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Effect of Ginger and Chamomile on Nausea and Vomiting Caused by Chemotherapy in Iranian Women with Breast Cancer

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Background: Chemotherapy-induced nausea and vomiting (CINV) places a significant burden on the patient. Herbal agents are the most commonly complementary therapies used among the public. This study was done to determine the effect of ginger and chamomile capsules on nausea and vomiting in chemotherapy for breast cnacer (BC). Materials and Methods: In a randomized, double-blind and clinical trial study, 65 women with BC undergoing chemotherapy were referred to Breast Cancer Research Center, Tehran, Iran, between May 2013 to June 2014. Regimen for 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, metoclopramide and aprepitant (DMA) capsules. Chamomile group similarly was: 2 times a day and 500 mg capsules of Matricaria chamomilla extract in addition to a routine antiemetic regimen consisting of DMA capsules. Control group, routine antiemetic regimen consisting of DMA capsules. Results: There were no significant differences between the ginger, chamomile and control groups regarding age. Drugs used for chemotherapy were identical and duration of disease was also matched (1-4 months). Ginger and chamomile were both significantly effective for reducing the frequency of vomiting, there being no significant difference between the ginger and chamomile groups. Moreover, unlike the chamomile, ginger effected significantly the frequency of nausea. Conclusions: According to the findings of this study, it should be declared that taking ginger capsules (1 g/day) might relieve CINV safely. Nurses dealing directly with cancer patients should be responsible for providing educational programs for patients and their families about how to deal with their drug regimens and its side effects.
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Asian Pacic Journal of Cancer Prevention, Vol 17, 2016 4127
DOI:http://dx.doi.org/10.7314/APJCP.2016.17.8.4127
Effect of Ginger and Chamomile on Nausea and Vomiting Caused by Chemotherapy in Women with Breast Cancer
Asian Pac J Cancer Prev, 17 (8), 4127-4131
Introduction
Breast cancer (BC) is a very common health problem in
Iranian women (Amirifard et al., 2016). Nowadays, cancer
therapy consists of surgery, radiotherapy, chemotherapy
and biological therapy as well as some other methods,
whereas in the locally advanced stage, chemotherapy such
as Trastuzumab therapy is often the only effective method
of cancer therapy (Payandeh et al., 2015). Chemotherapy-
induced nausea and vomiting (CINV) places a signicant
burden on the patient.
There are multiple classes of medications developed to
treat this symptom in a large number of patients (Carelle
et al., 2002; Sun et al., 2005). The incidence of vomiting
has been signicantly reduced through combinations of
anti-emetic medications, but efforts to control nausea
have been less successful. Affecting upwards of 60%
1Department of Nursing, University of Wefare and Rehabilitation Sciences, 2Breast Cancer Research Centre, Jahad Daneshgahi,
Tehran University of Medical Sciences, 3Department of Nursing, University of Welfare and Rehabilitation Sciences, Tehran, 4Medical
Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran *For correspondence: safa3n@yahoo.com
Abstract
Background: Chemotherapy-induced nausea and vomiting (CINV) places a signicant burden on the patient.
Herbal agents are the most commonly complementary therapies used among the public. This study was done
to determine the effect of ginger and chamomile capsules on nausea and vomiting in chemotherapy for breast
cnacer (BC). Materials and Methods: In a randomized, double-blind and clinical trial study, 65 women with
BC undergoing chemotherapy were referred to Breast Cancer Research Center, Tehran, Iran, between May
2013 to June 2014. Regimen for 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, metoclopramide and aprepitant (DMA) capsules. Chamomile group similarly was: 2 times a
day and 500 mg capsules of Matricaria chamomilla extract in addition to a routine antiemetic regimen consisting
of DMA capsules. Control group, routine antiemetic regimen consisting of DMA capsules. Results: There were
no signicant differences between the ginger, chamomile and control groups regarding age. Drugs used for
chemotherapy were identical and duration of disease was also matched (1-4 months). Ginger and chamomile
were both signicantly effective for reducing the frequency of vomiting, there being no signicant difference
between the ginger and chamomile groups. Moreover, unlike the chamomile, ginger effected signicantly the
frequency of nausea. Conclusions: According to the ndings of this study, it should be declared that taking ginger
capsules (1 g/day) might relieve CINV safely. Nurses dealing directly with cancer patients should be responsible
for providing educational programs for patients and their families about how to deal with their drug regimens
and its side effects.
Keywords: Breast cancer - chemotherapy - ginger - chamomile - vomiting - nausea
RESEARCH ARTICLE
Effect of Ginger and Chamomile on Nausea and Vomiting
Caused by Chemotherapy in Iranian Women with Breast
Cancer
Fateme Sanaati1, Safa Naja2*, Zahra Kashaninia3, Masoud Sadeghi4
of patients (Bloechl-Daum et al., 2006), CINV has also
been shown to signicantly impact on patient quality of
life. Moreover, although it happens rarely, CINV can be
so severe that it can lead to dose reduction or treatment is
continuation, and subsequently increase the risk of disease
progression (Bloechl et al., 2006; Ballatori et al., 2007;
Vidall et al., 2011). This is of particular concern as nausea
and vomiting in oncology patients can adversely affect
food intake, increasing the risk of malnutrition during
treatment. Previous studies report one in two patients in
this setting as malnourished (Carelle et al., 2002). The
cumulative effect of pretreatment and treatment-related
malnutrition can be one of compromised immune function,
decreased performance status, poor response to treatment,
and sometimes treatment discontinuation (Davidson et al.,
2012; Van Cutsem and Arends, 2005; Tong et al., 2009).
Herbal therapy is the most commonly complementary
Fateme Sanaati et al
Asian Pacic Journal of Cancer Prevention, Vol 17, 2016
4128
therapies used among the public (Olaku and White,2011).
Two of the roots of the plant are used as medicine, are
ginger and chamomile. Ginger (Zingiber ofcinale) has a
long history in many cultures as a folk-remedy for nausea
and gastrointestinal discomfort. Empirical research has
demonstrated that ginger may be effective as an anti-
nausea agent; in particular (Wu et al., 2008), it has been
proposed as a possible candidate for anti-CINV therapy
(Wu et al., 2008; Marx et al., 2014). Furthermore, animal
studies provide preliminary support for the role of ginger
supplementation in the prevention of cisplatin-induced
emesis ( Sharma et al.,1997; Sharma and Gupta,1998). Few
adverse effects from the ingestion of ginger are reported
in the literature ( Ernst and Pittler,2000). Chamomile is
also extensively consumed as a tea or tonic and is used
internally to treat anxiety, hysteria, nightmares, insomnia
and other sleep problems, convulsions, and even delirium
tremens (Martens D,1995). One of chamomile’s main roles
is as a multipurpose digestive aid to treat gastrointestinal
disturbances including atulence, indigestion, diarrhea,
anorexia, motion sickness, nausea, and vomiting.
Chamomile used in modern medicine primarily for their
spasmolytic, antiphlogistic, antibacterial properties,
and as a multipurpose digestive to treat gastrointestinal
disturbances including atulence, indigestion, diarrhea,
anorexia, motion sickness, nausea, and vomiting (Shikov
et al., 2008) .
This study was done to determine the effect of Ginger
and Chamomile capsules on nausea and vomiting in
chemotherapy.
Materials and Methods
Patients
This study was approved by Ethics Committee of
University of Social Welfare and Rehabilitation Sciences
and was registered in Iranian Registry of Clinical Trials
(IRCT) with code of IRCT2013020912404N1. In a
randomized, double-blind and clinical trial study, 65
women with BC undergoing chemotherapy referred to
Breast Cancer Research Center, Tehran, Iran, between
May 2013 to Jun 2014.
Criteria
Inclusion criteria: Patients between 20 and 60 years;
histological diagnosis of BC, history of receiving at least
one chemotherapy injection, receiving single-day cycles
of chemotherapy (each cycle separated from next by≥2
weeks); experiencing vomiting in previous sessions, and
having normal values of hematologic and biomedical
laboratory parameters.
Exclusion criteria: Patients with multiple-day
chemotherapy; receiving concurrent radiotherapy with
high risk of causing emesis (i.e., total body, hemi body,
upper abdomen, and craniospinal radiation); taking
therapeutic doses of warfarin, aspirin, or heparin;
had a history of bleeding disorder(s) like severe
thrombocytopenia; had an allergy to ginger or chamomile
or had taken it in the last week; had gastrointestinal
disorders and cancers; and had other emesis-inducing
diseases, such as hypertension, liver, and renal failure.
Also, patients who met the following criteria: forgotten
to take capsules ≥3 consecutive times; used other
antiemetic drugs or therapeutic methods except the routine
antiemetic; had severe gastrointestinal problems during
the study; and refusal to continue participating in trial.
Regimens
A. Intervention group 1 (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, metoclopramide and aprepitant (DMA)
capsule was consumed.
B. Intervention group 2 (chamomile group) for 5 days
before and 5 days after chemotherapy was: 2 times a day
and 500 mg capsules of Matricaria Chamomilla extract
in addition to a routine antiemetic regimen consisting of
DMA capsule was consumed.
C. Control group, routine antiemetic regimen
consisting of DMA capsule was consumed.
Method
The patients were randomly allocated to treatment
two experimental groups (ginger and chamomile) and
one control group using the 20 block random tables. The
treatment groups received white capsules of ginger or
chamomile manufactured by University Biochemistry
Laboratory Shahed, Tehran, Iran. Coding and blinding
of the 2 groups were performed privately by the
pharmacologist consultant, and all of the samples, data
analyzers, and all participants too, were unaware of the
real content of the capsules.
The dosage of capsules was selected based on the
results of clinical trials conducted by Sontakke et al.
(2003) and Ryan et al. (2009). A self-made, two-part self-
reporting instrument was used to measure the frequency
and severity of nausea and vomiting each member of three
groups, after checking the content validity. This instrument
was a reliable standard table that has been used in various
studies as well (Sontakke et al., 2003; Manusirivithaya
et al., 2004; Ozgoli et al., 2009; Zick et al., 2009). First
part contained two tables with a 10 cm visual analogue
scale (VAS) to record chemotherapy induced nausea and
vomiting (CINV), and the second section included 3
questions about the: (a) probable use of other antiemetics;
(b) missed cases of capsule taking; (c( probable side effects
due to capsules intake. The patients were asked to ll the
questionnaires out every night during the study and in any
cases of intolerable complications stop the consumption
and contact the researchers for more information.
Statistical Analysis
Professional blind interviewers collected and recorded
the information and then data entry and analysis, were
performed by a professional blind statistician. Data
were analyzed using SPSS software version 16 and the
application of descriptive and inferential statistics. The
Chi-squared test was applied to compare the 2 groups
regarding demographic characteristics, such as age
(continuous variable) and education (ranked qualitative
variance). To examine differences in the frequency and
Asian Pacic Journal of Cancer Prevention, Vol 17, 2016 4129
DOI:http://dx.doi.org/10.7314/APJCP.2016.17.8.4127
Effect of Ginger and Chamomile on Nausea and Vomiting Caused by Chemotherapy in Women with Breast Cancer
severity of nausea and vomiting, inferential statistics
of the linear logarithm model with Poison and paired
t-test function were applied. After completing the data
analysis the consultant pharmacologist broke the codes
and introduced the groups.
Results
Out of 65 patients, 20 patients (8 patients in the
intervention group with ginger; 7 patients in the
intervention group with chamomile; and 5 patients in the
control group) interrupted their participation (7 for general
weakness and canceling of the chemotherapy; 6 because
of unwillingness to continue the study; 6 for not lling
the tools; and 1 due to die). Sampling time was extended
to maintain the sample size (45 persons).
There were no signicant differences between the
ginger; chamomile and control groups regarding age
variable (P = 0.45). Most participants of all three groups
had Diploma and were homogenous (P = 0.19) according
to Table 1.
Used Drugs for chemotherapy were identical
(same severity of nausea) and duration of disease was
also matched (1-4 months). The ndings indicated no
signicant differences between the groups in terms of
state proles.
Table 2 indicates that ginger and chamomile are
ineffective on intensity of nausea (P=0.238) while both
are effective on the frequency of vomiting (P<0.0001),
though there is no signicant difference in the ginger and
chamomile groups (Table 3)
Moreover, unlike the chamomile (P=0.895) (Table
4), ginger effects on the frequency of nausea (P=0.006)
(Table 5).
Discussion
BC is the most frequent malignancy among females
and is a leading cause of death of middle-aged women
(Payandeh et al., 2015). Advances in our understanding of
the pathophysiology of CINV), the identication of patient
risk factors, and the development of new antiemetics
have led to signicant improvements in CINV prevention
(Jordan et al., 2014). In addition to controversial reports,
there are few studies about the effect of ginger extract on
the CINV. It seems that characteristics of those studies
could affect their results. For example, they have targeted
wide range and kind of cancers (Manusirivithaya et
al., 2004; Zick et al., 2009). Meanwhile, each of them
has special therapeutic protocol and each protocol has
also its own special emetogenicity in comparison to
the others. Hence, we can’t easily approve or refuse
the effectiveness of ginger plant on CINV and also we
Table 4. Paired Sample t-test Comparison of Number of Nausea
Group Mean difference Standard error of the coefcient Degree of freedom P-value
Ginger-Control 1.5845 0.5787 1 0.006
Chamomile-Control 0.0769 0.5851 10.895
Chamomile-Ginger 1.6615 0.5282 1 0.002
Table 3. Effects of the Groups on Nausea and Vomiting Using the Generalized Estimating Equations (GEE) Model
Component Model coefcient Standard error of the coefcient Statistics Degree of freedom P-value
Nausea
Ginger 0.746 0.2996 6.195 1 0.013
Chamomile 0.025 0.1932 0.017 1 0.896
Control Basic - - - -
Vomiting
Ginger 1.303 0.5597 16.924 1 <0.0001
Chamomile 1.145 0.4911 5.437 1 0.02
Control Basic - - - -
Table 5. Paired Sample t-test Comparison of Number of Vomiting
Group Mean difference Standard error of the coefcient Degree of freedom P-value
Ginger-Control 0.108 0.2474 1 <0.0001
Chamomile-Control 0.8394 0.2814 1 0.003
Chamomile-Ginger 0.2686 0.1989 1 0.177
Table 1. Baseline Characteristics of the Randomized
Groups
Variables Ginger Chamomile Control
N=15 N=15 N=15
Age, n(%)
20-30 1(6.7) 1(6.7) 1(6.7)
31-40 6(40) 1(6.7) 6(40)
41-50 7(46.7) 12(80) 7(46.7)
51-60 1(6.7) 1(6.7) 1(6.7)
Education
High school 1(6.7) 1(6.7) 1(6.7)
Diploma 10(66.7) 10(66.7) 9(60)
University 4(26.7) 4(26.7) 5(33.3)
There was no signicant different between groups and P-value was
considered signicant at P < 0.05 by Chi-square test
Table 2. Effects of the Groups on Components Using
the Generalized Estimating Equations (GEE) Model
Component Chi-square
statistics
Degree of
freedom P-value
Intensity of nauseaa2.867 20.238
Number of nausea 7.376 2 0.025
Number of vomiting 20.812 2<0.0001
aIntensity of nausea was evaluated by using Visual analog scale: (0 =
no nausea, 3-1 = mild, 6-4 = moderate 9-7 = severe, 10 = very severe)
Fateme Sanaati et al
Asian Pacic Journal of Cancer Prevention, Vol 17, 2016
4130
can’t generalize the results to other types of cancer. On
the other hand, no studies have examined the effect of
chamomile on the CINV. Therefore, this study was
carried out to address those issues that have been less
studied. Only women with BC were attended to increase
the accuracy and generalizability of the results because
BC is the most common type of cancer among women
in Iran and in the world (Sontakke et al., 2003; Ryan et
al., 2009) and almost the same chemotherapy protocol
is used to treat it. In this study, the results indicate that
ginger and chamomile are ineffective on intensity of
nausea while both inuence on the frequency of vomiting.
Moreover, unlike the chamomile (P>0.05), ginger effects
on the frequency of nausea signicantly. Similar to our
ndings, Zick et al. (2009) reported that in cancer patients
undergoing chemotherapy, ginger capsules could not
relieve the CINV in acute and delayed (P>0.05) phases
in comparison to the control group that could be probably
due to the use of cisplatin as a high cytotoxic agent.
Moreover, Manusirivithaya et al. (2004) expressed that
there was no signicant differences between ginger and
placebo groups related to the complete control of acute
and delayed vomiting that could be concerned using
cisplatin in chemotherapy protocol. In contrast, Ryan et
al. (2009) indicated that in cancer patients undergoing
chemotherapy the use of ginger (5.0, 1 and 5.1 g/day)
reduced the intensity of nausea in acute phase (P<0.05).
Sontakke et al. (2003) indicated that in cancer patients
undergoing chemotherapy the antiemetic effect of
metoclopramide was equivalent to ginger (1g/day) in
acute phase (58% versus 62%, respectively). Similar to our
ndings, Nanthakomon and Pongrojpaw (2006), reported
that in cancer patients undergoing chemotherapy, ginger
capsules reduced the frequency of nausea and vomiting
signicantly. The results of other studies about the effect
of ginger extract on pregnancy-induced vomiting (PINV)
are the same as ours. As Ozgoli et al. (2009) stated, the
use of ginger (1g/day ( signicantly reduced the cases of
PINV. In addition, Jenabi et al. (2009) revealed that taking
ginger powder (1 g/day) signicantly relieved PINV.
There is no published study about the effect of
chamomile on the CINV. This study was only performed
on women with BC undergoing single-day courses of
chemotherapy. This matter has its own privileges, but also
limitations. The most important limitation of this study
was that our results were only devoted and applicable for
patients with BC, and thus we cannot generalize the results
to other types of cancers. So, it should be suggested that to
conduct more widespread studies about the effect of ginger
and chamomile on the different types of cancers and also
to assess the effect of ginger and chamomile on patients
undergoing multiple-day chemotherapy to achieve more
accurate information about the efcacy of these herbs.
In conclusions, according to the ndings of this study,
it should be declared that taking ginger capsules (1 g/day)
might relieve the CINV safely. Nurses are dealing directly
with cancer patients and are responsible for providing
educational programs for patients and their families
about how to deal with their drug regimens and its side
effects. Therefore, nurses should introduce and teach those
patients to take these capsules, as the effectiveness and
safety of ginger are conrmed.
Acknowledgements
This study was carried out with the nancial support
of research deputy of University of Social Welfare and
Rehabilitation Sciences and with the favor of Breast
Cancer Research Center of University of Tehran. Hereby
we would like to express our appreciation to all the dear
participants and personnel of Breast Cancer Research
Center.
This study was registered at http://www.irct.ir
(registration number IRCT2013020912404N1).
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... al. (44) 2016 65 En el grupo que recibió jengibre, 500mg/2 veces al día de jengibre por 5 días antes y 5 días después de la quimioterapia Autorreporte para medir frecuencia y gravedad de náuseas y vómito. ...
... Incluso, en el estudio de Liu et al., en el cual no se administró tratamiento antiemético estándar de manera simultánea con la moxibustión y la acupuntura, las náuseas fueron las mismas entre los dos grupos en el día 1 de la quimioterapia (45). Dos estudios reportaron que el jengibre parece actuar mejor sobre las náuseas (40,43) que sobre la emesis (44,47). Es pertinente tener presente la heterogeneidad de los pacientes incluidos en los estudios así como de los esquemas de quimioterapia utilizados, que variaron desde levemente emetizantes hasta altamente emetizantes. ...
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Introduction: Uterine cervix tumors have an invasive nature, with the capacity to proliferate to surrounding organs such as the vagina, bladder, and rectum, as well as the capacity for dissemination and involvement of structures distant from its place of origin. According to the International Federation of Gynecology and Obstetrics, patients with stages IB I, IB I microscopic (small dimension <4 cm) are indicated for radiotherapy or adjuvant chemoradiotherapy with cisplatin (40 mg/m2). However, cisplatin has side effects such as hematological implications (anemia, neutropenia, and thrombocytopenia), gastrointestinal disorders (nausea, vomiting, diarrhea, constipation), and fatigue. Zingiber officinale contains bioactive compounds that act on pregnancy and postoperative nausea, chemotherapy-induced nausea and vomiting, and also in the management of fatigue, myalgia, and insomnia. This study aimed to evaluate the effects of ginger on chemotherapy-induced nausea and vomiting in patients with cervical cancer undergoing treatment with cisplatin and radiotherapy. Methods and analyses: A randomized intervention clinical and controlled trial with a triple-blind design is described, comparing the effects of institutional antiemetic therapy alone, as well as in combination with 2 different ginger concentrations. Ethics and dissemination: Due to the nature of the study, we obtained approval from the Division Ethics Committee of Liga Contra o Câncer. All participants signed an informed consent form prior to randomization. The results of this study will be published in peer-reviewed journals. The data collected will also be available in a public repository of data. Trial registration number: This study is registered in the Brazilian Registry of Clinical Trials under number RBR-47yx6p9. This study was approved by the Division Ethics Committee of Liga Contra o Câncer under CAAE 40602320.0.0000.5293.
... However, the mistletoe extracts did not affect the frequency of relapse or metastasis within 5 years [73]. Also, ginger capsules relieved chemotherapy-induced nausea and vomiting in breast cancer patients undergoing chemotherapy [74]. ...
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Breast cancer incidence is actually the highest one among all cancers. Overall breast cancer management is associated with challenges considering risk assessment and predictive diagnostics, targeted prevention of metastatic disease, appropriate treatment options, and cost-effectiveness of approaches applied. Accumulated research evidence indicates promising anti-cancer effects of phytochemicals protecting cells against malignant transformation, inhibiting carcinogenesis and metastatic spread, supporting immune system and increasing effectiveness of conventional anti-cancer therapies, among others. Molecular and sub-/cellular mechanisms are highly complex affecting several pathways considered potent targets for advanced diagnostics and cost-effective treatments. Demonstrated anti-cancer affects, therefore, are clinically relevant for improving individual outcomes and might be applicable to the primary (protection against initial cancer development), secondary (protection against potential metastatic disease development), and tertiary (towards cascading complications) care. However, a detailed data analysis is essential to adapt treatment algorithms to individuals' and patients' needs. Consequently, advanced concepts of patient stratification, predictive diagnostics, targeted prevention, and treatments tailored to the individualized patient profile are instrumental for the cost-effective application of natural anti-cancer substances to improve overall breast cancer management benefiting affected individuals and the society at large.
... Albrecht et al. (2014) reported comparable effectiveness of an herbal combination of chamomile, myrrh, and coffee charcoal to conventional therapy in 1062 patients with acute diarrhea. In a randomized double-blind clinical trial study by Sanaati et al. (2016), ginger and chamomile capsules (500 mg 2 times/day, 5 days before and 5 days after chemotherapy) showed comparable and significant effectiveness in reducing chemotherapy-induced nausea and vomiting among 65 breast cancer patients. In addition, a randomized controlled trial by Khadem et al. (2018) involving 142 patients with postoperative ileus, a common gastrointestinal complication after surgery, showed that the application of chamomile oil (20 drops every 1 h until fecal defecation) on the abdominal region of patients reduced the duration of time to first flatus, bowel sounds, abdominal pain, return of appetite, and rate of nausea and vomiting compared to placebo. ...
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... In anthroposophic medicine, bryophyllum was introduced in the 1970s as a well-tolerated agent for the treatment of preterm labor (Fürer et al., 2016;Hamburger et al., 2017); in Switzerland it is recommended for this indication (Schenkel et al., 2018) and commonly used in the main perinatal institutions (Fürer et al., 2015). Chamomile, the fourth most commonly used medicine has been also widely used and is known as a treatment for nausea and vomiting during pregnancy (Sanaati et al., 2016). Finally, lavender was frequently used (see below for information on its anxiolytic effects). ...
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... The antiemetic action of ginger has been investigated in various conditions including motion sickness, pregnancy, postanesthesia, post-surgery, and chemotherapy-induced nausea and vomiting. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Given at doses up to 2 g/day, ginger is effective at controlling vomiting without side effects. Besides its general antiinflammatory action, 26,27 potential mechanisms of action of ginger include the inhibition of 5-HT 3 and muscarinic acetylcholine (M3) receptors, and the modulation of esophageal and gastrointestinal motility. ...
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Zusammenfassung Ingwer ist eine tropische Pflanze, welche im Wurzelstock 1,5–3% ätherisches Öl enthält. Ingwer fördert die Magenentleerung und den Magen-Darm-Transit und kann einen kurzfristigen Effekt bei der Behandlung und Prävention von Übelkeit und Erbrechen hervorrufen. Als in Pulverform anerkannte Arznei findet sie auch in der Onkologie Verwendung. Es konnte gezeigt werden, dass Ingwer bei Chemotherapie-induzierter Übelkeit/Erbrechen (CINV) behilflich sein könnte. Es gibt Hinweise, dass höhere Ingwerdosen weniger wirksam sind oder vorhandene Symptome verstärken können. Es liegen erste Ergebnisse vor, dass die Tagesdosis von 1 g nicht überschritten werden sollte. Weiterhin zeigte sich in einer Studie mit fraglicher Qualität, dass mit Ingwer behandelte Ovarialkarzinompatientinnen weniger Metastasen im Vergleich zur Kontrollgruppe aufwiesen. Studien, welche den Einfluss von Ingwer auf die Lebensqualität untersuchten, zeigen keine einheitlichen Ergebnisse. Weitere qualitative hochwertige Studien sind nötig, um die medizinische Wirksamkeit des Ingwers im onkologischen Kontext bestätigen und in der Praxis etablieren zu können.
Chapter
Medicinal plants have been used for the prevention and treatment of cancer all over the world in different traditional medicines. Nowadays, numerous investigations have been carried out on various species of plants against various types of cancer, obtaining a variety of results that indicate a probable antineoplastic effect attributable to bioactive compounds. This chapter is intended to summarize the information related to medicinal plants and cancer.
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ZUSAMMENFASSUNG Ingwer ist eine tropische Pflanze, welche im Wurzelstock 1,5–3% ätherisches Öl enthält. Ingwer fördert die Magenentleerung und den Magen-Darm-Transit und kann einen kurzfristigen Effekt bei der Behandlung und Prävention von Übelkeit und Erbrechen hervorrufen. Als in Pulverform anerkannte Arznei findet sie auch in der Onkologie Verwendung. Es konnte gezeigt werden, dass Ingwer bei Chemotherapie-induzierter Übelkeit/Erbrechen (CINV) behilflich sein könnte. Es gibt Hinweise, dass höhere Ingwerdosen weniger wirksam sind oder vorhandene Symptome verstärken können. Es liegen erste Ergebnisse vor, dass die Tagesdosis von 1 g nicht überschritten werden sollte. Weiterhin zeigte sich in einer Studie mit fraglicher Qualität, dass mit Ingwer behandelte Ovarialkarzinompatientinnen weniger Metastasen im Vergleich zur Kontrollgruppe aufwiesen. Studien, welche den Einfluss von Ingwer auf die Lebensqualität untersuchten, zeigen keine einheitlichen Ergebnisse. Weitere qualitative hochwertige Studien sind nötig, um die medizinische Wirksamkeit des Ingwers im onkologischen Kontext bestätigen und in der Praxis etablieren zu können.
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Background: Breast cancer (BC) is the most frequent malignancy among females and is a leading cause of death of middle-aged women. Herein, we evaluated baseline characteristics for BC patients and also compared these variables across ealry and late recurrence groups. Materials and Methods: Between 1995 to 2014, among female breast cancer patients referred to our oncology clinic, eighty-six were entered into our study. All had distant metastasis. Early recurrence was defined as initial recurrence within 5 years following curative surgery irrespective of site. Likewise, late recurrence was defined as initial recurrence after 5 years. No recurrence was defined for survivors to a complete minimum of 10 years follow-up. Significant prognostic factors associated with early or late recurrence were selected according to the Akaike Information Criterion. Results: The median follow-up was 9 years (range, 1-18 years). During follow-up period, 51 recurrences occurred (distant metastasis), 31 early and 20 late. According to the site of recurrence, there were 51 distant. In this follow-up period, 19 patients died. Compared with the early recurrence group, the no recurrence group had lower lymph node involvement and more p53 positive lesions but the late recurrence group had lower tumor size. In comparison to no recurrence, p53 (odds ratio [OR] 6.94, 95% CI 1.49-32.16) was a significant prognostic factor for early recurrence within 5 years. Conclusions: Tumor size, p53 and LN metastasis are the most important risk factors for distance recurrence especially in early recurrence and also between of them, p53 is significant prognostic factor for early recurrence.
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Triple negative breast cancer (TNBC), characterized as estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 Her2 negative and accounting for 10-17% of all breast carcinomas, is only partially responsive to chemotherapy and suffers from a lack of clinically established targeted therapies. The aim of the current study was to evaluate the patterns of treatment and clinicopathology figures in Kurdish patients with triple-negative breast cancer, and to compare these to other reports. Between 2001 and 2014, 950 breast cancer patients were referred to our clinic. There were 74 female patients with TNBC, including 70 patients was invasive ductal carcinoma entered into our study. ER and PR positivity was defined as positive immunohistochemical staining in more than 10% of tumor cells. Immunohistochemistry assay with anti-HER2 antibodies was used to identify HER negative (0 and 1+) or positive (2+ and 3+). HER2 gene amplification was determined by fluorescent in situ hybridization (FISH). Overall survival (OS) was plotted with GraphPad Prism 5 Software using Kaplan-Meier and log-rank tests for comparison of results. The mean age in the first diagnosis for 70 patients with triple TNBC and invasive ductal carcinoma was 49.6 years that range of age was 27-82 years. All of the patients were female. Of 70 patients, 23 patients had metastasis. Thirty-two patients (45.7%) were treated with tamoxifen and 39 (55.7%) with radiotherapy. Three-year, 5-year and 10-year OS rates for all patients were 82%, 72% and 64%, respectively. The OS in our West Iran TNBC patients is less than reported elsewhere. However, treatment with combination of tamoxifen plus radiation increases the OS and reduces the mortality rate.
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Background: Preliminary research shows ginger may be an effective adjuvant treatment for chemotherapy-induced nausea and vomiting but significant limitations need to be addressed before recommendations for clinical practice can be made. Methods/design: In a double-blinded randomised-controlled trial, chemotherapy-naïve patients will be randomly allocated to receive either 1.2 g of a standardised ginger extract or placebo per day. The study medication will be administrated as an adjuvant treatment to standard anti-emetic therapy and will be divided into four capsules per day, to be consumed approximately every 4 hours (300 mg per capsule administered q.i.d) for five days during the first three cycles of chemotherapy. Acute, delayed, and anticipatory symptoms of nausea and vomiting will be assessed over this time frame using a valid and reliable questionnaire, with nausea symptoms being the primary outcome. Quality of life, nutritional status, adverse effects, patient adherence, cancer-related fatigue, and CINV-specific prognostic factors will also be assessed. Discussion: Previous trials in this area have noted limitations. These include the inconsistent use of standardized ginger formulations and valid questionnaires, lack of control for anticipatory nausea and prognostic factors that may influence individual CINV response, and the use of suboptimal dosing regimens. This trial is the first to address these issues by incorporating multiple unique additions to the study design including controlling for CINV-specific prognostic factors by recruiting only chemotherapy-naïve patients, implementing a dosing schedule consistent with the pharmacokinetics of oral ginger supplements, and independently analysing ginger supplements before and after recruitment to ensure potency. Our trial will also be the first to assess the effect of ginger supplementation on cancer-related fatigue and nutritional status. Chemotherapy-induced nausea and vomiting are distressing symptoms experienced by oncology patients; this trial will address the significant limitations within the current literature and in doing so, will investigate the effect of ginger supplementation as an adjuvant treatment in modulating nausea and vomiting symptoms. Trial registration: ANZCTR.org.au Identifier: ACTRN12613000120774.
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To determine the prevalence of malnutrition and chemotherapy-induced nausea and vomiting (CINV) limiting patients' dietary intake in a chemotherapy unit. Cross-sectional descriptive audit. Chemotherapy ambulatory care unit in a teaching hospital in Australia.Sample: 121 patients receiving chemotherapy for malignancies, aged 18 years and older, and able to provide verbal consent. An accredited practicing dietitian collected all data. Chi-square tests were used to determine the relationship of malnutrition with variables and demographic data. Nutritional status, weight change, body mass index, prior dietetic input, CINV, and CINV that limited dietary intake. Thirty-one participants (26%) were malnourished, 12 (10%) had intake-limiting CINV, 22 (20%) reported significant weight loss, and 20 (18%) required improved nutrition symptom management. High nutrition risk diagnoses, CINV, body mass index, and weight loss were significantly associated with malnutrition. Thirteen participants (35%) with malnutrition, significant weight loss, intake-limiting CINV, and/or who critically required improved symptom management reported no prior dietetic contact; the majority of those participants were overweight or obese. Of patients receiving chemotherapy in this ambulatory setting, 26% were malnourished, as were the majority of patients reporting intake-limiting CINV. Patients with malnutrition and/or intake-limiting CINV and in need of improved nutrition symptom management may be overlooked, particularly patients who are overweight or obese-an increasing proportion of the Australian population. Evidence-based practice guidelines recommend implementing validated nutrition screening tools, such as the Malnutrition Screening Tool, in patients undergoing chemotherapy to identify those at risk of malnutrition who require dietitian referral.
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Chemotherapy-induced nausea and vomiting (CINV) is a common, but now often overlooked side effect of cancer treatment, and one that can be largely prevented through the implementation of international evidence-based guidelines. The European CINV Forum, comprising nurses from France, Germany, Portugal, Spain and the UK, discussed the use of CINV preventive strategies in routine practice, and the factors that affect optimal delivery of antiemetic therapies. Based on these discussions, they developed a series of recommendations for optimal, evidence-based management of CINV. These state that all patients receiving chemotherapy should undergo full assessment of their risk of CINV and receive appropriate prophylactic treatment based on guidelines from the Multinational Association of Supportive Care in Cancer (MASCC) and the National Comprehensive Cancer Network (NCCN), which were both updated in 2011. Other recommendations, aimed at raising awareness of CINV and its management, include timely updates of relevant local practice guidelines and protocols, translation of the MASCC and NCCN guidelines into all European languages and their dissemination through accessible articles in nursing journals and newsletters and via nursing conferences and study days, improved training for nurses on CINV, collaboration between the European Oncology Nursing Society and national nursing organisations to promote consistent practice, the development of a CINV toolkit, information provision for patients, local audits of CINV management, and a survey of CINV management between and within European countries.
Article
9511 Background: Despite the widespread use of antiemetics, post-chemotherapy nausea and vomiting continue to be reported by up to 70% of patients receiving chemotherapy. Ginger (Zingiber Officinale), an ancient spice, is used by practitioners worldwide to treat nausea and vomiting. We conducted a multi-site, phase II/III randomized, placebo-controlled, double-blind clinical trial to assess the efficacy of ginger for chemotherapy-related nausea in cancer patients at the University of Rochester-affiliated Community Clinical Oncology Program (CCOP) member sites. Methods: Cancer patients who experienced nausea following any chemotherapy cycle and were scheduled to receive at least three additional cycles were eligible. Patients were randomized into four arms: 1) placebo, 2) 0.5g ginger, 3) 1.0g ginger, or 4) 1.5g ginger. All patients received 5-HT 3 receptor antagonist antiemetics on Day 1 of all cycles and took three 250mg capsules of ginger or placebo twice daily for six days starting three days before the first day of the next two cycles. Patients reported the severity of nausea during the morning, afternoon, evening, and night on a 7-point semantic rating scale (‘1' = ‘Not at all Nauseated' and ‘7' = “Extremely Nauseated”) for Days 1–4 of each cycle. The goal was to determine if ginger was more effective than placebo in controlling chemotherapy-related nausea in participants given a 5-HT 3 receptor antagonist antiemetic. Results: A total of 644 patients were accrued (90% female, mean age = 53). Breast (66%), alimentary (6.5%), and lung (6.1%) cancers were the most common cancer types. Analysis of covariance (ANCOVA) examined change in nausea in the four study arms on Day 1 of cycles 2 and 3. All doses of ginger significantly reduced nausea (p=0.003). The largest reduction in nausea occurred with 0.5g and 1.0g of ginger. Also, time of day had a significant effect on nausea (p<0.001) with a linear decrease over 24 hours for patients using ginger. Conclusions: Ginger supplementation at daily dose of 0.5g-1.0g significantly aids in reduction of nausea during the first day of chemotherapy. Supported by NCI PHS grants 1R25CA10618 and U10CA37420. No significant financial relationships to disclose.
Article
Objective: To study the antiemetic effect of ginger root on nausea and vomiting induced by cyclophosphamide. Methods: A randomized, prospective, cross-over, double-blind study was carried out in patients receiving cyclophosphamide in combination with other chemotherapeutic agents. Patients with atleast two episodes of vomiting in the previous cycle were included. The patients were randomly assigned to receive one of the three antiemetics: ginger, metoclopramide or ondansetron in the first cycle. They were admitted in the ward for 24 h and observed for the incidence of nausea and vomiting and adverse effects if any, were recorded. Patients were crossed over to receive the other antiemetic treatments during the two successive cycles of chemotherapy. Results: Complete control of nausea was achieved in 62% of patients on ginger, 58% with metoclopramide and 86% with ondansetron. Complete control of vomiting was achieved in 68% of patients on ginger, 64% with metoclopramide and 86% with ondansetron. No adverse effects attributable to ginger were recorded. Conclusion: Powdered ginger root in the dose used was found to be effective in reducing nausea and vomiting induced by low dose cyclophosphamide in combination with drugs causing mild emesis. The antiemetic efficacy of ginger was found to be equal to that of metoclopramide but ondansetron was found to be superior than the other two.
Article
Advances in our understanding of the pathophysiology of chemotherapy-induced nausea and vomiting (CINV), the identification of patient risk factors, and the development of new antiemetics have led to significant improvements in CINV prevention. With the correct use of antiemetic drugs, CINV can be prevented in the majority of patients. Extensive clinical data have been considered in the development of antiemetic treatment recommendations by reliable institutions such as the Multinational Association of Supportive Care in Cancer, the European Society of Medical Oncology and the American Society for Clinical Oncology. These guidelines are intended to enable physicians to incorporate the latest clinical research into their daily practice, considering CINV prevention as part of an optimal patient-centered approach to cancer management. Yet despite the availability of these guidelines, there is emerging evidence that implementation of treatment recommendations is suboptimal. Recently, guideline committees gave special consideration to patient-related risk factors (young, females) contributing to the emetogenic potential for patients receiving anthracycline and cyclophosphamide-based chemotherapy. As women with breast cancer represent a particularly challenging population regarding emesis control, it is especially important that treatment recommendations are followed. This review focuses on the content of the current antiemetic guidelines, addressing the importance of how these are intended to be implemented in routine clinical practice.