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.
Similar content being viewed by others
References
Aapro M (2005) 5-HT(3)-receptor antagonists in the management of nausea and vomiting in cancer and cancer treatment. Oncology 69:97–109
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 23:449–452
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 45:669–671
Brearley SG, Clements CV, Molassiotis A (2008) A review of patient self-report tools for chemotherapy-induced nausea and vomiting. Support Care Cancer 16:1213–1229
Burish TG, Carey MP, Krozely MG, Greco FA (1987) Conditioned side effects induced by cancer chemotherapy: prevention through behavioral treatment. J Consult Clin Psychol 55:42–48
Carey MP, Burish TG (1988) Etiology and treatment of the psychological side effects associated with cancer chemotherapy: a critical review and discussion. Psychol Bull 104:307–325
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 89:1634–1646
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 5:44–50
Geiger JL (2005) The essential oil of ginger. Zingiber officinale, and anaesthesia. Int J Aromather 15:7–14
Grontved A, Brask T, Kambskard J, Hentzer E (1988) Ginger root against seasickness. A controlled trial on the open sea. Acta Otolaryngol 105:45–49
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 13:80–84
Herrstedt J, Dombernowsky P (2007) Anti-emetic therapy in cancer chemotherapy: current status. Basic Clin Pharmacol Toxicol 101:143–150
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 6:765–772
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 97:2880–2886
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 4:247–250
Kenward MG, Roger JH (1997) Small sample inference for fixed effects from restricted maximum likelihood. Biometrics 53:983–997
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 14:545–551
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–G489
Meyer K, Schwartz J, Crater D, Keyes B (1995) Zingiber officinale (ginger) used to prevent 8-Mop associated nausea. Dermatol Nurs 7:242–244
Morrow GR, Hickok JT, Rosenthal SN (1995) Progress in reducing nausea and emesis. Comparisons of ondansetron (Zofran), granisetron (Kytril), and tropisetron (Navoban). Cancer 76:343–357
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 9:290
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 6:244–247
Mowrey DB, Clayson DE (1982) Motion sickness, ginger, and psychophysics. Lancet 1:655–657
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, City
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 56:234–238
Roscoe JA, Hickok JT, Morrow GR (2000) Patient expectations as predictor of chemotherapy-induced nausea. Ann Behav Med 22:121–126
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 18:869–876
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 26:731–742
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 29:923–931
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 27:837–845
Shukla Y, Singh M (2007) Cancer preventive properties of ginger: a brief review. Food Chem Toxicol 45:683–690
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 35:32–36
van Buuren S (2007) Multiple imputation of discrete and continuous data by fully conditional specification. Stat Methods Med Res 16:219–242
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 53:506–510
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 17:563–572
Acknowledgements
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ryan, J.L., Heckler, C.E., Roscoe, J.A. et al. Ginger (Zingiber officinale) reduces acute chemotherapy-induced nausea: a URCC CCOP study of 576 patients. Support Care Cancer 20, 1479–1489 (2012). https://doi.org/10.1007/s00520-011-1236-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-011-1236-3