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Volume 21, Edisi 1

Artikel asli 

Akses Gratis

Efektivitas minyak atsiri jahe inhalasi dalam meningkatkan

asupan makanan pada pasien kanker payudara yang
mengalami mual dan muntah yang diinduksi oleh kemoterapi
Noor Salihah PhD, BSc 

Nik Mazlan PhD, MSc, BSc

 ... Lihat semua penulis

Pertama kali diterbitkan:25 April 2016

https://doi.org/10.1111/fct.12236

Kutipan: 2

Tentang

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Bagikan di

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Abstrak

Latar Belakang
Bukti menunjukkan penggunaan terapi komplementer dapat membantu mengurangi efek buruk
dari pengobatan terkait kanker, termasuk mual.

Tujuan
Untuk mengevaluasi efektivitas minyak atsiri jahe inhalasi (EO) dalam meningkatkan asupan
makanan pada wanita penderita kanker payudara yang mengalami mual dan muntah yang
diinduksi kemoterapi (CINV). Persepsi umum tentang penggunaan aromaterapi jahe juga
dievaluasi.

Metode
A single‐blind, randomised, placebo‐controlled, crossover study was conducted in two oncology
clinics in Peninsular Malaysia. Women received 5 days of aromatherapy treatment using either
ginger EO or fragrance‐matched placebo [ginger fragrance oil (FO)] in an order dictated by the
treatment group sequence. The following aspects were evaluated: nutritional status (BMI,
nutritional requirement, dietary intake) and general perception of aromatherapy.
Results
Sixty women completed the study (age=47.3±9.26 years; receiving highly emetogenic
chemotherapy=86.7%; BMI=25.5±5.4 kg/m2). Energy intakes were significantly higher after
patients were treated with ginger EO than ginger FO at day 3 (P =0.015) and day 5 (P =0.002).
Significant improvements in energy intake were also observed over time
[F (2,57)=54.21, P <0.001], reaching almost 90% of the energy requirement 5 days’ post‐
chemotherapy. Inhaled aromatherapy using ginger EO was rated marginally more helpful than
the ginger FO (63.3% vs. 61.6%). Being delivered via a necklace, the treatment method was
considered feasible for participating women.

Conclusion
The use of inhaled ginger EO for CINV could possibly help patients resume their dietary intake.
This complementary treatment was also favourably received by the participating women.

Introduction
Nausea and vomiting are generally two of the most feared and distressing symptoms for cancer
patients treated with chemotherapy, even with the widespread use of
5HT3 antagonists.1, 2 Prolonged or delayed chemotherapy‐induced nausea and vomiting (CINV)
may cause patients to experience anorexia by preventing adequate nutritional intake and
resulting in a wasting cycle.3 Nausea has been found to adversely affect the dietary intake of 21–
35% of patients receiving chemotherapy from 1 month to 1 year of treatment.4 Patients who
experience nausea may fear that eating will trigger vomiting, so maintaining adequate nutritional
intake can therefore be a challenge. However, symptoms of malnutrition may be missed,
particularly in breast cancer patients, who are often overweight or obese.5-7 Assesment of
recent dietary intake and weight history is therefore important in identifying cancer patients at risk
of malnutrition.

In cancer care, the use of complementary therapies is becoming increasingly popular. Recent
scientific evidence seems to indicate that some complementary therapies (e.g. acupuncture,
hypnosis, reflexology and massage) may help in relieving cancer and related treatment
symptoms, such as pain and nausea.8 Many herbal supplements in the form of tea or
aromatherapy are also simultaneously escalating in popularity within the cancer community and
have been recommended for the relief of CINV;9 particularly the botanical form of ginger
(Zingiber officinale ), which is often advocated as beneficial for nausea and vomiting in various
conditions, including motion sickness, pregnancy and post‐surgery.10 It is hypothesised that the
direct effect of ginger on the gastrointestinal tract may be due to the aromatic, spasmolytic,
carminative and absorbent properties of the herb.11

Aromatherapy [i.e. the inhalation of the vapours of an essential oil (EO) or absorption of the oil
into the skin] is a particular kind of complementary and alternative therapy that is widely used to
treat or alleviate physical and emotional symptoms.12 Generally, the use of scented oils is
recognised as an effective treatment for nausea. It is known that this therapy is inexpensive, non‐
invasive and generally has a low level of adverse effects.12 However, the clinical evidence
justifying its use is still debatable. This study therefore aimed to evaluate the effectiveness of
inhaled ginger EO in improving dietary intake in breast cancer patients experiencing CINV.
Patients’ general perception of aromatherapy was also assessed.

Methods
Study design
This single‐blind, randomised, placebo‐controlled, crossover study was conducted in the
oncology clinics of Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu and Hospital Raja
Perempuan Zainab II (HRPZ II), Kota Bharu, Kelantan, Malaysia. Standard procedures for
nausea and emesis prevention and management were followed in accordance with the standard
chemotherapy protocol and each patient's clinical condition.

Participants
The study inclusion criteria were as follows: (1) women aged 18 years and above with a normal
sense of smell; (2) had a diagnosis of breast cancer; (3) were receiving chemotherapy and
experiencing nausea and/or vomiting of any severity (previously described in our earlier
article13); (4) were due to receive at least two further chemotherapy courses using similar
chemotherapeutic agents; and (5) provided consent to participate in the study. Excluded from the
study were women with other malignancies, allergies to ginger, perfumes or cosmetics or who
were undergoing concurrent radiotherapy.

Randomisation
Consenting patients were randomised on recruitment using permuted‐block randomisation, with
a block size of four and an allocation ratio of 1:1.

Interventions
In addition to standard care, patients were asked to wear an aromatherapy necklace containing
either two drops of ginger EO or ginger fragrance oil (FO) (fragrance‐matched placebo)
depending on the randomisation allocation sequence (Figure 1). Patients were blinded to the
allocated intervention. Only researchers were aware of the intervention that each patient was
receiving. As this study was susceptible to investigator bias, researchers avoided this problem by
exercising their best judgement during data collection and data assessment by not transferring
their inclinations or attitudes to the patients.
Figure 1

Open in figure viewerPowerPoint

CONSORT flow diagram.

The therapeutic value of FOs is substandard when compared to natural EOs. This is because of
changes in the chemical structure of the concentrated product (extract) and the mixture of
synthetic components that constitute the fragrance oil.14 While EOs and FOs are identical in
appearance and texture, fragrance oils usually smell inferior when compared to the pure EO.
Both the ginger EO and ginger FO were obtained from Take It Global Sdn. Bhd. Butterworth,
Penang, Malaysia (an authorised EO dealer for Ungerer Australia Pty Ltd, Kurnell, New South
Wales, Australia).

During the first chemotherapy course, patients in group one received ginger FO, followed by
ginger EO for the next chemotherapy course. In contrast, patients in group two were first given
ginger EO on their first chemotherapy course, and on their subsequent treatment course, were
provided with ginger FO. The wash‐out period was estimated around 2 weeks; the time gap
between two consecutive chemotherapy courses. Patients were instructed to remove the
necklace after 5 days of the treatment period ending.

Measurement of variables
Baseline demographic and disease characteristics, including age, cancer diagnosis and
treatment information, were collected from patient medical records. The following outcomes were
collected also: nutritional status (BMI, nutritional requirement, dietary intake) and general
perception on aromatherapy.
Nutritional status

The participants’ current weight and height were collected from the most recently recorded
values in the patient medical chart. The weight was routinely recorded by nurses on the day of
chemotherapy administration, which was also the day of the study visit. The BMI was calculated
as weight (in kg) divided by height (in m) squared. The World Health Organization (WHO)
classification of BMI was adapted as normal weight, if BMI was 18.5–24.9 kg/m2, overweight if
BMI was 25–29.9 kg/m2 and obese if BMI was >30 kg/m2.15

Basal energy requirements were estimated based on the WHO formulae for patients aged ≤60
years16 and the formula devised by Owen et al .17 for patients aged >60 years, because we
considered these to show a better performance in predicting resting metabolic rate compared to
the Harris and Benedict formula. Estimated daily energy requirements (EERs) were calculated by
multiplying the patient's basal requirements by a 1.2 activity factor. Daily protein requirements
were estimated to range between 1.0 and 1.2 g/kg per day to cater for the protein needs of
cancer patients.18

Usual nutritional intake at baseline (during chemotherapy treatment) was derived from the
patient's dietary history, which was completed by a research dietician. Subsequent food records
(for 3 consecutive days) were completed by the respondents. Patients were instructed on how to
keep a 3‐day food record using household measurements; a short reference manual was
attached together with the 3‐day food record form. Patients were required to record their nutrient
intake between day 3 and day 5 post‐chemotherapy for each phase (phases 1 and 2 of the
study). All nutrient intakes were estimated using Nutritionist Pro, based on the Malaysian Food
Composition database,19 focusing on energy and protein intake as well as the percentage of
total energy contributions (% of kcal) from fat, carbohydrate and protein.

General perception of aromatherapy

Patients were also required to complete a post‐session evaluation questionnaire related to their
general perception of aromatherapy, and a blinding assessment, at the end of each study phase.
The questions were adapted and modified from previous aromatherapy trials by Gedney et
al .20 and Graham et al .21 Using 9‐point Likert scale, patients were asked to rate the strength
of odour (1=very weak; 9=very strong), pleasantness of odour (1=not pleasant; 9=very pleasant)
and the feasibility of aromatherapy administration using a necklace (1=not feasible; 9=very
feasible). Higher scores indicated better responses. Provided with three categorical responses,
evaluation of perceived aromatherapy treatment effects (i.e. very helpful; helpful; and less
helpful) was also completed by patients. Additionally, patients were required to report any
adverse events associated with the aromatherapy inhalation.
Statistical analysis
The sample size calculation was based on our earlier study using the VAS as a primary outcome
measure. A sample size of 60 (30 in each group) was needed to obtain a power of 0.90, with an
α of 0.05, using a repeated measures ANOVA analysis. The Statistical Package for the Social
Sciences (SPSS), version 16.0 (SPSS Inc., Chicago IL, USA), was used for data compilation and
statistical analysis. Descriptive statistics and parametric tests were applied. The modified ITT
approach was applied for efficacy analysis whereby only patients who had completed all study
phases and received both inhaled ginger EO and ginger FO were included in the analysis. Two‐
factor (group and time) analyses of variance with repeated measures were performed on the
dietary intake comparing differences between ginger EO (study group) and ginger FO (placebo
group) taking treatment sequence into account. Main effects were evaluated for differences
between the study (ginger EO) and placebo (ginger FO) group as well as effects over time. Tests
for possible carry‐over effects were performed by comparing sequences (between‐groups factor)
and checking for treatment sequence by time interaction (within‐subjects factor). The Bonferroni
adjustment was used when necessary and significant level was fixed at 0.05.

Ethics
Permission to conduct the study was obtained from the Malaysia Ministry of Health's Research
and Ethics Committee (MREC) [Ref. no: (2) dlm.KKM/NIHSEC/08/0804/P11‐42].

Results
From December 2011 to January 2014, a total of 145 breast‐cancer patients undergoing
chemotherapy treatment were screened, of which only 75 patients were enrolled and
randomised: 37 into group one and 38 into group two. Figure 1 depicts the recruitment process
for potential participants and the reasons for exclusion and discontinuation of participation.
Overall, 30 patients from each group completed all study visits, providing a total of 60 evaluable
patients for data analysis.

The mean age of patients was 47 years, and the majority of them were Malay. Patients were
predominantly in the early stage of disease (stage I and II) (66.6%) and were receiving highly
emetogenic chemotherapy (anthracycline and cyclophosphamide combinations; 86.7%). All
patients were prescribed standard antiemetics. The baseline characteristics were equivalent
across treatment groups (Table 1).22

Table 1. Patients’ baseline data at the time of enrolment

Characteristics Ginger Ginger All
FO/Ginger EO/Ginger patients
EO (n  =30); FO (n  =30); (n  =60)
group one group two

Age (years); mean±SD 45.9±9.5 48.7±8.9 47.3±9.3

20–39 years, n  (%) 10 (33.3) 4 (13.3) 14 (23.3)

40–59 years, n  (%) 17 (56.7) 23 (76.7) 40 (66.7)

60–79 years, n  (%) 3 (10.0) 3 (10.0) 6 (10.0)

Race, n  (%)

Malay 29 (96.7) 30 (100) 59 (98.3)

Other (Siamese) 1 (3.3) – 1 (1.7)

Time after diagnosis (months); mean±SD 11.6±12.7 12.0±12.6 11.8±12.5

≤1 year, n  (%) 24 (80.0) 23 (76.7) 47 (78.3)

˃1 year, n  (%) 6 (20.0) 7 (23.3) 13 (21.7)

Breast cancer stage; n (%)

Stage I 3 (10.0) 2 (6.7) 5 (8.3)

Stage II 18 (60.0) 17 (56.7) 35 (58.3)

Stage III 7 (23.3) 8 (26.6) 15 (25.0)

Stage IV 2 (6.7) 3 (10.0) 5 (8.4)

Chemotherapy cycle; n  (%)

 Characteristics Ginger Ginger All
FO/Ginger EO/Ginger patients
EO (n  =30); FO (n  =30); (n  =60)
group one group two

Second 11 (36.6) 7 (23.3) 18 (30.0)

Third 8 (26.7) 7 (23.3) 15 (25.0)

Fourth 8 (26.7) 8 (26.7) 16 (26.7)

Fifth 3 (10.0) 8 (26.7) 11 (18.3)

Chemotherapeutic agentsa

High (˃90%) emetic risk n  (%)

5‐ 24 (80.0) 21 (70.0) 45 (75.0)

Flouracil+epirubicin+cyclophosphamide

(FEC)

Docetaxel+doxorubicin and 5 (16.7) 2 (6.7) 7 (11.7)

cyclophosphamide (TAC)

Low (10–30%) emetic risk n (%)

Docetaxel 1 (3.3) 7 (23.3) 8 (13.3)

 EO, essential oil; FO, fragrance oil.

 a
 American Society of Clinical Oncology guidelines, 2011.22

Table 2 presents the baseline nutritional characteristics of the patients.18, 23, 24 The mean BMI

for all patients at study entry was 25.5±5.4 kg/m2. Although over half of the patients (51.7%) were
categorised as normal weight, 23.3% of individuals were found to be overweight and 20.0%
obese. A one‐way repeated measures ANOVA revealed that there was no statistically significant
difference in weight [F (2,58)=3.09, P =0.053] or BMI [F (2,58)=3.02, P =0.057] between the
three time points (i.e. baseline, first follow‐up and second follow‐up), although a continuous
decreasing trend in weight within the 2‐month study period deserved nutritional attention
(61.7±13.6 kg→61.2±13.5kg→60.9±13.4 kg).

Table 2. Nutritional characteristics at baseline (n =60)

Characteristics Value

BMI (kg/m2), mean±SDa 25.5±5.4

Underweight n  (%) 3 (5)

Normal n (%) 31 (51.7)

Overweight n  (%) 14 (23.3)

Obese n (%) 12 (20)

Estimated energy requirement (EER) 1626.7±148.0

(kcal/day), mean±SD

Protein requirement (g/day), mean±SDb 59.3±9.6

Value Recommended
(mean±SD) range

Baseline dietary intake

Energy intake 1630.6±142.6 1780–2180c

(kcal/day)

Protein (g/day) 69.5±18.2 51–55c

Percentage of 53.8±7.7 55–70c

 Characteristics Value

carbohydrate

(%)

Percentage of 17.1±4.5 10–15c

protein (%)

Percentage of 29.1±6.7 20–30c

fat (%)

Dietary fibre 6.1±3.6 20–30d

(g/day)

 a
 Categorical variables are also presented as counts (%).
 b
 Calculated based on 1.0–1.2 g/kg body weight/day.18
 c
 Recommended nutrient intakes for Malaysia, National Coordinating Committee on Food
and Nutrition, Ministry of Health Malaysia, 2005.23
 d
 Malaysian Dietary Guidelines, Ministry of Health Malaysia, 2010.24

At baseline, the energy intake was 1630.6±142.6 kcal/day (range=1300–2000 kcal/day), and the
protein intake was 69.5±18.2 g/day or 1.2 g/kg body weight. While on chemotherapy, nearly 60%
of the patients were meeting their individual daily energy requirements and another 40% met at
least 80% of their requirements. For macronutrient analysis, the intakes were close to the
acceptable range for carbohydrate (53.8%; acceptable range=55–70%) and protein (17.1%;
acceptable range=10–15%), and within the acceptable range for fat (29.1%; acceptable
range=20–30%). However, during the first week post‐chemotherapy, there was a significant
reduction in energy intake (P <0.001). Half of the patients reported that nausea had caused them
to limit their food intake for at least 2 weeks after receiving chemotherapy.

There were significant differences between the two treatment groups in terms of mean energy
intake [F (1,58)=23.88, P <0.001] and percentage meeting energy requirements
[F (2,57)=3.26, P <0.001; Table 3]. Energy intakes were significantly higher after patients were
treated with ginger EO than ginger FO at day 3 (P =0.015) and day 5 (P =0.002). Significant
improvements in energy intake were also observed over time [F (2,57)=54.21, P <0.001], with
patients meeting almost 90% of their energy requirements 5 days post‐chemotherapy.
Table 3. Comparison of dietary intake between ginger essential oil (EO) and ginger fragrance oil
(FO) at each study phase (phase 1 and 2) and overall treatment effect

Phase 1 Phase 2 Treatment mode

Ginger FO Ginger EO P  a Ginger EO Ginger FO Ginger FO Ginger EO

(group one) (group two) (group one) (group two)

N 30 30 30 30 60 60

Energy (kcal), mean±SD

Baselin 1626.3±170.4 1635.0±110.9 0.816 – – 1630.6±142.6

Day 3 1240.4±244.8 1250.8±242.4 0.869 1274.2±240.3 1235.2±262.9 1237.8±251.9 1262.5±23

Day 4 1357.6±233.2 1344.1±245.1 0.829 1369.8±256.2 1321.6±218.2 1339.6±224.7 1357.0±24

Day 5 1402.3±239.6 1365.6±320.5 0.730 1427.2±253.2 1382.8±234.1 1392.5±235.0 1424.9±23

Time 53.26

(<0.001)

F (P  )c Group×Time 0.45 (0.638

Group 23.88

(<0.001)

Energy requirement met (%), mean±SD

 Phase 1 Phase 2 Treatment mode

Ginger FO Ginger EO P  a Ginger EO Ginger FO Ginger FO Ginger EO

(group one) (group two) (group one) (group two)

Baselin 100.5±7.0

Day 3 75.8±14.5 77.9±14.4 0.574 77.9±14.5 76.8±14.6 76.3±14.5 77.9±14.3

Day 4 83.0±14.2 83.8±14.7 0.833 83.7±15.6 82.4±13.5 82.7±13.8 83.7±15.0

Day 5 85.6±14.0 88.7±13.6 0.391 87.0±14.1 86.1±14.0 85.9±13.9 87.8±13.7

Time 54.21

(<0.001)

F (P  )c Group Time 0.50 (0.604

Group 23.36

(<0.001)

Carbohydrate (%), mean±SD

Baselin 53.4±6.7 54.3±8.6 0.664 – – 53.8±7.7

Day 3 58.8±8.9 59.3±11.0 0.841 57.2±11.2 59.3±11.1 59.0±10.0 58.2±11.1

Day 4 56.8±9.3 57.0±10.9 0.935 57.1±10.3 59.7±10.4 58.3±9.9 57.1±10.5

Day 5 57.6±9.5 56.7±10.2 0.750 56.8±9.0 56.8±10.1 56.8±9.7 56.8±9.5

 Phase 1 Phase 2 Treatment mode

Ginger FO Ginger EO P  a Ginger EO Ginger FO Ginger FO Ginger EO

(group one) (group two) (group one) (group two)

Time 1.98 (0.142

F (P  )c Group×Time 0.16 (0.856

Group 1.66 (0.202

Protein (%), mean±SD

Baselin 17.5±4.6 16.7±4.4 0.513 – – 17.1±4.5

Day 3 16.3±5.1 15.4±4.0 0.446 16.6±5.2 15.9±5.7 16.1±5.4 15.9±4.6

Day 4 15.9±5.1 17.4±4.9 0.233 16.8±5.4 16.2±5.2 16.0±5.1 17.1±5.1

Day 5 15.6±4.6 17.2±6.8 0.280 16.6±5.6 16.1±4.4 15.8±4.5 16.9±6.2

Time 0.60 (0.551

F (P  )c Group×Time 0.99 (0.379

Group 2.23 (0.141

Fat (%), mean±SD

 Phase 1 Phase 2 Treatment mode

Ginger FO Ginger EO P  a Ginger EO Ginger FO Ginger FO Ginger EO

(group one) (group two) (group one) (group two)

Baselin 29.1±6.5 28.9±7.1 0.953 – – 29.0±6.7

Day 3 24.9±8.9 25.3±9.3 0.868 26.3±10.8 24.9±9.5 24.9±9.1 25.8±10.0

Day 4 26.1±7.9 25.6±9.9 0.824 26.0±8.8 24.1±8.5 25.7±8.5 25.8±9.3

Day 5 27.3±6.7 26.1±8.4 0.538 26.6±8.2 27.1±8.9 27.2±7.8 26.3±8.3

Time 2.05 (0.138

F (P  )c Group×Time 0.81 (0.451

Group 0.18 (0.675

Fibre (g), mean±SD

Baselin 6.0±3.9 6.1±3.3 0.977 – – 6.1±3.4

Day 3 5.6±3.8 5.6±3.0 0.989 5.3±3.4 5.8±3.3 5.7±3.5 5.4±3.2

Day 4 6.0±4.2 5.8±3.4 0.811 5.8±3.4 5.7±3.1 5.9±3.7 5.8±3.4

Day 5 5.4±3.9 6.2±3.9 0.407 5.9±3.2 6.2±3.2 5.8±3.1 6.0±3.5

 Phase 1 Phase 2 Treatment mode

Ginger FO Ginger EO P  a Ginger EO Ginger FO Ginger FO Ginger EO

(group one) (group two) (group one) (group two)

Time 0.92 (0.405

F (P  )c Group×Time 0.60 (0.552

Group 0.12 (0.732

 Group×Time, treatment group and time interaction.

 a
 Independent t ‐test; significant at P <0.05.
 b
 Paired t ‐test; significant at P <0.05.
 c
 Two‐way mixed design repeated measure ANOVA was applied adjusted for treatment
sequence assuming no carry over. No significant interaction between treatment sequence and
time (P >0.05). Overall, no significant mean difference by treatment sequence was detected.

Post‐hoc tests using a Bonferroni correction showed that the differences in energy intake
between each time point were all significant. For both measured variables (i.e. energy intake and
percentage meeting energy requirement), there was no significant interaction between time and
treatment groups or between time and treatment sequence. Overall, no significant mean
difference by treatment sequence was detected. Therefore, the results showed that the use of
inhaled ginger EO could elicit a statistically significant increase in energy intake in patients with
CINV, helping patients to meet their energy requirements. However, the mean differences in the
percentage of energy intake and fibre intake were all non‐significant with regard to time or
between treatment‐group comparisons.

Table 4 shows data from the post‐treatment questionnaire. More patients rated the ginger EO as
being more helpful than the ginger FO (63.3% vs. 61.6%). The most frequent positive comments
from patients following ginger EO inhalation included aiding to decrease intestinal gas, relieve
flatulence and alleviate bloating. The strength and pleasantness of both ginger oils were mostly
rated in the middle of the range, scoring from 4.3–5.0. The feasibility of aromatherapy treatment
delivered using a necklace was observed to be more on the positive side with a rating close to
six out of a maximum value of nine.
 Table 4. General perception of aromatherapy administration

Characteristics Ginger Ginger P  ‐

(n  =60) essential fragrance value
oil oil

Strength of 4.3±1.5 4.6±1.6 0.227b

odour,a mean±SD

Pleasant‐smelling of 4.6±1.9 5.0±2.0 0.393b

odour,a mean±SD

Feasibility of 5.7±2.0 5.9±2.0 0.341b

treatment,a mean±SD

Perceived treatment effect, n  (%)

Very helpful 8 (13.3) 5 (8.3)

Helpful 30 (50.0) 32 (53.3) 0.9999c

Less helpful 22 (36.7) 23 (38.4)

 a
 Scales ranged from one (very weak; very unpleasant; not feasible) to nine (very strong;
very pleasant; very feasible).
 b
 Paired t ‐test; significant at P <0.05.
 c
 McNemar test; significant at P <0.05, variable was recoded into dichotomous – helpful
and less helpful.

Discussion
Nutritional evaluation using BMI categorisation revealed that only 5% of participants were
underweight while the other 95% were normal, overweight or obese. The high proportion of
patients with normal or excess weight may sometimes compromise the identification of those in
need of dietetic intervention. Adding to this clinical concern, patients undergoing chemotherapy
experience many symptoms that negatively affect their dietary intake. Previous research has
demonstrated that nausea is the most common symptom experienced by patients undergoing
chemotherapy.4, 25-27 The symptom is a major concern as nausea has been found to adversely
affect dietary intake in 21–35% of patients receiving chemotherapy from 1 month to 1 year of
treatment.4 In our study cohort, half of the patients reported that nausea had caused them to limit
their food intake for at least 2 weeks after receiving chemotherapy. The impact of CINV
symptoms on dietary intake was particularly prominent during the early days post‐chemotherapy,
resulting in lower energy intake than the usual intake.

Despite presenting with CINV symptoms, energy and nutrient intake were within normal range,
with all patients meeting at least more than 80% of their energy requirements at baseline. Mean
protein intake was reported to be in excess of the actual requirement. Negative nitrogen balance
is still a major concern for cancer patients,28-30 especially among those who receive
chemotherapy since antineoplastic drugs are known to cause this side‐effect.31 Another study
indicates that a significant negative nitrogen balance may be experienced by cancer patients who
gain or maintain their weight while undergoing chemotherapy.32

Energy intake was significantly higher following ginger EO inhalation compared to ginger FO
inhalation. A significant improvement in energy intake was also observed over time, with patients
meeting almost 90% of their energy requirements at day 5 post‐chemotherapy. In our earlier
publication, we documented that there was a significant reduction in the severity of acute nausea
following inhaled ginger EO application.13 Dietary intake of cancer patients is usually
compromised by a variety of symptoms including nausea and vomiting.33-35 These symptoms
constitute barriers to dietary intake. Thus, it is conceivable that with improved control of nausea
and vomiting, spontaneous dietary intake could be improved. Although the improvement seemed
to be limited, even a slight increase in dietary intake could actually offer supportive measures to
prevent further deterioration in the nutritional intake and nutritional status of this vulnerable
population.

Several possible limitations of this study should be considered when interpreting the data. There
was a potential for selection bias attributable to the method used in recruiting the patients.
Patients with low literacy and a higher symptom burden were mostly declined from participating
in the study because of the requirement for the completion of a substantial list of self‐reported
instruments. Patients selected for this study therefore represented a more educated and
‘healthier’ sample of those affected by CINV. Although biochemical parameters such as serum
albumin and haemoglobin would have enhanced the results of the present study, all these
parameters were subject to homeostatic mechanisms and may be altered by underlying disease
and/or treatment.36 With regards to this issue, anaemia is the most common haematological
abnormality in cancer patients receiving chemotherapy, and serum albumin remains a non‐
specific parameter of nutritional status because of its relatively long half‐life and correlation with
stress and illness,37 hence limiting the value of such measurements.
Conclusion
Pada dasarnya, temuan kami menunjukkan bahwa manfaat positif tertentu dapat diamati melalui
penggunaan EO jahe inhalasi untuk CINV, mungkin dengan membantu pasien untuk
melanjutkan asupan makanan mereka. Pemberian EO jahe menggunakan kalung juga diterima
dengan baik oleh sebagian besar pasien. Memang, di era sadar biaya kita saat ini, di mana
perawatan hemat biaya terus-menerus dicari, intervensi aromaterapi ini bisa menjadi terobosan
penting dalam penelitian mendatang. Oleh karena itu akan sangat menggembirakan untuk
menggunakan temuan awal ini sebagai dasar untuk desain penelitian yang lebih besar, lebih
kuat merekrut sampel yang lebih besar dengan berbagai diagnosis kanker dan rejimen
kemoterapi untuk mengkonfirmasi kembali manfaat tepat dari intervensi aromaterapi yang
tersebar luas.

Konflik kepentingan
Penulis tidak memiliki konflik kepentingan untuk dinyatakan.

Referensi
Mengutip Sastra

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