 4.
    Brearley SG, Clements CV, Molassiotis A (2008) A review of patient self-report tools for chemotherapy-induced nausea and vomiting. Support Care Cancer 16:1213–1229PubMedCrossRefGoogle Scholar
  5. 5.
    Burish TG, Carey MP, Krozely MG, Greco FA (1987) Conditioned side effects induced by cancer chemotherapy: prevention through behavioral treatment. J Consult Clin Psychol 55:42–48PubMedCrossRefGoogle Scholar
  6. 6.
    Carey MP, Burish TG (1988) Etiology and treatment of the psychological side effects associated with cancer chemotherapy: a critical review and discussion. Psychol Bull 104:307–325PubMedCrossRefGoogle Scholar
  7. 7.
    Cleeland CS, Mendoza TR, Wang XS, Chou C, Harle MT, Morrissey M, Engstrom MC (2000) Assessing symptom distress in cancer patients: the M.D. Anderson Symptom Inventory. Cancer 89:1634–1646PubMedCrossRefGoogle Scholar
  8. 8.
    Figueroa-Moseley C, Jean-Pierre P, Roscoe JA, Ryan JL, Kohli S, Palesh OG, Ryan EP, Carroll J, Morrow GR (2007) Behavioral interventions in treating anticipatory nausea and vomiting. J Natl Compr Canc Netw 5:44–50PubMedGoogle Scholar
  9. 9.
    Geiger JL (2005) The essential oil of ginger. Zingiber officinale, and anaesthesia. Int J Aromather 15:7–14CrossRefGoogle Scholar
  10. 10.
    Grontved A, Brask T, Kambskard J, Hentzer E (1988) Ginger root against seasickness. A controlled trial on the open sea. Acta Otolaryngol 105:45–49PubMedCrossRefGoogle Scholar
  11. 11.
    Grunberg SM, Osoba D, Hesketh PJ, Gralla RJ, Borjeson S, Rapoport BL, du Bois A, Tonato M (2005) Evaluation of new antiemetic agents and definition of antineoplastic agent emetogenicity—an update. Support Care Cancer 13:80–84PubMedCrossRefGoogle Scholar
  12. 12.
    Herrstedt J, Dombernowsky P (2007) Anti-emetic therapy in cancer chemotherapy: current status. Basic Clin Pharmacol Toxicol 101:143–150PubMedCrossRefGoogle Scholar
  13. 13.
    Hickok JT, Roscoe JA, Morrow GR, Bole CW, Zhao H, Hoelzer KL, Dakhil SR, Moore T, Fitch TR (2005) 5-Hydroxytryptamine-receptor antagonists versus prochlorperazine for control of delayed nausea caused by doxorubicin: a URCC CCOP randomised controlled trial. Lancet Oncol 6:765–772PubMedCrossRefGoogle Scholar
  14. 14.
    Hickok JT, Roscoe JA, Morrow GR, King DK, Atkins JN, Fitch TR (2003) Nausea and emesis remain significant problems of chemotherapy despite prophylaxis with 5-hydroxytryptamine-3 antiemetics: a University of Rochester James P. Wilmot Cancer Center Community Clinical Oncology Program Study of 360 cancer patients treated in the community. Cancer 97:2880–2886PubMedCrossRefGoogle Scholar
  15. 15.
    Hickok JT, Roscoe JA, Morrow GR, Ryan JL (2007) A phase II/III randomized, placebo-controlled, double-blind clinical trial of ginger (Zingiber officinale) for nausea caused by chemotherapy for cancer: a currently accruing URCC CCOP cancer control study. Support Cancer Ther 4:247–250PubMedCrossRefGoogle Scholar
  16. 16.
    Kenward MG, Roger JH (1997) Small sample inference for fixed effects from restricted maximum likelihood. Biometrics 53:983–997PubMedCrossRefGoogle Scholar
  17. 17.
    Levine ME, Gillis MG, Koch SY, Voss AC, Stern RM, Koch KL (2008) Protein and ginger for the treatment of chemotherapy-induced delayed nausea. J Altern Complement Med 14:545–551PubMedCrossRefGoogle Scholar
  18. 18.
    Lien HC, Sun WM, Chen YH, Kim H, Hasler W, Owyang C (2003) Effects of ginger on motion sickness and gastric slow-wave dysrhythmias induced by circular vection. Am J Physiol Gastrointest Liver Physiol 284:G481–G489PubMedGoogle Scholar
  19. 19.
    Meyer K, Schwartz J, Crater D, Keyes B (1995) Zingiber officinale (ginger) used to prevent 8-Mop associated nausea. Dermatol Nurs 7:242–244PubMedGoogle Scholar
  20. 20.
    Morrow GR, Hickok JT, Rosenthal SN (1995) Progress in reducing nausea and emesis. Comparisons of ondansetron (Zofran), granisetron (Kytril), and tropisetron (Navoban). Cancer 76:343–357PubMedCrossRefGoogle Scholar
  21. 21.
    Morrow GR, Roscoe JA, Hickok JT, Banerjee TK, Issel B, Kirshner JJ (2001) Time of first occurrence, severity, and persistence of nausea following initial chemotherapy in 322 patients: aURCC CCOP study. Support Care Cancer 9:290Google Scholar
  22. 22.
    Morrow GR, Roscoe JA, Kirshner JJ, Hynes HE, Rosenbluth RJ (1998) Anticipatory nausea and vomiting in the era of 5-HT3 antiemetics. Support Care Cancer 6:244–247PubMedCrossRefGoogle Scholar
  23. 23.
    Mowrey DB, Clayson DE (1982) Motion sickness, ginger, and psychophysics. Lancet 1:655–657PubMedCrossRefGoogle Scholar
  24. 24.
    Pace JC (1986) Oral ingestion of encapsulated ginger and reported self-care actions for the relief of chemotherapy-associated nausea and vomiting. In: Editor (ed)^(eds) Book Oral Ingestion of Encapsulated Ginger and Reported Self-Care Actions for the Relief of Chemotherapy-associated Nausea and Vomiting. University of Alabama, CityGoogle Scholar
  25. 25.
    Pillai AK, Sharma KK, Gupta YK, Bakhshi S (2011) Anti-emetic effect of ginger powder versus placebo as an add-on therapy in children and young adults receiving high emetogenic chemotherapy. Pediatr Blood Cancer 56:234–238PubMedCrossRefGoogle Scholar
  26. 26.
    Roscoe JA, Hickok JT, Morrow GR (2000) Patient expectations as predictor of chemotherapy-induced nausea. Ann Behav Med 22:121–126PubMedCrossRefGoogle Scholar
  27. 27.
    Roscoe JA, Morrow GR, Colagiuri B, Heckler CE, Pudlo BD, Colman L, Hoelzer K, Jacobs A (2010) Insight in the prediction of chemotherapy-induced nausea. Support Care Cancer 18:869–876PubMedCrossRefGoogle Scholar
  28. 28.
    Roscoe JA, Morrow GR, Hickok JT, Bushunow P, Pierce HI, Flynn PJ, Kirshner JJ, Moore DF, Atkins JN (2003) The efficacy of acupressure and acustimulation wrist bands for the relief of chemotherapy-induced nausea and vomiting. A University of Rochester Cancer Center Community Clinical Oncology Program multicenter study. J Pain Symptom Manage 26:731–742PubMedCrossRefGoogle Scholar
  29. 29.
    Rosenthal DI, Mendoza TR, Chambers MS, Asper JA, Gning I, Kies MS, Weber RS, Lewin JS, Garden AS, Ang KK, Wang XS, Cleeland CS (2007) Measuring head and neck cancer symptom burden: the development and validation of the M.D. Anderson symptom inventory, head and neck module. Head Neck 29:923–931PubMedCrossRefGoogle Scholar
  30. 30.
    Schwartzberg L, Szabo S, Gilmore J, Haislip S, Jackson J, Jain G, Balu S, Buchner D (2011) Likelihood of a subsequent chemotherapy-induced nausea and vomiting (CINV) event in patients receiving low, moderately or highly emetogenic chemotherapy (LEC/MEC/HEC). Curr Med Res Opin 27:837–845PubMedCrossRefGoogle Scholar
  31. 31.
    Shukla Y, Singh M (2007) Cancer preventive properties of ginger: a brief review. Food Chem Toxicol 45:683–690PubMedCrossRefGoogle Scholar
  32. 32.
    Sontakke S, Thawani V, Naik MS (2003) Ginger as an antiemetic in nausea and vomiting induced by chemotherapy: a randomized, cross-over, double-blind study. Indian J Pharm 35:32–36Google Scholar
  33. 33.
    van Buuren S (2007) Multiple imputation of discrete and continuous data by fully conditional specification. Stat Methods Med Res 16:219–242PubMedCrossRefGoogle Scholar
  34. 34.
    Visalyaputra S, Petchpaisit N, Somcharoen K, Choavaratana R (1998) The efficacy of ginger root in the prevention of postoperative nausea and vomiting after outpatient gynaecological laparoscopy. Anaesthesia 53:506–510PubMedCrossRefGoogle Scholar
  35. 35.
    Zick SM, Ruffin MT, Lee J, Normolle DP, Siden R, Alrawi S, Brenner DE (2009) Phase II trial of encapsulated ginger as a treatment for chemotherapy-induced nausea and vomiting. Support Care Cancer 17:563–572PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Julie L. Ryan
    • 1
    • 2
    • 3
  • Charles E. Heckler
    • 2
    • 3
  • Joseph A. Roscoe
    • 2
    • 3
  • Shaker R. Dakhil
    • 4
  • Jeffrey Kirshner
    • 5
  • Patrick J. Flynn
    • 6
  • Jane T. Hickok
    • 2
    • 3
  • Gary R. Morrow
    • 2
    • 3
  1. 1.Departments of DermatologyUniversity of Rochester Medical CenterRochesterUSA
  2. 2.Radiation OncologyUniversity of Rochester Medical CenterRochesterUSA
  3. 3.CCOPUniversity of Rochester Medical CenterRochesterUSA
  4. 4.Witchita CCOPWitchitaUSA
  5. 5.HOACNY CCOPSyracuseUSA
  6. 6.Metro-Minnesota CCOPSt. Louis ParkUSA

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