Ginger and Chemotherapy related nausea

From Medscape Medical News
ASCO 2009: Ginger Helps Relieve Chemotherapy-Associated Nausea
Roxanne Nelson


The data, which will be presented at the 2009 Annual Meeting of the American Society of Clinical Oncologists (ASCO), were discussed during a premeeting presscast.

"Despite widespread use of antiemetics, chemotherapy-related nausea continues to be reported in more than 70% of patients receiving chemotherapy," said lead author Julie Ryan, PhD, MPH, assistant professor in the departments of radiation oncology and dermatology at the University of Rochester in New York. "For many years, ginger has been used worldwide to treat gastrointestinal upsets such as nausea."

"We have not identified the exact mechanism of action, but other research shows that it acts as a potent anti-inflammatory agent in the gut," she said.

In their study, patients already taking antiemetics who supplemented with ginger had an approximately 40% decrease in nausea, Dr. Ryan reported. Study participants who received placebo reported almost no change in nausea.

"It is important to note that all patients received standard emetics," said Douglas W. Blayney, MD, president-elect of ASCO, professor of internal medicine at the University of Michigan Medical School, and medical director of the Comprehensive Cancer Center at the University of Michigan in Ann Arbor. "This will be an interesting abstract for patients who often ask their oncologist if there is anything more that they can do for nausea."

Dr. Blayney pointed out that the patients used ginger in capsule form, and so they were unaware whether they were getting placebo or the active agent. "This added to the robustness of the results that were observed," he said.

Ginger (Zingiber officinale) is a commonly used spice, and smaller studies that have examined the benefit of ginger for chemotherapy-related nausea have produced inconsistent results, Dr. Ryan explained in her presentation. However, these studies did not evaluate ginger supplementation prior to the initiation of chemotherapy, which allows for earlier absorption by the body.

Effective in Reducing Nausea

Dr. Ryan and colleagues conducted a multisite phase 2/3 randomized trial to assess the efficacy of ginger for chemotherapy-related nausea in cancer patients at member sites of the University of Rochester–affiliated Community Clinical Oncology Program. The cohort consisted of 644 primarily female patients (90%) who were randomly assigned to receive a placebo or 0.5 g, 1.0 g, or 1.5 g of ginger in capsule form, which was divided into 2 doses given each day for 6 days. Breast cancer was the most common type of malignancy among the participants (66%), followed by alimentary (6.5%) and lung (6.1%) cancers.

Patients who had experienced nausea following any chemotherapy cycle and who were scheduled to receive at least 3 additional treatment cycles were eligible to participate in the study. All of the patients received 5-HT3 receptor antagonist antiemetics — ondansetron (Zofran, GlaxoSmithKline) or granisetron (Kytril, Roche) — starting on day 1 of all cycles, and began supplementation with either ginger or placebo 3 days before the first day of a chemotherapy cycle.

The degree of nausea experienced was rated at various times during the first 4 days of each chemotherapy cycle. Analysis of covariance examined change in nausea on day 1 of cycles 2 and 3, because patients are most likely to experience the worst nausea on the first day of chemotherapy, explained Dr. Ryan.

Their results showed that all doses of ginger significantly reduced nausea more than the placebo, with the 0.5 g and 1.0 g doses having the greatest effect. That dose is the equivalent of 1/4 to 1/2 a teaspoon of ground ginger, she added.

Participants rated their nausea on a 7-point scale. "Patients using ginger rated their nausea 1, which is none at all, or 2, which is slight nausea," said Dr. Ryan, "while the placebo group rated their nausea 4, which is extremely nauseated."

Dr. Ryan speculates that the highest dose might not have worked as well as the lower doses because they may have reached the saturation point with the lower doses. She also could not speculate whether food products that contain ginger, such as cookies and tea, would have the same effect. "If they contain the same amount of ginger, then it's possible," she said. "But my guess is that a lot of them just use ginger flavoring, not real ginger. And they may also contain ingredients like sugar, which could affect the efficacy."

"We conclude that ginger supplementation at a daily dose of 0.5 to 1 g significantly aids in reduction of nausea on the first day of chemotherapy," Dr. Ryan summarized. "Reduced nausea will improve cancer patient quality of life during chemotherapy."

The study was funded by the National Cancer Institute. Dr. Blayney serves as a consultant to Eli Lily and Cephalon, is on Bristol Myers Squibb's Data Safety Monitoring Board, and receives research funding from the National Comprehensive Cancer Network.

2009 Annual Meeting of the American Society of Clinical Oncologists (ASCO): Abstract 9511. To be presented May 30, 2009