Support Care Cancer. Author manuscript; available in PMC 2012 July 1.

Published in final edited form as:

Support Care Cancer. 2012 July; 20(7): 14791489.
Published online 2011 August 5. doi: 10.1007/s00520-011-1236-3
PMCID: PMC3361530
NIHMSID: NIHMS358570

Ginger (Zingiberofficinale) reduces acute chemotherapyinduced nausea: A URCC CCOP study of 576 patients
Julie L. Ryan, PhD, MPH,1,2,3Charles E. Heckler, PhD,2,3Joseph A. Roscoe, PhD,2,3Shaker R.
Dakhil, MD,4Jeffrey Kirshner, MD,5Patrick J. Flynn, MD,6Jane T. Hickok, MD, MPH,2,3 and
Gary R. Morrow, PhD, MS2,3
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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) 0.5g ginger, 3) 1.0g ginger, or 4) 1.5g 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 (250mg) or placebo
twice daily for six days starting three 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 0.5g and 1.0g 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 daily dose of 0.5g-1.0g significantly aids in reduction of the
severity of acute chemotherapy-induced nausea in adult cancer patients.
Keywords: chemotherapy, cancer, nausea, ginger
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Introduction
Despite the widespread use of the 5-HT3 receptor antagonist antiemetics, ondansetron
(Zofran,) granistron (Kytril), and dolasetron mesylate (Anzemet), post-chemotherapy
nausea and vomiting continue to be reported by over 70% of patients [12, 15]. Research also
suggests that the 5-HT3 receptor antagonists are clinically more effective against emesis than
they are against nausea [1, 11, 13, 14]. In general, there is still room for improvement in the
control of nausea associated with chemotherapy for cancer.
Chemotherapy-induced nausea (CIN) can be categorized into three different types of nausea.
Anticipatory nausea occurs before the start of chemotherapy in anticipation of the treatment
and develops in 8-20% of patients [8, 22]. Acute nausea occurs within 24 hours postchemotherapy, whereas delayed nausea occurs after 24 hours and up to five days postchemotherapy. The majority of patients report the most severe nausea on Day 1 of
chemotherapy and are less likely to have severe nausea on subsequent days if they do not
experience it on Day 1 [21]. Recently, Schwartzberg et al demonstrated that patients who
experience nausea and vomiting from their initial chemotherapy cycle of low emetogenic
chemotherapy were 3.1 times more likely to experience nausea and vomiting at subsequent
chemotherapy cycles compared to patient who did not experience nausea and vomiting with
their initial chemotherapy cycle [30]. This rate is comparable to the rates of 3.8 and 3.7 for
patients receiving moderate or highly emetogenic chemotherapy [30]. Therefore, it can be
concluded that a patient who experiences nausea and vomiting at a chemotherapy cycle will
be more likely to experience nausea and vomiting at subsequent chemotherapy cycle
regardless of the type of chemotherapy (i.e., low, moderate or highly emetogenic).
Ginger, an ancient spice, is most notably known for its role as a flavoring agent for food in
Asian and Indian recipes [31]. For over 2,500 years, the dried aromatic rhizome (underground
stem) of ginger (Zingiber Officinale, Roscoe), has been used to treat gastrointestinal upsets,
as well as joint and muscle pain. Ginger is listed as a food on the FDA's generally regarded
as safe list. Research studies have demonstrated ginger's effectiveness against nausea
associated with motion sickness, pregnancy, and surgery [2, 3, 10, 23, 34]. Previous clinical
trials suggest that ginger may be effective against CIN, but design inadequacies, small
numbers, and lack of dose-finding studies, limit their power and generalizability [17, 19, 24,
32, 35]. We conducted a randomized, double-blind, placebo-controlled, dose-finding clinical
trial to determine if ginger was more effective than placebo in controlling acute CIN in cancer
patients receiving 5-HT3 receptor antagonist antiemetics.
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Methods

Patients and Study Design

Eligible patients were 18 years of age, able to understand English, had a diagnosis of
cancer, may have received 1 chemotherapy cycle, and were scheduled for at least three
additional chemotherapy cycles. Chemotherapy must have been given without concurrent
radiation therapy or interferon and without planned interruption by radiation therapy or
surgery. All patients must have experienced nausea of any severity in any chemotherapy cycle
before study enrollment, as well as scheduled to receive a 5-HT3 receptor antagonist (e.g.,
Zofran, Kytril, Navoban, or Anzemet) plus dexamathasone at all chemotherapy
cycles. Patients were not on coumadin or heparin for therapeutic anticoagulation, did not
have a bleeding disorder, and had platelet count > 100,000/l before the baseline cycle.
This study was a phase II/III, randomized, double-blind, placebo-controlled clinical trial
conducted in 23 private practice oncology groups funded by the National Cancer Institute's
Community Clinical Oncology Program (CCOP) and affiliated with the University of
Rochester Cancer Center CCOP Research Base. The primary objective of the study was to
determine if ginger supplementation reduced acute CIN (i.e., nausea on Day 1) in patients
receiving standard 5-HT3 receptor antagonist antiemetics plus dexamethasone. The
institutional review board of the University of Rochester and each participating site approved
the protocol. Written informed consent was obtained from each patient. This study is
registered on ClinicalTrials.gov, #NCT00040742.
Randomization was stratified by CCOP site. Within each site, a computer-generated random
numbers table with block size eight was used to randomly assign patients to one of four
treatment arms (Placebo, 0.5g, 1.0g, and 1.5g Ginger). The randomization assigned patients
to the four arms in the ratio 1:1:1:1.

Study Medication
The ginger and placebo capsules were manufactured by Aphios Corporation in Woburn, MA.
Ginger capsules contained a purified liquid extract of ginger root (Zingiber officinale) with
concentrated 8.5mg of combined gingerols, zingerone, and shogoal content, equivalent to
250mg of ginger root, in extra virgin olive oil containing other excipients to improve
solubilization and increase bioavailability. The placebo capsules consisted of only the extra
virgin olive oil containing a higher level of excipients in order to match the weight of the
ginger capsules. Both the ginger and placebo products were double encapsulated in size 0,
white, opaque, hard gelatin capsules with a nitrogen cap. The double encapsulation and
nitrogen cap masked any difference in smell or color between the two products. The capsules
were packaged in blister packs containing six capsules (ginger or placebo) and were grouped
into morning and evening doses (3 capsules each). The contents of the blister packs for each
study arm were: arm 1 (placebo) = 3 placebo capsules twice daily; arm 2 (0.5g daily ginger
dose) = 2 placebo capsules and 1 ginger capsule twice daily; arm 3 (1.0g daily ginger dose) =
1 placebo capsule and 2 ginger capsules twice daily; arm 4 (1.5g daily ginger dose) = 3
ginger capsules twice daily.

Procedures
The days surrounding each chemotherapy infusion were identified for study purposes as
follows: Days -3 to -1 were before chemotherapy, Day 1 was the day of chemotherapy
infusion, and Days 2-4 were post-chemotherapy. All patients received 5-HT3 antiemetics plus

dexamathasone on Day 1 of all chemotherapy cycles. All patients took the study medication
twice daily for six days, starting three days before the start chemotherapy for study cycles 2
and 3. Compliance was measured by pill counts at the end of each study cycle. Nausea and
emesis were measured using a modified four-day patient report diary developed by Burish[5]
and Carey[6] and used by us in previous large clinical trials[13, 14, 26, 28]. Patients reported
the severity of nausea four times each day (morning, afternoon, evening, and night) over
three four-day periods (Days 1 4) during each cycle (baseline, study cycle 2 and study cycle
3) using a 7-point semantic rating scale anchored by 1 = Not at all Nauseated and by 7
= Extremely Nauseated. Anti-nausea medication use and number of vomiting episodes
were also recorded. A 13-item Symptom Inventory was used to assess potential side effects of
ginger, as well as anticipatory nausea, on an 11-point scale anchored by 0 (Not Present) and
10 (As Bad As You Can Imagine) [7, 29]. The Symptom Inventory was completed once
during the baseline cycle (i.e., Day 4) and three times during study cycles 2 and 3 (i.e., before
starting the study medication (Day -4), before Day 1 of chemotherapy (i.e., Day -1), and after
completion of study medication (Day 4)). Anticipatory nausea was analyzed using the nausea
item on the Symptom Inventory completed prior to chemotherapy (i.e., Day -1). Quality of
life was assessed using the 27-item Functional Assessment of Chronic Illness TherapyGeneral (FACIT-G) at baseline and follow-up assessments (i.e., Day 4).

Statistical Analysis
All statistical tests were performed at the two-tailed 5% level of significance and data were
analyzed on an intent-to-treat basis. Acute nausea severity was measured as the average and
maximum of the evening and night Day 1 responses. In order to analyze acute nausea severity
accurately, we had to ensure that patients received chemotherapy before rating their nausea
severity on Day 1 in the four-day diary. We excluded the morning and afternoon nausea
responses on Day 1 because it was unlikely that a patient would have received chemotherapy
prior to either of these rating times. Delayed nausea severity was measured as the average and
maximum of all the values for Days 2 and 3. The follow-up phase nausea severity was
measured as the average and maximum of the responses for Day 4. Average nausea severity
(NAv) is indicated as the primary outcome measure in the protocol, but the maximum nausea
severity (NMx) (i.e. nausea at its worst) was considered to be more relevant from the patient's
point of view. Mixed model analyses and Type 3 tests of fixed effects using the KenwardRoger degrees of freedom procedure [16] were used to examine the change from baseline
NAv and NMx on Day 1. The fixed effects in the model were Dose, Cycle and Dose*Cycle
interaction and the random effects consisted of subject-subject and within-subject variation.
Under the missing-at-random assumption, missing values should not cause substantial bias
using this method of analysis; however we checked this with multiple imputation (multiple
imputation by chained equations, MICE [33]) and the changes in the results were minor.
Contrasts were used to estimate and test the effect size of placebo versus ginger at any dose.
Mean differences between each ginger dose and placebo were also estimated and tested using
the Tukey-Kramer procedure for multiple comparisons. Similar analyses were used to
examine the secondary outcomes delayed nausea, quality of life, and vomiting. To examine
the effects of anticipatory nausea, the pre-chemotherapy nausea symptom inventory item
score was added as a covariate in the above mixed model. Computations were performed
with SAS Version 9.2 (PROC MIXED) and R Version 2.9.1 (MICE package Version 1.21).
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Results
Patient Characteristics
From June 2002 to December 2008, a total of 744 cancer patients were enrolled and
randomized into one of the four treatment arms (Figure 1). Of these 744 patients, 662
completed the baseline measures prior to the study medication being administered. Of the 662
patients who completed the baseline cycle, 562 (85%) completed Study Cycle 2 (i.e., first
cycle of study medication) and 471 (71%) completed Study Cycle 3 (i.e., second cycle of
study medication). The analyses reported herein were conducted on 576 (87%) patients who
provided evaluable data at either Study Cycle 2 or 3. The baseline characteristics were
equivalent across treatment groups (Table 1). The majority of patients were white (91%),
female (93%) with a mean age of 53 years and the most common types of cancer were breast
(74%), gastrointestinal (8%), and lung (6%) cancers. Overall reasons for non-completion of
the study included: changed mind about participation (n=81), incomplete study forms (n=36),
gastrointestinal symptoms (n=32), other medical reasons (n=31), off chemotherapy (n=22),
and chemotoxicity (n=19). The two most prominent reasons for dropout at baseline were
changed mind about participation (n=36; 43%) and incomplete study forms (n=11, 13%),
which were also the major causes for dropout for Study Cycles 2 and 3 (n=45; 23% and
n=25; 13%, respectively). There were no meaningful or statistically significant mean
differences between the four treatment arms at baseline for NAv (mean range = 2.2 to 2.6),
NMx (mean range = 2.5 to 2.9), or quality of life (mean range = 71 to 72). Compliance to
study medication did not significantly differ between treatment arms or study cycle (93%
compliance = placebo; 83% compliance = 0.5g ginger; 90% compliance = 1.0g ginger; and
84% compliance = 1.5g ginger). In the four-day diary, patients were asked to record the
number of times they used antiemetic medication after their chemotherapy treatment. The
antiemetic medications were categorized into four types of medication: Type 1 (granisetron,
odansetron, dolasetron mesylate, tropisetron), Type 2 (prochlorperazine), Type 3
(dexamethasone), and Type 4 (metochlopramide). There were no significant differences
between treatment arms in regards to the use of antiemetics. Overall, the majority of patients
did report taking antiemetic medications and the placebo arm tended to report more use of
antiemetic medications compared to the ginger arms.

Figure 1
Patient Flow Diagram

Table 1
Baseline Characteristics of Patients (N = 576)

Ginger effects on chemotherapy-related nausea

The primary objective of this clinical trial was to determine if ginger was more effective than
placebo at reducing nausea severity on Day 1 of chemotherapy (i.e., acute nausea). Initially,
the protocol called for ANCOVA on NAv on Day 1 ratings from the daily diary, with baseline
as the covariate. However, the distribution of the baseline and post-treatment outcome were
positively skewed and using baseline as covariate in ANCOVA would give high-baseline
subjects disproportionate influence. Change scores showed no skewness.
Consequently, mixed model analyses on change scores were performed to combine the
information in both study cycles, obtain more power, and evaluate any differences in the two
cycles. The mixed model analyses across both study cycles 2 and 3, using NAv and NMx,
revealed that all doses of ginger significantly reduced acute CIN in both study cycles
compared to placebo (p = 0.013 and 0.003, respectively; Figure 2). Differences in the leastsquares means showed that 0.5g and 1.0g daily ginger were the most effective at reducing
acute CIN (Table 2).

Figure 2
Ginger reduces severity of acute chemotherapy-induced nausea

Table 2
Mixed Model Analyses for Nausea on Day 1 of Chemotherapy
The secondary objectives of the study were to determine the effects of ginger on delayed
nausea, anticipatory nausea, and quality of life in patients receiving chemotherapy. Mixed
model analyses were used to examine delayed nausea for all time intervals on Day 2 and Day
3 and follow-up nausea on Day 4 when patients were no longer on study medication. Despite
the significant reduction in acute nausea on Day 1 (i.e., acute) in all the ginger arms
compared to placebo, the significance of ginger supplementation weakens for delayed (Days
2 and 3) and follow-up nausea (Day 4) (Figures 3 and and4).4). These data suggest that
patients reported more severe delayed nausea compared to acute nausea. Overall, no
significant differences were observed in vomiting or quality of life (FACIT-G), between the
three ginger arms and placebo. The majority of patients did not report episodes of vomiting
(mean incidence = 0.5). In contrast, type 3 tests of fixed effects revealed that anticipatory
nausea (p < 0.0001) is also a factor in acute CIN.

Figure 3
Average nausea severity (NAv) over time for each study cycle

Figure 4
Maximum nausea severity (NMX) over time for each study cycle

Adverse Events
A total of 24 adverse events were reported during the course of the study. Only nine of the
reported adverse advents were considered to be related to study drug (i.e., ginger) and these
patients withdrew from the study. These adverse reactions included gastrointestinal
symptoms, such as Grade 2 heartburn, bruising/flushing, and rash.
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Discussion
Nausea is a complicated symptom to research and effectively treat because it is a subjective
and unobservable phenomenon [4]. Previous research has shown that perceived susceptibility
and expectancy, as well as age, are important risk factors for nausea severity [27]. In this
large, multisite clinical trial, ginger reduced the severity of acute nausea in cancer patients
receiving chemotherapy. One key feature of this study was the implementation of the six-day
course of ginger three days before the start of chemotherapy, an approach similar to the
administration of ginger in prevention of motion sickness [10, 23]. Although our primary
objective was to reduce acute CIN, the six-day course of ginger or placebo allowed us to
evaluate anticipatory and delayed CIN. Our data suggests that anticipatory nausea contributes
to the report of acute nausea. This phenomenon is by Roscoe et al [27]. The authors reported
that the odds of cancer patients reporting severe nausea from chemotherapy was 2.85 times
greater in patients who said they were susceptible to nausea compared to others who stated
they were not susceptible [27].
We can only speculate that the mechanism by which ginger alleviates nausea is through a
combination of anti-inflammatory and anti-spasmodic activities. Current antiemetic
medications, such as 5-HT3, are receptor antagonists for specific neurotransmitters in the
gastrointestinal tract [12]. Likewise, ginger can bind 5-HT3 receptors to enhance antiemetic
effects and can increase detoxification enzymes to counteract oxidative damage to tissues [9].
We speculate that starting ginger three days before the start of chemotherapy may have
primed the gut for an anti-nausea response through 5-HT3 receptor binding and induction of
detoxification enzymes. Furthermore, a receptor-based mechanism of action could explain

why the lower ginger doses were more effective than the highest dose. Hypothetically, a
certain dose ginger (i.e., 1.0g) may saturate the receptors rendering higher doses ineffective.
Similar to our findings, Lien et al published that 1.0g dose of ginger was more effective
against motion sickness than 2.0g dose [18].
The main strengths of this study include the large sample size, double-blinded treatment, and
evaluation of three types of CIN. Two main weaknesses of the study, which should be
controlled for in future studies, were not controlling for chemotherapy regimens (i.e., high
versus low emetogenic regimens) or the severity level of nausea before enrollment. Recent
research demonstrated that patients are more likely to experience CINV from subsequent
chemotherapy cycles if CINV is experienced during the initial or earlier cycle, regardless of
chemotherapy regimen (i.e., low, moderate or highly emetogenic) [30]. Our study did not
collect information on the type of chemotherapy regimen because we only enrolled patients
that reported nausea from previous chemotherapy cycle. This study design enabled the
investigation of presence of nausea without vomiting. The low incidence of emesis was
expected since 5-HT3 receptor antagonist antiemetics [20] were used. However, we did not
expect the NAv and NMx severity at baseline to be low considering patients reported nausea
during a previous chemotherapy cycle. Limitations of the study results include the small
effect size for nausea severity and the lack of effect on delayed nausea and quality of life. The
effect size for nausea severity may have been larger if the study only enrolled patients with
moderate to severe nausea with chemotherapy prior to enrollment. Furthermore, our data
showed that patients reported more severe delayed nausea (Day 2 and Day 3) compared to
acute nausea (Day 1) suggesting that delayed nausea is a more debilitating problem for
patients than acute nausea. The inability to detect a significant difference on quality of life
could be due to the inability to control delayed nausea. We speculate that a reduction in
delayed nausea would significantly improve patient quality of life during chemotherapy.
Although some cancer patients may use ginger for prevention or treatment of CIN, little
published work has addressed the efficacy of ginger for CIN. Since 1986, only five articles
published the use of ginger for CINV in cancer patients receiving chemotherapy. In 1986,
Pace et al studied 20 patients being treated for leukemia with cytosine arabinoside (ARA-C)
and showed that patients who received ginger had significantly less severe nausea on the day
of chemotherapy and on the following day than those taking the placebo capsules [24].
Similarly, Sontakke et al showed that 1g of ginger before and after chemotherapy was as
good as metoclopramide at complete control of nausea [32]. In contrast, Zick et al showed no
improvement in acute or delayed CIN with ginger (1.0g or 2.0g) in a randomized, doubleblind, placebo-controlled study in 162 cancer patients [35]. Levine et al showed that a high
protein diet with 1.0g of ginger reduced severity of delayed nausea and use of antiemetic
medications [17]. However, the study contributed the reduction to the high protein diet and
not necessarily to ginger supplementation. Most recently, Pillai et al demonstrated the ginger
powder (1-2g daily) reduced the severity of acute and delayed CINV in children and young
adults receiving highly emetogenic chemotherapy for sarcoma [25]. We conclude that ginger
(Zingiber officinale), at dose of 0.5g to 1.0 g daily, significantly aids in the reduction of acute
CIN in patients receiving standard antiemetics. Thus far, ginger has demonstrated a beneficial
effect on acute nausea from chemotherapy, however the effectiveness of ginger for nausea
associated with other medical conditions awaits further controlled trials.
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Acknowledgments

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).
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Footnotes
None of the authors have conflicts of interest to disclose.
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of encapsulated ginger as a treatment for chemotherapy-induced nausea and vomiting.
Support Care Cancer. 2009;17:563572. [PubMed]

Integr Cancer Ther. 2012 Sep;11(3):204-11. doi: 10.1177/1534735411433201. Epub 2012

Feb 7.

Effect of ginger on acute and delayed chemotherapyinduced nausea and vomiting: a pilot, randomized, openlabel clinical trial.
Panahi Y, Saadat A, Sahebkar A, Hashemian F, Taghikhani M, Abolhasani E.

Author information
Abstract
BACKGROUND:
Nausea and vomiting are among the most prevalent and disturbing side effects of
chemotherapy. Therefore, there is a need for additional antiemetic agents that could
effectively reduce chemotherapy-induced nausea and vomiting (CINV), whether alone or in
combination with current standard therapies. Since clinical data on the effectiveness of ginger
in patients with advanced breast cancer is lacking, the present study aimed to evaluate the
effects of ginger against both acute and delayed forms of CINV in a population with
advanced breast cancer as the main malignancy.
METHODS:

In this pilot, randomized, open-label clinical trial, 100 women (mean age = 51.83 9.18
years) with advanced breast cancer who were initially assigned to standard chemotherapy
protocol with docetaxel, epirubicin, and cyclophosphamide (the TEC regimen) were
randomized to receive ginger (1.5 g/d in 3 divided doses every 8 hours) plus standard
antiemetic regimen (granisetron plus dexamethasone; the ginger group) or standard
antiemetic regimen alone (control group). The duration of treatment with ginger was
specified to 4 days from the initiation of chemotherapy. Prevalence, score, and severity of
nausea, vomiting, and retching were assessed using a simplified form of Rhodes index in the
first 6 hours, between 6 to 24 hours, and days 2, 3, and 4 postchemotherapy.
RESULTS:
A significantly lower prevalence of nausea was observed in the ginger group during 6 to 24
hours postchemotherapy. Despite this effect, no other significant additional benefit from
ginger (1.5 g/d) was observed against prevalence or severity of nausea, vomiting, and
retching in any of the assessed periods.
CONCLUSION:
Addition of ginger (1.5 g/d) to standard antiemetic therapy (granisetron plus dexamethasone)
in patients with advanced breast cancer effectively reduces the prevalence of nausea 6 to 24
hours postchemotherapy. However, there is no other additional advantage for ginger in
reducing prevalence or severity of acute or delayed CINV.

Meskipun meluasnya penggunaan antiemetik , mual terus dilaporkan oleh lebih

dari 70 % dari pasien yang menerima kemoterapi .
metode
Dalam blind , percobaan multicenter double , kami secara acak 744 pasien
kanker untuk empat lengan : 1 ) plasebo , 2 ) jahe 0.5g , 3 ) 1.0g jahe , atau 4 )
1.5g jahe . Terjadinya mual dan tingkat keparahan dinilai pada siklus awal dan
dua siklus berikut di mana pasien minum obat studi mereka ditugaskan . Semua
pasien menerima 5 - HT3 antagonis reseptor antiemetik pada Hari 1 dari semua
siklus . Pasien menggunakan kapsul jahe ( 250mg ) atau plasebo dua kali sehari
selama enam hari mulai tiga hari sebelum hari pertama kemoterapi . Pasien
melaporkan keparahan mual pada skala rating 7 -point ( " 1 " = " Sama sekali
tidak mual " dan " 7 " = " Sangat mual " ) untuk Days 1-4 dari setiap siklus . Hasil
utama adalah untuk menentukan dosis dan khasiat jahe untuk mengurangi
keparahan mual akibat kemoterapi pada Hari 1 dari kemoterapi .
hasil
Sebanyak 576 pasien dilibatkan dalam analisis akhir ( 91 % perempuan , usia
rata-rata = 53 ) . Analisis model campuran menunjukkan bahwa semua dosis
jahe secara signifikan mengurangi keparahan mual akut dibandingkan dengan
plasebo pada hari 1 dari kemoterapi ( p = 0,003 ) . Penurunan terbesar dalam
intensitas mual terjadi dengan 0.5g dan 1.0g jahe ( p = 0,017 dan p = 0,036 ,
masing-masing) . Mual antisipasi adalah faktor kunci dalam mual kemoterapiinduksi akut ( p < 0,0001 ) .
kesimpulan
Suplemen jahe pada dosis harian 0.5g - 1.0g secara signifikan membantu dalam
pengurangan keparahan mual akibat kemoterapi akut pada pasien kanker
dewasa .
Kata kunci : kemoterapi , kanker , mual , jahe
Pergi ke :
pengantar
Meskipun meluasnya penggunaan 5- HT3 antiemetik antagonis reseptor ,
ondansetron ( Zofran , ) granistron ( Kytril ) , dan dolasetron mesylate
( Anzemet ) , mual pasca kemoterapi dan muntah tetap dilaporkan oleh lebih
dari 70 % pasien [ 12 , 15 ] . Penelitian juga menunjukkan bahwa antagonis
reseptor 5 - HT3 secara klinis lebih efektif terhadap emesis daripada mereka
melawan mual [ 1 , 11 , 13 , 14 ] . Secara umum , masih ada ruang untuk
perbaikan dalam pengendalian mual yang berkaitan dengan kemoterapi untuk
kanker .
Kemoterapi -induced nausea ( CIN ) dapat dikategorikan menjadi tiga jenis mual .
Mual antisipasi terjadi sebelum memulai kemoterapi dalam mengantisipasi
pengobatan dan berkembang pada 8-20 % pasien [ 8 , 22 ] . Mual akut terjadi
dalam 24 jam pasca - kemoterapi , sedangkan tertunda mual terjadi setelah 24
jam dan sampai lima hari pasca - kemoterapi . Sebagian besar pasien

melaporkan mual yang paling parah pada Hari 1 dari kemoterapi dan kecil
kemungkinannya untuk mengalami mual parah pada hari-hari berikutnya jika
mereka tidak mengalaminya pada Hari 1 [ 21 ] . Baru-baru ini , Schwartzberg et
al menunjukkan bahwa pasien yang mengalami mual dan muntah dari siklus
kemoterapi awal mereka kemoterapi emetogenik rendah adalah 3,1 kali lebih
mungkin mengalami mual dan muntah pada siklus kemoterapi berikutnya
dibandingkan dengan pasien yang tidak mengalami mual dan muntah dengan
kemoterapi awal mereka siklus [ 30 ] . Angka ini sebanding dengan tingkat 3,8
dan 3,7 untuk pasien yang menerima kemoterapi sedang atau sangat
emetogenik [ 30 ] . Oleh karena itu, dapat disimpulkan bahwa pasien yang
mengalami mual dan muntah pada siklus kemoterapi akan lebih mungkin
mengalami mual dan muntah pada siklus kemoterapi berikutnya terlepas dari
jenis kemoterapi ( yaitu , rendah, sedang atau sangat emetogenik ) .
Jahe , rempah-rempah kuno , yang terutama dikenal karena perannya sebagai
agen bumbu untuk makanan dalam resep Asia dan India [ 31 ] . Selama lebih
dari 2.500 tahun , rimpang aromatik kering ( batang bawah tanah ) jahe
( Zingiber officinale , Roscoe ) , telah digunakan untuk mengobati gangguan
pencernaan , serta nyeri sendi dan otot . Jahe terdaftar sebagai makanan di FDA
" umumnya dianggap aman " daftar . Studi penelitian telah menunjukkan
efektivitas jahe terhadap mual yang berkaitan dengan motion sickness ,
kehamilan , dan operasi [ 2 , 3 , 10 , 23 , 34 ] . Uji klinis sebelumnya
menunjukkan bahwa jahe dapat efektif terhadap CIN , tetapi kekurangan desain ,
jumlah kecil , dan kurangnya studi dosis - menemukan , membatasi kekuasaan
dan generalisasi mereka [ 17 , 19 , 24 , 32 , 35 ] . Kami melakukan secara acak ,
double-blind , placebo-controlled , uji klinis dosis - menemukan untuk
menentukan apakah jahe lebih efektif daripada plasebo dalam mengendalikan
CIN akut pada pasien kanker yang menerima 5 - HT3 antagonis reseptor
antiemetik .
Pergi ke :
metode
Pasien dan Studi Desain
Pasien yang memenuhi syarat 18 tahun , mampu mengerti bahasa Inggris ,
memiliki diagnosis kanker , mungkin telah menerima 1 siklus kemoterapi , dan
dijadwalkan untuk setidaknya tiga siklus kemoterapi tambahan. Kemoterapi
harus telah diberikan tanpa terapi radiasi konkuren atau interferon dan tanpa
direncanakan gangguan dengan terapi radiasi atau operasi . Semua pasien harus
mengalami mual setiap keparahan dalam setiap siklus kemoterapi sebelum
pendaftaran studi , serta dijadwalkan untuk menerima antagonis reseptor 5-HT3
( misalnya , Zofran , Kytril , Navoban , atau Anzemet ) ditambah
dexamathasone sama sekali kemoterapi siklus . Pasien tidak pada coumadin atau
heparin untuk antikoagulasi terapi , tidak memiliki gangguan perdarahan , dan
memiliki jumlah trombosit > 100.000 / ml sebelum siklus awal .
Penelitian ini merupakan fase II / III , acak , double-blind , uji klinis terkontrol
plasebo yang dilakukan di 23 kelompok praktek onkologi swasta yang didanai
oleh Masyarakat Clinical Oncology Program National Cancer Institute ( CCOP )
dan berafiliasi dengan University of Rochester Cancer Center CCOP Basis
Research. Tujuan utama dari penelitian ini adalah untuk menentukan apakah
suplementasi jahe mengurangi CIN akut ( yaitu , mual pada Hari 1 ) pada pasien

yang menerima standar 5 - HT3 antiemetik antagonis reseptor ditambah

deksametason . The review institusional dari University of Rochester dan setiap
situs yang berpartisipasi menyetujui protokol. Informed consent tertulis diperoleh
dari masing-masing pasien . Penelitian ini terdaftar pada ClinicalTrials.gov , #
NCT00040742 .
Pengacakan dikelompokkan berdasarkan situs CCOP . Dalam setiap situs ,
sebuah angka acak meja yang dihasilkan komputer dengan ukuran blok delapan
digunakan untuk menetapkan secara acak pasien ke salah satu dari empat
kelompok pengobatan ( Placebo , 0.5g , 1.0g , 1.5g dan jahe ) . Pengacakan
ditugaskan pasien untuk empat kelompok rasio 1:1:1:1 .
Obat Study
Jahe dan plasebo kapsul yang diproduksi oleh Aphios Corporation di Woburn ,
MA . Kapsul jahe mengandung ekstrak murni cair jahe ( Zingiber officinale )
dengan 8.5mg terkonsentrasi gingerol gabungan , zingerone , dan konten
shogoal , setara dengan 250mg jahe , dalam minyak zaitun extra virgin
mengandung bahan pengisi lain untuk meningkatkan kelarutan dan
meningkatkan bioavailabilitas . Kapsul plasebo terdiri dari hanya minyak zaitun
extra virgin mengandung tingkat yang lebih tinggi dari eksipien dalam rangka
untuk mencocokkan berat kapsul jahe . Kedua jahe dan produk plasebo ganda
dikemas dalam ukuran " 0 " , putih , buram , keras kapsul gelatin dengan topi
nitrogen . Ganda enkapsulasi dan nitrogen topi menutupi perbedaan dalam bau
atau warna antara kedua produk . Kapsul dikemas dalam kemasan blister berisi
enam kapsul ( jahe atau plasebo ) dan dikelompokkan menjadi pagi dan sore
dosis ( 3 kapsul masing-masing) . Isi dari kemasan blister untuk setiap lengan
penelitian adalah : lengan 1 ( plasebo ) = 3 kapsul plasebo dua kali sehari;
lengan 2 ( 0.5g jahe harian dosis ) = 2 kapsul plasebo dan 1 kapsul jahe dua kali
sehari; lengan 3 ( 1.0g harian dosis jahe ) = 1 kapsul plasebo dan 2 kapsul jahe
dua kali sehari; lengan 4 ( 1.5g harian dosis jahe ) = 3 kapsul jahe dua kali sehari
.
prosedur
Hari-hari di sekitar setiap infus kemoterapi diidentifikasi untuk tujuan studi
sebagai berikut : Hari ke -1 -3 adalah sebelum kemoterapi , Day 1 adalah hari
infus kemoterapi , dan hari 2-4 adalah pasca- kemoterapi . Semua pasien
menerima 5 - HT3 antiemetik ditambah dexamathasone pada Hari 1 dari semua
siklus kemoterapi . Semua pasien mengambil obat studi dua kali sehari selama
enam hari , mulai tiga hari sebelum kemoterapi mulai untuk siklus belajar 2 dan
3 . Kepatuhan diukur dengan jumlah pil pada akhir setiap siklus penelitian . Mual
dan muntah diukur dengan menggunakan dimodifikasi empat hari laporan pasien
diary dikembangkan oleh Burish [ 5 ] dan Carey [ 6 ] dan digunakan oleh kami
dalam uji klinis besar sebelumnya [ 13 , 14 , 26 , 28 ] . Pasien melaporkan
keparahan mual empat kali setiap hari ( pagi , siang, sore , dan malam ) selama
tiga periode empat hari ( Hari 1 - 4 ) selama setiap siklus (baseline , studi siklus
2 dan studi siklus 3 ) menggunakan 7 - titik skala rating semantik berlabuh oleh "
1 " = " sama sekali tidak mual " dan dengan " 7 " = " Sangat mual . "
penggunaan obat anti - mual dan muntah jumlah episode juga dicatat . A 13
-item Gejala Inventarisasi digunakan untuk menilai potensi efek samping dari
jahe , serta mual antisipatif , pada skala 11 -point berlabuh oleh 0 ( " Tidak
Hadir ) dan 10 ( " As Bad As You Can Imagine " ) [ 7 , 29 ] . The Gejala

Inventarisasi selesai sekali selama siklus awal (yaitu , Day 4 ) dan tiga kali
selama siklus studi 2 dan 3 (yaitu , sebelum memulai obat studi ( Hari -4 ) ,
sebelum Hari 1 kemoterapi (yaitu , Day -1 ) , dan setelah selesai obat studi ( Day
4 ) ) . Mual antisipatif dianalisis menggunakan item mual pada Inventarisasi
Gejala selesai sebelum kemoterapi ( yaitu , Hari -1 ) . Kualitas hidup dinilai
menggunakan 27 -item Penilaian Fungsional Terapi Penyakit Kronis Jenderal
( FACIT - G ) pada awal dan penilaian tindak lanjut (yaitu , Day 4 ) .
Analisis Statistik
Semua uji statistik dilakukan pada dua sisi tingkat signifikansi 5% dan data
dianalisis pada " intent- to-treat " dasar . Keparahan mual akut diukur sebagai
rata-rata dan maksimum sore dan malam hari 1 tanggapan . Untuk menganalisis
keparahan mual akut akurat , kita harus memastikan bahwa pasien menerima
kemoterapi sebelum Peringkat keparahan mual mereka pada Hari 1 dalam empat
hari buku harian . Kami mengeluarkan tanggapan mual pagi dan sore pada Hari 1
karena itu tidak mungkin bahwa pasien akan menerima kemoterapi sebelumnya
baik dari kali ini . Keparahan mual Tertunda diukur sebagai rata-rata dan
maksimum dari semua nilai-nilai untuk Hari 2 dan 3 . The tindak lanjut fase
keparahan mual diukur sebagai rata-rata dan maksimum tanggapan untuk Hari 4
. Keparahan mual Rata-rata (NAB ) diindikasikan sebagai ukuran hasil utama
dalam protokol , tetapi keparahan mual maksimum ( NMX ) ( yaitu mual yang
paling buruk ) dianggap lebih relevan dari sudut pasien pandang . Model
campuran analisis dan Tipe 3 tes efek tetap menggunakan derajat Kenward Roger prosedur kebebasan [ 16 ] yang digunakan untuk memeriksa perubahan
dari baseline Nav dan NMX pada Hari 1 . Efek tetap dalam model adalah Dosis ,
Cycle dan Dosis * interaksi Cycle dan efek random terdiri dari subjek - subjek dan
dalam subyek variasi . Di bawah asumsi hilang - di - acak , nilai-nilai yang hilang
seharusnya tidak menimbulkan bias yang besar menggunakan metode analisis
ini , namun kami memeriksa ini dengan imputasi ganda ( multiple imputasi oleh
persamaan dirantai , MICE [ 33 ] ) dan perubahan dalam hasil yang kecil .
Kontras digunakan untuk memperkirakan dan menguji ukuran efek plasebo
dibandingkan jahe pada dosis apapun. Berarti perbedaan antara masing-masing
dosis jahe dan plasebo juga diperkirakan dan diuji dengan menggunakan
prosedur Tukey - Kramer untuk beberapa perbandingan . Analisis serupa yang
digunakan untuk memeriksa hasil sekunder tertunda mual , kualitas hidup , dan
muntah . Untuk meneliti efek mual antisipatif , pra - kemoterapi persediaan
gejala mual barang skor ditambahkan sebagai kovariat dalam model campuran
di atas . Perhitungan dilakukan dengan SAS Versi 9.2 ( PROC MIXED ) dan R Versi
2.9.1 (paket MICE Versi 1.21 ) .
Pergi ke :
hasil
pasien Karakteristik
Dari bulan Juni 2002 sampai Desember 2008, total 744 pasien kanker yang
terdaftar dan acak ke salah satu dari empat kelompok pengobatan ( Gambar 1 ) .
Dari 744 pasien , 662 menyelesaikan langkah-langkah dasar sebelum obat studi
yang diberikan . Dari 662 pasien yang menyelesaikan siklus awal , 562 ( 85 % )
menyelesaikan studi Siklus 2 (yaitu , siklus pertama pengobatan studi ) dan 471
( 71 % ) menyelesaikan studi Siklus 3 (yaitu , siklus kedua obat studi ) . Analisis
yang dilaporkan dilakukan pada 576 ( 87 % ) pasien yang memberikan data
dievaluasi di kedua Study Cycle 2 atau 3 . Karakteristik dasar yang setara di

kelompok perlakuan ( Tabel 1 ) . Sebagian besar pasien adalah kulit putih ( 91

% ) , perempuan ( 93 % ) dengan usia rata-rata 53 tahun dan jenis yang paling
umum kanker payudara adalah ( 74 % ) , gastrointestinal ( 8 % ) , dan paru-paru
( 6 % ) kanker . Secara keseluruhan alasan untuk non - penyelesaian studi
termasuk : berubah pikiran tentang partisipasi ( n = 81 ) , bentuk studi lengkap
( n = 36 ) , gejala gastrointestinal ( n = 32 ) , alasan medis lainnya ( n = 31 ) , of
kemoterapi ( n = 22 ) , dan chemotoxicity ( n = 19 ) . Dua alasan yang paling
menonjol untuk putus sekolah pada awal berubah pikiran tentang partisipasi ( n
= 36 , 43% ) dan bentuk-bentuk yang tidak lengkap studi ( n = 11 , 13 % ) , yang
juga penyebab utama putus sekolah untuk Studi Siklus 2 dan 3 ( n = 45 , 23 %
dan n = 25; 13 % , masing-masing) . Tidak ada perbedaan yang berarti
bermakna atau signifikan secara statistik antara empat kelompok pengobatan
pada awal untuk Nav (rata-rata kisaran = 2,2-2,6 ) , NMX (rata-rata kisaran =
2,5-2,9 ) , atau kualitas hidup (rata-rata kisaran = 71-72 ) . Kepatuhan untuk
mempelajari obat-obatan tidak secara signifikan berbeda antara kelompok
pengobatan atau siklus studi ( 93 % kepatuhan = plasebo , 83 % kepatuhan =
0,5 g jahe , 90 % kepatuhan = 1.0g jahe , dan 84 % kepatuhan = 1.5g jahe ) .
Dalam empat hari diary , pasien diminta untuk mencatat berapa kali mereka
menggunakan obat antiemetik setelah perawatan kemoterapi mereka . Obatobatan antiemetik dikategorikan menjadi empat jenis obat : Tipe 1 ( granisetron ,
odansetron , dolasetron mesylate , tropisetron ) , Type 2 ( proklorperazin ) , Tipe
3 ( deksametason ) , dan Tipe 4 ( metochlopramide ) . Tidak ada perbedaan yang
signifikan antara kelompok pengobatan dalam hal penggunaan antiemetik .
Secara keseluruhan , mayoritas pasien tidak mengambil obat antiemetik laporan
dan kelompok plasebo cenderung melaporkan lebih banyak menggunakan obat
antiemetik dibandingkan dengan lengan jahe .
Gambar 1
Gambar 1
Pasien Flow Diagram
tabel 1
tabel 1
Karakteristik Baseline Pasien ( N = 576 )
Efek jahe pada kemoterapi yang berhubungan dengan mual
Tujuan utama dari uji klinis ini adalah untuk menentukan apakah jahe lebih
efektif daripada plasebo dalam mengurangi keparahan mual pada Hari 1
kemoterapi (yaitu , mual akut ) . Awalnya, protokol menyerukan ANCOVA di Nav
pada Hari 1 peringkat dari catatan harian , dengan dasar sebagai kovariat .
Namun, distribusi baseline dan hasil pasca perawatan yang positif miring dan
menggunakan dasar sebagai kovariat dalam ANCOVA akan memberikan tinggi dasar subjek pengaruh yang tidak proporsional . Perubahan skor tidak
menunjukkan skewness .
Akibatnya , model campuran analisis pada nilai perubahan dilakukan untuk
menggabungkan informasi dalam kedua siklus penelitian , mendapatkan lebih
banyak kekuatan , dan mengevaluasi setiap perbedaan dalam dua siklus . Model
campuran analisis di kedua siklus studi 2 dan 3 , menggunakan Nav dan NMX ,
mengungkapkan bahwa semua dosis jahe secara signifikan mengurangi CIN akut
pada kedua siklus penelitian dibandingkan dengan plasebo ( p = 0,013 dan
0,003 , masing-masing; Gambar 2 ) . Perbedaan dalam kuadrat-terkecil berarti
menunjukkan bahwa 0.5g dan 1.0g jahe harian adalah yang paling efektif dalam

mengurangi CIN akut ( Tabel 2 ) .

Gambar 2
Gambar 2
Jahe mengurangi keparahan mual akibat kemoterapi akut
tabel 2
tabel 2
Analisis Model Campuran untuk Mual pada Hari 1 Kemoterapi
Tujuan sekunder dari penelitian ini adalah untuk mengetahui efek jahe pada
mual tertunda , mual antisipatif , dan kualitas hidup pada pasien yang menerima
kemoterapi . Analisis model campuran yang digunakan untuk memeriksa mual
tertunda untuk semua interval waktu pada hari 2 dan Day 3 dan tindak lanjut
mual pada Hari 4 ketika pasien tidak lagi pada obat studi . Meskipun penurunan
yang signifikan dalam mual akut pada Hari 1 (yaitu , akut ) di semua lengan jahe
dibandingkan dengan plasebo , pentingnya suplementasi jahe melemah untuk
tertunda ( Hari 2 dan 3 ) dan tindak lanjut mual ( Day 4 ) (Angka 3 dan and4 ) .4 )
. Data ini menunjukkan bahwa pasien melaporkan mual tertunda lebih parah
dibandingkan dengan mual akut . Secara keseluruhan , tidak ada perbedaan
signifikan yang diamati pada muntah atau kualitas hidup ( FACIT - G ) , antara
tiga lengan jahe dan plasebo . Sebagian besar pasien tidak melaporkan episode
muntah (rata-rata kejadian = 0,5 ) . Sebaliknya , tipe 3 tes efek tetap
mengungkapkan bahwa mual antisipatif ( p < 0,0001 ) juga merupakan faktor di
CIN akut .
Gambar 3
Gambar 3
Keparahan mual Rata-rata (NAB ) dari waktu ke waktu untuk setiap siklus studi
Gambar 4
Gambar 4
Keparahan mual Maksimum ( NMX ) dari waktu ke waktu untuk setiap siklus studi
Adverse Event
Sebanyak 24 kejadian buruk yang dilaporkan selama penelitian. Hanya sembilan
dari advents merugikan dilaporkan dianggap terkait untuk mempelajari obat
(yaitu , jahe ) dan pasien menarik diri dari penelitian . Efek samping ini termasuk
gejala gastrointestinal , seperti Grade 2 mulas, memar / flushing , dan ruam .
Pergi ke :
diskusi
Mual adalah gejala yang rumit untuk penelitian dan efektif mengobati karena
merupakan fenomena subyektif dan tidak dapat diamati [ 4 ] . Penelitian
sebelumnya telah menunjukkan bahwa persepsi kerentanan dan harapan , serta
usia , merupakan faktor risiko penting bagi tingkat keparahan mual [ 27 ] .
Dalam uji coba ini besar , multisite klinis , jahe mengurangi keparahan mual akut
pada pasien kanker yang menerima kemoterapi . Salah satu fitur kunci dari
penelitian ini adalah pelaksanaan kursus enam hari jahe tiga hari sebelum
dimulainya kemoterapi , pendekatan yang sama dengan administrasi jahe dalam
pencegahan mabuk [ 10 , 23 ] . Meskipun tujuan utama kami adalah untuk
mengurangi akut CIN , kursus enam hari jahe atau plasebo memungkinkan kita
untuk mengevaluasi antisipatif dan tertunda CIN . Data kami menunjukkan
bahwa mual antisipatif kontribusi untuk laporan mual akut . Fenomena ini oleh
Roscoe et al [ 27 ] . Para penulis melaporkan bahwa kemungkinan pasien kanker

melaporkan mual dari kemoterapi adalah 2,85 kali lebih besar pada pasien yang
mengatakan mereka rentan terhadap mual dibandingkan dengan orang lain yang
menyatakan mereka tidak rentan [ 27 ] .
Kita hanya bisa berspekulasi bahwa mekanisme yang jahe meredakan mual
adalah melalui kombinasi aktivitas anti - inflamasi dan anti - spasmodik . Obat
antiemetik saat ini, seperti 5 - HT3 , yang reseptor antagonis untuk
neurotransmitter tertentu dalam saluran pencernaan [ 12 ] . Demikian juga , jahe
dapat mengikat reseptor 5 - HT3 untuk meningkatkan efek antiemetik dan dapat
meningkatkan enzim detoksifikasi untuk melawan kerusakan oksidatif pada
jaringan [ 9 ] . Kami berspekulasi bahwa mulai jahe tiga hari sebelum dimulainya
kemoterapi mungkin telah prima usus untuk respon anti - mual melalui reseptor
5 - HT3 mengikat dan induksi enzim detoksifikasi . Selain itu , mekanisme
berbasis reseptor tindakan bisa menjelaskan mengapa dosis rendah jahe lebih
efektif daripada dosis tertinggi . Secara hipotesis , jahe dosis tertentu
( misalnya , 1.0g ) dapat menjenuhkan reseptor render dosis yang lebih tinggi
tidak efektif . Serupa dengan temuan kami , Lien et al diterbitkan bahwa 1.0g
dosis jahe lebih efektif terhadap mabuk daripada 2.0g dosis [ 18 ] .
Kekuatan utama dari studi ini termasuk ukuran besar sampel , pengobatan buta
ganda , dan evaluasi dari tiga jenis CIN . Dua kelemahan utama dari penelitian
ini , yang harus dikontrol dalam studi masa depan , tidak mengontrol rejimen
kemoterapi (yaitu , tinggi dibandingkan rejimen emetogenik rendah) atau tingkat
keparahan mual sebelum pendaftaran . Penelitian terbaru menunjukkan bahwa
pasien lebih mungkin untuk mengalami CINV dari siklus kemoterapi berikutnya
jika CINV berpengalaman selama siklus awal atau sebelumnya , terlepas dari
rejimen kemoterapi (yaitu , rendah, sedang atau sangat emetogenik ) [ 30 ] .
Studi kami tidak mengumpulkan informasi tentang jenis rejimen kemoterapi
karena kita hanya mendaftarkan pasien yang melaporkan mual dari siklus
kemoterapi sebelumnya . Desain penelitian ini memungkinkan penyelidikan
adanya mual tanpa muntah . Insiden rendah emesis diharapkan sejak 5 - HT3
antiemetik antagonis reseptor [ 20 ] yang digunakan . Namun, kami tidak
berharap keparahan Nav dan NMX pada awal menjadi mempertimbangkan
pasien melaporkan mual selama siklus kemoterapi sebelumnya rendah.
Keterbatasan hasil studi meliputi efek ukuran kecil untuk keparahan mual dan
kurangnya efek pada mual tertunda dan kualitas hidup . Ukuran berlaku untuk
keparahan mual mungkin lebih besar jika studi hanya terdaftar pasien dengan
moderat untuk mual parah dengan kemoterapi sebelum pendaftaran . Selain itu ,
data kami menunjukkan bahwa pasien melaporkan mual tertunda lebih parah
( Day 2 dan Day 3 ) dibandingkan dengan mual akut ( Day 1 ) menunjukkan
bahwa mual tertunda adalah masalah yang lebih melemahkan untuk pasien
daripada mual akut . Ketidakmampuan untuk mendeteksi perbedaan yang
signifikan terhadap kualitas hidup bisa disebabkan ketidakmampuan untuk
mengontrol mual tertunda . Kami berspekulasi bahwa penurunan tertunda mual
secara signifikan akan meningkatkan kualitas hidup pasien selama kemoterapi .
Meskipun beberapa pasien kanker dapat menggunakan jahe untuk pencegahan
atau pengobatan CIN , sedikit kerja yang dipublikasikan telah membahas khasiat
jahe untuk CIN . Sejak tahun 1986 , hanya lima artikel yang dipublikasikan
penggunaan jahe untuk CINV pada pasien kanker yang menerima kemoterapi .
Pada tahun 1986 , Pace et al mempelajari 20 pasien yang dirawat karena

leukemia dengan sitosin arabinoside ( ARA - C ) dan menunjukkan bahwa pasien

yang menerima jahe memiliki mual secara signifikan kurang parah pada hari
kemoterapi dan pada hari berikutnya daripada mereka yang memakai kapsul
plasebo [ 24 ] . Demikian pula , Sontakke et al menunjukkan bahwa 1g jahe
sebelum dan sesudah kemoterapi adalah baik seperti metoclopramide pada
kontrol penuh mual [ 32 ] . Sebaliknya , Zick et al menunjukkan tidak ada
perbaikan dalam akut atau tertunda CIN dengan jahe ( 1.0g atau 2.0g ) dalam ,
double-blind , placebo-controlled secara acak di 162 pasien kanker [ 35 ] . Levine
et al menunjukkan bahwa diet protein tinggi dengan 1.0g keparahan jahe
mengurangi mual tertunda dan penggunaan obat antiemetik [ 17 ] . Namun,
penelitian ini memberikan kontribusi pengurangan untuk diet protein tinggi dan
tidak perlu untuk suplemen jahe . Baru-baru ini , Pillai et al menunjukkan bubuk
jahe ( 1 - 2g sehari ) mengurangi keparahan akut maupun yang tertunda CINV
pada anak-anak dan dewasa muda yang menerima kemoterapi yang sangat
emetogenik untuk sarkoma [ 25 ] . Kami menyimpulkan bahwa jahe ( Zingiber
officinale ) , pada dosis 0,5 g menjadi 1,0 g sehari , secara signifikan membantu
dalam pengurangan CIN akut pada pasien yang menerima antiemetik standar.
Sejauh ini, jahe telah menunjukkan efek yang menguntungkan pada mual akut
dari kemoterapi , namun efektivitas jahe untuk mual yang berhubungan dengan
kondisi medis lainnya menanti lebih terkontrol .
Pergi ke :
Ucapan Terima Kasih
Penelitian ini didukung oleh National Cancer Institute dari National Institutes of
Health PHS memberikan 1R25CA10618 ( Pengendalian Kanker Research) dan
U10CA37420 ( Clinical Oncology Program Community ) .
Pergi ke :
Catatan kaki
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