| Summary: | The burden that chemotherapy-induced nausea and vomiting (CINV) places on cancer patients is undoubtedly substantial and its inadequate control can lead to nutritional deficiencies and pose negative impacts on patient'sHRQoL. These specific issues were explored during the first three studies. Firstly, a cross-sectional study using convenience sampling was conducted in two government hospitals in Terengganu and Kelantan enrolling 41 female breast cancer patients undergoing chemotherapy treatment. The following aspects were evaluated: incidence of CINV [Morrow Assessment of Nausea and Emesis Follow-up (MANE-FU), body weight status, usual dietry intake (diet history) and HRQoL [European Organization for Reasearch and Treatment of Cancer Quality of Life Questionnaire (EORTC QLC-C30)]. This study generally ascertained that CINV remained poorly controlled with 90.2% of patients experiencing nausea and rated it as 'severe' (48.7%). CINV significantly interfered with patients HRQoL status, was particularly associated with Fatigue and Pain (p<0.05). Despite most patients declaring weight loss (46.0%), obesity and excess dietry intake were somehow noted (energy intake= 1,792.6 ± 304.9kcal/day vs. daily requirement= 1,606.6 ± 132.4 kcal/day; p=0.001). The nutritional status of chemotherapy breast canser patients was then investigated in the second study, aiming to evaluate the magnitude and frequency of weight changes during chemotherapy as well as its possible association with event-free survival (EFS). This retrospective study in Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu involved 63 women diagnosed with breast cancer who have been treated by anthracycline-based chemotherapy between 2005 and 2011. A small weight reduction was observed (-0.8 ± 4.0kg; p=0.106 and a weight change during the treatment period was significantly associated with shorter event-free survival (p=0.044). Another key to better understanding of CINV of symptoms is to gather information from patients' subjective experience. Subsequently, a qualitative study which was also the third study was conducted (as part of a final intervention study) among 13 selected patients to obtain in-depth descriptive data on their experiences related to CINV symptoms and its impact on daily life. Communicating about CINV, particularly nausea was a challenge to this group of patients. Depending on its severity and duration, different impacts on food intake, social interaction, sleeping patterns, and fatigue were highlighted by patients, confirming that CINV remained a problem. On the other hand, a growing literature recently provides evidence that ginger is a promising anti-emetic, and aromatherapy recognised as an effective treatment for nausea in general. Consequently, an intervention study was designed to evaluate the impact of aromatherapy using ginger essential oil in alleviating CINV in breast cancer patients. A single-blind, randomized, controlled, cross-over study was conducted in two government hospitals in Terengganu and Kelantan. Patients received 5-day aromatherapy treatment using either ginger essential oil (EO) or fragrance-matched artificial placebo [ginger fragrance oil (FO) which was instilled in a necklace in an order dictated by the treatment group sequence. Of the 75 patients randomized; 30 of 37 patients in Group 1 (first received ginger FO, then ginger EO) and 30 of 38 patients in Group 2 (first received ginger EO, the ginger FO) completed all study procedures, hence 60 patients were included in the final data analysis. The results demonstrated that VAS nausea score was significantly lower after ginger EO inhalation compared to ginger FO during acute phase (p=0.040) but not sustained for overall treatment effect (treatment effect : F= 1.82, p=0.183; time effect: F=43.98, p<0.001; treatment x time effect: F= 2.04; p=0.102). The benefits of aromatheraphy intervention on CINV had also helped improve dietry intake and HRQoL status. In summary, CINV is still prevalent, compromising nutritional status and often impacts patients' HRQoL. The evidence from this study is somehow promising - inhaled ginger aromatherapy could be an effective complementary therapy for CINV, especially its psychological and nutritional effects. Future studies with an additional control arm (no treatment) would permit a more accurate comparison for similar outcomes.
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