Nausea and vomiting

Efficacy
The available evidence suggests hypnotherapy to be effective for anticipatory nausea and vomiting. Six RCTs (ranging from 20 to 70 participants) found positive effects. Five thereof found a reduction in emesis, and one found a reduction in antiemetic drug use.  

Safety
Generally considered safe when administered by qualified professionals. Contraindications include acute psychoses, severe personality disorders, and an inability to be hypnotized.

Read the full version of Hypnotherapy summary. 

Music interventions

Efficacy
The available data suggests music therapy to be effective for CINV. One SR (n=7 RCTs) found music therapy reduced CINV among gastrointestinal cancer patients. A second SR (n=1 RCT) found no significant effect.  

Safety
Generally considered safe with no safety issues on record. Caution is advised for acutely distressed and/or emotionally fragile patients, particularly in patients with serious and life-threatening cancers.

Read the full version of the Music interventions summary. 

Acupuncture

Efficacy
The available data on the effect of acupuncture on CINV are contradictory. Eleven SRs (ranging from 2 to 21 studies of mixed design) and 25 additional RCTs (ranging from 18 to 500 participants) have evaluated the effect of different types of acupuncture on nausea and vomiting. Two of the SRs found a positive effect on nausea and vomiting. Two SRs also showed positive effects, but the included studies were of poor methodological quality.  The remaining SRs showed inconclusive results. While 14 of the 25 additional RCTs showed positive effects, methodological limitations were identified in 10 of these studies. The remaining 11 studies reported no effect. 

Safety
Generally safe when administered by a professional qualified practitioner.  Mild adverse effects, such as pain or bleeding at the site of acupuncture can be expected in about 10% of all cases.  Serious complications seem to be very rare.  

Read the full version of the Acupuncture summary. 

Aromatherapy 

Efficacy
The available evidence on the effect of aromatherapy on CINV is contradictory. The results are based on one SR (n=9 RCTs). Four of the included RCTs reported positive effects of aromatherapy using different oils such as cardamom, peppermint, coconut, ginger, and chamomile. The remaining five trials reported no effect of aromatherapy on nausea and vomiting.  

Safety
Generally safe and only associated with minimal adverse effects when used in appropriate dilutions. Allergic reactions can occur with all oils. Should not be used undiluted.

Read the full version of the Aromatherapy summary.  

Astragalus spp

Efficacy
Few data on the effect of astragalus on CINV are available. One open-label RCT (n=136) found significant improvements in CINV.    

Safety
Generally, it is well tolerated and considered safe when good-quality products are used.  Safety research is needed, particularly for possible herb-drug interactions.  

Read the full version of the Astragalus spp summary. 

Biofeedback

Efficacy
Few data on the effect of biofeedback on CINV are available. One RCT (n=81) showed that biofeedback is not effective in reducing side effects of chemotherapy such as nausea and vomiting.  The study had six intervention groups that were small, so it is unclear if the study was powered.  

Safety
Biofeedback is generally considered safe and no adverse events have been reported in the included studies. Some concern for individuals with a history of psychiatric illness.  

Read the full version of the Biofeedback summary. 

Cannabis and cannabinoids

Efficacy
The available data on the effect of cannabis and cannabinoids on CINV are contradictory. Five RCTs evaluated the effect of cannabis and cannabinoids. Three RCTs (n=16, n=64, n=112) reported reduction or prevention of nausea and vomiting; however, two of the RCTs were of low methodological quality. The last two studies (n=40, n=56) reported no significant differences between the treatment and control groups.  

Safety
Cannabis and cannabinoids are generally considered safe.  Adverse effects on the central nervous system are common (e.g., mood changes, anxiety, memory disorders, loss of consciousness, hallucinations, blurred vision, dizziness, and dry mouth); these are dose dependent.  Caution is advised during pregnancy and lactation.  The risk of drug interactions is low.

Read the full version of the Cannabis and cannabinoids summary.  

Homeopathy

Efficacy
Few data on the effect of homeopathy on CINV are available. Two RCTs (n= 65, n=431) assessed the effect of homeopathy on nausea and vomiting. The results of the RCTs were mixed: one found no effect on CINV, while the other reported a significant difference in patient-reported vomiting during the third chemotherapy cycle.  

Safety
Generally safe and there are no serious direct risks associated with homeopathy. There are indirect risks if homeopathic preparations are used in place of conventional cancer treatment.  

Read the full version of the Homeopathy summary. 

Massage (Classical/Swedish)

Efficacy
The available evidence on massage for CINV is contradictory. Three SRs have been conducted (n=7 RCTs, n=8 RCTs, n=9 RCTs). In the SR with nine RCTs, two reported decreased nausea and vomiting during and after chemo. In the second SR, only one study found beneficial effects of massage. The last SR reported insufficient evidence.  

Safety
Generally considered safe when administered by a qualified professional. Contraindications include strong, forceful massage in patients suffering from haemorrhagic disorders, low platelet counts, and blood thinning medication.

Read the full version of the Massage summary. 

Mindfulness

Efficacy
Few data on the effects of mindfulness-based approaches for CINV are available.  One RCT of mindfulness-based stress reduction (n=474) found positive effects on nausea but not vomiting.  

Safety
Mindfulness-based approaches are generally considered safe in supportive cancer care. However, no rigorous assessment of their safety in cancer patients is available.

Read the full version of the Mindfulness summary. 

Progressive Muscle Relaxation

Efficacy
The evidence for the effect of PMR on CINV is inconclusive due to the low methodological quality of the available data. Two SRs (n=6 RCTs, n=3 RCTs) have been conducted; one review found positive effects on incidence, frequency, and degree. The second SR found a decrease in nausea and vomiting. However, one SR judged the evidence as low-quality; the other SR judged 3 RCTs as low quality and 3 RCTs as moderate quality. One RCT (n=30) was conducted among children and found no significant difference.  

Safety
Generally considered safe when administered by a qualified practitioner. Some concerns have been raised about the use of relaxation therapy interventions among individuals who have a history of psychiatric disorders.

Read the full version of the Progressive Muscle Relaxation summary. 

Reflexology

Efficacy
Few data on the effect of reflexology on CINV are available. One RCT (n=80) found that consumption of antiemetic drugs decreased among those who received reflexology treatment.  

Safety
Generally considered safe when administered by a qualified practitioner.  

Read the full version of the Reflexology summary. 

Therapeutic touch

Efficacy  
The available evidence on therapeutic touch for CINV is inconclusive. One RCT (n=108) found short-term effects in patients with breast cancer, but the study was of low methodological quality.  

Safety
Generally considered safe when administered by a qualified practitioner, no serious safety concerns are known.

Read the full version of the Therapeutic touch summary. 

Yoga

Efficacy
Few data on the effect of yoga on CINV are available. A SR of yoga including one RCT specifically evaluating nausea found that yoga practice led to improvements in nausea alongside reductions in anxiety, gastrointestinal distress, and emotional irritability. An additional RCT (n=100) found that vomiting but not nausea improved among those participating in a yoga regimen. The study neglected to report details on the methods hence the reliability is unclear.  

Safety
Generally considered safe when administered by a qualified practitioner. Few adverse events are reported in clinical trials, and serious adverse effects appear to be rare. Overall, injury rates are comparable to other exercise types.

Read the full version of the Yoga summary. 

At the time of assessment, the available evidence did not suggest no effects for any of the treatments evaluated by CAM Cancer for this symptom.