Ginger (Zingiber officinale) reduces acute chemotherapy-induced nausea: a URCC CCOP study of 576 patients
Despite the widespread use of antiemetics, nausea continues to be reported by over 70% of patients receiving chemotherapy.
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.
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).
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.
KeywordsChemotherapy Cancer Nausea Ginger
This research was supported by the National Cancer Institute of the National Institutes of Health PHS grants 1R25CA10618 (Cancer Control Research) and U10CA37420 (Community Clinical Oncology Program). None of the authors have conflicts of interest to disclose.
- 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.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.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
- 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
- 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
- 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.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.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
- 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