Pillai, A.K., Sharma, K.K., Gupta, Y.K., & Bakhshi, S. (2010). Anti-emetic effect of ginger powder versus placebo as an add-on therapy in children and young adults receiving high emetogenic chemotherapy. Pediatric Blood and Cancer, 56, 234–238.

To evaluate the efficacy of ginger powder in reducing chemotherapy-induced nausea and vomiting (CINV) in children and young adults

Participants were randomly assigned to receive either ginger powder tablets or placebo tablets to be taken daily at night during the first three days of chemotherapy and then three times daily for the next two days after chemotherapy was completed. The total dose of ginger powder was 1,000–2,000 mg per day, based on body weight. Ondansetron and dexamethasone were used as standard antiemetics.

Randomization was done for each cycle of chemotherapy. Data were analyzed according to treatment cycle grouping. Patients received a follow-up telephone call on the seventh and tenth days of chemotherapy to reinforce diary use.

• The sample consisted of 32 patients who were studied over a total of 60 chemotherapy cycles.
• Patient ages ranged from 8–21 years old.
• Data was reported by chemotherapy cycle, not known in patient sample.
• All patients had been newly diagnosed with bone sarcoma.

All participants were pediatric patients in active treatment.

This was a randomized, double-blind, placebo-controlled trial.

• The Edmonton Symptom Assessment Scale (ESAS) and National Cancer Institute guidelines for grading of nausea and vomiting were used to measure symptoms.
• Patients or guardians were instructed to complete daily diaries recording of emesis episodes and questions related to grading of nausea and vomiting.

• Incidence of acute nausea in both study groups was 100%. In the control group, acute moderate-to-severe nausea was 93.3% compared to 55.6% in those receiving ginger (p < 0.003).
• Complete absence of vomiting was reported in 3.3% of controls, compared to 14.81% in the experimental group.
• Moderate to severe delayed nausea was seen in 73.3% of control cycles compared to 25% in the experimental group (p < 0.001).
• Moderate to severe delayed-phase vomiting was seen in 46.7% of controls and 14.8% of those who received ginger (p = 0.022).
• No adverse effects were seen with ginger or the placebo.

Ginger powder may have a positive impact in reducing acute and delayed nausea as an adjunct to standard antiemetic treatment in children and young adults, and it was not associated with any adverse effects.

• The sample was small with less than 100 participants.
• Patients may have received either ginger or placebo during different chemotherapy cycles; however, the study design was not done as an actual crossover design. This is a substantial design flaw in this study.
• Results showed that there was a complete absence of vomiting in the control cycles for the acute phase; however the authors did not discuss or explain this observation, since all other observations suggested reduction in CINV with ginger. 
• No discussion of compliance with diary documentation of nausea grading was provided.
• Analysis of subgroups according to the cycle of chemotherapy was not possible, and anticipatory CINV was not measured.
• Gender distribution between control and experimental groups was significantly different with more males in the experimental group. Known gender differences occur in adults in response to antiemetic therapies. It is not clear if this is also the case in pediatric patients.

Ginger may be helpful in mitigation of CINV symptoms for younger patients; however, effectiveness remains unclear.