Running head: CANNABINOIDS VS PROTEIN AND GINGER TO TREAT NAUSEA
Cannabinoids vs. Protein and Ginger to Treat Nausea and Vomiting in Advanced Disease
Sarah DeLaat
Ferris State University
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CANNABINOIDS VS PROTEIN AND GINGER TO TREAT NAUSEA
Abstract
This paper will explore the treatment in chemotherapy induced nausea and vomiting
(CINV). Research and evidence will be shown for the use of cannabinoids as the
pharmacological treatment for CINV and a protein and ginger combination as the nonpharmacological treatment form.
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CANNABINOIDS VS PROTEIN AND GINGER TO TREAT NAUSEA
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Cannabinoids vs. Protein and Ginger to Treat Nausea and Vomiting in Advanced Disease
Introduction
Nausea and vomiting are very common, specific, and unpleasant complications related to
chemotherapy.” Chemotherapy –induced nausea and vomiting (CINV) is a significant, well
documented problem” (Cotter, 2009). These symptoms are sometimes intense enough that a
patient will withdraw from life saving treatment to avoid their debilitating effects. There are
multiple treatments for CINV, but this paper will focus specifically on the use of cannabinoids as
the pharmacological treatment and a high protein diet with ginger as the non-pharmacological
treatment for these symptoms. It is important for nurses to be familiar with these treatments in
order to provide support to their patients as well as appropriate patient education. “Nurses should
be cognizant of the side-effect profiles for CINV treatments” (Cotter, 2009).
As nurses it is also important to put aside any personal bias when it comes to a patient’s
choice of treatment with specific regards to cannabinoids. Even in this day and age with
marijuana now being a legal form of CINV treatment, there sometimes remains a social stigma
attached to this form of treatment.
Descriptive Summary
Cannabinoids
“Marijuana has been used medically for millennia and in the United States for over 150
years” (Hollister, 2001). It was not until recently that the use of delta-9 tetrahydrocannabinol
(THC) was legalized as an actual medical treatment for nausea and vomiting. “Dronabinol, the
active ingredient in Marinol capsules is the synthetic form of THC that is prescribed” (Cotter,
2009). Studies done in the 1970’s and 1980’s have been re-evaluated over the past ten years in
order to prove the efficacy of marijuana in relation to CINV. In a THC vs. placebo study, “22
CANNABINOIDS VS PROTEIN AND GINGER TO TREAT NAUSEA
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patients received a single dose of THC or placebo two hours prior to chemotherapy treatment
and two and six hours after. Fourteen of 20 patients who received the THC capsule reported an
antiemetic effect, whereas 0 of 22 patients receiving the placebo reported no antiemetic effect”
(Cotter, 2009).
THC has also been compared to prochlorperazine or compazine. “Doses of 15mg of THC
were compared to 10mg doses of prochlorperazine in a controlled crossover trial in 84 patients.
THC produced complete response in 36 of 79 courses, while prochloperazine was effective in
only 16 of 78 courses” (Hollister, 2001). THC provided more central nervous system effects on
these patients participating in this study. Even though the nausea and vomiting were controlled,
some patients reported undesirable effects such as dizziness, nervousness, decreased motor
control, or limited concentration.
Aside from taking the orally administered THC, smoking marijuana or ingesting it in a
baked form are also effective ways to treat nausea and vomiting. “Orally administered THC is
slow in onset of action though longer in duration. Smoked marijuana produces an immediate
effect that might be more desirable to patients” (Hollister, 2001). Smoking marijuana is not
always recommended due to the fact that it can further complicate respiratory issues patients may
already have.
In a study comparing oral THC to smoked marijuana, a total of 142 patients participated.
“67 took the THC capsule, and 75 smoked a marijuana cigarette. Investigators found that both
treatments were effective in decreasing CINV with no significant differences observed between
the two treatments” (Cotter, 2009). It is important to know that many people are unable to
tolerate the harshness of a marijuana cigarette, making it a poor option. As nurses, “infection can
CANNABINOIDS VS PROTEIN AND GINGER TO TREAT NAUSEA
also be a concern when an immunocompromised patient is smoking marijuana because it
contains many bacteria and fungi, as it is a natural substance” (Cotter, 2009).
Protein and Ginger
“Ginger has a long history of use as a home remedy against nausea, including nausea
caused by drugs. It is slowly earning a reputation for its ability to quell nausea induced by some
drugs- particularly chemotherapy” (Abascal & Yarnell, 2009).
There was a study done in 2007 that trialed the use of ginger for treating nausea in post
chemotherapy patients that occurred 24 hours after their treatment according to Abascal &
Yarnell, 2009. The study also included the use of protein mixed with ginger to determine
whether or not this improved nausea in this group of patients. This open study consisted of
“participants either ate their regular diet, their diet plus a protein drink and 1g of ginger, or their
diet plus a high protein drink and 1g of ginger daily. The high-protein/ginger combination
reduced the delayed nausea, and participants in that group used less antiemetic medication”
(Abascal & Yarnell, 2009).
There was a study conducted in 2011, “composed of intervention (n=15) and control
(n=30) patients where control patients received antiemetic drugs for ethical reasons and
intervention patients received ginger tablets (800mg)” (Alparslan et al, 2012). According to
Alparslan, 2012, “no nausea or vomiting was found to have occurred in those receiving ginger.
The rate of nausea/ and or vomiting was 76.7% in the group using only antiemetic drugs. A
significant difference was found between the group receiving ginger and the group receiving
antiemetic drugs, suggesting that ginger is effective for nausea/and or vomiting (p<0.05).”
Critical Appraisal
Cannabinoids
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The evidence supporting the use of cannabinoids as an antiemetic in CINV patients
shows improvement with nausea in the studies stated above. Unfortunately there are no recent
studies that could be found. The studies on cannabinoids were all re-researched in today’s time,
but no new studies were actually performed. This makes the evidence itself weak due to the fact
that most of it is thirty years old. The sample sizes for the cannabinoid studies are very small
when attempting to research a medicinal intervention. This also contributes to the weakness of
the evidence.
However weak the actual studies themselves may be, given the research from the
cannabinoid studies, evidence does show an improved effect on nausea and vomiting in CINV
patients. These studies do not clearly state which form of cannabinoid works the best for CINV
patients, but gives the impression that it is individualized per patient.
Protein and Ginger
Both studies discussed in relation to protein and ginger and their effects on CINV patients
show improvement in nausea and vomiting. The fact that there are only two studies showing any
real information in relation to these components and improvement in nausea and vomiting makes
the evidence weak. Again, the sample size to these studies is small, but does in fact show
improvement of nausea and vomiting. In the 2007 study “it was unclear what role, if any, ginger
played in reducing nausea in these patients” (Abascal & Yarnell, 2009).
In the 2011 study, evidence clearly stated that “results of the present study suggest that
ginger is more effective than an antiemetic drug for the prevention of nausea and/or vomiting in
patients receiving chemotherapeutic agents” (Alparslan et al, 2012).
Recommendations
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CINV is such an individualized symptom in patients. There are many treatments for
CINV currently. Finding the right combination of antiemetic treatment is what truly seems to be
the goal for these patients. Based on the research in these studies I could make recommendations
for use of both treatments for CINV. Cannabinoid treatment has been around for many years; it
wasn’t until recently that it became legal and more socially acceptable for medicinal purposes.
Ginger has also been around as a natural substance for a very long time. I believe that based on
these studies it would be worth it to attempt this form of treatment for CINV.
My true recommendation would have to be in support of cannabinoids for the treatment
of CINV. This is not solely based on the research in these articles, but based on nursing
experience with patients and loved ones who have had the debilitating experience of dealing with
CINV. Cannabinoids dull the nausea and vomiting, improve appetite, and are sometimes an
analgesic to these patients. Now that it is considered a legal medicinal treatment form, I believe it
gives less of a stigma to these patients and they feel more comfortable using it as CINV
treatment.
Conclusion
CINV can be a crippling symptom, not only at the end of life, but at any given time in a
patient’s treatment process. Finding the right medication or non-pharmacological treatment can
sometimes be difficult. There may be a lot of trial and error experiments with different drugs,
times patients take them, or what they take them with. What it boils down to is this: if a patient
suffering from CINV is fortunate enough to find the pharmacological or non-pharmacological
treatment or even a combination of both that works for them, as nurses we should support them
and their choice of treatment.
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References
Abascal, K., & Yarnell, E. (2009, October). Clinical Uses of Zingiber Officinale (Ginger). The
Journal of Alternative and Complimentary Medicine, 15(5), 231-237. doi:
10.1089/act.2009.15501
Alparslan, G., Yilmaz, S., Acikgoz, A., & Orsal, O. (2012, March). Effect of Ginger on
Chemotherapy-Induced Nausea and/or Vomiting in Cancer Patients. Journal of the
Atmospheric Sciences, 18(1), 15-17.
Cotter, J. (2009, May). Efficacy of Crude Marijuana and Synthetic Delta-9Tetrahydrocannabinol as Treatment for Chemotherapy-Induced Nausea and Vomiting.
Oncology Nursing Forum, 36(3), 345-351.
Hollister, L. (2001). Marijuana (Cannabis) as Medicine. Journal of Cannabis Therapeutics, 1(1),
1-27.