Adjuvant Ginger Administration Improved Nausea, Vomiting, and Fatigue Symptoms in Subjects Undergoing Chemotherapy

by | Apr 24, 2024 | Botanicals, Cancer, Ginger, Recent Articles

Written by Taylor Woosley, Science Writer. Findings of a multisite, double-blind, placebo-controlled randomized trial with two parallel arms show that adjuvant ginger supplementation at daily dose of 1.2 g ginger root powder significantly improved nausea and vomiting-related quality of life scores in subjects undergoing moderately to highly emetogenic chemotherapy. 

ginger - botanicalsChemotherapy-induced nausea and vomiting (CINV) is a debilitating side effect of cancer treatment, affecting up to 40% of patients1. CINV can lead to higher cancer-related fatigue, anxiety, work loss, and decreased adherence to chemotherapy2. Furthermore, it is associated with significantly worse quality of life (QoL), declines in nutrition status, and decreases in day-to-day functioning3.

Ginger is rich in a variety of components including phenolic compounds, polysaccharides, terpenes, lipids, and organic acids4. The bioactive compounds, such as gingerols and shogaols, are affective against pregnancy and postoperative nausea such as CINV, as well as in the management of fatigue5. Previous research has indicated that the inhibition of 5-HT3R largely contributed to the antiemetic effect of ginger6.

Crichton et al. conducted a multisite, double-blind, placebo-controlled randomized trial with two parallel arms to analyze the effect of a standardized adjuvant ginger root powder supplement on chemotherapy-induced nausea-related QoL and secondary outcomes including severity of CINV, fatigue, nutritional status, and mental health. Participants attending cancer care units at 2 metropolitan hospitals in Queensland, Australia were invited to join the trial. Subject inclusion consisted of chemotherapy-naïve adult participants who were physically and cognitively functional and scheduled to undergo single-day moderately to highly emetogenic chemotherapy.

Participants were randomized to either the ginger powder group or placebo and stratified by chemotherapy emetogenicity (moderate or high), sex (male or female), age (younger than age 55 years or age 55 years or older), and research site (A or B). The intervention group received nonsynthetic standardized 300 mg ginger capsules containing 21 mg bioactive compounds per capsule (5% gingerols and 2% shogaols), with a total daily dose of 1.2 g ginger root powder containing 84 mg active ingredients (64 mg gingerols, 20 mg shogaols). Those in the placebo group received capsules containing 150 to 200 mg microcrystalline cellulose filler. All subjects were instructed to consume one capsule four times daily with food. Supplements were instructed to be taken the day of chemotherapy before chemotherapy administration and continued for 4 days post chemotherapy during Cycle 1 and was repeated for Cycles 2 and 3.

The primary study outcome was chemotherapy-induced nausea-related QoL which was measured using the Functional Living Index Emesis 5-Day Recall (FLIE-5DR). Secondary outcomes were the FLIE-5DR subgroups of vomiting-related QoL and overall CINV-related QoL. Additionally, health related QoL, nausea incidence and severity, vomiting incidence and number of episodes, fatigue, nutritional status, anxiety, and depression were included as secondary outcomes. Subject characteristics were analyzed at baseline (T0; before chemotherapy). Primary and secondary outcomes were measured 1 day before chemotherapy (T1), 12 to 24 hours after chemotherapy (T2), 4 days after chemotherapy (T3), and 5 to 8 days after chemotherapy (T4).

Mixed analysis of variance with repeated measured (RMA-NOVA) was used to determine the main group effect, main time effect, and interaction effect between group and time. The null hypothesis was no difference between groups. X2 tests were used at each chemotherapy cycle to analyze the difference in nausea, vomiting, and malnutrition incidence between ginger and placebo groups at T1, T2, and T3. 70 subjects completed all 3 chemotherapy cycles, with 68% of subjects being women. Significant findings of the study are as follows:

  • There was evidence against the null hypothesis of no difference between groups for the main effect for group for nausea-related QoL (p = 0.003), vomiting-related QoL (p = 0.002), and overall CINV-related QoL (p < 0.001); a main effect for time for nausea-related QoL (p < 0.001); and an interaction effect between group and time for vomiting-related QoL (p < 0.001).
  • The ginger group experienced a 22% lower incidence of delayed nausea at Cycle 2 (p = 0.020) and 30% lower incidence at Cycle 3 (p = 0.002) compared to placebo.
  • Regarding clinically significant fatigue occurrence, a main effect for group (p = 0.002), time (p = 0.001), as well as interaction effect between group and time for fatigue (p < 0.001). There was evidence against the null hypothesis for ginger being associated with less change in fatigue following chemotherapy at Cycle 1 only (p < 0.001).

Results of the study suggest that adjuvant ginger nausea and vomiting-related quality of life in subjects undergoing chemotherapy. Ginger may be an effective treatment to reduce nausea, vomiting, and fatigue for those experiencing moderately to highly emetogenic chemotherapy. Study limitations include the sample subject sample and the larger number of participants in the ginger group who had a history of moderate to severe motion sickness which is a known risk factor for CINV.

Source: Crichton, Megan, Skye Marshall, Elizabeth Isenring, Anna Lohning, Alexandra L. McCarthy, Alex Molassiotis, Robert Bird et al. “Effect of a Standardized Ginger Root Powder Regimen on Chemotherapy-Induced Nausea and Vomiting: A Multicenter, Double-Blind, Placebo-Controlled Randomized Trial.” Journal of the Academy of Nutrition and Dietetics 124, no. 3 (2024): 313-330.

© 2024 by the Academy of Nutrition and Dietetics. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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Posted April 24, 2024.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

References:

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  2. Patel P, Robinson PD, Wahib N, et al. Interventions for the prevention of acute phase chemotherapy-induced nausea and vomiting in adult and pediatric patients: a systematic review and meta-analysis. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. Nov 2022;30(11):8855-8869. doi:10.1007/s00520-022-07287-w
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