Muzeyyen Arslan, ORAL INTAKE OF GINGER DECREASES CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING IN WOMEN W

The use of ginger in nausea and vomiting

Turgut Ozal University School of Nursing Asst. Prof. M端zeyyen Arslan

Ginger ‫) )زنجبيل‬ Ginger (‫ )زنجبيل‬is one of the types of plant mentioned in the Quran.

Ginger is referred to in verse (76:17) of chapter (76) sūrat l-insān Sahih International: And they will be given to drink a cup [of wine] whose mixture is of ginger

"Foods Ment覺oned in The Qur'an- The Amazing Ginger!"

Scientific Name

• Zingiber officinale,

• Ginger -- the "root," or actually the rhizome, of the plant Zingiber officinale -- has been a popular spice and herbal medicine for thousands of years.

It has a long history of being used as medicine in Asian, Indian, and Arabic herbal traditions.

Source: Ginger | University of Maryland Medical Center http://umm.edu/health/medical/altmed/herb/ginge r#ixzz3GG2dOglV .

People Use This For: Orally, ginger is used for motion sickness, morning sickness, colic, dyspepsia, flatulence, chemotherapy-induced nausea, rheumatoid arthritis (RA), osteoarthritis, post-surgical nausea and vomiting, migraine headache‌...

They also need to refreshment ‌.

• Breast cancer occurs at a rate of 23% globally among all cancer types in women and 1.38 million cases were reported in 2008 (Curado, 2011).

of the developments in • Despite pharmacological treatment, 70-86.7% of patients with breast cancer experience nausea and/or vomiting (Cohen, de Moor, Eisenberg, Ming, & Hu, 2007; Lindley et al., 2005; Yap, Low, & Chan, 2012).

• Ginger has antiemetic effect in hyperemesis gravidarum and postoperative nausea and/or vomiting(Bilir, Akdemir, Ozden, Cevrioglu, & Bilir, 2013; Hines, Steels, Chang, & Gibbons, 2012; Marcus & Snodgrass, 2005) ..

• There has also been a small amount of research studying the use of ginger for chemotherapy induced nausea.

• The applicable parts of ginger are the rhizome and root. Ginger contains active constituents known as gingerol and shogaol.

• The mechanism by which ginger reduces nausea and vomiting might be due to the 6gingerol constituent.

Adverse Reactions: Orally, ginger is usually well tolerated when used in typical doses. However, higher doses of 5 grams per day increase the risk of side effects and decrease tolerability.

Possible Interactions • Blood-thinning medications .

• Diabetes medications • High blood pressure medications

Dosage/Administration: • Oral: For morning sickness, 250 mg ginger 4 times daily has been used. • Ginger can be consumed as a fresh or dried root.

The dosage of ginger in the literature is between 250 mg and 1 g powdered root in capsular form taken one to four times per day (White, 2007).

Recommended therapeutic doses are from 500 to 1000 mg fresh root three times daily or 500 mg dried root two to four times per day (Newall, Anderson, & Phillipson, 1996).

A study on ginger • ORAL INTAKE OF GINGER DECREASES CHEMOTHERAPYINDUCED NAUSEA AND VOMITTING IN WOMEN WITH BREAST CANCER: A RANDOMİZED-CONTROLLED TRIAL FROM TURKEY

• Because of the increase in occurrence of breast cancer, prevention of the complications of systemic chemotherapy administration, determining symptoms at an early phase and symptom-control gain more significance gradually. • Although chemotherapy-induced nausea and/or vomiting are a side effect most frequently reported by patients receiving breast cancer therapy; its severity and intensity vary according to the patient. Despite of the developments in pharmacological treatment, 7086.7% of patients with breast cancer experience nausea and/or vomiting (Cohen, de Moor, Eisenberg, Ming, & Hu, 2007; Lindley et al., 2005; Yap, Low, & Chan, 2012).

• Women with breast cancer appeal to complementary treatment methods in order to reduce side effects of the treatment and psychological stress, and achieve a control sense in the treatment (Kav et al., 2008; Ozlem, Seda, Nimet, Alper, & Celalettin, 2008; Sebahat, Ayfer, & Mehmet, 2003; Yavuz, İlçe, Kaymakçı, Bildik, & Dıramalı, 2007)

• This study was conducted to determine the effect of powdered ginger on chemotherapyinduced nausea and/or vomiting (adjuvant antracycline) in women with breast cancer.

• The research sample was formed of a total of 60 patients undergoing chemotherapy in the outpatient clinic of an Oncology Hospital.

• (In this study, a standard sampling size of 0.90 test power was estimated by using “G.Power3.1.7” program. It was determined as a result of the analysis that at the level of α=0.05, and the effect size of 0.10 and at 90% power, a total of 60 patients)

Inclusion criteria • Inclusion criteria for the study were that being female who have undergone surgical treatment for breast cancer, receiving chemotherapy with adjuvant antracycline (Chemotherapy protocols: Anthracycline, cyclophosphamide, adriamycin, 5FU), taking palonosetron-aprepitant antiemetic treatment, being maximum in the third stage of the disease, in the minimum second cycle of chemotherapy, and having chemotherapy-induced nausea severity of three and above.

• Data Collection • The data were collected using “Patient Information Form” and “Patient Diary”.

• Patients were followed up for two cycles of treatment within the study scope and the data were collected in two stages.

• In the first phase of the data collection, “Patient Information Form” and “Patient Diary” was filled out in the first day of the chemotherapy treatment.

• Nausea and the number of vomiting and retching episodes were evaluated four times for each day during five days in the patient diary. Nausea severity was evaluated with a numerical scale with the beginning of “0” “no nausea” and the end of “10” “very severe nausea”

• The patients in both groups were called by phone during five days, and reminded about filling out patient diary. The researcher asked the patients by telephone that they should bring the diary to the hospital in the next cycle.

• The patients in the intervention group swallowed powdered ginger 30 minutes before the administration of chemotherapy. 500 mg of powdered ginger was given to patients twice a day for three days by mixing it with a spoonful of yogurt to ease swallowing.

• The patients in the intervention group took the first ginger 30 minutes before the chemotherapy with the researcher’s observation. The remaining five usage powder ginger (five packages of 500 mg) was given to patients and they were enabled to use them at home. On the other hand, no intervention was performed other than the standard care provided at the hospital in the control group patients.

Before the administration of chemotherapy medicine, 5-HT3 receptor antagonists palonosetron + dexamethasone + antihistaminic + ranitidine were given intravenously to the intervention and control group patients in the scope of antiemetic protocol.

• Ethical Consideration • Ethical permission were obtained from the Ethical Committee in Turgut Ozal University Medical School in Turkey. Informed consents of the patients participated in the study were obtained and the written approvals of patients were gained.

• Statistical Analysis • The data were evaluated with SPSS (Statistical Packages for the Social Sciences) 18.0 package program

Findings • There was no difference between the intervention and control group patients in terms of age, educational level, marital status, the number of children and body mass index (p>0.05).

– There was no statistically significant difference between the groups in terms of nausea, vomiting and retching episodes before the study intervention (p>0.05).

•

Table 1.The Changes of Nausea Severity, the Number of Vomiting and Retching Episodes Means by Days

• • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Days Day 1

Nausea Vomiting Retching episodes

Day 2

Nausea Vomiting Retching episodes

Day 3

Nausea Vomiting Retching episodes

Day 4

Nausea Vomiting Retching episodes

Day 5

Nausea Vomiting Retching episodes Intervention

Group Control Intervention Control Intervention Control Intervention Control Intervention Control Intervention Control Intervention Control Intervention Control Intervention Control Intervention Control Intervention Control Intervention Control Intervention Control Intervention Control Intervention Control 30

n 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 0.2

Mean 1.2 0.8 0.1 0.0 0.3 0.0 6.3 3.8 0.3 0.0 0.7 0.3 6.5 3.8 0.2 0.0 0.7 0.3 6.3 3.7 0.1 0.0 0.7 0.2 5.4 2.8 0.2 0.0 0.4 1.0

Std. Deviation 1.1 0.9 0.2 0.1 1.0 0.0 1.9 1.9 0.6 0.1 1.5 1.0 1.8 1.8 0.4 0.1 1.4 1.1 1.8 1.9 0.4 0.1 1.5 1.0 2.3 1.7 0.4 0.0 1.1

t 1.46

Sd 58

P 0.150

1.27

58

0.210

1.81

58

0.080

5.10

58

p<0.001

2.64

58

0.010

1.07

58

0.290

5.88

58

p<0.001

2.56

58

0.010

1.40

58

0.170

5.54

58

p<0.001

1.83

58

0.070

1.44

58

0.160

4.89

58

p<0.001

2.09

58

0.040

0.82

58

0.420

â&#x20AC;˘ Following the research intervention, there was a statistically significant difference in terms of nausea severity during 2., 3., 4., and 5. days in favor of intervention group (p<0.05). The number of vomiting decreased in 2., 3., and 5. days in the patients of intervention group (p<0.05).

Table 2. The Changes of Nausea Severity, the Number of Vomiting and Retching Episodes Means before and following Research Intervention *1Before intervention, **2Following intervention

Nausea-*1 Nausea-**2

Vomiting-*1 Vomiting-**2 Retching episodes*1 Retching episodes -**2

Group

n

Mean

Std. deviation

Control

30

5.2

1.5

Intervention

30

5.3

1.0

Control

30

5.1

1.5

Intervention

30

3.0

1.5

Control

30

0.2

0.4

Intervention

30

0.1

0.3

Control

30

0.2

0.3

Intervention

30

0.0

0.0

Control

30

0.7

1.5

Intervention

30

1.2

2.6

Control

30

0.6

1.2

Intervention

30

0.2

0.8

t

df

p.(sig)

-0.115

58

0.909

5.582

58

p<0.001

0.453

58

0.653

2.632

58

0.011

-0.823

58

0.414

1.492

58

0.141

â&#x20AC;˘ Five-day mean severity of nausea, the number of vomiting, and retching episodes were analyzed. Based on this comparison, the severity of nausea and the number of vomiting was significantly low in the intervention group comparing with control group (p<0.05).

Table 3. The Mean Severity Score of Acute and Delayed Nausea

Intervent Delayed ion Nausea Control Acute Nausea

Mean

n

3.6

30

Std. deviati Statistical value on 1.8 t=5.399 p<0.001

6.1

30

1.7

Intervent ion

1.6

15

1.1

Control

3.9

U=44.00 p<0.001 21

1.6

â&#x20AC;˘ In this study, it was found that 500 mg of powdered ginger administered twice a day during the first three days of chemotherapy was effective on chemotherapy-induced nausea-vomiting. â&#x20AC;˘ The administration of powdered ginger in addition to standard antiemetic treatment was effective on reducing the severity of acute and delayed nausea.

Thank you for your patienceâ&#x20AC;Ś