A Study to Assess the Effectiveness of Ginger powder with Honey on Gastrointestinal symptoms in patients undergoing Chemotherapy in a selected hospital Bangalore

 

Elsamma Xavier

M.Sc Nursing Student, Department of Medical Surgical Nursing, Karnataka, India.

*Corresponding Author E-mail:

 

ABSTRACT:

Introduction: Chemotherapy induced gastrointestinal symptoms are distressing and affect QOL, which may lead to non adherence to treatment regimen. This study was conducted to assess the effectiveness of ginger with honey on gastrointestinal symptoms in patients undergoing chemotherapy. Methods: A pre-experimental one group pretest post test design was adopted; wherein 66 cancer patients receiving chemotherapy selected using non-probability purposive sampling technique. Baseline variables were assessed. Pretest assessment of gastrointestinal symptoms, were done using VAS and a check list, at the end of the day after chemotherapy.100mg ginger powder with 5 ml of honey was administered orally thrice.  (0 hr, 2hr and4hr of chemotherapy) Post test scoring was done after chemotherapy on the same day. Result: Ginger was found to be effective in reducing gastrointestinal symptoms [nausea p<0.001, anorexia- p<0.001, vomiting-p<0.045]. Females had more nausea and subjects with respiratory cancers expressed more gastric burning/pain. Conclusion: Present study proves ginger with honey to be effective in reducing chemotherapy induced gastrointestinal symptoms. It can be used to achieve a better quality living.

 

KEYWORDS: Gastrointestinal symptoms, Ginger with honey, Cancer patients, Chemotherapy.

 

 


INTRODUCTION:

Health is a state of complete physical, mental, and social well being and not merely an absence of disease or infirmity” (WHO)1. And disease is a condition in which body health is impaired. Cancer is one type of disease which begins in our cells, which are the building blocks of our body. Normally our body forms new cells as we need them, replacing old cells that die. Sometimes this apoptosis (programmed cell death) gets deranged and the extra cells form a mass which is called cancer. There are more than 100 different types of Cancer.

 

India is likely to have 17.3 lakh new cases of cancer and over 8.8 lakh deaths due to the disease by 2020. The Indian council of medical research (ICMR) said in 2016, the total number of new cancers expected to be around 14.4 lakh and the figure is likely to reach nearly 17.3 lakh new cases in 2020 with cancers of breast, lung and cervix topping the list.2

 

There are many modalities of cancer treatments, the modality depends on the type and how advanced it is. Chemotherapy is one mode of treatment that uses drugs to stop the growth of cancer cells either by killing the cells or by stopping them from multiplying. Chemotherapy may be given orally, parentally or topically depending upon the type and stage of cancer being treated. Chemotherapy treats many types of cancers effectively. But like other treatments it often causes side effects. The severity and nature of side effects of chemotherapy are different from patient to patient. The most common side effects are nausea, vomiting, which happens when chemotherapy damages the healthy cells of digestion system.3 Despite advances in antiemetic therapy, chemotherapy induced nausea vomiting (CINV) still possess a significant burden to patients undergoing chemotherapy. Many remedies have been used and tested to decrease CINV. Ginger is one such traditional remedy used for gastro intestinal complaints and has been suggested as a viable adjuvant treatment for nausea and vomiting in the cancer context. Substantial numbers of researches have revealed that ginger possesses properties that could exert multiple beneficial effects on chemotherapy patients who experience nausea and vomiting. Bioactive compounds within the rhizome of ginger, particularly the gingerol and shogaol class of compounds interact with several path ways that are directly implicated in CINV in addition to pathways that would play secondary roles by exacerbating symptoms.4

 

PROBLEM STATEMENT:

A study to assess effectiveness of ginger powder with honey on gastrointestinal Symptoms in patients undergoing chemotherapy

 

OBJECTIVES OF THE STUDY

1.   To assess the severity of gastrointestinal symptoms among patients undergoing chemotherapy.

2.   To compare the severity of gastrointestinal symptoms associated with chemotherapy before and    

      after administering ginger powder with honey.

3.   To determine the association of gastro intestinal symptoms with selected variables.

 

HYPOTHESIS:

H1: There will be a significant difference in the severity of gastrointestinal symptoms among patients receiving chemotherapy before and after administration of ginger powder with honey at 0.05 level of significance.

H2: There will be a significant association of severity of gastrointestinal symptoms and selected baseline variables at 0.05 level of significance.

 

METHODOLOGY:

Research approach:

Research design:

Pre experimental one group pre-test post-test design

 

RESEARCH VARIABLES:

Demographic variables:

Age, gender, type of cancer, stage of cancer, chemotherapeutic agents, cycle of chemotherapy, type of anti emetics.

 

Independent variable: 

Independent variable is Oral administration of Ginger powder with honey.

 

Dependent variable:   

Chemotherapy induced Gastro intestinal symptoms.

 

Target population:

The population of the study includes cancer patients who come to oncology unit for chemotherapy

 

Setting of the study:

This   study was conducted in oncology unit and selected wards of St.Johns Medical College Hospital Bangalore.  It is a teaching hospital and tertiary level referral center with 1350 beds. On an average 380 patients receive chemotherapy per month.

 

Sampling technique:

Non probability purposive sampling technique

 

Sample and sample size:

66 cancer patient were selected

 

Inclusion criteria:

·       Cancer patients receiving chemotherapy above the age of 18yrs.

·       Subjects receiving only one day of chemotherapy per cycle.

·       Subjects who receive minimum 4hrs of chemotherapy

·       Subjects who verbalize having had any one of the chemotherapy induced gastrointestinal symptoms nausea/vomiting/anorexia and gastritic burning / pain   at the end of the day in the present cycle

 

Exclusion criteria:

·       Patients who are having the Cancer of stomach.

·       Gastric outlet obstruction patients

·       Patients with thrombocytopenia 

·       Patients who are nil per oral

 

Development and description of the tool:

The tool consisted of three sections.

 

Section 1 Proforma to elicit baseline variables by using structured interview schedule. The baseline variables included to age, gender, type of cancer, stage of cancer, chemotherapy agents, cycle of Chemotherapy and antiemetic given.

 

Section 2 Visual analogue scale for assessing intensity of nausea, anorexia and gastric burning / pain (0-None, 1-3 mild, 4-6 moderate, 7-10 severe)

 

Section 3 Check list for vomiting which included Yes/ No question 

Data collection Procedure: The data was analyzed by using both descriptive and inferential statistics.

 

Major findings:

Section 1:

Table: 1 Description of baseline variables of patients   receiving   Chemotherapy

Variables

F

%

Age

 

 

15-35

6

9.1%

36-55

36

54.5%

56- 75

24

36.4%

Gender

 

 

Female

47

71.2

Male

19

28.8

Stage of cancer

 

 

1

8

12.1

2

24

36.4

3

21

31.8

4

13

19.7

Cycle of chemotherapy

 

 

1

43

65.2

2

7

10.6

3 and above

16

24.2

Type of cancer

 

 

Cancer related to reproductive system

37

56.1

Cancer related to G.I system

14

21.2

Cancer related to respiratory system

9

13.6

Cancer related to hematology system

6

9.1

Type of antiemetics

 

 

Injectable

63

95.5

Injectable +orals

3

4.5

Chemotherapeutic agents

 

 

Anti tumor and alkylating agents

14

21.2

Anitmetabolites

6

9.1

Alkylating And plant alkaloids

13

19.7

Alkylating Agents

15

22.7

Alkylating, antitumor, plant alkaloids, anitmetabolites

13

19.7

Alkylating, antitumor, and plant alkaloids

5

7.6

 

Section 2: Description of the Severity of Gastrointestinal Symptoms among patients undergoing Chemotherapy.

·       Objective: To assess the severity of gastrointestinal symptoms among patients undergoing chemotherapy.

 

 

Fig. 1 (a): Percentage distribution of severity of Nausea among patients undergoing chemotherapy

 

 

The above figure shows 65.15% had mild nausea, 18.19% had moderate and 3.03% had severe nausea and 13.63% had no nausea during the chemotherapy.

 

 

Fig. 1 b: Percentage distribution of severity of Anorexia among patients undergoing chemotherapy

 

The above figure shows that 75.76% patients had mild, 18.18% moderate and 1.52% had severe anorexia and 4.55%had d no anorexia.

 

 

Fig. 1 c: Percentage distribution of severity of gastric burning/pain among patients undergoing chemotherapy

 

The above figure shows 25.79% of subjects had mild gastric pain 1.5% had moderate and severe gastric pain and 71.21 had no gastric pain during the chemotherapy.

 

 

Fig. 1d: Percentage distribution of the presence of vomiting among patients undergoing chemotherapy

 

The above figure shows only 7.58% experienced vomiting during the chemotherapy.


 

Table 2(a): Range, Median, IQR and Wilcoxon test to compare the pretest - post test score of nausea, anorexia, gastritis  n = 66

 

Variables

Pre – Test

Post – Test

Wilcoxon test

p- value

 

Range

Median

IQR

Range

Median

IQR

Nausea

0 – 7

3

1 - 3

0 – 3

0

0 - 1

16699.5

*<0.001

Anorexia

0 – 6

2

1 - 3

0 -3

1

0 - 1

1583.5

*<0.001

Gastritis

0 – 7

0

0 - 1

0 – 3

0

0 - 0

Cannot   be computed

 

*Significant

 


SECTION - 3

Comparison of The Severity of Gastrointestinal Symptoms Associated With Chemotherapy Before And After Administering Ginger Powder With Honey.

 

Objective  2.  To compare the severity of gastrointestinal symptoms associated with chemotherapy before and after administering ginger powder with honey.

 

H1.  There will be a significant difference in the severity of gastrointestinal symptoms among patients receiving chemotherapy before and after administration of ginger powder with honey at 0.05 level of Significance

 

Table 2(a) shows the median score of nausea is 3, the obtained Wilcoxon value is 16699.5, which is statistically significant at (p<0.001). The median score of anorexia is 2, the obtained Wilcoxon value is 1583.5, which is statistically significant (p<0.001). The median score of gastritis is 0.It is not statistically computable.


 

Table 2 (B): To Compare The Pretest - Post Test Score Vomiting           N=66

 

Variable

Pre Test

Post Test

Test

p-value

YES

NO

YES

NO

Mc Nemar’s test

 

0.045

S

 

Vomiting

F

%

F

%

F

%

F

%

 5

7.58%

61

92.42%

1

1.52%

65

98.48%

S – Significant

 


 

Fig. 2(a): Pretest Post Test Comparison of Nausea Associated With Chemotherapy.

 

The Fig 2(a) depicts the severity of nausea associated with chemotherapy before and after administering ginger powder with honey.

 

 

Fig. 2(b):    Pretest Post Test Comparison of Anorexia Associated With Chemotherapy

 

The Fig 2(b) depicts the severity of anorexia associated with chemotherapy before and after administering ginger powder with honey.

 

 

Fig 2(C): Pretest Post Test Comparison of Gastritis Associated With Chemotherapy

 

The Fig 2 (c) depicts the severity of gastritis associated with chemotherapy before and after administering ginger powder with honey.

 

 

Fig. 2(d): Pretest Post Test Comparison of Vomiting Associated with Chemotherapy

 

The Fig 2(d) depicts the severity of vomiting associated with chemotherapy before and after administering ginger powder with honey.

 

SECTION 4: 

Association of Gastro Intestinal Symptoms With Selected Baseline Variables:

·       Objectives: To determine the association of gastro intestinal symptoms with selected baseline variables.

      H2.

·       There will be a significant association of severity of gastrointestinal symptoms and selected baseline variables at 0.05 level of significance

 


 

I.     Association of Nausea with selectd Baseline variables.

Table 2(a) Range, median, IQR, test of significance and p value to determine the association of Nausea with age in years and gender. n= 66

S. No

Baseline Variables

Range

Median

IQR

Test

p – value

1

Age

 

 

 

Kruskal wallies test

 a

15 - 35

0 - 5

3

1.5-3.75

0.42

0.3722

NS

 b

36 - 55

0 – 7

3

1 – 3

 c

56 - 75

0 -4

2.5

1 – 3

2.

Gendr

 

 

 

Mann Whitney Test

a

Female

0 – 7

3

1.5- 4

637

0.0058

S

b

Male

0 – 4

1

0.5 - 3

NS – not significant, S – significant 

 

Table 2(a) depicts that there is no significant association found between the age and gastrointestinal symptoms there is a significant relationship between gender and gastrointestinal symptoms.

 

Table 2(b) Range, median, IQR, test of significance and p value to determine the association of Nausea with stage of cancer and cycle of cancer n = 66

S. No.

Baseline Variables

Range

Median

IQR

Test

p – value

3

Stage Cancer

 

 

 

Kruskal Wallis test

a

1

1-4

3

2-3

 

 

0.78

 

0.8554

NS

b

2

0-7

3

1-3

c

3

0-7

2

1-3

d

4

0-5

3

1-3

4

Cycle of Chemotherapy

 

 

 

Kruskal Wallis test

a

1

0-7

3

1.5-3

 

2.93

 

0.2311

NS

b

2

0-4

3

1.5-3.5

c

3 and above

0-7

1

0.75-3

NS – not significant

 

Table 2(b) depicts that there is no significant association between nausea with stage of cancer and cycle of cancer at 0.05 levels. Thus H2 is rejected

 

Table 2(c) Range, median, IQR, test of significance and p value to determine the association of Nausea with type of cancer n= 66

S. No

Baseline Variables

Range

Median

IQR

Test

p – value

5

Type of Cancer

 

 

 

Kruskal Wallis test

a

Cancer related to reproductive system

0

3

1-3

 

  6.35

0.1746

 

NS

b

Cancer related to G. I system

1

3

1.5- 3.5

c

Cancer related to respiratory system

0

3

1-3

d

Cancer related to hematology

0

3

1.5 – 4.5

 

Table 2(c) depicts that there is no significant association between nausea with type of cancer at 0.05 levels.  Thus H2 is rejected.

 

Table 2(d) Range, median, IQR, test of significance and p value to determine the association of Nausea with antiemetics and chemotherapeutic agents. n= 66

S. No.

Baseline Variables

Range

Median

IQR

Test

p – value

6

Antiemetics

 

 

 

 

 

A

Injectable

 

 

 

 

 

B

Injectable +oral

 

 

 

 

 

7

Chemotherapeutic Agents

 

 

 

Kruskal Wallis test

A

Anti tumor and alkylating agents

0

2.5

1.25-3.75

 

 

7.7

 

 

 

0.1733

NS

B

Anitmetabolites

0

1

0.25-2.50

C

Alkylating And plant alkaloids

0

3

3.0-4.0

D

Alkylating Agents

0

3

1.5 – 3.0

E

Alkylating, antitumor, plant alkaloids, anitmetabolites

0

1

1.0-3.0

F

Alkylating, antitumor, and plant alkaloids

0

3

2.0-5.0

NS - not significant

 

 

Table 2(d) depicts that there is no significant association between nausea with anti emetic and chemotherapeutic agents at 0.05 levels. Thus H2 is rejected.

 

11. Association of Anorexia with Selectd Baseline Variables.

Table 2 (e) Range, median, IQR, test of significance and p value to determine the association of anorexia with age in years and gender. n= 66

S. No

Baseline Variables

Range

Median

IQR

Test

p – value

1

Age

 

 

 

Kruskal Wallis test

A

15 - 35

1-4

3

1.25-4

2.39

0.3028

NS

B

36 - 55

0-6

2

1-3

C

56 - 75

0-5

2

1.75-3.25

2.

Gendr

 

 

 

Mann Whitney test

A

Female

0-6

2

1-3

474

0.6939

NS

B

Male

0-5

2

1-3

NS-not significant

 

Table 2(e) depicts that there is no significant association between anorexia with age and gender at 0.05 levels. Thus H2 is rejected.

 

Table 2 (f) Range, median, IQR, test of significance and p value to determine the association of anorexia with   stage of cancer and cycle of cancer n = 66

S. No

Baseline Variables

RANGE

MEDIAN

IQR

 

TEST

 

p – value

3

Stage Cancer

 

 

 

 

Kruskal Wallis test

A

1

1-4

2

1.75-3.25

 

0.3

 

0.9607

NS

B

2

0-6

2

1-3

C

3

0-5

2

1-3

D

4

1-5

2

1-3

4

CYCLE OF CHEMOTHERAPY

 

 

 

Kruskal Wallis test

A

1

0-5

2

1-3

 

1.48

 

0.4766

NS

 

B

2

0-4

2

1.5-3.5

c

3 and above

1-6

1

1-3

NS- not significant

 

Table 2(f) depicts that there is no significant association between anorexia with stage and cycle of cancer at 0.05 levels.  Thus H2 is rejected.

 

Table 2(g) Range, median, IQR, test of significance and p value to determine the association of anorexia with type of cancer n= 66

S. No

Baseline Variables

Range

MEDIAN

IQR

TEST

p – value

5

Type of Cancer

 

 

 

Kruskal Wallis test

a

Cancer related to reproductive system

0-4

2

1-3

 

 

8.94

 

0.0626

NS

b

Cancer related to G. I system

0-4

3

2-3.5

c

Cancer related to respiratory system

1-5

3

2-4

d

Cancer related to hematology

1-6

3

2-4

NS-not significant

 

Table 2(g) depicts that there is no significant association between anorexia with type of cancer at 0.05 levels.  Thus H2 is rejected.

Table 2(h) Range, median, IQR, test of significance and p value to determine the association of anorexia with antiemetics and chemotherapeutic agents. n= 66

S. No

Baseline Variables

Range

Median

IQR

Test

p – value

6

Antiemetics

 

 

 

 

 

a

Injectable

 

 

 

 

 

b

Injectable +oral

 

 

 

 

 

7

Chemotherapeutic Agents

 

 

 

Kruskal Wallis test

a

Anti tumor and alkylating agents

0

2

1.25-2.75

 

 

7.47

 

 

0.1882

NS

b

Anitmetabolites

1

1

1-2.5

c

Alkylating And plant alkaloids

1

3

2-3

d

Alkylating Agents

0

2

1-3.5

e

Alkylating, antitumor, plant alkaloids, anitmetabolites

1

1

1-3

f

Alkylating, antitumor, and plant alkaloids

2

2

2-4

NS- not significant

Table 2(h) depicts that there is no significant association between anorexia with ant emetics and chemotherapeutic agents at 0.05 levels.  Thus H2 is rejected.

 

111.   Association of Gastritis with Selectd Baseline Variables.

Table 2(i) Range, median, IQR, test of significance and p value to determine the association of gastritis with age in years and gender.

n= 66

S. No

Baseline Variables

Range

Median

IQR

Test

p – value

1.

AGE

 

 

 

Kruskal Wallis test

a

15  - 35

0-3

0.5

0- 1.75

 

2.51

 

0.2851

NS

b

36  - 55

0-5

0

0-1

c

56  - 75

0-7

0

0-0

2.

GENDR

 

 

 

Mann Whitney test

a

Female

0-5

0

0-1

 

428.5

0.7558

NS

b

Male

0-7

0

0-1

NS-not significant

 

Table 2(i) depicts that there is no significant association between gastritis with age and gender at 0.05 levels.  Thus H2 is rejected.

 

Table 2(j) Range, median, IQR, test of significance and p value to determine the association of gastritis with stage of cancer and cycle of cancer n = 66

S. No

Baseline Variables

Range

Median

IQR

TEST

p – value

3

Stage Cancer

 

 

 

Kruskal Wallis test

A

1

0-2

0

0-1

 

 

1.22

 

0.7843

NS

B

2

0-5

0

0-0

C

3

0-7

0

0-1

D

4

0-3

0

0-1

4

Cycle of Chemotherapy

 

 

 

Kruskal Wallis test

A

1

0-7

0

0-1

3.02

0.2208

NS

b

2

0-0

0

0-0

 

c

3 and above

0-5

0

0-1

NS-not significant

 

Table 2(j) depicts that there is no significant association between gastritis with stage of cancer and cycle of cancer at 0.05 levels. Thus H2 is rejected.

 

Table 2 (k) Range, median, IQR, test of significance and p value to determine the association of gastritis with type of cancer n= 66

S. No

Baseline Variables

Range

Median

IQR

Test

p – value

5

Type of Cancer

 

 

 

Kruskal Wallis test

a

Cancer related to reproductive system

0-3

0

0-0

 

 

 

10.87

 

0.0281

S

b

Cancer related to G. I system

0-1

0

0-0

c

Cancer related to respiratory system

0-7

1

0-1

d

Cancer related to hematology

0-5

1

0-2.75

S- Significant

 

Table 2(k) depicts that there is a significant association between gastritis with type of cancer at 0.05 levels.  Thus H2 is accepted.

 

Table 2 (l) Range, median, IQR, test of significance and p value to determine the association of gastritis with antiemetics and chemotherapeutic agents. n=66

S. No

Baseline Variables

Range

Median

IQR

Test

p – value

6

Antiemetics

 

 

 

 

 

a

Injectable

 

 

 

 

 

b

Injectable +oral

 

 

 

 

 

7

Chemotherapeutic Agents

 

 

 

Kruskal Wallis test

a

Anti tumor and alkylating agents

0-3

0

0-0

3.93

0.5601

NS

b

Anitmetabolites

0-2

0

0-0

c

Alkylating And plant alkaloids

0-7

0

0-1

d

Alkylating Agents

0-2

0

0-1

 

 

e

Alkylating, antitumor, plant alkaloids, anitmetabolites

0-1

0

0-0

f

Alkylating, antitumor, and plant alkaloids

0-5

0

0-3

NS-not significant

 

Table 2 (l) depicts that there is no significant association between gastritis with antiemetics and chemotherapeutics at 0.05 levels. Thus H2 is rejected.

 

 

Association of Vomiting with Selectd Baseline Variables:

Table 2 (m) frequency, percentage, test of significance and p- value to determine the association of vomiting with age and gender. n=66

Baseline variable

Yes

No

Test

p- value

1.      AGE

F

%

F

%

Mann Whitney test

0.7795

NS

15 – 35

-

-

6

9.84%

36 – 55

4

80%

32

52.46%

56 – 75

1

20%

23

37.70%

2.      GENDER

 

 

 

 

 

 

Female

5

10.64%

42

89.36%

Fisher’s exact test               

 

0.3105

NS 

 

 

 

 

 

Male

-

-

19

100%

NS - not significant

 

Table 2(m) depicts that there is no significant association between vomiting with age and gender at 0.05 levels.  Thus H2 is rejected.

 

Table 2 (n) frequency, percentage, test of significance and p- value to determine the association of vomiting with stage of cancer and cycle of cancer  

Baseline variable

Yes

No

Test

p- value

1. Stage Cancer

F

%

F

%

 

Fisher’s exact test

 

0.8482

NS

1

0

-

8

13.11%

2

3

60%

21

34.43%

3

1

20%

20

32.79%

4

1

20%

12

19.67%

2. Cycle of Chemotherapy

 

 

 

Fisher’s exact test

0.7791

NS

 

1

3

60%

40

65.57%

2

0

-

7

11.48%

3 and above

2

40%

14

22.95%

NS- not significant

 

Table 2(n) depicts that there is no significant association between vomiting with stage of cancer and cycle of chemotherapy at 0.05 levels. Thus H2 is rejected.

 

Table 2(o) frequency, percentage, test of significance and p- value to determine the association of vomiting with type of chemotherapeutic agents

Baseline variable

Yes

No

Test

p- value

Type of Chemotherapeutic Agents Used

 

F

 

%

 

F

 

%

 

 

Fisher’s exact test

 

 

 

 

 

0.2563

NS

Anti tumor and alkylating agents

2

405

12

19.67%

Anitmetabolites

1

20%

5

8.20%

Alkylating And plant alkaloids

1

20%

12

19.67%

Alkylating Agents

0

-

15

24.59%

Alkylating, antitumor, plant alkaloids, anitmetabolites

0

-

13

21.31%

Alkylating, antitumor, and plant alkaloids

1

20%

4

6.565

NS- not significant

 


Table 2(o) depicts that there is no significant association between vomiting with chemotherapeutic agents at 0.05 levels. Thus H2 is rejected.

 

DISCUSSION:

1.     Description of Baseline Variables of Patients Receiving Chemotherapy:

Subjects in the current study comprised of 66 cancer patients undergoing chemotherapy. The investigator studied the baseline variables of the subjects on the presumption that they may have an effect on the severity of the gastrointestinal symptoms. Baseline variables of the subjects assessed were age, gender, type of cancer, stage of cancer, cycle of cancer, anti emetics and chemotherapeutic agents used.

 

 

Finding in the present study revealed that 54.5%were in the age group of 36- 55. A similar study done in Australia on effect of ginger on chemotherapy induced nausea and vomiting in cancer patients revealed that among the 45 patients 92.3% patients were aged between 20 – 45 years.5

 

In the present study 71.2% were females and 28.8% were male. In agreement with the current study findings a study was done in Newyork on ginger reduces acute chemotherapy induced nausea revealed that the majority of the patients were female (93%) 8

 

With regard to stage of cancer 36.4% were in second stage and 31.8% were in 3rd stage. In a similar study done in Turkey on oral intake of ginger for chemotherapy – induced nausea and vomiting among women with breast cancer showed that among the 60 subjects 50% were in third stage of breast cancer.7

 

Present study finding revealed that 65.2%of subjects were in the 1st cycle of the chemotherapy.10.6% was of second cycle and 24.2% in 3 and above.

 

In the current study 56.1 % of subjects had cancer related to reproductive system, 10.6% cancer related to gastrointestinal system and 13.6% related to respiratory system. A similar study done in Newyork on ginger reduces acute chemotherapy induced nausea revealed that the most common types of cancer were breast (74%, gastrointestinal (8%) and lung (6%).

 

The current study showed that 95.5% of subjects had injectable antiemetics. A similar study done in AIIMS, India on Anti – emetic effect of ginger powder versus placebo as an add on therapy in children and young adults receiving high emetogenic chemotherapy showed that patients who received the chemotherapy was treated with injectable (ondansetron 4 – 8mg) anti emetics.6

 

The present study revealed that 22.7% had got alkylating chemotherapeutic agents. A similar study done in Iran, Shahroud University of Medical Sciences on effect of herbal therapy to intensity chemotherapy – induced nausea and vomiting in cancer patients has shown that among the 73 study subjects,47.7% received alkylating agents alone or in combination with other drugs.

 

2.     The severity of gastrointestinal symptoms among patients undergoing chemotherapy:

The severities of the gastrointestinal symptoms of the subjects were assessed after finishing the chemotherapy using the numeric rating scale with the maximum score of 10. Numeric rating scale was used to assess the nausea, anorexia and, gastritis score on a scale of 0 – 10, with 0 being No, 1 – 3 mild, 4 – 6 moderate, 7 – 10 severe. And the presence of vomiting was assessed in a check list.

 

The present study on the severity of gastrointestinal symptoms revealed that among the 66 subjects 13.63% had no nausea, 65.15% had mild nausea, 18.19% had moderate nausea, and 3% had severe nausea. In relation to anorexia 4.55% had no anorexia, 75.8% had mild anorexia, 18.18% had moderate anorexia and 1.52% had severe anorexia. 71.21% had no gastric pain, 25.79% had mild gastric pain and 1.5% had moderate and severe gastric pain. Check list on the presence of vomiting showed that only 7.58% of participants experienced vomiting

 

A similar study done in China on efficacy of ginger in ameliorating acute and delayed chemotherapy – induced nausea and vomiting among patients with lung cancer receiving cisplatin-based regimen showed that among 146 subjects 88 (62.9%) had acute nausea, and 17 participants (12.1%) had acute vomiting.

 

Comparison of The Severity of Gastrointestinal Symptoms Associated With Chemotherapy Before And After Administering Ginger Powder With Honey

 

Ginger has been traditionally used as a folk remedy for gastro intestinal complaints and has been suggested as a viable adjuvant treatment for nausea and vomiting in the cancer context. Substantial researches have revealed ginger to possess properties that could exert multiple beneficial effects on chemotherapy patients who experience nausea and vomiting.

 

The present study aimed at reducing the gastrointestinal symptoms of the patients receiving the chemotherapy. The severity of the symptoms was assessed before and after administration of the intervention using a numeric rating scale of maximum score 10,(where o is no,1-3 is mild,4-6 is moderate ,7-10 is severe.) and a checklist. Numeric rating scale was used for assessing the severity of Nausea, anorexia, and gastric pain and check list was used to assess the vomiting.

 

The findings of the study showed that there was a reduction in the gastrointestinal symptoms after the intervention, Wilcoxon test was used to test the significance difference and the finding revealed that there was statistically significant (p<0.001) reduction in the severity of the gastrointestinal symptoms.

 

The finding was supported by a study by Panahi et.al. (2012), 78 female patients with advanced breast cancer who were undergoing chemotherapy were randomly assigned to receive 500mg of ginger versus no administration of ginger daily for five days, in addition to the treatment. Ginger administration was observed to decrease the acutely observed nausea score of the patients.

 

Another similar study conducted in India, a randomized, controlled study by Pillai Sharma, Gupta and Bakhshi (2011), “Antiemetic effect of Ginger powder versus placebo as add on therapy in children and young adults receiving high emetogenic chemotherapy”. Children and adolescents undergoing chemotherapy with standard antiemetics were randomized to receive ginger powder and placebo. Ginger root powder was effective in decreasing the severity of nausea and vomiting following acute and late period of chemotherapy.6

 

A contrasting finding was seen in a randomized double- blind, placebo controlled study done in Michigan in 2006. The study finding showed that ginger provides no additional benefit for reduction of the prevalence or severity of acute or delayed CINV when given with 5HT3 receptor antagonists or aprepitant

 

 

Association of Gastro Intestinal Symptoms with Selected Variables

 

Assuming that baseline variables of cancer patients could probably influence severity of gastrointestinal symptoms, attempts were made to find the association of selected baseline variables with the score of pretest to assess the severity of gastrointestinal symptoms

 

This study revealed that no statistically significant association exists between any of the baseline variables with the severity score of gastrointestinal symptoms.

 

CONCLUSION:

This study has given me great insight into research methodology and on the importance of using simple intervention to reduce gastrointestinal symptoms caused by chemotherapy. Although there wasn’t any significant association between baseline variables and GI symptoms, in the present research in all statistical tests, significant difference was found in the severity of nausea and anorexia and vomiting after the intervention of ginger powder. Therefore on the basis of present research study and the other studies done all over the world, ginger can be used as a simple method, which is inexpensive and safe and as a complimentary therapy in controlling chemotherapy induced gastro intestinal symptoms. Introduction of this simple technique will be beneficial for the patients receiving the chemotherapy.

 

REFERENCES:

1.      Park k. Text Book of Preventive and Social Medicine .21st ed. Jabalpur (IND): Banarsidas Bhanot Publisher; 2011.p.353-397.

2.      Hawkins R, Grunbergs. Chemotherapy induced nausea and vomiting; challenges and opportunities for improved patient outcomes. Clinical Journal of Oncology Nursing. 13:1

3.      Lee J, Oh H. Ginger as an anti emetic modality for chemotherapy induced nausea and vomiting: a systematic review and Meta analysis. Oncology Nursing Forum. 2013; 40(2):  163-170

4.      Ansari M, Hamedi SH, Porouhan P, Ahammadloo N. Efficacy of ginger in control of chemotherapy induced nausea and vomiting in breast cancer patients receiving Doxorubicin based chemotherapy. Asian Pacific Journal of Cancer Prevention. 2016; 17: 3877-3879.

5.      Alparslan, Culer Balci, et al. Effect of ginger on chemotherapy-induced nausea and/or vomiting in cancer patients. Journal Of The Australian Traditional-Medicine Society. 2012; 18(1): 15-18.

6.      Pillai AK, Sharma KK, Gupta VK. Antiemetic effect of Ginger powder versus placebo as add on therapy in children and young adults receiving high emetogenic chemotherapy pediatric blood cancer. 2010: 234-8.

7.      Arslan M, Ozdemir L. Oral intake of ginger for chemotherapy induced nausea and vomiting among women with breast cancer. Clinical Journal of Oncology Nursing.  2015; 19(5): 92 - 96

8.      Ryan JL, Heckler CE, Roscoe JA, Dakhil SR, Kirshner J, Flynn PJ, Hickok JT, Morrow GR. Ginger (Zingiber officinale) reduces acute chemotherapy-induced nausea: a URCC CCOP study of 576 patients. Support Care Cancer. 2012; 20(7): 1479-89.

 

 

 

 

Received on 29.01.2024         Modified on 15.02.2024

Accepted on 28.02.2024       ©A&V Publications All right reserved

A and V Pub J. of Nursing and Medical Res. 2024; 3(1):7-16.

DOI: 10.52711/jnmr.2024.02