Benefícios do gengibre no controle da náusea e vômito induzidos pela quimioterapia

Dayane Oliveira Borges Karina Alexandra Batista da Silva Freitas Eliana Maria Minicucci Regina Célia Popim Sobre os autores

ABSTRACT

Objectives:

To identify and discuss scientific evidence of the effects of ginger use on the management of chemotherapy-induced nausea and vomiting.

Methods:

This is an integrative reviewperformed by Ganong’s reference.

Results:

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

RESUMEN

Objetivos:

Identificar y discutir evidencias científicas de los efectos del uso del jengibre en el manejo de la náusea y vomito inducidos por la quimioterapia.

Métodos:

Se trata de revisión integranterealizada por el referencial Ganong.

Resultados:

Han sido incluidos 24 estudios, destacándose 3 categorías temáticas: 1) acción antiemética del jengibre - ha sido evaluada la náusea (13 artículos [9 significativos]) y emesis (10 estudios [6 significativos]); 2) acción en el control de la náusea (11 artículos [6 significativos]) y vomito (8 artículos [3 significativos]) en la fase aguda; 3) acción en el control de la náusea (6 artículos [3 significativos]) y vomito (6 artículos [3 significativos]) en la fase tardía. Hubo divergencias de los métodos utilizados.

Consideraciones finales:

Esa terapia complementar ha sido de bajo costo y fácil acceso, pero no ha sido encontrada confirmación estadística de su efectividad en el manejo de la náusea y vomito en pacientes oncológicos.

Descriptores:
Náusea; Vómitos; Quimioterapia; Jengibre; Zingiber Officinale

RESUMO

Objetivos:

Identificar e discutir evidências científicas dos efeitos do uso do gengibre no manejo da náusea e vômito induzidos pela quimioterapia.

Métodos:

Trata-se de revisão integrativabaseada no referencial de Ganong.

Resultados:

Foram incluídos 24 estudos, destacando-se 3 categorias temáticas, a saber, 1) ação antiemética do gengibre - foi avaliada a náusea (13 artigos; destes, 9 significativos) e êmese (10 estudos; destes, 6 significativos); 2) ação no controle da náusea (11 artigos; destes, 6 significativos) e vômito (8 artigos; destes, 3 significativos) na fase aguda; 3) ação no controle da náusea (6 artigos; destes, 3 significativos) e vômito (6 artigos; destes, 3 significativos) na fase tardia. Houve divergências dos métodos utilizados.

Considerações finais:

Essa terapia complementar é de baixo custo e fácil acesso, mas não foi encontrada confirmação estatística de sua efetividade no manejo da náusea e vômito em pacientes oncológicos.

Descritores:
Náusea; Vômito; Quimioterapia; Gengibre; Zingiber Officinale

INTRODUÇÃO

De acordo com o Instituto Nacional do Câncer (INCA)(11 Instituto Nacional do Câncer (Br). Estimativa 2018: incidência do câncer no Brasil [Internet]. Rio de Janeiro: INCA; 2018 [cited 2018 Aug 01]. Available from: http://www.inca.gov.br/estimativa/2018/sintese-de-resultados-comentarios.asp
http://www.inca.gov.br/estimativa/2018/s...
), estima-se que 600 mil novos diagnósticos da doença serão realizados em 2018 e 2019, exceto pela neoplasia de pele não melanoma, que deverá apresentar aproximadamente 170 mil novos episódios. Assim, prevê-se uma taxa de 420 mil novos cânceres para o período.

A utilização de complementação nutricional e de tratamentos derivados de plantas fez-se frequente entre pacientes com neoplasia(22 Bossi P, Cortinovis D, Rocca MC, Roila F, Seminara P, Fabi A, et al. Searching for evidence to support the use of ginger in the prevention of chemotherapy-induced nausea and vomiting. J Altern Complement Med. 2016;22(6):486-8. doi: 10.1089/acm.2015.0315
https://doi.org/10.1089/acm.2015.0315...
-33 Gansler T, Kaw C, Crammer C, Smith T. A population-based study of prevalence of complementary methods use by cancer survivors: a report from the American Cancer Society's studies of cancer survivors. Cancer. 2008;113(5):1048-57. doi: 10.1002/cncr.23659
https://doi.org/10.1002/cncr.23659...
). Aproximadamente 80% dos pacientes que resistem ao câncer já consomem suplementos vitamínicos e minerais, enquanto 14% a 32% iniciam o uso de complementos posteriormente ao diagnóstico da neoplasia(22 Bossi P, Cortinovis D, Rocca MC, Roila F, Seminara P, Fabi A, et al. Searching for evidence to support the use of ginger in the prevention of chemotherapy-induced nausea and vomiting. J Altern Complement Med. 2016;22(6):486-8. doi: 10.1089/acm.2015.0315
https://doi.org/10.1089/acm.2015.0315...
,44 Frenkel M, Sierpina V. The use of dietary supplements in oncology. Curr Oncol Rep. 2014;16(11):411. doi: 10.1007/s11912-014-0411-3
https://doi.org/10.1007/s11912-014-0411-...
). Essas terapias complementares podem auxiliar no manejo dos efeitos adversos (como náusea, êmese e mucosite) da patologia e do tratamento(22 Bossi P, Cortinovis D, Rocca MC, Roila F, Seminara P, Fabi A, et al. Searching for evidence to support the use of ginger in the prevention of chemotherapy-induced nausea and vomiting. J Altern Complement Med. 2016;22(6):486-8. doi: 10.1089/acm.2015.0315
https://doi.org/10.1089/acm.2015.0315...
,55 Lyman GH, Greenlee H, Bohlke K, Bao T, DeMichele AM, Deng GE, et al. Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. J Clin Oncol. 2011;36(25):2647-55. doi: 10.1200/JCO.2018.79.2721
https://doi.org/10.1200/JCO.2018.79.2721...
). A área da oncologia integrativa sistematiza o provimento dos tratamentos complementares baseados em evidência associados à terapêutica tradicional da neoplasia. Essas formas de terapia compreendem uma variedade de ações psicológicas e físicas, produtos naturais e alterações no modo de vida(66 Boon HS, Olatunde F, Zick SM. Trends in complementary/alternative medicine use by breast cancer survivors: Comparing survey data from 1998 and 2005. BMC Womens Health. 2007;7:4. doi: 10.1186/1472-6874-7-4
https://doi.org/10.1186/1472-6874-7-4...

7 Link AR, Gammon MD, Jacobson JS, Abrahamson P, Bradshaw PT, Terry MB, et al. Use of self-care and practitioner-based forms of complementary and alternative medicine before and after a diagnosis of breast cancer. Evid Based Complement Alternat Med. 2013;2013:301549. doi: 10.1155/2013/301549
https://doi.org/10.1155/2013/301549...
-88 Mendes KDS, Silveira RCCP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto Enferm. 2008;17(4):758-64. doi: 10.1590/S0104-07072008000400018
https://doi.org/10.1590/S0104-0707200800...
).

O gengibre é utilizado há muitos anos como um fármaco para estados gastrointestinais devido aos seus componentes químicos. O rizoma de gengibre tem uma diversidade de elementos bioativos, entre eles, os gingeróis, shogaóis, zingibereno, zingerona e paradol, os quais podem incentivar as secreções orais e gástricas, normalizar a motilidade gastrointestinal, comunicar-se com os receptores 5HT3 e NK1 relacionados ao reflexo da náusea e êmese decorrentes, por exemplo, do tratamento quimioterápico, além de atuar sobre os radicais livres. Porém, pode também causar reações adversas, como dermatite e má digestão, que pode ser confundida com a permanência da náusea(22 Bossi P, Cortinovis D, Rocca MC, Roila F, Seminara P, Fabi A, et al. Searching for evidence to support the use of ginger in the prevention of chemotherapy-induced nausea and vomiting. J Altern Complement Med. 2016;22(6):486-8. doi: 10.1089/acm.2015.0315
https://doi.org/10.1089/acm.2015.0315...
).

Existem autores que observaram que o gengibre pode influenciar no controle da náusea e vômitos induzidos pela quimioterapia, entretanto divergências nas metodologias empregadas e resultados contraditórios dificultam a convergência das conclusões(22 Bossi P, Cortinovis D, Rocca MC, Roila F, Seminara P, Fabi A, et al. Searching for evidence to support the use of ginger in the prevention of chemotherapy-induced nausea and vomiting. J Altern Complement Med. 2016;22(6):486-8. doi: 10.1089/acm.2015.0315
https://doi.org/10.1089/acm.2015.0315...
). As diferentes evidências na literatura se devem também à avaliação dos sintomas ser realizada em diferentes fases do tratamento, entre elas: antecipatória (antes da realização da quimioterapia), aguda (até 24 horas após a administração do antineoplásico) e tardia (a partir de 24 horas após a aplicação até 4 ou 5 dias posteriores)(99 Delgado GL, Gazzi LAP, Pondé NF, Beraldo FB, Soares WGP, Pires LA. Náuseas e vômitos antecipatórios: Pontos Fundamentais. Rev Bras Oncol Clín [Internet]. 2006[cited 2018 Aug 01];3(8):7-11. Available from: https://www.sboc.org.br/sboc-site/revista-sboc/pdfs/8/artigo1.pdf
https://www.sboc.org.br/sboc-site/revist...
). Diante desse cenário, pergunta-se: “Qual o efeito do gengibre no controle de náusea e êmese induzidos pela quimioterapia em pacientes em tratamento quimioterápico?” Para responder essa questão, foi proposto este estudo.

OBJETIVOs

Identificar e discutir estudos publicados que avaliaram o efeito do consumo do gengibre para o manejo da náusea e vômito induzidos pela quimioterapia.

MÉTODOs

Aspectos éticos

Os aspectos éticos e legais foram considerados, visto que foram utilizados manuscritos publicados em periódicos internacionais, e os autores foram referenciados posteriormente à citação.

Desenho, período e local de estudo

Este estudo realizou uma revisão integrativa da literatura, isto é, uma investigação do conhecimento científico já elaborado acerca de um conteúdo estabelecido. Nessa perspectiva, o método possibilita a síntese de variadas pesquisas divulgadas, proporcionando, assim, conclusões gerais sobre um campo de investigação(1010 Klopper R, Lubbe S, Rugbeer H. The matrix method of literature review. Alternation [Internet]. 2007 [cited 2018 Aug 01];14(1):262-76. Available from: http://alternation.ukzn.ac.za/Files/docs/14.1/12%20Klopper%20.pdf
http://alternation.ukzn.ac.za/Files/docs...
). Foi utilizado Ganong(1111 Ganong LH. Integrative reviews of nursing research. Res Nurs Health [Internet]. 2007 [cited 2018 Aug 1];10(1):1-11. Available from: https://www.ncbi.nlm.nih.gov/pubmed/3644366
https://www.ncbi.nlm.nih.gov/pubmed/3644...
) como referencial teórico para desenvolver a estratégia de revisão. Além disso, usou-se o Check List Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA)(1212 Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement [Internet]. 2018 [cited 2018 Aug 1]. Available from: http://www.equator-network.org/reporting-guidelines/prisma/
http://www.equator-network.org/reporting...
) com o propósito de assegurar a qualidade deste estudo, garantir o desenvolvimento textual detalhado e a concepção do diagrama que distingue as etapas de seleção dos artigos incluídos (Figura 1). A seleção dos artigos foi feita em junho e julho de 2018 na cidade de Botucatu, SP, Brasil.

Figura 1
Diagrama de seleção dos artigos incluídos nesta revisão integrativa, segundo Check List Preferred Items for Systematic Reviews and Meta-Analyses, 2018(1212 Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement [Internet]. 2018 [cited 2018 Aug 1]. Available from: http://www.equator-network.org/reporting-guidelines/prisma/
http://www.equator-network.org/reporting...
)

Amostra, critérios de inclusão e exclusão

Os critérios de inclusão consistiram em pesquisas com os descritores presentes no título ou no resumo e que abordassem o efeito do gengibre para controle da náusea e vômito em paciente em tratamento quimioterápico, sem delimitação de tempo de publicação e sem restrição de método de estudo. Foram excluídas investigações que não tivessem o resumo ou o artigo completo disponível; revisões sistemáticas e integrativas; estudos que estivessem em outro idioma que não o inglês, português e espanhol; publicações repetidas; literatura cinzenta, a qual divulga trabalhos não publicados, entre eles resumos de congresso e documentos técnicos; pesquisas que se baseavam em experiência com animais; ou que estivessem em andamento e não utilizassem a administração do gengibre por via oral.

Protocolo do estudo e análise de resultados

Conforme o referencial teórico de Ganong(1111 Ganong LH. Integrative reviews of nursing research. Res Nurs Health [Internet]. 2007 [cited 2018 Aug 1];10(1):1-11. Available from: https://www.ncbi.nlm.nih.gov/pubmed/3644366
https://www.ncbi.nlm.nih.gov/pubmed/3644...
), foram incluídas as seguintes etapas:

1ª. Etapa: Seleção da pergunta de pesquisa

Foi realizado o reconhecimento do tema, que compreende a ação do gengibre para o manejo da náusea e êmese induzidos pela quimioterapia. Consideraram-se os quatro componentes da estratégia PICO(1313 Santos CMC, Pimenta CAM, Nobre MRC. A estratégia PICO para a construção da pergunta de pesquisa e busca de evidências. Rev Latino-Am Enfermagem. 2007;15(3). doi: 10.1590/S0104-11692007000300023
https://doi.org/10.1590/S0104-1169200700...
) - Paciente: àqueles em tratamento quimioterápico; Intervenção: uso do gengibre por via oral; Comparação: grupos que não realizaram o uso do gengibre ou que utilizaram placebo; Outcomes (desfecho): ação antiemética do gengibre. Com base nisso, foi desenvolvida a pergunta de pesquisa: “Qual o efeito do gengibre no controle de náusea e êmese induzidos pela quimioterapia em pacientes em tratamento quimioterápico?”

Foram selecionados os seguintes termos de busca e suas respectivas combinações em inglês por meio do MeSH (Medical Subject Headings) Database: chemotherapy OR chemotherapies AND nausea AND vomiting OR emesis AND ginger OR zingiber AND officinale OR zingiber AND officinales. Por meio dos DeCS (Descritores em Ciência da Saúde), foram usados os seguintes descritores e combinações em português: quimioterapia AND náusea AND vômito OR êmese AND Gengibre OR Zingiber officinale. Utilizou-se a forma booleana, AND/OR, para auxiliar a encontrar os estudos da base de dados on-line.

2ª. Etapa: Amostragem

A definição da amostra foi feita em junho e julho de 2018. Para a seleção das publicações, foram utilizados os bancos de dados eletrônicos Embase, National Library of Medicine e Cochrane Library. Com o intuito de manter a qualidade do método da revisão, a seleção dos estudos foi feita por dois avaliadores, de modo autônomo e cego, seguindo os critérios de inclusão e exclusão estipulados. Para isso, os artigos foram analisados inicialmente pelo título e resumo; nos casos em que estes não apresentaram conteúdo suficiente para definir a seleção inicial, foi feita a leitura da íntegra da investigação, e as divergências foram solucionadas por concordâncias entre os autores. A análise crítica dessa amostragem é essencial para avaliar a validade interna da revisão, pois se trata de um indício para comprovar a fidedignidade, dimensão e influência de generalização das conclusões da revisão(1111 Ganong LH. Integrative reviews of nursing research. Res Nurs Health [Internet]. 2007 [cited 2018 Aug 1];10(1):1-11. Available from: https://www.ncbi.nlm.nih.gov/pubmed/3644366
https://www.ncbi.nlm.nih.gov/pubmed/3644...
).

3ª. Etapa: Representação das características da pesquisa

O recolhimento, organização e análise dos dados e síntese do conhecimento foram realizados pela descrição da caracterização das investigações após uma leitura criteriosa do título, resumo e artigo. Assim, com a conclusão dessa etapa, elaborou-se uma tabela em Excel com os estudos pré-selecionados para a revisão integrativa.

4ª. Etapa: Análise dos estudos selecionados

Para a categorização das pesquisas selecionadas, a pesquisadora utilizou um instrumento baseado na matriz de síntese para sintetizar e integrar os resultados das investigações, possibilitando a avaliação isolada de cada artigo, tanto no nível metodológico quanto em relação aos resultados das pesquisas.

5ª. Etapa: Análise e interpretação dos resultados

Para a sumarização das evidências encontradas, foram realizadas leituras, categorização e investigação dos artigos referentes aos objetivos propostos, e os dados foram expressos em tabelas para auxiliar a interpretação.

6ª. Etapa: Relato da revisão

A partir da análise dos dados descritos na matriz de síntese e das tabelas e gráficos gerados, foi realizada a síntese representativa dos artigos selecionados.

RESULTADOS

Foram analisados os títulos e os resumos de 1.798 artigos na Embase, 3.329 na National Library of Medicine; e 188 na Cochrane Library. Destes, atenderam aos critérios de inclusão 24 estudos, sendo realizada leitura na íntegra e sintetização dos dados descritos no Quadro 1.

Os artigos sobre a temática começaram a ser publicados no ano de 2000, e a distribuição territorial dessas publicações foram mais frequentes no Irã e Tailândia, com 6 investigações em cada.

Conforme o Quadro 1, observa-se que, dos 24 estudos intervencionistas, 3 foram cruzados (cross-over). Destes, 1 não conseguiu avaliar a efetividade no uso do gengibre. Dentre os artigos selecionados, 13 estão publicados nas duas bases de dados: Embase e Pubmed. Em relação ao periódico, a maior incidência (n = 4) de publicações sobre a temática durante o período analisado foi na Support Care Cancer, considerada Qualis Capes A2 na área de Enfermagem; consecutivamente, estão: Journal of Clinical Oncology, Integrative Cancer Therapies e Asian Pacific Journal of Cancer Prevention, com uma incidência de 2 investigações em cada. Ressalta-se que os estudos foram desenvolvidos até a fase II (n = 9), mas foram mais frequentes investigações de fase I (n = 15).

Quadro 1
Características dos estudos clínicos selecionados de acordo com a referência, ano/país, delineamento/ número de pacientes, intervenções e desfechos, São Paulo, Brasil, 2019

Nos estudos avaliados, foram identificadas três categorias temáticas: 1) ação antiemética do gengibre; 2) sua influência no controle da náusea e vômito na fase aguda (nas primeiras 24 horas após a quimioterapia); 3) sua influência no controle da náusea e vômito na fase tardia (após 24 horas da aplicação do antineoplásico até 4 ou 5 dias posteriores).

Em relação à ação antiemética do gengibre, 13 estudos observaram a ação do gengibre na náusea(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...
,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-...
,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/...
-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...
,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...

24 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...

25 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...

26 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...

27 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-...

28 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-...

29 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...
-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...
,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...
); destes, 9(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-...
,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...

24 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...

25 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...

26 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...

27 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-...

28 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-...

29 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...
-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...
) apresentaram resultados significativos considerando nível de significância de 5% (p < 0,001(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-...
); p = 0,002(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...
); p = 0,0001(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...
); p = 0,04(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...
); p = 0,0003(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-...
), p = 0,003(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...
-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...
)). Quanto à êmese, 11 investigações(1313 Santos CMC, Pimenta CAM, Nobre MRC. A estratégia PICO para a construção da pergunta de pesquisa e busca de evidências. Rev Latino-Am Enfermagem. 2007;15(3). doi: 10.1590/S0104-11692007000300023
https://doi.org/10.1590/S0104-1169200700...
,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...
-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-...
,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/...
-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...
,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...
,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...
,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-...
-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...
,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...
,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...
)descreveram vantagens nessa terapia, sendo que 6 apresentaram resultado com nível de significância menor que 5% (p < 0,001(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-...
,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...
); p < 0,0001(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/...
); p < 0,05(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...
); p = 0,002(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...
); p = 0,04(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...
)).

Referente à influência dessa intervenção no controle da náusea e vômito na fase aguda, foram detectadas 11 publicações que analisaram a náusea na fase aguda(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...
-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-...
,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...

23 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...

24 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...

25 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...

26 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...

27 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-...

28 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-...

29 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...
-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...
), entre as quais 8(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...

24 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...

25 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...

26 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...

27 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-...

28 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-...

29 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...
-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...
) detectaram vantagens, porém apenas 6 investigações tiveram resultados estatisticamente significativos com p < 5% (p = 0,002(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...
); p = 0,0001(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...
); p = 0,04(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...
); p = 0,0003(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-...
), p = 0,003(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...
-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...
)). Referente à êmese, 8 estudos analisaram a etapa aguda(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...
,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...
,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...
-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...
,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...
,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-...
-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-...
,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...
); destes, 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/...
,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...
,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...
,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-...
,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...
) observaram o efeito terapêutico do gengibre, mas apenas 2 tiveram resultados significativos considerando nível de significância de 5% (p = 0,002(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...
); p = 0,04(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...
)).

Relativo à influência no controle da náusea e vômito na fase tardia, 6 estudos(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...
-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-...
,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...
-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...
,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-...
-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...
) analisaram a náusea tardia, sendo que 4 observaram vantagens no uso do gengibre(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...
,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...
,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-...
-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-...
). Das investigações, 3 tiveram resultados significativos (p < 0,001(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-...
,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...
,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...
)). Já na êmese, 6 publicações(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...
,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...
-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...
,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-...
-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...
,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...
) avaliaram a fase tardia, sendo que 4(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...
,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-...
-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...
,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...
) descreveram que o gengibre auxiliou no manejo desse sintoma; destas, 3(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...
,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-...
,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...
) apresentaram resultados significativos (p < 0,001(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...
); p = 0,022(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...
); p = 0,003(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...
)).

A náusea antecipatória foi avaliada em 3 investigações(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...
,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-...
,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...
), das quais 2 demonstraram evidências do efeito benéfico da terapia complementar com o gengibre (p = 0,0001(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...
) e p < 0,0001(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-...
)); e, em 1 estudo, o nível de significância foi maior que 5% (p = 0,04(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...
)).

A ação antiemética do gengibre interciclo foi verificada em duas investigações, nas quais uma observou que o efeito foi vantajoso e a outra não verificou eficácia(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-...
,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...
).

As escalas utilizadas para avaliação da incidência e intensidade dos sintomas foram variadas; destas, se destacaram: Common Terminology Criteria for Adverse Events (CTCAE)(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-...
-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-...
,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...
), Rhodes Inventory of Nausea, Vomiting and Retching (INVR) (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...
,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...
,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...
) e Escala de Edmonton(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-...
,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-...
-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...
) .

As manifestações adversas foram observadas de forma isolada em seis estudos, que compreenderam: constipação e refluxo(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...
,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...
), azia(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...
-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-...
,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...
), dor de cabeça(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...
), vertigem(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...
), erupção cutânea(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-...
,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...
), prurido(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...
), desconforto intestinal(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...
) - os quais podem estar relacionados também à quimioterapia.

As amostras dos estudos eram predominantemente compostas por pessoas do sexo feminino, e a média da faixa etária apresentou variação entre 41 e 59 anos, sendo que apenas 1 estudo(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-...
) analisou crianças e jovens entre 9 a 21 anos. Foram publicados 16 estudos com uma amostragem inferior a 100 pacientes.

O tipo de câncer foi abordado em 18 estudos, dos quais 12(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...

16 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-...
-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-...
,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/...
-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/...
,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...
,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...
,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...
-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-...
,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...
,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...
,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...
) analisaram a mama; e 4, o pulmão(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...
,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-...
,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...
,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...
,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...
). O estágio da patologia foi abordado apenas em 4 estudos(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...
,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-...

17 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-...
-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...
), sendo que, em 2 deles, a fase II apresentou uma maior ocorrência(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...
,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-...
).

O protocolo quimioterápico investigado foi exposto por 17 estudos, dos quais 6(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...
-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-...
,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...
-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...
,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-...
,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...
)avaliaram aqueles que possuíam potencial emetogênico de moderado a alto, mas sem mencionar os nomes dos fármacos. Já as investigações que especificaram o tratamento, foi mais recorrente o protocolo à base de platina, o qual foi mencionado em sete investigações(1313 Santos CMC, Pimenta CAM, Nobre MRC. A estratégia PICO para a construção da pergunta de pesquisa e busca de evidências. Rev Latino-Am Enfermagem. 2007;15(3). doi: 10.1590/S0104-11692007000300023
https://doi.org/10.1590/S0104-1169200700...
,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-...
,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...
,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-...
,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-...
,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...
,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...
), vindo em seguida a ciclofosfamida(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-...
,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/...
,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...
,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...
).

Dentre os critérios de exclusão relacionados ao uso de medicamentos concomitantes que poderiam interferir nos resultados, oito estudos consideraram a utilização de anticoagulantes(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...
,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/...
,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...
,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-...
,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-...
,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...

35 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...
-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...
); quatro, a varfarina(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-...
,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/...
,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...
-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...
), e três, a aspirina(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/...
,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...
-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...
). Isso se deve pelo gengibre ter ação anticoagulante.

O uso do composto aprepitant associado ao gengibre foi avaliado em cinco estudos(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...
,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...
,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-...
,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-...
,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...
), dos quais dois referiram que a combinação interferiu na melhora dos sintomas(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-...
,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...
).

Dentro da categoria 1, também foi considerada a dosagem e posologia. Nessa perspectiva, foi observado que a dosagem de 1 g de gengibre por dia foi apresentada em 14 estudos, e a quantidade de cápsulas diversificou conforme a quantidade de miligramas de cada comprimido, sendo mais comumente consumidas 4 vezes (10 artigos) ou 2 vezes (9 publicações) ao dia. A maior parte das investigações referiu que o gengibre em pó em uma dose de 1 g/dia amenizou a náusea clínica de variadas causas(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...
,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/...
-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/...
,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...
,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-...
,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...
-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...
,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...
-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...
,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...
). Os períodos de utilização mais analisados foram o de 3 dias (8 investigações) e 5 dias (5 estudos). Dessas publicações, quatro relataram o início da utilização do gengibre três dias antes da quimioterapia; uma o observou cinco dias antes; e as demais, no dia do tratamento. Em todas as investigações em que a terapia complementar iniciou-se nos três e cinco dias anteriores à quimioterapia, foram demonstrados os benefícios do gengibre.

A quantidade de componentes ativos da cápsula foi referida em 7 estudos, os quais especificaram a concentração de gingerol em um intervalo de 1,4% a 5%, sendo que 5% foi a composição mais frequente por ser descrita em 4 artigos. Referente ao shogaol, 4 investigações o utililizaram na proporção entre 0,00112 a 0,0085, e a dosagem 0,00092 ocorreu de forma repetida em 2 artigos. Com isso, observa-se a divergência nos estudos na formulação da cápsula, de modo que não é possível comparar os resultados em relação à biodisponibilidade dessa terapia complementar. Apenas quatro estudos descreveram que foi realizado teste de validação do teor dos componentes ativos da cápsula; destes, três especificaram que foi feito o teste por cromatografia líquida de alta eficiência(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...
,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...
,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...
,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-...
).

DISCUSSÃO

Os estudos de revisão não foram incluídos neste manuscrito, porém, na literatura, observa-se que, na primeira investigação com esse tipo de delineamento, publicada em 2000, concluiu-se que os dados clínicos analisados foram insuficientes para obter evidências categóricas, mas destacou-se que o gengibre é um potencial fármaco natural antiemético(3838 Ernst E, Pittler MH. Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials. Br J Anaesth. 2000;84(3):367-71. doi: 10.1093/oxfordjournals.bja.a013442
https://doi.org/10.1093/oxfordjournals.b...
). Esse resultado condiz com o que foi encontrado nos resultados dos primeiros ensaios clínicos publicados. Novas revisões foram realizadas apenas em 2012, ou seja, após mais de uma década, e os resultados foram contraditórios, não sendo possível comprovar benefícios estatisticamente significativos da ação do gengibre(3939 Lee J, Oh H. Ginger as an antiemetic modality for chemotherapy-induced nausea and vomiting: a systematic review and meta-analysis. Oncol Nurs Forum. 2013;40(2):163-70. doi: 10.1188/13.ONF.163-170
https://doi.org/10.1188/13.ONF.163-170...

40 Marx WM, Teleni L, McCarthy AL, Vittetta L, McKavanagh D, Thomson D, et al. Is ginger supplementation effective in ameliorating chemotherapy-induced nausea and vomiting? Cosa 39Th Annual Scientific Meeting and IPOS 14Th World Congress of Psycho-Oncology. Asia Pac J Clin Oncol. 2012 [cited 2018 Aug 5];8(Suppl-3):323. Available from: https://research.bond.edu.au/en/publications/is-ginger-supplementation-effective-in-ameliorating-chemotherapy-
https://research.bond.edu.au/en/publicat...

41 Lee J, Oh H. Ginger for chemotherapy-induced nausea and vomiting (CINV) control? Current evidence of ginger as an antiemetic modality for CINV management: a systematic review. Support Care Cancer. 2012;20(Suppl 1):S79. doi: 10.1007/s00520-012-1479-7
https://doi.org/10.1007/s00520-012-1479-...
-4242 Haniadka R, Rajeev AG, Palatty PL, Arora R, Baliga MS. Zingiber officinale (ginger) as an anti-emetic in cancer chemotherapy: a review. J Altern Complement Med. 2012;18(5):440-4. doi: 10.1089/acm.2010.0737
https://doi.org/10.1089/acm.2010.0737...
). Porém a partir de 2013, os benefícios do gengibre começaram a ser confirmados; e, de 2015 até 2018, divulgaram-se revisões nas quais foram observadas as vantagens dessa terapia integrativa conforme avaliação de diferentes metodologias(4343 Marx W, Ried K, McCarthy AL, Vitetta L, Sali A, McKavanagh D, et al. Ginger-Mechanism of action in chemotherapy-induced nausea and vomiting: a review. Crit Rev Food Sci Nutr. 2017;57(1):141-6. doi: 10.1080/10408398.2013.865590
https://doi.org/10.1080/10408398.2013.86...

44 Lete I, Allué J. The effectiveness of ginger in the prevention of nausea and vomiting during pregnancy and chemotherapy. Integr Med Insights. 2016;11:11-17. doi: 10.4137/IMI.S36273
https://doi.org/10.4137/IMI.S36273...

45 Marx W, Kiss N, Isenring L. Is ginger beneficial for nausea and vomiting? An update of the literature. Curr Opin Support Palliat Care. 2015;9(2):189-95. doi: 10.1097/SPC.0000000000000135
https://doi.org/10.1097/SPC.000000000000...

46 Giacosa A, Morazzoni P, Bombardelli E, Riva A, Bianchi Porro G, Rondanelli M. Can nausea and vomiting be treated with ginger extract? Eur Rev Med Pharmacol Sci [Internet]. 2015 [cited 2018 Aug 01];19(7):1291-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25912592
https://www.ncbi.nlm.nih.gov/pubmed/2591...
-4747 Crichton M, Marshall S, Marx W, Isenring E. Efficacy of ginger (zingiber officinale) in ameliorating chemotherapy-induced nausea and vomiting and chemotherapy-related outcomes: a systematic literature review update and meta-analysis. Nutr Diet. 2018;75(S1):42. doi: 10.1111/1747-0080.12426
https://doi.org/10.1111/1747-0080.12426...
).

No Brasil, desde 2016, há a Política e Programa Nacional de Plantas Medicinais e Fitoterápicos, na qual apresentam-se diretrizes para seu manejo, produção, cultivo, comercialização, monitoramento, estratégias de comunicação, recursos humanos, qualificação, validações, definição de conceitos, entre outros. Assim, essas diretrizes possibilitam a produção de equipamentos e tecnologias fundamentais para a garantia e controle de qualidade, fomento do sistema de produção e criação de métodos de monitoramento e análise de inclusão de tecnologia(4848 Corrêa Jr CC, Scheffer MC. Boas Práticas Agrícolas (BPA) de plantas medicinais, aromáticas e condimentares [Internet]. Instituto Paranaense de Assistência Técnica e Extensão Rural - EMATER. Curitiba. 2013[cited 2018 Aug 01]. Available from: http://portalarquivos.saude.gov.br/images/pdf/2015/agosto/28/bpa-plantas-medicinais-aromaticas-condimentares.pdf
http://portalarquivos.saude.gov.br/image...
).

Nesse contexto, a Organização Mundial da Saúde (OMS) publicou diretrizes de monitorização e farmacovigilância de plantas medicinais em 2003, nas quais recomenda a inclusão de plantas medicinais, medicina tradicional e complementar; define conceitos; aborda erros de medicação, eficácia, excesso e combinações de fármacos e interações; reconhece as reações adversas e métodos de prevenção; estima os riscos e prevenção de eventos. Tal material tem como propósito apoiar os países membros na qualificação em farmacovigilância; inserir plantas no Sistema Internacional de Farmacovigilância; padronizar os termos e classificações; incentivar e consolidar trocas internacionais de informações e instruções seguras entre os centros; e viabilizar a segurança. Esses tipos de política evitam a introdução intencional ou acidental de componentes proibidos ou restritos, a modificação dos constituintes, a contaminação com substâncias tóxicas e a declaração inadequada entre o teor declarado e o real(4949 World Health Organization. Guidelines on good agricultural and collection practices (GACP) for Medicinal plants [Internet]. Geneva: WHO; 2003[cited 2018 Aug 01]. Available from https://apps.who.int/medicinedocs/en/d/Js4928e/
https://apps.who.int/medicinedocs/en/d/J...
-5050 Silveira PF, Bandeira MAM, Arrais PSD. Farmacovigilância e reações adversas às plantas medicinais e fitoterápicos: uma realidade. Rev Bras Farmacogn. 2008;18(4). doi: 10.1590/S0102-695X2008000400021
https://doi.org/10.1590/S0102-695X200800...
).

Todavia, observa-se que, na literatura, não há divulgação de dados referentes a formulação, métodos de extração, controle de qualidade e validação, os quais podem interferir na biodisponibilidade dos componentes ativos derivados do gengibre. Apenas quatro estudos citaram o teste de validação do teor dos componentes ativos da cápsula(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...
,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...
,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...
,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-...
), sendo que essa falta de controle de qualidade pode interferir na comprovação da evidência.

Nesse contexto, a ação antiemética e anti-inflamatória do gengibre é relacionada aos seus componentes bioativos, entre eles o gingerol e o shogaol, os quais possuem ação do manejo da náusea e êmese, da temperatura corporal, tosse, inflamações e pressão arterial sistêmica(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...
). Assim, reforça a necessidade de padronização da dose dos componentes bioativos do gengibre na composição das cápsulas concomitantemente ao controle de qualidade.

Em tal cenário, foi demonstrada a efetividade do gengibre em cápsula para e redução da náusea aguda e antecipatória na dosagem de 1 g/dia, com o protocolo iniciando 3 dias antes da administração quimioterápica até os 3 dias posteriores, associado ao tratamento antiemético(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...
). Em outro artigo com similar metodologia, foi apresentado o mesmo resultado positivo em relação à náusea aguda e antecipatória, sendo que o emprego precoce do gengibre foi relacionado à indução da ligação de 5-HT3 com consequente estímulo às enzimas de desintoxicação que neutralizam o dano oxidativo aos tecidos causadores desses sintomas gastrointestinais. Além disso, nesse ensaio clínico, observou-se que doses menores de gengibre são mais benéficas do que doses superiores, pois estas podem saturar a base de receptores de mecanismo de ação(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-...
). Dessa mesma forma, um estudo que analisou as dosagens de 0,5 g, 1 g e 1,5 g evidenciou a maior efetividade das duas composições menores(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...
).

Além disso, o gengibre demonstrou sua ação antiemética como terapia complementar aos fármacos ondansetron (8mg) e dexametasona (12 ou 8 mg conforme potencial emetogênico) por via endovenosa no dia da aplicação quimioterápica e do 2º ao 4º dia, por via oral, combinado com metoclopramida 10 mg três vezes/dia como tratamento padrão para pacientes com tumores sólidos(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...
) assim como combinado com palonosetron e dexametasona(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-...
). Entretanto, em dois estudos não foi comprovada a efetividade do gengibre em pacientes com câncer de mama em quimioterapia com potencial emetogênico alto combinado com o ondansetron (8 mg) e metoclopramida (10 mg) empregados como protocolo padrão com inclusão de medicamentos de resgate (ondansetron, domperidona ou metoclopramida) conforme necessidade nos dias posteriores à quimioterapia(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-...
,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...
). Conclui-se que foi observada a ação antiemética do gengibre quando utilizado concomitante ao tratamento convencional preventivo tanto no dia de administração quimioterápica quanto nos 4 dias seguintes.

Em uma publicação o efeito do gengibre foi comparado a 40 mg/dia de metoclopramida no período tardio (2º ao 5º dia após à quimioterapia), porém sua efetividade não foi superior à terapia convencional com granisetron e dexametasona em pacientes com câncer de mama submetidos a protocolos quimioterápicos com potencial emetogênico de moderado a alto(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...
). Essa comparação foi similarmente realizada em um estudo que analisou pacientes em tratamento à base de cisplatina(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...
)e, em outro, que avaliou participantes em tratamento combinado à base de ciclofosfamida, porém, neste, observou-se que o ondansetron foi mais efetivo do que o gengibre e o metoclopramida(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...
).

A terapia combinada do extrato de gengibre em uma dosagem de 2 g/dia com aprepitant ocasionou aumento da intensidade da náusea e vômito tardio (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-...
), porém há divergência no resultado quando utilizada a dosagem 0,5 g/dia, em que não se demonstraram diferenças significativas na incidência e gravidade desses sintomas(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...
). Como citado anteriormente, ressalta-se que a ação do gengibre foi mais efetiva em doses menores. Existem dúvidas em relação à influência do gengibre combinado com o aprepitant na redução da absorção gastrointestinal e amplificação da sua motilidade com consequente diminuição do tempo de esvaziamento gástrico e da efetividade antiemética do fármaco(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-...
), por isso são necessários mais estudos para confirmação dessa afirmação.

A divergência de resultados referente à terapia combinada de gengibre com o protocolo antiemético padrão pode estar relacionada às diferentes metodologias empregadas.

Em relação às características das amostras, há evidências de que as mulheres possuem uma maior probabilidade de ter sintomas de náusea e vômito induzidos pela quimioterapia do que os homens(4040 Marx WM, Teleni L, McCarthy AL, Vittetta L, McKavanagh D, Thomson D, et al. Is ginger supplementation effective in ameliorating chemotherapy-induced nausea and vomiting? Cosa 39Th Annual Scientific Meeting and IPOS 14Th World Congress of Psycho-Oncology. Asia Pac J Clin Oncol. 2012 [cited 2018 Aug 5];8(Suppl-3):323. Available from: https://research.bond.edu.au/en/publications/is-ginger-supplementation-effective-in-ameliorating-chemotherapy-
https://research.bond.edu.au/en/publicat...
). Dessa forma, o sexo pode ter contribuído na reação do paciente à terapia com gengibre ao diminuir a intensidade do sintoma e, assim, colaborar para a efetividade das terapêuticas antieméticas.

Limitações do estudo

Há ainda muitos estudos controversos quanto aos benefícios do gengibre. Isso se deve à escassez de evidências comprobatórias por causa do pequeno número de investigações, bem como da falta de padronização da amostra, composição, método e período de utilização.

Contribuições para a área

A náusea e a êmese são importantes sintomas em pacientes em tratamento quimioterápico, pois, apesar das variadas terapias existentes, continuam sendo reações de alta incidência. Portanto, a inclusão da terapia complementar baseada em evidências associada ao tratamento farmacológico tradicional pode auxiliar no manejo da incidência e intensidade dessas adversidades que afetam a qualidade de vida e a rotina do paciente. Apesar de os resultados sobre os benefícios do gengibre para manejo das reações adversas gastrointestinais induzidas pela quimioterapia serem conflitantes, o presente estudo permitiu a integração do conhecimento sobre o tema; a identificação de variadas abordagens teóricas e metodológicas; e a detecção das limitações das investigações que podem interferir na comprovação da evidência. Sendo assim, esta revisão integrativa pode contribuir para o desenvolvimento de pesquisas futuras.

CONSIDERAÇÕES FINAIS

Neste estudo, observou-se que os resultados sobre os benefícios do gengibre para o manejo da náusea e êmese nas etapas aguda e tardia são contraditórios. A dificuldade encontrada para a convergência da evidência esteve relacionada à heterogeneidade das amostras, à diversidade do tratamento antiemético utilizado, à falta de padronização na dosagem e formulação dos componentes ativos. Há necessidade de estudos futuros com a finalidade de melhor entendimento e padronização na sua utilização para avaliação da sua biodisponibilidade no organismo. Essa terapia complementar é de baixo custo, fácil acesso, e alguns trabalhos demonstraram a sua efetividade no controle da náusea e vômito induzidos pela quimioterapia. Contudo, outros estudos com metodologia padronizada contribuirão para uma melhor definição de protocolos assistenciais.

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Datas de Publicação

  • Publicação nesta coleção
    30 Mar 2020
  • Data do Fascículo
    2020

Histórico

  • Recebido
    19 Nov 2018
  • Aceito
    19 Dez 2019
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