Review Article

Open Access Journal of Review Article Biomedical Science ISSN: 2690-487X

Efficacy of Ginger Use for Chemotherapy Induced Nausea and Vomiting in Cancer Patients: Scoping Review

Nourah Aldousari1*, Nada Aljehani1*, Areej Hadad1, Fatimah Alharthi1, Aishah Magrabi1, Monirah Alhawsawi1 and Elham Abdullah Al Nagshabandi2 1RN, BSN, MSN, Medical Surgical Nursing, Faculty of Nursing, King AbdulAziz University, Saudi Arabia 2Associated professor, Department of Medical Surgical Nursing, Faculty of Nursing, King AbdulAziz University, Saudi Arabia

ABSTRACT

Background: Chemotherapy induced nausea and vomiting are the main undesired side effect that distress around 70 % to

this condition or not it is still a matter of debate. Objective: This scoping review is conducted to assess the effect of ginger usage on nausea80% of andcancer vomiting patients. induced Ginger by ischemotherapy often advocated amongst as beneficial adult patients for nausea with and cancer. vomiting, whether the herb is truly efficacious for

Methodology: Databases searched include MEDLINE, CINHALE, PubMed and Google scholar for related articles between 2012 to 2019 was performed. After extensive review,188 studies were retrieved from the databases and only 15 studies found eligible according to applied inclusion and exclusion criteria. (14 randomized controlled trails, 1 pilot study) with a total of 1974 patients with different cancer types receiving emetogenic chemotherapy.

Results: The majority of available evidence demonstrates that ginger is an effective, inexpensive and safe treatment for nausea and vomiting.

Conclusion

: Ginger supplementation can be potentially efficient effects on the patients who receives chemotherapy-induced nausea and vomiting. The results of this scoping review provide significant suggestions for further research using standardized gingerKEYWORDS products: andCancer reflective patients; larger Chemotherapy sample sizes induced to confirm nausea, the efficacy Vomiting; of ginger Ginger; extract Ginger supplement extract and optimal dosing regimens.

INTRODUCTION as a result of failure to meet nutritional requirements, which Due to of the intrinsic emetogenicity of chemotherapeutic further jeopardizes medication results Rapoport [4]. In addition agents Chemotherapy related induced nausea and vomiting is a to having a destructive experience, CINV may cause consequently major issue distressful for cancer patients undergoing treatment affect the immune system, performance status and electrolyte Bossi et al. [1]. Its prevalence is reported between 54% and 96% imbalance Ansari et al. [5]. Despite the decrease in CINV by using Sheikhi [2]. Chemotherapy-induced nausea and vomiting (CINV) various classes of antiemeting agents, CINV occurs in 60-80% of among patients with cancer impacts treatment outcomes and chemotherapy patients Ansari et al. [5]. quality of life Adel [3]. As a result, nausea and vomiting caused by chemotherapy are due to 50% to 60% of the symptoms of In addition, different approaches, including pharmaceutical chemotherapy patients suffering from protein food deprivation or complementary treatments, are used to monitor CINV. Herbal

Quick Response Code: Address for correspondence: Nourah Aldousari, Nada Aljehani RN, BSN, MSN, Medical Surgical Nursing, Faculty of Nursing, King AbdulAziz University, Saudi Arabia Received: January 18, 2021 Published: January 26, 2021

How to cite this article: Nada A, Nourah A, Areej H, Fatimah A, Aishah M, Monirah A, Elham Abdullah Al. Efficacy of Ginger Use for Chemotherapy Induced Nausea and Vomiting in Cancer Patients: Scoping Review. 2021- 3(3) OAJBS.ID.000248. DOI: 10.38125/OAJBS.000248

C 2021 Open Access Journal of Biomedical Science 812 Open Acc J Bio Sci. January- 3(3): 812-822 Nourah Yousef Aldousari Review Article

therapy is the most commonly complementary therapies used This integration of functions explains the ability of ginger to among the people Sanaati [6]. Based on a World Health Organization relieve symptoms of functional gastrointestinal disorders, such (WHO) report, about 80% of the world population stratify herbal as dyspepsia, nausea, and vomiting, which is often associated compounds now Sanaati [6]. Ginger (Zingiber officinale) is a with decreased gastric motility Lete [8]. For this reason, the conventional remedy in many cultures for nausea and vomiting and investigators conducted the current search based on best evidence- has been investigated for use in motion sickness, morning sickness based practice (EBP) for the effect of ginger on CINV addressing and postoperative nausea Palatty [7]. different perspectives starting from reduction to no effect. The PICOT question addressed in this paper is: In patients with cancer who are receiving chemotherapy, how does the use of ginger, the safe list of herp and included it in many pharmacopeias Western Ginger on the U.S. Food and Drug Administration classified in compared with no of use ginger, affect reports of chemotherapy countries Lete [8]. The exact mechanism remains indistinct; induced nausea and vomiting? however, the effects of “gingerol and shogaol” compounds on various chemotherapy-induced nausea and vomiting processes are AIM effects on muscarinic and histaminergic receptors through its The aim of this scoping review is to identify, describe, and antagonisticknown to have effect; beneficial its capacity effects Marx to control et al. [9]. gastric Ginger emptying has beneficial and evaluate importance of the evidence of ginger usage among cancer gastrointestinal motility; and its function in reducing oxidative patients to relive episodes of chemotherapy induce nausea and vomiting (CINV); (Table 1).

Tablestress and1: PICOT inflammation question. Marx et al. [9].

Picot Content Picot Question Cancer patient, received chemotherapy induce nausea and P vomiting I Ginger use In patients with cancer treated by chemotherapy, how does the C No intervention use ginger compared with no use ginger affect experience of O Reduction of nausea and vomiting nausea and vomit induced by chemotherapy? T No time Type Interventional PICOT question

SEARCH STRATEGIES our aim of study to identify the most appropriate articles to answer PICOT question which included the following: stages methodology Arksey H 2005. First, the PICOT question Inclusion Criteria This literature guided by Arksey and O’Malley stated of five a) Studies that are available in English language only. how does the used ginger, compared with no use ginger, affect the experiencewas identified of nausea“In patients and vomitwith cancer induced treated by chemotherapy?” by chemotherapy, To b) Studies address only cancer who receive chemotherapy. guide the search process in the database. Then, to identify articles relevant to this scoping review, which focus on the effect of ginger c) Studies was conducted in adult population 18 years or use on reducing nausea and emesis, searching was initiated in an more. electronic database between October and November 2019. Recent d) Published studies conducted in the last 7 years between articles were collected between 2012-2019 to identify the recent 2012-2019. and exclusion criteria. Finally, a thematic framework sated to guide e) Only quantitative research included. andstudies sorting conducted of existing under literature the same and objective review under matrix specific was completed inclusion f) Articles that study ginger or ginger extract with patient to collating, summarizing, and reporting the results (Appendix 1). treated with chemotherapy induced nausea and vomiting with KEYWORDS different types of cancer and measured effect to reduce nausea and vomiting. Combination of key ward was used which include: ‘ginger or ginger extract’, ‘chemotherapy induced nausea and vomiting’ and Exclusion Criteria ‘cancer patients’. a) Studies in other language than English language SEARCH ENGINES b) Articles that are not relevant to the topic such as articles The electronic searching included extensive searching in address effect in other of chemotherapy as radiation therapy. databases from the Database of Cumulative Index of Nursing and c) Studies that included infant and children in population. Allied Health Literature “CINHAL”, Midline, PubMed, and grey literature also conducted using Google scholar for more evidence. d) Articles was before 2012. through examined for population, intervention, comparison, the outcome of the study. ARTICLES RETRIEVED AND SCREENING PROCESS INCLUSION AND EXCLUSION CRITERIA To identify literature screen PRISMA was used. (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). Inclusion and Exclusion Criteria were developed according to

PRISMA contain four phase flow diagrams explained in Figure C 2021 Open Access Journal of Biomedical Science 813 Open Acc J Bio Sci. January- 3(3): 812-822 Review Article Review Article Nourah Yousef Aldousari

the researchers and only relevant articles were retrieved. Finally, 15 Full-text articles were included, 7 articles not relevant outcome literature).1. At first, After a total duplicates of 188 studiesremoved were 9 articles found were through eliminated. search were eliminated. 1 pediatric article excluded. Also, 6 review articles Thedatabases. search plus,was narrowed 5 records to identified 184 articles through according other to sources the inclusion (gray were eliminating. We included in our search published articles only and exclusion criteria were established Then the remaining 29 quantitative methods are screens. articles, titles, abstract and full texts were screened manually by

Figure 1.

FINDING AND RESULTS Konmun et al. [10]; Alexander [11]; Sanaati [6]; Tahir [12]; Ryan et al. [13]; Yekta et al. [14] conducted similar studies and established the use of ginger along with antiemetic medication to reduce nausea and vomiting experience in a cancer patient who is The finding of our Scope Review was identified by thematic discussing the reduction effect of ginger on chemotherapy induced receiving chemotherapy. nauseaanalysis and into vomiting categorizes while in the three Second themes. theme the is firstdiscussing theme the is According to Konmun et al. [10] who conduct a randomized Themes are illustrated in Table 2 below. double-blind placebo-controlled in Thailand. The aim was to conflict effect. The last theme discusses the non-reduction effect. study the effect of one of bioactive ginger extract (6-gingerol) on Theme 1: Reduction Effect on CINV a client who receives chemotherapy-induced nausea (CINV). The Ginger had been used for centuries for gastrointestinal effect of ginger was tested in at least 3 cycles of chemotherapy in disturbance. Chemotherapy-induced (CINV) can have a negative the multicycle interval that included an eighty-eight patient with impact on patients’ quality-of-life. There is evidence that suggests different cancers types participant were assigned into two groups, taken ginger with standard antiemetic drugs, ginger may add the intervention group took ginger extract, referred to as 6-gingerol additional reducing or eliminating of nausea and vomiting pre and 10 mg capsules while the control group take placebo capsule to intra chemotherapy cycles. contain microcrystalline cellulose three days prior of the first day of

C 2021 Open Access Journal of Biomedical Science 814 Open Acc J Bio Sci. January- 3(3): 812-822 Nourah Yousef Aldousari Review Article

chemotherapy and continued to 12 weeks of treatment. The result acute and delayed nausea and emesis experiences (p=0.003) in illustrated that as compared to placebo, all patients in interventional addition to ondansetron, metoclopramide, and dexamethasone use in both groups.

Tablegroups 2 : of Scope ginger review experiment theme. experienced significantly reduced

Themes/ sub-themes Name Theme (1) Reduction effect on CINV Theme (2) Partial effects on nausea or vomiting Theme (3) Non reduction effect on CINV

Another study was conducted by Alexander [11] investigated groups was crossed over to receive the other regime. The severity the effect of Indian ginger tea on nausea and emesis induced by of nausea and vomiting assessed using kortila tools. The result of chemotherapy among cancer patients in Bharat Hospital and Institute of Oncology at Mysore India. The sample consisted of 60 patients, 30 patients allocated in each experimental and control andthe studyvomiting identified compared that toparticipants the participant who whoreceiving received ginger a placebo. showed group. The experimental group (n=30) had oral administration a significant reduction in frequency and less severe form of nausea of Indian ginger tea from the 1st day of the chemotherapy cycle, These results were consistent with the Sanaati [6] randomized, while the control group was not given Indian ginger tea. The result double-blind, and clinical trial research to locate the impact of ginger indicated that administration of Indian ginger tea was reducing and chamomile capsules on nausea and vomiting in chemotherapy nausea and vomiting effectively as the independent ‘t’ values were on 65 women with breast cancer. The women Participating in this experiment were divided into two groups. Ginger and chamomile and one control group, a routine antiemetic regimen consisting of statisticallyOther study significant was done at 0.05 in levelturkey of significance.that support similar result dexamethasone, metoclopramide, and aprepitant (DMA) capsule conducted through a double blind randomized controlled trials were consumed. Consequently, the results showed that Ginger and study to evaluate the effect of ginger on nausea and vomiting induced by chemotherapy. All sample in the study 60 patients received standard antiemetic drug. Patients in the intervention andchamomile chamomile had groups. a significant Moreover, effect unlike in reducing chamomile, the frequency the level of group consumed powdered ginger added to yogurt, 30 minutes nauseavomiting, was there greatly being affected no significant by ginger. difference between the ginger before chemotherapy administration while control group provided standard care. The study tests the mean score of nausea severity, Ryan et al. [13] performed a randomized, double-blinded, frequency of vomiting and retching episodes. According to the placebo-controlled, multicenter trial in the United States to result of this comparison, the study emphasis that nausea severity determine the effects of ginger in controlling chemotherapy- induced nausea (CIN). The study included 744 patients (576 in the group who receive ginger than in the control group (p > 0.05).and the Despite frequency this, of the vomiting variation episodes in of wereretching significantly episodes decreasewas not givenpatients a placebo, included while in thethe finalother analysis)three groups with received different different cancer p > 0.05) between the intervention and who were randomly assigned into four groups the first group control groups Arslan [15]. concentration ginger doses 0.5 g, 1.0 g, 1.5 g of capsules ginger statistically significant ( beside received the standard antiemetic a 5-hydroxytryptamine (3) Furthermore, Alparslan et al. [16] Non- randomized controlled receptor antagonist plus dexamethasone. Patients started to take 3 ginger capsules or placebo, three days prior to chemotherapy cycles ginger on chemotherapy-induced nausea and emesis on cancer for 6 days. The result illustrated that the different ginger doses (0.5 patientsstudy (NRS). who The received study waschemotherapy conducted into evaluatethe hematology the efficacy clinic. of g, 1.0 g, or 1.5 g) reduced the severity of acute nausea (p = 0.003) Over time, the study group was consisting of 15 in the intervention compared to the placebo. The researchers reported that the largest group and 30 in the control group. Whereas the intervention group reduction in the intensity of nausea was taking place with 0.5 g and received ginger tablets (800 mg) compared with the control group 1.0 g of the ginger capsule (p = 0.017 and p = 0.036, respectively). received antiemetic drugs. The current study proposed that ginger is effective in lowering chemotherapy-induced nausea and emesis. Recent research has been published by Tahir [12]. Who conduct

According to a randomized cross-over experimental study a prophylactic antiemetic in reducing the delayed chemotherapy- published by Montazeri et al. [17] aimed to evaluate ginger use induceda randomized vomiting, control additionally trial to find to standardout the effect antiemetic of using therapy ginger for as among cancerous under chemotherapy-induced nausea and patients who receiving emetogenic chemotherapy? The study was vomiting. The participants of this trial were selected from oncology conducted in Jinnah Hospital, Lahore, Pakistan, with a total study patients’ presence in haematology departments in many university sample of 90 patient, who divided into two groups, intervention hospitals in Iran. The researcher was allocated participants into group how received a cap of 500 mg ginger orally TID, 3 days prior to chemotherapy and 3 days after chemotherapy and olanzapine as to evaluate the effects of these two regimes on the patients who a based standard antiemetic regimen. The other group consists of treatedtwo groups with A andemetogenic B with specific chemotherapy interventional according or placebo to inclusion regimes 45 patients who received only olanzapine as standard antiemetic criteria to in role to the plan. The interventional group was a standard antiemetic drug additional to 4 ginger capsules, two of the addition of ginger capsules. Only 35.6% of patients had vomiting capsules taken 30 minutes prior to chemotherapy administration, aftertherapy. chemotherapy The results as of compared the study to did 62% respond of patients significantly in the standard to the the other two capsules were given after 6 hours chemotherapy therapy group, (p-value 0.006). session. The placebo group was received a routine antiemetic therapy with 4 placebo capsules. Then, participant of these two Yekta et al. [14] conducted a related study under similar

C 2021 Open Access Journal of Biomedical Science 815 Open Acc J Bio Sci. January- 3(3): 812-822 Review Article Review Article Nourah Yousef Aldousari

concern by using double-blind randomized experiment trial, study neck cancer were the most represented tumors types. The result was accomplished on eighty female who diagnosed with breast carcinoma and on single-day chemotherapy cycle in Imam Khomeini throughout the two cycles of chemotherapy, no difference was a Hospital in Iran, the patients were selected through convenience noticeshows inthat emesis there nausea are no significantassessment differences scores between between the two ginger groups and sampling and allocated randomly into two groups intervention and placebo group Bossi et al. [1]. placebo-control groups. In contrast, Thamlikitkul et al. [18], A double-blind, crossover The intervention members received capsules of ginger powder study RCT in Thailand to investigate the effects of ginger for 250 mg called (Zintoma) that contained (250 mg dry powdered chemotherapy-induced nausea and vomiting (CINV) prophylaxis in ginger root that was prepared with 10:1 ratio of ethanol 50% female patient with cancer patients who received adriamycin and and ginger root and included 5.38 mg (2.15%) 6-gingerol, 1.8 mg cyclophosphamide (AC) chemotherapy. The study suggests that (0.72%) 8-gingerol, 4.19 mg (1.78%) 10-gingerol, and 0.92 mg ginger capsule, was safe, at a dose of 1 g/day for 5 days, starting (0.37%) 6-shagaol), all of these components are active form of difference compared with control group in word of reducing nausea capsules, both of these groups received four times a day with a andon the vomiting first day severity of chemotherapy, in female patients but indicate with breastthat no cancer significant who six-hourginger extract. interval, the the placebo total dose group was received(1000 grams 250 mgper starch-filledday) for six receiving AC chemotherapy. contagious days, 3 days prior initiate chemotherapy sessions in addition to antiemetic including granisetron hydrochloride, and Li [19] conducted randomized, double-blind, placebo- dexamethasone use in each group. A daily self-report assessment controlled clinical trial of 140 patients with lung cancer receiving tool was used to evaluate the ginger effect. The result shows that cisplatin-based regimens was enrolled and devoted to receiving either ginger root powder or a placebo. However, the result showed placebo-control groups throughout of chemotherapy session, Also, no the difference is obvious was spotted between the ginger and thethere only is a reported significantly adverse lower event vomiting was heartburnrate in the effectginger experience group and control groups in the lowering of the incidence and severity of notice. nausea and vomiting (P > .05). Theme 2: Partial Effects on Nausea or Vomiting with Shiraz University of Medical Sciences, Shiraz, Iran aimed A Prospective study conducted in Namazi Hospital affiliated controlling of nausea and vomiting induced by chemotherapy induced by chemotherapy in female patients who were newly One study conducted to measure the efficacy of ginger in the to assess the efficacy of ginger in control of nausea and vomiting is a ginger effect on one symptom and nothing on another symptom. 119 females were randomized to intervention group who receive among cancer patients shown conflicting results, means that there 500diagnosed mg ginger with powder,breast cancer twice fora day the for first 3 days3 chemotherapy and control cycles,group According to a pilot, randomized clinical trial study carried who received placebo. In all sessions, the result illustrates that no

acute and delayed CINV. Among 100 women newly diagnosed group Ansari et al. [5]. without by advanced Panahi etstages al. purposed breast cancer to assess who the received efficacy chemotherapy of ginger for significant differences between the ginger group and the control treatment, including docetaxel, epirubicin, and cyclophosphamide, Lua [20] studied the effects of ginger inhalation as aromatherapy and those patients who randomly assigned to ginger group (1.5 g/d on chemotherapy-induced nausea and vomiting for breast cancer in 3 separated doses every 8 hours intended for 4 days) in addition women. A 100 mm visual analog assessment scale (VAS) was to standard antiemetic regimen, while control group received used. They conduct this study through single-blind, randomized, standard antiemetic regimen alone. The result display that taking controlled, cross-over study at two clinics of oncology in the East ginger with antiemetic drugs helped to reduce chemotherapy- Coast of Peninsular in Malaysia. Sixty patients divided into two equal

the frequency of vomiting 2013. therapy as (placebo) group, then they inhaled ‘’essential oil’’ on the induced nausea. However, there is no significant effect of ginger on fallowedgroups, group chemotherapy 1 inhaled ‘’gingercycle. While fragrance Group oil’’ 2 were on their initially first inhaledcycle of Theme 3: Non-Reduction Effect on CINV ‘’ginger fragrance oil ‘’ for the followed treatment cycle. The result ‘’essential oil’’ on their first cycle of chemotherapy, then were given issue, there are four recent studies that evaluated participant experiencesBased on whoour findingsreceived through ginger literatureextract through reviewing the of cycles relevant of nausea scores between the two groups (P=0.183). Likewise, ginger showed that there was no significant difference in the mean of VAS chemotherapy, the result revealed that using of ginger did not add reduction of vomiting (P=0.59). The only study was found ginger werearomatherapy not ingested.it treatment was used not as significantly inhaled aromatherapy. has an effect on the any Bossisignificant et al. [1]effect conducted on nausea a randomized, and vomiting double-blind, reduction. placebo- controlled, multicenter study in patients in six Italian oncology LIMITATIONS centers, planned to receive two cycles or more of nightly emetogenic 2 chemotherapy with a high dose of cisplatin (>50 mg/m ), in evidence to support ginger usage in a patient were treated with CINV. treatment duration range from 42-56 days. Patients were randomly In this scope review, most of the recent studies show insufficient distributed into two groups, the intervention group received ginger of chemotherapy used through the studies and antiemetic regimens capsules extract 160 mg/day (Gingerols: 16 mg and Shogaoil 1.12 asDiscrepancies well as cancer in the stage result or typesof studies and participantreflect varies condition of emetogenicity in study mg combined dose of bioactive compounds) or placebo in addition duration. In addition, substantial clinical heterogeneity was to the prophylactic antiemetic medication for CINV, starting introduced through different ginger active substance composition, dose frequency regimens, and administration techniques as well conducted on 251 patients, 121 patients received ginger extract from the first day and fifth day of cisplatin administration. It was as using different assessment tools. Furthermore, this review capsule and while the control group was 123. Lung and head and was limited by the small recent numbers of available studies that

C 2021 Open Access Journal of Biomedical Science 816 Open Acc J Bio Sci. January- 3(3): 812-822 Nourah Yousef Aldousari Review Article

reported the outcomes of interest. Most of our literature found Science and Nutrition 53(7): 659-669. internationally while no studies were conducted in the Middle East 8. Lete I, Allué J (2016) The Effectiveness of Ginger in the Prevention of or in Saudi Arabia [21,22]. Nausea and Vomiting during Pregnancy and Chemotherapy. Integrative Medicine Insights 11: 11-17. STUDY IMPLICATION 9. Marx W, Ried K, Mc Carthy AL, Vitetta L, Sali A, et al. (2017) Ginger- Nursing Practice mechanism of action in chemotherapy-induced nausea and vomiting: A review. Critical Reviews in Food Science and Nutrition 57(1): 141-146. Cancer and its treatment often cause physical and psychological 10. Konmun J, Danwilai K, Ngamphaiboon N, Sripanidkulchai B, Sookprasert problems that impact the quality of patient life’s. administration A, et al. (2017) A phase II randomized double-blind placebo-controlled of ginger tea is a simple and less expensive intervention can be study of 6-gingerol as an anti-emetic in solid tumor patients receiving adopted to decrease nausea and emesis induced by chemotherapy. moderately to highly emetogenic chemotherapy. Medical Oncology 34(4): 69. Nursing Research 11. Alexander AM, Williams S (2016) Effectiveness of Indian ginger tea in Ginger has been used for a long time as a traditional herbal management of chemotherapy induced nausea and vomiting-a nursing perspective among cancer patients. International Journal of Nursing Education 8(1): 172-177. of ginger as an antiemetic in chemotherapy-induced nausea and vomitingantiemetic. to Weadvance recommended nursing practice for future this studiesincludes on examining the efficacy the 12. Tahir M, Ilyas S, Qamar S (2019) Chemotherapy induced nausea and effects of the ginger administer more than once, for an extended for chemotherapy induced nausea and vomiting (cinv) in cancer period, bigger sample sizes, which include different cancer types. patients.vomiting; Professional efficacy of adding Medical ginger Journal to 26(3).standard therapy as prophylaxis

Nursing Education 13. Ryan JL, Heckler CE, Roscoe JA, Dakhil SR, Kirshner J, et al. (2012) Ginger (Zingiber officinale) reduces acute chemotherapy-induced nausea: we recommend training sessions on complementary alternative a URCC CCOP study of 576 patients. Supportive Care in Cancer 20(7): therapies to improve the knowledge and skills of nurses and make 1479-1489. them more competent to provide high standard quality care for 14. Yekta ZP, Ebrahimi SM, Hosseini M, Nasrabadi AN, Sedighi S, et al. (2012) cancer patients who are receiving chemotherapy. Furthermore, we Ginger as a miracle against chemotherapy-induced vomiting. Iranian suggest adding the alternative and complementary therapy to the Journal of Nursing and Midwifery Research 17(5): 325-329. curriculum of the nursing university to prepare the nursing student 15. Arslan M, Ozdemir L (2015) Oral intake of ginger for chemotherapy- to research, analyse and integrate the evidence-based practice in induced nausea and vomiting among women with breast cancer. Clinical their practice. J of Oncology Nursing 19(5): E92-97. CONCLUSION 16. Alparslan CB, Ozkarman A, Eskin N, Yilmaz S, Akay M, et al. (2012) Effect of ginger on chemotherapy-induced nausea and/or vomiting in cancer patients. Journal of the Australian Traditional-Medicine Society 18(1): the patient who receives chemotherapy-induced vomiting. In this 15. scopingGinger review supplementation literature, there can were potentially a variation efficiently of ginger effect dose on 17. Montazeri AS, Raei M, Ghanbari A, Dadgari A, Montazeri AS, et al. (2013) used in experiment, different form of ginger extract, sample size Effect of herbal therapy to intensity chemotherapy-induced nausea and vomiting in cancer patients. Iranian Red Crescent Medical Journal 15(2): 101-106. the variation in the result. and different assessment tool used through the experiment reflect 18. Thamlikitkul L, Srimuninnimit V, Akewanlop C, Ithimakin S, REFERENCES chemotherapy-induced nausea and vomiting in breast cancer patients 1. Bossi P, Cortinovis D, Fatigoni S, Cossu Rocca M, Fabi A, et al. (2017) A receivingTechawathanawanna adriamycin-cyclophosphamide S, et al. (2017) Efficacy regimen:of ginger fora prophylaxisrandomized, of randomized, double-blind, placebo-controlled, multicenter study of double-blind, placebo-controlled, crossover study. Supportive Care in a ginger extract in the management of chemotherapy-induced nausea Cancer 25(2): 459-464. and vomiting (CINV) in patients receiving high-dose cisplatin. Annals of Oncology 28(10): 2547-2551. 19. ameliorating acute and delayed chemotherapy-induced nausea and 2. Sheikhi MA, Ebadi A, Talaeizadeh A, Rahmani H (2015) Alternative vomitingLi X, Qin Y,among Liu W, patients Zhou XY,with Li YN,lung et cancer al. (2018) receiving Efficacy cisplatin-based of ginger in methods to treat nausea and vomiting from cancer chemotherapy. regimens: a randomized controlled trial. Integrative Cancer Therapies Chemotherapy Research and Practice 2015: 818759. 17(3): 747-754. 3. Adel N (2017) Overview of chemotherapy-induced nausea and vomiting 20. Lua PL, Salihah N, Mazlan N (2015) Effects of inhaled ginger aromatherapy and evidence-based therapies. The American J of Managed Care 23(14 on chemotherapy-induced nausea and vomiting and health-related Suppl): S259-S265. quality of life in women with breast cancer. Complementary Therapies 4. Rapoport BL (2017) Delayed chemotherapy-induced nausea and in Medicine 23(3): 396-404. vomiting: pathogenesis, incidence, and current management. Frontiers 21. Liu YQ, Sun S, Dong HJ, Zhai DX, Zhang DY, et al. (2015) Wrist-ankle in Pharmacology 8: 19. acupuncture and ginger moxibustion for preventing gastrointestinal 5. Ansari M, Porouhan P, Mohammadianpanah M, Omidvari S, Mosalaei reactions to chemotherapy: A randomized controlled trial. Chinese Journal of Integrative Medicine 21(9): 697-702. nausea and vomiting in breast cancer patients receiving doxorubicin- 22. Panahi Y, Saadat A, Sahebkar A, Hashemian F, Taghikhani M, et al. (2012) basedA, et al. chemotherapy. (2016) Efficacy Asian of gingerPac J Cancer in control Prev of17(8): chemotherapy 3877-3880. induced Effect of ginger on acute and delayed chemotherapy-induced nausea 6. and vomiting: a pilot, randomized, open-label clinical trial. Integrative chamomile on nausea and vomiting caused by chemotherapy in iranian Cancer Therapies 11(3): 204-211. womenSanaati F,with Najafi breast S, Kashaninia cancer. Asian Z, Sadeghi, Pac J Cancer M (2016) Prev 17(8): Effect 4125-9.of ginger and

7. Palatty PL, Haniadka R, Valder B, Arora R, Baliga MS (2013) Ginger in the prevention of nausea and vomiting: a review. Critical Reviews in Food

C 2021 Open Access Journal of Biomedical Science 817 Open Acc J Bio Sci. January- 3(3): 812-822 Review Article Review Article Nourah Yousef Aldousari

Appendix 1: Data extraction table/review matrix.

Author/s, Year Control/ Total Sample of Publication Intervention Placebo/ Study Objective Study Design and Type of Main Finding Country of Study Group Comparison Participants Group

Percentage of patients in the intervention group compared to the standard therapy who did not have even a single episode of vomiting (64.4%versus 37.7%, p value 0.006). Mild To determine vomiting was experienced the effect of in 6 (13.3%) patients in prophylactic Group A received the intervention group use of ginger olanzapine compared to 7 (15.5%) in decreasing based standard patients in the standard arm. Tahir M, Ilyas S, the delayed Group B received 90 Cancer patients antiemetic regimen -Almost double the number Qamar S (2019) chemotherapy olanzapine receiving highly and cap ginger of patients in the standard Pakistan induced vomiting, Randomized based standard emetogenic 500 mg per oral arm had grade 2 vomiting when added as an control trial. antiemetic chemotherapy. TID 3 days prior compared with the add on therapy regimen only. to chemotherapy intervention arm 15.5% vs to the standard and 3 days after 28.9% in group A and Group antiemetic chemotherapy. B respectively. There was treatment in patients receiving in the severe vomiting that highly emetogenic alsois grade significant 3 and 4, reduction grade 3 chemotherapy. vomiting was observed in only 6.6%versus 15.5% patients, while none had grade 4 vomiting in group A compared to one patient (2.2%) in group B.

Group A received Group B received was observed between No significant difference study medication the ginger and control the30 minutesfirst dose before of the of the study groups in the reduction of To examine the the first dose chemotherapy medication 30 the incidence and severity minutes before of nausea and vomiting as an adjuvant chemotherapy (P Li X, Qin Y, Liu W, efficacydrug to standardof ginger, Randomized, 140 patients of treatment. Zhou XY, Li YN, with lung cancer Gingeron the firstcapsules day difference in adverse events antiemetic therapy, double-blind, > .05). No significant Wang LY (2018) receiving cisplatin- administered orally of treatment. was observed between in ameliorating placebo- on the first day China based regimens. (0.5 g, 2 capsules placebo capsules the 2 groups (P > .05). No acute and delayed controlled administered studytreatment-related CINV in patients clinical trial. per day, 0.25 g per capsule, every orally (0.5 g, 2 adverse events were with lung cancer capsules per observed in this study. As an receiving cisplatin- 12 hours) for 5 days beginning day, 0.25 g per adjuvant drug to standard based regimens. capsule, every antiemetic therapy, ginger chemotherapy. 12 hours) for 5 on the first day of days beginning in ameliorating CINV in hadpatients no additional with lung efficacy cancer chemotherapy. receiving cisplatin-based on the first day of regimens.

C 2021 Open Access Journal of Biomedical Science 818 Open Acc J Bio Sci. January- 3(3): 812-822 Nourah Yousef Aldousari Review Article

34 patients were The purpose of women aged 18 this study is to years or older determine the with documented breast cancer who for reducing had received a Thamlikitku L, efficacychemotherapy- of ginger Double-blind Capsule (powdered Srimuninnimit V, induced nausea and crossover chemotherapy and ginger root extract) Placebo between intervention and Akewanlop C, et al. first cycle of AC No significant difference vomiting (CINV) placebo RCT. who experienced 1 g (0.5 g BD). control groups in breast (2017) Thailand in breast cancer vomiting or cancer patients receiving AC patients receiving moderate to severe chemotherapy. adriamycin and nausea. cyclophosphamide Their treatment plan (AC) regimens. included at least two more cycles of AC.

42 Capsule(6- Konmun J, Danwilai This randomized, 6-Gingerol in addition gingerol) dose: K, Ngamphaiboon controlled trial to ondansetron, 5mg x2 capsule N, Sripanidkulchai was done to assess Double -blind, 88 patients metoclopramide, and x2 BID from 3rd B, Sookprasert, the effect of ginger placebo- Moderate or High day before CT day Subongkot S in solid tumor controlled RCT. emetogenicity 56 placebo reduced CR rate in both 1 until last day of (2017) Thailand patients receiving chemotherapy dexamethasoneacute and delayed significantly phases 3 cycles (at least 3 chemotherapy- General wound. CINV. related nausea and cycles). vomiting.

The aim of study evaluates the Bossi, Cortinovis, Fatigoni, Cossu, in reducing the Rocca, Fabi, efficacyincidence of ginger and No difference was evident in Seminara, 125 patients reduction impact of nausea intensity of Double-blind Capsule (Gingerols: delayed nausea Placebo- & vomiting due to cisplatin Granata, Bergamini, 16 mg + Shogaoil 123 patient, in patients on controlled RCT. 251patients, High throughout the two cycles Seminara,Ripamonti,Ripamonti, Alfieri, 1.12 mg).dose: placebo high-dose cisplatin emetogenicity of chemotherapy, without Agustoni, Bidoli, 160mg /day (2 x and standard chemotherapy. Nole 40mg x BD). antiemetic therapy anticipatory and intercycle (2017) Italy any benefit in delayed, for high emetogenic assessments between the chemotherapy. ginger and placebo group.

C 2021 Open Access Journal of Biomedical Science 819 Open Acc J Bio Sci. January- 3(3): 812-822 Review Article Review Article Nourah Yousef Aldousari

The aim of the study was to assess the effect The administration of of Indian ginger Quasi- 60 patients Indian ginger tea was tea to subside experimental Alexander, Williams who having effective in reducing the chemotherapy nonequivalent Oral administration (2016) India chemotherapy Not given chemotherapy induced induced nausea and pretest - of Indian ginger tea induced nausea and nausea and vomiting among vomiting among posttest control vomiting cancer patients receiving cancer patients group design. chemotherapy. which is simple and less expensive intervention.

A. Ginger group for 5 days before and 5 days after chemotherapy was: 2 times a day and 500 mg capsules of powdered ginger root in addition to a routine antiemetic regimen consisting of dexamethasone, Ginger and chamomile metoclopramide To determine the and aprepitant effective for reducing the effect of ginger (DMA) capsule was C. Control group, were both significantly Kashaninia, Sadeghi 65 women with frequency of vomiting, and chamomile A randomized, consumed. routine antiemetic Sanaati,M (2016) Najafi, Iran capsules on nausea double-blind BC undergoing regimen difference between the and vomiting in and clinical trial chemotherapy. B. Chamomile consisting of thereginger being and no chamomile significant cases undergoing study. group for 5 days DMA capsule was groups. Moreover, unlike chemotherapy for before and 5 days consumed. the chamomile, ginger breast cancer (BC). after chemotherapy was: 2 times frequency of nausea. a day and 500 significantly influenced the mg capsules of Matricaria Chamomilla extract in addition to a routine antiemetic regimen consisting of DMA capsule was consumed.

difference, in decrease -Noof nauseastatistically and vomitingsignificant One hundred and severity was reported between the 2 groups. newly diagnosed st To evaluate the fiftybreast female cancer patients -After 1 chemotherapy Ansari et al. (2016) effect of Ginger patients who were session ( no statistically powder on N/V Phase II-III patients received 75 patients Iran going to receive Seventy five after chemotherapy clinical trial. Ginger capsules. received placebo doxorubicin based -After 2nd chemotherapy in breast cancer significant differences) chemotherapy were session ( difference was not patients. included in the study. -After significant)3rd chemotherapy session( not statistically

significant.)

C 2021 Open Access Journal of Biomedical Science 820 Open Acc J Bio Sci. January- 3(3): 812-822 Nourah Yousef Aldousari Review Article

mean difference of VAS To assess the -There was no significant Patients in Group 1 nausea scores between supplied with was provided with ginger essential oil and inhaled ginger Groupginger 2 essentialwere first ginger fragrance oil ginger fragrance oil [F(1, 58) Lua, Salihah, Mazlan aromatherapyefficacy of on Single-blind, (placebo) on their = 1.82, P = 0.183] indicating (2015) Malaysia nausea, vomiting controlled, Sixty female patients chemotherapy and health- randomized with breast cancer oilcourse on their ,and first course, followed effect of aromatherapy on related quality cross-over on Chemotherapy. then were given that there was no significant firstby ginger chemotherapy essential nausea severity. of life( HRQoL) study. placebo (ginger oil on the next in chemotherapy fragrance oil) for -Similarly, there was chemotherapy breast cancer the next treatment course. patients. course. aromatherapy treatment on vomitingno significant [F(1,58) effect = 0.29, of P = 0.594].

60 females with breast cancer, currently receiving chemotherapy with adjuvant This experimental anthracycline, The current study randomized, Receiving demonstrated that ginger Arslan M, Ozdemir L palonosetron- Sachet (powdered (2015) Turkey controlled trial was administration was effective done to assess the aprepitant ginger root on in decreasing the severity of RCT Standard care. effect of ginger on antiemetic yogurt). acute and delayed nausea in chemotherapy- treatment, being women with breast cancer related nausea and at least in the receiving anthracycline- vomiting. second cycle of based chemotherapy. chemotherapy and having experienced chemotherapy- induced nausea.

-The severity of the nausea at end of 24 hours in people who received regime A rather than placebo reduced

Group B regime and the severity of the Group A regime was a routine nauseaby %27.3 at end in the of 24 first hours cycle in The objective of was a routine antiemetic along people who received regime Montazeri, Raei, this study was to antiemetic drugs with 4 placebo B rather than placebo Ghanbari, Dadgari, along with 4 ginger cycle was 44. In the capsules. Then, reduced by %24.1. in the Montazeri AS, of complimentary Randomized capsules. Then, evaluate the efficacy secondDuring cycle, the first were subjects of the second cycle. The severity Hamidzadeh A ginger among cross-over subjects of the 31 patients. study were of the vomiting at end of 24 (2013) Iran cancer patients clinical trial. study were crossed crossed over to experiencing over to receive the nausea and receive the other measurement for group A is other regime. hours, in the first cycle of vomiting. regime. 4.7 less than (placebo). - The severity of vomiting at end of 24 hours, in the second cycle of measurement for group B reduced by % 8.3 in comparison to the placebo.

C 2021 Open Access Journal of Biomedical Science 821 Open Acc J Bio Sci. January- 3(3): 812-822 Review Article Review Article Nourah Yousef Aldousari

Zohreh Parsa Yekta, 40 patients, 250 Seyyed Meisam mg, Ginger root Ebrahimi, Mostafa powder Capsule Hosseini, Alireza The aim of this 80 patients of breast 40 patients Randomized (zintoma) Dose: Nikbakht Nasrabadi, study was to cancer who receive 250 mg Starch Vomiting cases were double-blind 1000 mg /day (1 Sanambar Sedighi, evaluate the effect any emetogenicity capsules QID placebo- x 250mg x QID) Mohammad-Hosein of ginger plant on chemotherapy. (placebo). group at anticipatory , acute controlled 6 days , from significantly lower in ginger Salehi Surmaghi, chemotherapy- and delayed phases. clinical trial. 3 days before Hossein Madani induced vomiting. chemotherapy. (2013) Iran

The aim to Total sample was determine if ginger 744 while 576 Three arms: effective in reducing CIN. was more effective Double-blind patients included GingerGinger at dosewas significantly of 0.5g to 1.0g Ryan et al. (2012) than placebo in placebo 1)0.5 g ginger United States controlling acute multicenter trial patients experienced aids in reducing acute CIN in in the final analysis 2)1.0 g ginger Placebo CIN in cancer RCT. chemotherapy patientsdaily significantly receiving (P<0.05)standard patients receiving induced nausea 3) 1.5 g ginger. antiemetics and the lack of 5-HT3 receptor receiving 5-HT3 effect on quality of life. antagonist receptor antagonist antiemetics. antiemetics.

-45 Patients were aged 18 years or older

- They had no oral or gastrointestinal The present study abnormalities was conducted to investigate the Tablet (ginger Type Alparslan et al. -They were not effects of ginger experiencing other that ginger is effective for (2012) Turkey The main finding show on chemotherapy- Non-RCT illnesses that might g/d (2x 0.4 g BD) IV antiemetic reducing chemotherapy- induced nausea induce nausea unspecified) 1.6 induced nausea and/or and/or vomiting. and/or vomiting. vomiting. No changes were no additional interventions for nausea and/or vomiting.

100 women who had cancer (mainly new cases of To evaluate advanced breast the antiemetic cancer diagnosed by Ginger (1.5 g/d in Addition of ginger to the activity of ginger the oncologist and 3 divided doses standard antiemetic therapy against both thus undergoing every 8 hours) Standard was found to be associated acute and delayed A Pilot, plus standard antiemetic Panahi et al. (2012) types of CINV Randomized, of chemotherapy). antiemetic regimen regimen alone in the prevalence of nausea, Iran in patients with Open-Label theirMost first of experience these (granisetron plus (control group; n withbut not a significant vomiting, reductionat 6 to 24 advanced breast Clinical Trial. patients were dexamethasone; = 50). hours postchemotherapy in cancer who were initially assigned ginger group; n the ginger group compared undergoing their to the components = 50) with the control group. of TEC regimen, chemotherapy. first experience of including docetaxel, epirubicin, and cyclophosphamide.

C 2021 Open Access Journal of Biomedical Science 822 Open Acc J Bio Sci. January- 3(3): 812-822