Nausea is a common side-effect in patients who are undergoing chemotherapy. Despite the use of powerful anti-nausea medication such as ondansetron (Zofran, GlaxoSmithKline) and granisetron (Kytril,Roche), many patients still experience significant nauseous feelings. This can affect food intake and adds to the unpleasantness of undergoing chemotherapy.

Researchers from the University of Rochester are going to present the results of a study on the use of ginger in patients undergoing chemotherapy, at the upcoming 2009 Annual Meeting of the American Society of Clinical Oncologists (ASCO). Six hundred and forty four, primarily female (90%), patients (from the University of Rochester-affiliated Community Clinical Oncology Programme) were randomly assigned to receive a placebo or 0.5 gm, 1.0 gm or 1.5 gm of ginger in capsule form. All patients undergoing chemotherapy received 5-HT₃ receptor antagonist antiemetics – ondansetron (Zofran, GlaxoSmithKline) or granisetron (Kytril, Roche) – starting on day 1 of all chemotherapy cycles and began supplementation with either ginger or placebo 3 days before the first day of a chemotherapy cycle. The ginger was given in 2 doses daily for 6 days. The degree of nausea was rated on a 7-point scale during the first 4 days of each chemotherapy cycle. The study found that all doses of ginger significantly reduced nausea more than the placebo. Patients taking ginger capsules rated their nausea as 1, which was none at all, or 2, which was slight nausea. Patients who were taking placebo rated their nausea as 4, which was extremely nauseated. The greatest anti-nausea effect was with the 0.5 gm and 1.0 gm doses, which is equivalent to ¼ and ½ a teaspoon of ground ginger, respectively.

Ginger, the rhizome of Zingiber officinale Roscoe (Zingiberaceae), has been used as a spice and condiment in many societies since time immemorial. It has also been use as a medicine for treating common colds, fever, rheumatic disorders, gastrointestinal complications, motion sickness, diabetes and cancer. If we can prevent nausea with the help of ginger, it would indeed be a relief for many patients who are undergoing chemotherapy. Furthermore, the cost of ginger capsules would be negligible compared to the cost of the chemotherapeutic agents.

Perhaps, one day, the serving of ginger cakes and biscuits to patients in a chemotherapy centre will be a common sight!

Some of us may find the constant reminder that one should eat healthily, exercise regularly and maintain a normal BMI annoying. The attitude is born out of either a sense of denial or belief: denying that the ill effects of having an unhealthy lifestyle will ever affect one’s health or believing that destiny and not lifestyle will determine if one gets seriously ill or not. Perhaps a recent report from the University of California might make these individuals reconsider.

Researchers studied changes in the prostate gene expression in men, with low-grade prostate cancer, who underwent intensive lifestyle and nutrition intervention over a period of 3 months (PAS 2008; 105: 8369 – 8374). Thirty one men with low-grade prostate cancer, who declined immediate surgery, hormonal therapy or radiation, participated in the study. They agreed to a comprehensive lifestyle change instead. A prostate biopsy was performed prior to initiation of the lifestyle change programme. The 3 month lifestyle modification comprised of a 3-day intensive residential retreat followed by weekly outpatient follow-up by a study nurse. The modifications included a low fat (10% of calories from fat), whole foods, plant-based diet; stress management 60 minutes / day (gentle yoga-based stretching, breathing, meditation, imagery and progressive relaxation), moderate aerobic exercise (walking 30 minutes / day for 6 days / week) and a one hour group support session per week. The diet was supplemented with soy (one daily serving of tofu plus 58 gm of a fortified soy protein powdered beverage), fish oil (3 gm daily), vitamin E (100 units daily) selenium (200 mg daily) and vitamin C (2 gm daily). Another prostate biopsy was performed at the end of the 3 months intervention. The gene expression from the normal prostate tissue obtained before and after the lifestyle changes was compared. At the end of 3 months, they found 48 genes up-regulated and 453 genes down-regulated (simplistically, up-regulation means switched on and down-regulation means switched off) in the prostate tissue. The pathways under the control of these genes were found to be involved in tumorigenesis (formation of tumours). For example, they found a set of down-regulated RAS family oncogenes (RAN, RAB14 and RAB8A). In the prostate, RAN may function as an androgen receptor coactivator and its expression is increased in tumour tissues. (Androgen stimulates prostate cancer to grow and oestrogen can suppress prostate cancer growth. Hence, one of the treatments for prostate cancer is to castrate the patient and remove testosterone, an androgen, from circulation. This manoeuvre will then deprive the prostate cancer its driving force, thus, slowing its growth.)

While this study involves only a small number of patients, if its findings are shown to be true in subsequent larger studies, it will make us sit up and take note. We can no longer blame it all on fate or parents for passing on ‘bad’ genes. In the meantime will you continue with your unhealthy lifestyle habits or might you, just to be on the safe side, adopt a more healthy lifestyle?

Recently, a lady from Malaysia consulted me for a second opinion as she had been diagnosed with stage IV pancreatic cancer. Apart from a history of epigastric discomfort, early satiety and slight loss of weight, she felt fine. The CT scan showed a locally advanced pancreatic cancer with metastases to the liver. The family wanted to know why she developed the cancer. Was it something she had eaten, drunk or something she had come into contact with?

Researchers from the National Cancer Institute, USA, studied the link between 5 lifestyle factors and the risk of pancreatic cancer in 450,416 participants in the National Institutes of Health-AARP Diet and Health Study (Arch Intern Med 2009; 169: 764 – 770). During 1995 – 1996, these participants completed a baseline frequency questionnaire eliciting diet and lifestyle information and were followed up through 31^st December 2003. The participants were scored on 5 modifiable lifestyle factors as unhealthy (0 points) or healthy (1 point), receiving 1 point each for non-smoking, limited alcohol use, adherence to the Mediterranean dietary pattern, body mass index (BMI, ≥ 18 and < 25) and regular physical activity. A combined score of 5 meant most healthy and a score of 0 meant least healthy.

The distribution of lifestyle scores was 1.5%, 10.7%, 27.8%, 31.3%, 21.1% and 7.6% for scores of 0, 1, 2, 3, 4 and 5, respectively. Those with higher scores tended to be older, were less likely to be African-American and had a higher educational level. Having a combined lifestyle score of 5 was associated with a 58% risk reduction for pancreatic cancer. Non-smoking and normal BMI were associated with a statistically significant reduction of pancreatic cancer risk. Among the 5 risk factors, non-smoking had the higher population-attributable risk of 14%; that is 14% of cases would have been prevented if all participants were non-smokers.

Among cancers, pancreatic cancer incidence among men and women is 9^th and 10^th respectively. However, the mortality rate is worse compared to other more common cancers and it ranks 4^th among men and women. It carries a much poorer prognosis because the pancreas lies deep at the back of the abdominal cavity. It tends to grow to a more advanced stage before giving symptoms. In order to reduce the burden of this disease we should think more in terms of prevention. The simplest preventative measures should start with what we do and what we eat / drink. We need to modify our lifestyle habits in order to reduce our risk for pancreatic cancer.

As the saying goes - you reap what you sow!