The Effects Of Selective Ginger-separated Moxibustion Pretreatment On Nausea And Vomiting To Breast Cancer Patients After First Chemotherapy

Objectives:To observe the differences in Chemotherapy-related gastrointestinal reactions,quality of life and safety among four groups of breast cancer patients after first chemotherapy,which are ginger-separated moxibustion treatment,selective ginger-separated moxibustion treatment,ginger-separated moxibustion pretreatment and selective ginger-separated moxibustion pretreatment;to investigate the preventive effect of selective ginger-separated moxibustion pretreatment on the severity and incidence of CINV in breast cancer patients to provide an evidence-based basis and theoretical reference for clinical practice.Methods:A random number table method was used to randomly divide 128 patients who met the inclusion criteria for first chemotherapy for breast cancer attending the Cancer Hospital of the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from November 1,2021 to November 30,2022 into four groups of 32 cases each.The severity of patients’nausea,acute vomiting,delayed vomiting and appetite status were assessed on days 1,2,3 and 7 of chemotherapy using the WHO antineoplastic drug side toxicity and effect classification criteria.The vomiting control effect of patients remediated with toltestrone hydrochloride was assessed using the vomiting control effect evaluation criteria.The quality of life of patients was assessed using the Karnofsky performance score criteria.And the safety grade evaluation criteria were used to assess patients’chemotherapy concomitant symptoms and complications of ginger-separated moxibustion.Excel and SPSS 26.0 were used for statistical and analysis of the data.Results:1.Comparison of the severity of chemotherapy-related gastrointestinal reactions（1）Comparison of the severity of chemotherapy-related nauseaThere was a statistically significant difference in the severity of chemotherapy-related nausea in the four groups of patients(Waldχ2_groups=18.375,P<0.001),and a statistically significant difference in the severity of nausea on days 1,2,3,and 7 of chemotherapy in the four groups of patients(Waldχ2_time=79.259,P<0.001),but there was no interaction effect between groups and time(Waldχ2_interaction=10.351,P>0.05).The severity of chemotherapy-related nausea in the four groups of patients was statistically different by nonparametric rank sum test on days 1,2,3,and 7 of chemotherapy respectively（H=12.877-17.035,P<0.05）.（2）Comparison of the severity of chemotherapy-related vomitingThere was a statistically significant difference in the severity of chemotherapy-related acute vomiting in the four groups（H=16.370,P<0.05）.There was a statistically significant difference in the severity of chemotherapy-related delayed vomiting in the four groups(Waldχ2_groups=12.364,P<0.05),and statistically significant differences in the severity of delayed vomiting on days 2,3,and 7 of chemotherapy in the four groups of patients(Waldχ2_time=76.085,P<0.001),and there was an interaction effect between groups and time(Waldχ2_interaction=18.898,P<0.05).The severity of chemotherapy-related delayed vomiting in the four groups of patients was statistically different by nonparametric rank sum test on days 2,3 and7 of chemotherapy respectively（H=8.062-15.461,P<0.05）.There were statistically significant differences in the severity of chemotherapy-related vomiting in the four groups of patients when compared on days 1,2,3,and 7 of chemotherapy（H=8.062-16.370,P<0.05）.（3）Comparison of the severity of appetiteThere was a statistically significant difference in the appetite status during chemotherapy in the four groups of patients(Waldχ2_groups=15.902,P<0.05),and a statistically significant difference in the severity of appetite on days 1,2,3,and 7 of chemotherapy in the four groups of patients(Waldχ2_time=82.569,P<0.001),but there was no interaction effect between groups and time(Waldχ2_interaction=5.522,P>0.05).2.Comparison of CINV incidenceThe overall incidence of CINV of the patients in the selective ginger-separated moxibustion pretreatment group showed a decreasing trend.The incidence of chemotherapy-related nausea in the four groups of patients was statistically different by chi-square test on days 1,2,3,and 7 of chemotherapy respectively（χ2=8.318-16.193,P<0.05）.There were statistically significant differences in the incidence of chemotherapy-related vomiting in the four groups on days 1-3 of chemotherapy（χ2=12.718-20.277,P<0.05）;but there was no statistically significant difference in the incidence of chemotherapy-related vomiting in the four groups of patients on day 7 of chemotherapy（P>0.05）.3.Comparison of remedial treatmentThere was a statistically significant difference in comparing the number of cases requiring remedial treatment with toltesetron hydrochloride in the four groups of patients（χ2=8.515,P<0.05）;a two-by-two comparison between groups showed that only the AD group had a statistically significant difference in remedial therapy（χ2=7.585,P<0.05）,while the rest of the groups had no statistically significant difference（P>0.05）.There were no statistically significant differences in the four groups of patients in comparing the effectiveness and efficiency of vomiting control after remedial treatment with toltestrone hydrochloride（P>0.05）.4.Comparison of Karnofsky performance scoreThere was a statistically significant difference in the quality of life after intervention in the four groups of patients（F=5.186,P<0.05）;a two-by-two comparison between groups showed that the quality of life scores after intervention in groups B,C and D were significantly higher than those in group A（P<0.05）,but there was no statistically significant difference among the three groups of B,C and D（P=0.148-0.716>0.05）.5.Comparison of safetyThere were statistically significant differences in the incidence of chemotherapy-related bloating,constipation,and headache in the four groups of patients（χ2=8.095-11.897,P<0.05）,but there was no statistically significant difference in the incidence of chemotherapy-related dizziness（P>0.05）.None of the patients in the four groups had serious complications from ginger-separated moxibustion therapy,but the difference was statistically significant when the safety level was assessed by combining the concomitant symptoms related to chemotherapy（H=11.596,P<0.05）.Conclusions:1.Selective ginger-separated moxibustion treatment,ginger-separated moxibustion pretreatment,and selective ginger-separated moxibustion pretreatment can significantly improve the severity of CINV in breast cancer patients,reduce its incidence,and reduce the remedial treatment of Western medicine.The efficacy of selective ginger-separated moxibustion pretreatment to prevent delayed vomiting is more significant.2.Selective ginger-separated moxibustion treatment,ginger-separated moxibustion pretreatment,selective ginger-separated moxibustion pretreatment can reduce patients’subjective discomfort,stabilize patients’physiological state and improve patients’quality of life.3.Selective ginger-separated moxibustion treatment,ginger-separated moxibustion pretreatment,selective ginger-separated moxibustion pretreatment did not increase complications related to moxibustion therapy such as pruritus and blisters,and had a significant efficacy in preventing concomitant symptoms related to chemotherapy,especially abdominal distension,constipation and headache,which could enhance the safety of the trial.4.The efficacy of selective ginger-separated moxibustion pretreatment on CINV was better than that of selective ginger-separated moxibustion treatment and ginger-separated moxibustion pretreatment,and both selective treatment and pretreatment functioned independently and did not interfere with each other.