Treatment of Nausea and Vomiting During Chemotherapy
Evidence suggests that a patient’s expectations of experiencing nausea strongly predict the actual occurrence of ANV.34,40
It is most likely that a
combination of classic conditioning and expectancy theories more fully explain the psychopathology of ANV because conditioning effects are mediated by patient expectations and conditioning effects moderate patient expectations.41–43
A patient’s expectations of nausea are also a strong predictor of post-treatment nausea even when controlling for other known contributors.44–50
US Food and Drug Administration (FDA) approved medicinal treatment in the US. However, ginger is readily available over the counter and in grocery stores as it is not an FDA regulated substance. The FDA currently classifies ginger as a generally regarded as safe substance if consumption is limited to 4 g daily. As previously mentioned, current 5-HT anti-emetic medications are receptor antagonists for specific neurotransmitters in the gastrointestinal tract.66
Likewise, ginger can
bind 5-HT3 receptors to enhance anti-emetic effects and can increase levels of detoxification enzymes to counteract oxidative damage to
Individual variation in patient expectations may also explain why the frequency and severity of CINV are different for different patients on the same chemotherapy regimens. These between-patient differences cannot be fully accounted for by the properties of the chemotherapy agents or patient demographic characteristics.30,50,51 Patient and treatment factors associated with CINV include female gender, younger age, lower alcohol intake history, history of motion sickness, history of emesis during pregnancy, history of CINV, and pre-treatment expectations of nausea.52
Family conflict has been found to
be related to post-treatment nausea and ANV for younger adult and female patients.53
Additional cognitive and behavioral interventions that focus on changing expectations are needed as adjuncts to standard pharmaceutical anti-emetic therapies to help fully control anticipatory, acute, and delayed CINV. Roscoe and colleagues found that using a cognitive manipulation technique to increase beliefs that acupressure bands could prevent CINV resulted in significantly reduced CINV among patients with high initial expectations of experiencing CINV.49
These
findings enhance our understanding of factors that contribute to CINV. The combined use of techniques such as systematic desensitization, overshadowing, and expectation manipulation with pharmaceutical interventions may lead to more effective management of CINV. More research is needed investigating the psychopathology of CINV to effectively manage the full spectrum of anticipatory, acute, and delayed CINV.
Integrative Medicine Interventions
Integrative medicine approaches, consisting of both complementary and alternative medicine interventions, are commonly used by cancer patients to reduce the toxic adverse effects of chemotherapy treatment. Patients typically use these types of intervention along side their traditional allopathic (e.g. pharmaceutical) interventions. Integrative modalities are used by the majority of patients with cancer and are most commonly used by patients with advanced-stage disease.54,55
These types of treatment usually do not require a prescription from a physician, can be accessed in the community, and are gaining increasing scientific evidence to support their use.
Herbal Supplements
Ginger has been thoroughly studied and found to be useful for nausea and vomiting associated with motion sickness, surgery, and pregnancy.57–65
ginger is not a
Ginger is the most abundantly used supplement for the prevention and/or reduction of CINV. Since the 16th century, the dried aromatic rhizome (underground stem) of ginger (Zingiber officinale) has been used by practitioners of both Indian (Ayurvedic) and traditional Chinese medicine to treat gastrointestinal upsets such as nausea and excessive flatulence.56
Although ginger has been approved for use to prevent motion sickness in Europe and its use is recommended,56
US ONCOLOGY & HEMATOLOGY Acupuncture and Acupressure
Acupuncture is another form of traditional Chinese medicine that has been used for centuries to treat nausea and vomiting. Over the past 20 years, clinical evidence has supported the use of acupuncture for CINV.74
Research suggests that acupuncture works
For the best results in reducing CINV, ginger should be implemented before the onset of symptoms or before the first chemotherapy treatment cycle. Our research group previously demonstrated, in a 744-patient phase III randomized, placebo-controlled clinical trial, that three different daily doses of ginger (0.5, 1.0, 1.5 g) plus
tissues.67
standard 5-HT3 receptor antagonists and dexemethasone significantly reduced acute CINV compared with placebo plus standard standard 5-HT3 receptor antagonists and dexamethasone.68,690
Our findings suggest
that cancer patients can achieve greater alleviation of acute CINV by using ginger supplementation of 0.5–1.0 g daily (equivalent to quarter to
half a teaspoon of ground ginger) along with standard 5-HT3 receptor antagonists and dexamethasone.68,69
It is important to note that the ginger
used in this study consisted of capsules containing a purified liquid extract equivalent to 250 mg ginger. The purified liquid extract concentrated the biologically active components of the ginger root, such as gingerols, zingerones, and shogaols.57
Unclear forms of ginger, such as crystallized, raw, tea, or aromatherapy, are thought to have similar effectiveness.
Similar to ginger, these herbs have antispasmodic activity and promote digestive health. Studies have shown that citrus bioflavonoids can actually cause nausea and vomiting.70
Many other herbal supplements, in the form of tea or aromatherapy, have been recommended for the relief of CINV. Cinnamon bark, peppermint, chamomile, fennel, and rosewood are among the most common.70
Chinese
medicinal herbs have demonstrated effectiveness against CINV.54 Chinese medicinal herbs are highly variable compounds and include any liquid extract of a mixture of herbal compounds used to treat symptoms or diseases. Chinese medicinal herbs are prepared by Chinese medicine practitioners to reduce therapeutic toxicity and/or strengthen the body’s resistance and immunity.54
Usually, Chinese herbalists determine the
combination of herbs on an individual basis depending on patient symptoms and conditions. Therefore, a Chinese herbalist as well as an oncologist should be consulted before use of Chinese medicinal herbs. Three published studies favored use of Chinese medicinal herbs for the relief of CINV. Shenqi fuzheng injections (consisting of two herbs),71 Aidi injections (consisting of four herbs),72 herbs)73
and Aifukang (consisting of 11 reduced CINV in a sample of breast cancer patients.55
Acupuncture is a 4,000-year-old therapeutic technique that involves inserting and manipulating needles with and without electrical stimulation and providing pressure or electrical stimulation at specific points in the body.74
primarily on the nervous system through stimulating brain activation or 93
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