Skip to main content

Efficacy of ginger for prophylaxis of chemotherapy-induced nausea and vomiting in breast cancer patients receiving adriamycin–cyclophosphamide regimen: a randomized, double-blind, placebo-controlled, crossover study

Supportive Care in Cancer volume 25, pages 459–464 (2017)Cite this article

Abstract

Purpose

The purpose of this study is to determine the efficacy of ginger for reducing chemotherapy-induced nausea and vomiting (CINV) in breast cancer patients receiving adriamycin and cyclophosphamide (AC) regimens.

Methods

We enrolled breast cancer patients receiving AC who experienced moderate to severe nausea or vomiting during the first chemotherapy cycle. Subjects were randomized to receive a 500-mg ginger capsule or placebo twice a day for 5 days starting on the first day of the second AC cycle and were switched to the other treatment in the third cycle. All participants also received ondansetron and dexamethasone for CINV prophylaxis. Nausea severity was recorded once a day during the first 5 days of each cycle. The primary outcome was reduction in nausea score.

Results

Thirty-four subjects (68 cycles of AC) were enrolled. Mean (range) maximum nausea score in the first AC cycle was 58 (40–90). Thirty-three subjects (97 %) received the same AC doses in the second as in the third cycle. Mean (±standard error) maximum nausea scores in patients receiving ginger and placebo were 35.36 (±4.43) and 32.17 (±3.71), respectively. The difference in mean maximum nausea scores was 3 (95 % confidence interval, −3 to 9; P = 0.3). There were no significant differences between ginger and placebo in terms of vomiting incidence and severity, rescue medication use, chemotherapy compliance, and adverse events.

Conclusions

Ginger (500 mg) twice daily was safe, but conferred no additional benefit in terms of reducing nausea severity in breast cancer patients receiving AC and ondansetron and dexamethasone for CINV prophylaxis.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Griffin AM, Butow PN, Coates AS, Childs AM, Ellis PM, Dunn SM, Tattersall MH (1996) On the receiving end. V: Patient perceptions of the side effects of cancer chemotherapy in 1993. Ann Oncol 7(2):189–195

    Article  CAS  PubMed  Google Scholar 

  2. de Boer-Dennert M, de Wit R, Schmitz PI, Djontono J, v Beurden V, Stoter G, Verweij J (1997) Patient perceptions of the side-effects of chemotherapy: the influence of 5HT3 antagonists. Br J Cancer 76(8):1055–1061

    Article  PubMed  PubMed Central  Google Scholar 

  3. Osoba D, Zee B, Warr D, Kaizer L, Latreille J, Pater J (1996) Quality of life studies in chemotherapy-induced emesis. Oncology 53(Suppl 1):92–95

    Article  PubMed  Google Scholar 

  4. NCCN (2015) Guidelines® Antiemesis., http://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf. Accessed 26 February 2016

  5. MASCC/ESMO Antiemetic Guideline 2016 (2016) http://www.mascc.org/assets/Guidelines-Tools/mascc_antiemetic_guidelines_english_2016_v.1.0.pdf. Accessed 26 February 2016

  6. Meattini I, Francolini G, Scotti V, De Luca CC, Cappelli S, Meacci F, Furfaro IF, Muntoni C, Scoccianti S, Detti B, Mangoni M, Nori J, Orzalesi L, Fambrini M, Bianchi S, Livi L (2015) Aprepitant as prophylaxis of chemotherapy-induced nausea and vomiting in anthracyclines and cyclophosphamide-based regimen for adjuvant breast cancer. Med Oncol 32(3):80. doi:10.1007/s12032-015-0535-9

    Article  PubMed  Google Scholar 

  7. Warr DG, Hesketh PJ, Gralla RJ, Muss HB, Herrstedt J, Eisenberg PD, Raftopoulos H, Grunberg SM, Gabriel M, Rodgers A, Bohidar N, Klinger G, Hustad CM, Horgan KJ, Skobieranda F (2005) Efficacy and tolerability of aprepitant for the prevention of chemotherapy-induced nausea and vomiting in patients with breast cancer after moderately emetogenic chemotherapy. J Clin Oncol 23(12):2822–2830. doi:10.1200/JCO.2005.09.050

    Article  CAS  PubMed  Google Scholar 

  8. Giacosa A, Morazzoni P, Bombardelli E, Riva A, Bianchi Porro G, Rondanelli M (2015) Can nausea and vomiting be treated with ginger extract? Eur Rev Med Pharmacol Sci 19(7):1291–1296

    CAS  PubMed  Google Scholar 

  9. Chrubasik S, Pittler MH, Roufogalis BD (2005) Zingiberis rhizoma: a comprehensive review on the ginger effect and efficacy profiles. Phytomedicine 12(9):684–701. doi:10.1016/j.phymed.2004.07.009

    Article  CAS  PubMed  Google Scholar 

  10. Chaiyakunapruk N, Kitikannakorn N, Nathisuwan S, Leeprakobboon K, Leelasettagool C (2006) The efficacy of ginger for the prevention of postoperative nausea and vomiting: a meta-analysis. Am J Obstet Gynecol 194(1):95–99. doi:10.1016/j.ajog.2005.06.046

    Article  PubMed  Google Scholar 

  11. Viljoen E, Visser J, Koen N, Musekiwa A (2014) A systematic review and meta-analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting. Nutr J 13:20. doi:10.1186/1475-2891-13-20

    Article  PubMed  PubMed Central  Google Scholar 

  12. Thomson M, Corbin R, Leung L (2014) Effects of ginger for nausea and vomiting in early pregnancy: a meta-analysis. J Am Board Fam Med 27(1):115–122. doi:10.3122/jabfm.2014.01.130167

    Article  PubMed  Google Scholar 

  13. Ryan JL, Heckler CE, Roscoe JA, Dakhil SR, Kirshner J, Flynn PJ, Hickok JT, Morrow GR (2012) Ginger (Zingiber officinale) reduces acute chemotherapy-induced nausea: a URCC CCOP study of 576 patients. Support Care Cancer 20(7):1479–1489. doi:10.1007/s00520-011-1236-3

    Article  PubMed  Google Scholar 

  14. Manusirivithaya S, Sripramote M, Tangjitgamol S, Sheanakul C, Leelahakorn S, Thavaramara T, Tangcharoenpanich K (2004) Antiemetic effect of ginger in gynecologic oncology patients receiving cisplatin. Int J Gynecol Cancer 14(6):1063–1069. doi:10.1111/j.1048-891X.2004.14603.x

    Article  CAS  PubMed  Google Scholar 

  15. 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. Integr Cancer Ther 11(3):204–211. doi:10.1177/1534735411433201

    Article  PubMed  Google Scholar 

  16. 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(2):234–238. doi:10.1002/pbc.22778

    Article  PubMed  Google Scholar 

  17. Sontakke S, Thawani V, Naik M (2003) Ginger as an antiemetic in nausea and vomiting induced by chemotherapy: a randomized, cross-over, double blind study. Indian J Pharmacol 35:32–36

    Google Scholar 

  18. 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(5):563–572. doi:10.1007/s00520-008-0528-8

    Article  PubMed  Google Scholar 

  19. Lee J, Oh H (2013) Ginger as an antiemetic modality for chemotherapy-induced nausea and vomiting: a systematic review and meta-analysis. Oncol Nurs Forum 40(2):163–170. doi:10.1188/13.ONF.163-170

    Article  PubMed  Google Scholar 

  20. Schwertner HA, Rios DC (2007) High-performance liquid chromatographic analysis of 6-gingerol, 8-gingerol, 10-gingerol, and 6-shogaol in ginger-containing dietary supplements, spices, teas, and beverages. J Chromatogr B Analyt Technol Biomed Life Sci 856(1-2):41–47. doi:10.1016/j.jchromb.2007.05.011

    Article  CAS  PubMed  Google Scholar 

  21. Mandal P, Das A, Majumdar S, Bhattacharyya T, Mitra T, Kundu R (2014) The efficacy of ginger added to ondansetron for preventing postoperative nausea and vomiting in ambulatory surgery. Pharmacognosy Res 6(1):52–57. doi:10.4103/0974-8490.122918

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The authors thank the Government Pharmaceutical Organization for providing ginger capsules and placebo, Siriraj Cancer Center for providing funding support, the personnel of the Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, for coordinating the study, and Mr. Suthipol Udompanthurak for performing statistical analyses of the data.

Author information

Authors and Affiliations

  1. Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Lucksamon Thamlikitkul, Vichien Srimuninnimit, Charuwan Akewanlop, Suthinee Ithimakin, Sirisopa Techawathanawanna, Krittiya Korphaisarn, Jomjit Chantharasamee, Pongwut Danchaivijitr & Nopadol Soparattanapaisarn

Authors
  1. Lucksamon Thamlikitkul
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vichien Srimuninnimit
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Charuwan Akewanlop
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Suthinee Ithimakin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sirisopa Techawathanawanna
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Krittiya Korphaisarn
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jomjit Chantharasamee
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Pongwut Danchaivijitr
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nopadol Soparattanapaisarn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nopadol Soparattanapaisarn.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Thamlikitkul, L., Srimuninnimit, V., Akewanlop, C. et al. Efficacy of ginger for prophylaxis of chemotherapy-induced nausea and vomiting in breast cancer patients receiving adriamycin–cyclophosphamide regimen: a randomized, double-blind, placebo-controlled, crossover study. Support Care Cancer 25, 459–464 (2017). https://doi.org/10.1007/s00520-016-3423-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-016-3423-8

Keywords

  • Ginger
  • Breast cancer
  • Chemotherapy
  • Nausea
  • Vomiting
  • Anthracycline