Benefits of ginger in the control of chemotherapy-induced nausea and vomiting

We included 24 studies, highlighting three thematic categories, namely 1) antiemetic action of ginger - nausea (13 articles; of these, nine significant) and emesis (10 studies; of these, six significant); 2) action in the control of nausea (11 articles; of these, six significant) and vomiting (8 articles; of these, three significant) in the acute phase; 3) action in the control of nausea (6 articles; of these, three significant) and vomiting (6 articles; of these, three significant) in the delayed phase. There were divergences of the methods used.

Final considerations:

This complementary therapy has low cost and easy access, but no statistical confirmation of its effectiveness in the management of nausea and vomiting in cancer patients was found.

Descriptors:
Nausea; Vomiting; Chemotherapy; Ginger; Zingiber Officinale

Reference	Year/ Country	Design/Number of patients	Interventions	Outcomes
1⁽¹⁴14 Shokri F, Gharebaghi PM, Esfahani A, Sayyah-Melli M, Shobeiri MJ, Ouladsahebmadarek E, et al. Comparison of the complications of platinum-based adjuvant chemotherapy with and without ginger in a pilot study on ovarian cancer patients. Int J Womens Health Reprod Sci. 2017;5(4):324-31. doi: 10.15296/ijwhr.2017.55 https://doi.org/10.15296/ijwhr.2017.55... ⁾	2017/ Iran	Randomized controlled clinical trial, n = 49 women.	Continuous consumption of 1 gram of ginger 2 times/day, for 6 cycles, by patients undergoing platinum treatment (carboplatin and paclitaxel).	There were no differences between the control group and the intervention group (p = 0,57).
2⁽¹⁵15 Marx W, McCarthy AL, Ried K, McKavanagh D, Vitetta L, Sali A, et al. The effect of a standardized ginger extract on chemotherapy-induced nausea-related quality of life in patients undergoing moderately or highly emetogenic chemotherapy: a double blind, randomized, placebo-controlled trial. Nutrients. 2017;9(8):867. doi: 10.3390/nu9080867 https://doi.org/10.3390/nu9080867... ⁾	2017/ Australia	Double-blind, randomized placebo-controlled trial, n = 51 (19 men and 32 women).	A dose of 1.2 g of ginger 4 times/day, for 5 days, in 3 cycles, by chemotherapy patients with emetogenic potential from moderate to high.	There was no significant difference between the placebo group and the intervention group (p > 0.05) concerning nausea and emesis. There were also no differences between the groups concerning the use of aprepitant (p > 0,05).
3⁽¹⁶16 Konmun J, Danwilai K, Ngamphaiboon N, Sripanidkulchai B, Sookprasert A, Subongkot S. A phase II randomized double-blind placebo-controlled study of 6-gingerol as an anti-emetic in solid tumor patients receiving moderately to highly emetogenic chemotherapy. Med Oncol. 2017;34(4):69. doi: 10.1007/s12032-017-0931-4 https://doi.org/10.1007/s12032-017-0931-... ⁾	2017/ Thailand	Double-blind, randomized placebo-controlled phase II study, n = 96 (21 men and 75 women).	Consumption of 10 g of ginger 2 times/day, for 4 days, in 4 cycles, by chemotherapy patients with emetogenic potential from moderate to high.	The emesis was lower in the experimental group (p < 0.001), similar to grade 3 vomiting (p = 0.001). The intensity of nausea was lower in the experimental group (mild, > 17%; moderate, > 39%; and severe, > 34%; p = 0.001).
4⁽¹⁷17 Thamlikitkul L, Srimuninnimit V, Akewanlop C, Ithimakin S, Techawathanawanna S, Korphaisarn K, et al. Efficacy of ginger for prophylaxis of chemotherapy-induced nausea and vomiting in breast cancer patients receiving adriamycin-cyclophosphamide regimen: a randomized, double-blind, placebo-controlled, crossover study. Support Care Cancer. 2017;25(2):459-64.doi: 10.1007/s00520-016-3423-8 https://doi.org/10.1007/s00520-016-3423-... ⁾	2016/ Thailand	Randomized controlled, double-blind, crossover study, n = 34 women.	1 g ginger, 2 times/day, for 5 days, in the 2nd and 3rd cycles, by patients undergoing treatment with doxorubicin and cyclophosphamide.	Emesis: p = 0.5. There was no statistically significant difference in the use of rescue medication, considering a significance level of 5%.
5⁽¹⁸18 Bossi P, Cortinovis D, Fatigoni S, Rocca MC, Fabi A, Seminara P, et al. A randomized, double-blind, placebo-controlled, multicenter study of a ginger extract in the management of chemotherapy-induced nausea and vomiting (CINV) in patients receiving high-dose cisplatin. Ann Oncol. 2017;28(10):2547-51. doi: 10.1093/annonc/mdx315 https://doi.org/10.1093/annonc/mdx315... ⁾	2017/ Italy	Randomized, double-blind, placebo-controlled multicenter study, n = 244 (160 men and 84 women).	1 g ginger, 4 times/day, for 19 or 27 days during 2 cycles by patients undergoing cisplatin treatment.	In the 1st cycle, mean FLIE score on day 1: p = 0.147. In the 2nd cycle, mean FLIE score on day 1: p = 0.675. In the 1st cycle, day 2: p = 0.782. In the 2nd cycle, day 2: p = 0.733. In the 1st cycle delayed nausea: p = 0.851. In the 2^nd cycle delayed nausea: p = 0.379. Therefore, both cycles (1st and 2nd) did not present statistically significant differences considering significance level of 5%.
6⁽¹⁹19 Ansari M, Porouhan P, Mohammadianpanah M, Omidvari S, Mosalaei A, Ahmadloo N, et al. Efficacy of ginger in control of chemotherapy induced nausea and vomiting in breast cancer patients receiving doxorubicin-based chemotherapy. Asian Pac J Cancer Prev. 2016;17(8):3877-80. doi: 10.14456/apjcp.2016.186/APJCP.2016.17.8.3877 https://doi.org/10.14456/apjcp.2016.186/... ⁾	2016/ Thailand	Prospective, randomized, placebo-controlled study, n = 150 women.	1 g ginger, 4 times/day, for 3 days during 3 cycles by patients undergoing treatment with Doxorrubicicin/cyclophosphamide; cyclophosphamide/Doxorrubicicin/5-Fluorouracil; Docetaxel/ Doxorrubicicin/cyclophosphamide.	In the 1st cycle nausea: experimental group (1.36); control group (1.46) .2nd cycle nausea: experimental group (1.36); control group (1.32). 3rd cycle nausea: experimental group (1.42), control group (1.37); therefore, nausea was higher in the group that used ginger in the 2nd and 3rd cycle. Reduction of emesis in the experimental group from 1.4 to 0.71.
7⁽²⁰20 Sanaati F, Najafi S, Kashaninia Z, Sadeghi M. Effect of ginger and chamomile on nausea and vomiting caused by chemotherapy in iranian women with breast cancer. Asian Pac J Cancer Prev. 2016;17(8):4125-9. doi: 10.14456/apjcp.2016.225/APJCP.2016.17.8.4125 https://doi.org/10.14456/apjcp.2016.225/... ⁾	2016/ Thailand	Randomized, double-blind clinical trial, n = 65 women.	1 g of ginger, 2 times/day, for 10 days from the 2nd cycle.	Ginger was not effective for the management of nausea (p = 0.238), but it demonstrated benefits in the incidence of vomiting (p <0.0001).
8⁽²¹21 Arslan M, Ozdemir L. Oral intake of ginger for chemotherapy-induced nausea and vomiting among women with breast cancer. Clin J Oncol Nurs. 2015;19(5):E92-7. doi: 10.1188/15.CJON.E92-E97 https://doi.org/10.1188/15.CJON.E92-E97... ⁾	2015 / Turkey	Randomized and controlled experimental study, n = 60 women.	Ginger consumption for 3 days, no further specifications.	The incidence of emesis and intensity of nausea were lower in the experimental group (p <0.05). Nevertheless, the incidence of nausea did not change between groups.
9⁽²²22 Marx W, McCarthy A, Vitetta L, Ried K, McKavanagh D, Thomson D, et al. Standardized ginger extract improves quality of life associated with chemotherapy-induced nausea and vomiting. Asia Pac J Clin Oncol. 2016;12(S5):87-87. doi: 10.1111/ajco.12630 https://doi.org/10.1111/ajco.12630... ⁾	2015/ Australia	Double-blind, randomized placebo-controlled study, n = 53.	A dose of 1.2 g of ginger, 4 times/day, for 5 days, by chemotherapy patients with emetogenic potential from moderate to high.	There were no significant differences between groups regarding adverse effects (p> 0.05).
10⁽²³23 Konmun J, Danwilai K, Ngamphaiboon N, Sookprasert A, Sirachainan E, Subongkot S. A phase II randomized, double-blind placebo-controlled trial of an antiemetic, 6-gingerol in solid tumor patients receiving moderately to highly emetogenic adjuvant chemotherapy. J Clin Oncol. 2014;32(15 Suppl):9647. doi: 10.1200/jco.2014.32.15_suppl.9647 https://doi.org/10.1200/jco.2014.32.15_s... ⁾	2014/ Thailand	Randomized, double-blind, controlled clinical trial, n = 87.	Consumption of 10 mg of ginger, 2 times/day, for 4 cycles, by chemotherapy patients with emetogenic potential from moderate to high.	Significant reduction in the occurrence of acute (p = 0.013) and delayed emesis (p < 0,001), acute nausea (p = 0.002) and delayed (p <0.001).
11⁽²⁴24 Ebrahimi SM, Parsa-Yekta Z, Nikbakht-Nasrabadi A, Hosseini SM, Sedighi S, Salehi-Surmaghi MH. Ginger effects on control of chemotherapy induced nausea and vomiting. Tehran Univ Med J [Internet]. 2013 [cited 2018 Aug 1];71(6):395-403. Available from: http://tumj.tums.ac.ir/browse.php?a_id=5429&sid=1&slc_lang=en http://tumj.tums.ac.ir/browse.php?a_id=5... ⁾	2013/ Iran	Randomized, double-blind, placebo-controlled clinical trial, n = 80 women.	1 g of ginger, 4 times / day, for 6 days.	The incidence and intensity of anticipatory nausea were significantly lower in the experimental group (p = 0.0008 vs. p = 0.0007), as well as in acute nausea (incidence and intensity p = 0.0001).
12⁽²⁵25 Montazeri AS, Raei M, Ghanbari A, Dadgari A, Montazeri AS, Hamidzadeh A. Effect of herbal therapy to intensity chemotherapy-induced nausea and vomiting in cancer patients. Iran Red Crescent Med J. 2013;15(2):101-106. DOI:10.5812/ircmj.4392 https://doi.org/10.5812/ircmj.4392... ⁾	2013/ Iran	Randomized crossover clinical trial (1st cycle, n = 44; and 2nd cycle, n = 31.	Consumption of 0.25 g of ginger, 4 times/day, for 2 cycles, by patients undergoing cisplatin treatment.	In the 1st cycle, ginger reduced the intensity of nausea in the 1st hour by 9%; in the 2nd hour, by 18.2%; in the 3rd hour, by 13.7%; in the 4th hour, by 22.7%; and, at the end of 24 hours, by 27.3%. Concerning vomiting, in the 1st cycle, there was a reduction of 9.1% in the 1st hour, 9.1% in the 2nd hour, 9.1% in the 3rd hour, 4.6% in the 4th hour, and 4.7% in the final 24 hours. In the 2nd cycle, the intensity was lower in the control group. The value of p in both was> 0.05.
13⁽²⁶26 Panahi Y, Saadat A, Sahebkar A, Hashemian F, Taghikhani M, Abolhasani E. Effect of ginger on acute and delayed chemotherapy-induced nausea and vomiting: a pilot, randomized, open-label clinical trial. Integr Cancer Ther. 2012;11(3):204-11. doi: 10.1177/1534735411433201 https://doi.org/10.1177/1534735411433201... ⁾	2012/ Iran	Randomized, open pilot clinical trial, n = 100 women.	Consumption of 1.5 g of ginger, 3 times/day, for 4 days, by patients undergoing treatment with docetaxel, epirubicin, cyclophosphamide.	Experimental group: a significant decrease in the incidence of nausea in the period from 6 to 24 hours after chemotherapy (p = 0.04). In the first 6 hours, on the second, third, and fourth day after chemotherapy, there was no difference between the groups in the incidence of nausea, emesis (p> 0.05).
14⁽²⁷27 Ryan JL, Heckler CE, Roscoe JA, Dakhil SR, Kirshner J, Flynn PJ, et al. Ginger (Zingiber officinale) reduces acute chemotherapy-induced nausea: a URCC CCOP study of 576 patients. Support Care Cancer. 2012;20(7):1479-89. doi:10.1007/s00520-011-1236-3 https://doi.org/10.1007/s00520-011-1236-... ⁾	2012/ United States	Randomized, double-blind, placebo-controlled clinical trial, n = 576 (55 men and 521 women).	Consumption of 0.5 g, 1 g or 1.5 g of ginger for 1, 2 or 3 times / day, for 6 days for 3 cycles.	Experimental group: reduction of acute nausea (p = 0.013 vs. 0.003). There was a reduction in anticipatory nausea (p <0.0001). The incidence of emesis in all patients was low (p = 0.5).
15⁽²⁸28 Chandra A, Martin JP. Antiemetic effect of encapsulated ginger powder as na add-on therapy for chemotherapy - induced nausea and vomiting. A study from India. Support Care Cancer. 2011;19(Suppl 2):S347. doi: 10.1007/s00520-011-1184-y https://doi.org/10.1007/s00520-011-1184-... ⁾	2011 / India	Prospective study, n = 600 cycles.	Consumption of 2 g of ginger for 3 days.	All patients used ginger; of these, 5% had moderate to severe acute nausea, 5% had moderate to severe acute emesis, 15% had moderate to severe nausea and emesis.
16⁽²⁹29 Pillai AK, Sharma KK, Gupta YK, Bakhshi S. Anti-emetic effect of ginger powder versus placebo as an add-on therapy in children and young adults receiving high emetogenic chemotherapy. Pediatr Blood Cancer. 2011;56(2):234-8. doi: 10.1002/pbc.22778 https://doi.org/10.1002/pbc.22778... ⁾	2011 / India	Prospective, randomized, double-blind and randomized institutional study, n = 60 (40 men and 20 women).	Consumption of 1 or 2 g of ginger according to weight, 5 or 6 times/day, for 3 days up to 3 cycles, by patients undergoing cisplatin / doxorubicin treatment.	Moderate to severe acute nausea was lower in the experimental group (p = 0,003). Moderate to severe acute emesis was lower in the experimental group (p = 0.002). Moderate to severe delayed nausea was lower in the experimental group (p <0.001). Moderate to severely delayed emesis was lower in the experimental group (p = 0.022).
17⁽³⁰30 Ryan JL, Heckler C, Dakhil SR, Kirshner J, Flynn PJ, Hickok JT, et al. Ginger for chemotherapy-related nausea in cancer patients: A URCC CCOP randomized, double-blind, placebo-controlled clinical trial of 644 cancer patients. J Clin Oncol. 2009;27(15Suppl):9511. doi: 10.1200/jco.2009.27.15_suppl.9511 https://doi.org/10.1200/jco.2009.27.15_s... ⁾	2009/ United States	Double-blind, randomized, phase II / III, placebo-controlled clinical trial, n = 644 (64 men and 580 women).	Consumption of 0.5 g, 1 g, or 1.5 g of ginger for 3 times/day, for 6 days for 3 cycles.	Experimental group: reduction of nausea (p = 0.003). Acute nausea: p < 0,001, significant reduction.
18⁽³¹31 Zick SM, Ruffin MT, Lee J, Normolle DP, Siden R, Alrawi S, et al. Phase II trial of encapsulated ginger as a treatment for chemotherapy-induced nausea and vomiting. Support Care Cancer. 2009;17(5):563-72. doi: 10.1007/s00520-008-0528-8 https://doi.org/10.1007/s00520-008-0528-... ⁾	2009/ United States	Randomized, double-blind, placebo-controlled clinical trial, n = 162 (40 men and 122 women).	A dose of 1.2 g of ginger, 4 or 8 times/day, for 3 days, by chemotherapy patients with emetogenic potential from low to high.	Acute nausea: without aprepitant, p = 0.47; with aprepitant, p = 0.55. Delayed nausea: without aprepitant, p = 0.69; with aprepitant, p = 0.01. Acute emesis: without aprepitant, p = 0.61; with aprepitant, p = 0.91. Delayed emesis: without aprepitant, p = 0.88; with aprepitant, p = 0.77. In the experimental group using aprepitant, the intensity of delayed nausea was higher (p = 0.01). At higher dosages of ginger (2 g), there was a higher incidence of delayed nausea (without aprepitant, n = 17; with aprepitant, n = 9).
19⁽³²32 Manusirivithaya S, Sripramote M, Tangjitgamol S, Sheanakul C, Leelahakorn S, Thavaramara T, et al. Antiemetic effect of ginger in gynecologic oncology patients receiving cisplatin. Int J Gynecol Cancer. 2004;14(6):1063-9. doi: 10.1111/j.1048-891X.2004.14603.x https://doi.org/10.1111/j.1048-891X.2004... ⁾	2004/ Thailand	Randomized controlled clinical trial, n = 48 women.	Consumption of 1 g of ginger, 4 times/day, for 5 days up to the 2nd cycle, by patients undergoing cisplatin treatment.	Nausea day 1: p = 0.875. Nausea day 2: p = 0.582. Nausea day 3: p = 0.865. Nausea day 4: p = 0.294. Nausea day 5: p = 0.554. Number of nausea days - from day 2 to day 5: p = 0.763. Control of emesis in the experimental group: p = 0.754. Considering a significance level of 5%, the results were not statistically significant.
20⁽³³33 Sontakke S, Thawani V, Naik MS. Ginger as an antiemetic in nausea and vomiting induced by chemotherapy: a randomized, cross-over, double blind study. Indian J Pharmacol [Internet]. 2003 [cited 2018 Aug 1];35:32-6. Available from: medind.nic.in/ibi/t03/i1/ibit03i1p32.pdf medind.nic.in/ibi/t03/i1/ibit03i1p32.pdf... ⁾	2003 / India	Randomized, prospective, crossover, double-blind study, n = 50 (11 men and 39 women).	Consumption of 1 g ginger, 2 times/day, for 3 days during 2 cycles, by patients being treated with combined cyclophosphamide.	Complete nausea control: with ginger (62%), metoclopramide (58%) and ondansetron (86%). Complete control of emesis: with ginger (68%), metoclopramide (64%) and ondansetron (86%).
21⁽³⁴34 Li X, Qin Y, Liu W, Zhou XY, Li YN, Wang LY. Efficacy of ginger in ameliorating acute and delayed chemotherapy-induced nausea and vomiting among patients with lung cancer receiving cisplatin-based regimens: a randomized controlled trial. Integr Cancer Ther. 2018;17(3):747-54. doi: 10.1177/1534735417753541 https://doi.org/10.1177/1534735417753541... ⁾	2017 / China	Randomized, double-blind, placebo-controlled clinical study, n = 140 (100 men and 40 women)	Consumption of 0.5 g ginger, 2 times/day, for 5 days, by patients being treated with cisplatin.	There was no significant difference between the experimental and control groups in decreasing the incidence and intensity of delayed nausea and emesis (p> 0.05). Delayed nausea: experimental group, 60.6%; control group, 72.5%. Delayed emesis: experimental group, 22.5%; control group, 26.1%.
22⁽³⁵35 Yekta ZP, Ebrahimi SM, Hosseini M, Nasrabadi AN, Sedighi S, Surmaghi MH, et al. Ginger as a miracle against chemotherapy-induced vomiting. Iran J Nurs Midwifery Res [Internet]. 2012 [cited 2018 Aug 5];17(5):325-9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3703071/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	2017/ Iran	Randomized, double-blind, placebo-controlled clinical trial, n = 80 women.	Consumption of 1 g of ginger, 4 times/day, for 6 days, by chemotherapy patients with emetogenic potential from low to high.	The incidence of emesis was lower in the experimental group in the anticipatory (p = 0.04), acute (p = 0.04) and delayed (p = 0.003) period.
23⁽³⁶36 Fahimi F, Khodadad K, Amini S, Naghibi F, Salamzadeh J, Baniasadi S. Evaluating the effect of Zingiber officinalis on nausea and vomiting in patients receiving cisplatin based regimens. Iran J Pharm Res [Internet]. 2011 [cited 2018 Aug 5];10(2):379-84. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3828901/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	2017/ Iran	Randomized, double-blind, placebo-controlled crossover clinical study, n = 36 (26 men and 10 women).	Consumption of 1 g ginger, 4 times/day, for 3 days during 2 cycles, by patients being treated with cisplatin.	Control of emesis: day 1 (experimental group, 42%; control group 25%), day 2 (experimental group, 25%; control group, 19%) and day 3 (experimental group, 19%; control group, 22%). Nausea control: day 1 (p = 0.14), day 2 (p = 0.31) and day 3 (p = 0.73), that is, p> 0.05.
24⁽³⁷37 Levine ME, Gillis MG, Koch SY, Voss AC, Stern RM, Koch KL. Protein and ginger for the treatment of chemotherapy-induced delayed nausea. J Altern Complement Med. 2008;14(5):545-51. doi: 10.1089/acm.2007.0817 https://doi.org/10.1089/acm.2007.0817... ⁾	2008/ United States	Randomized, clinical study, n = 28.	No specified dose, 2 times/day, for 3 days.	There was a reduction in the incidence and intensity of delayed nausea in the experimental group, in addition to a decrease in the use of antiemetic drugs, but it was not statistically significant (p> 0.05).

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[1] Corresponding Author: Dayane Oliveira Borges E-mail: d.oliveiraborges@yahoo.com.br