Extended Abstract
1. Introduction
Cancer is one of the most common diseases and problems in human societies. According to studies, breast cancer is the third most common cancer in the world and is the second leading cause of death among women after lung cancer. The treatment of breast cancer is complex and includes chemotherapy, radiotherapy, and surgery. Chemotherapy is one of the main, oldest, and most common cancer treatments that have the greatest impact on patients’ quality of life following cancer, causing disruption to their physical, mental, social, and spiritual well-being.
Among these complications, nausea and vomiting are the most common side effects of these drugs experienced by about 40-80% of patients. These complications caused by chemotherapy has a devastating effect on patients’ quality of life. These complications can be disruptive in many ways. The attempts to treat nausea and vomiting have not been effective and 60% of these patients still suffer from nausea and vomiting. On the other hand, various nausea and vomiting medications such as dexamethasone, metoclopramide, and ondansetron may lead to complications such as headache, dizziness, constipation, insomnia, and extrapyramidal effects. Therefore, nowadays, complementary therapies are used to treat this complication along with conventional treatments. This study aimed to investigate the effect of sucking sucking ice bits with plain water on nausea and vomiting during chemotherapy in patients with breast cancer.
2. Materials and Methods
This is a clinical trial conducted on 60 patients with breast cancer who referred to oncology ward of Omid Hospital in Mashhad, Iran from September to November 2015. They all were receiving adriamycin and cyclophosphamide for treatment of chemotherapy regimen. They were randomly divided into two control and intervention (ice) groups. Data collection tools included a demographic form (surveying age, educational level, marital status, disease grade), Visual Analogue Scale (VAS) for evaluating nausea, and a table for recording the number of vomiting cases completed by the patient, his/her companion or, if necessary, by the researcher.
The intervention was performed in both groups from 5 minutes before starting chemotherapy until the end of receiving chemotherapy medications. At first, both groups went under nausea and vomiting evaluation by using VAS. In the control group, in addition to routine treatment (granisetron and dexamethasone), patients received 30-cc tap water to consume 5 min before and during chemotherapy, and then their nausea and vomiting were checked in the end of chemotherapy. In the ice group, in addition to routine treatment (granisetron, dexamethasone), patients received  30 1×1 ice bits containing 1-cc plain water to consume every 5 min (before and during chemotherapy), and in the end of chemotherapy, nausea and vomiting rates were recorded in both groups. In the end, the data were compared and analyzed in SPSS V. 16 software using t-test.
3. Results
The study groups were compared in terms of demographic characteristics using Chi-square and independent t-test whose results showed no significant difference between them. they were also homogenous in terms of nausea and vomiting rate before the intervention, but after the intervention, the mean of nausea in the ice group (1.28±1.9) and the control group (1.787±2.9) showed the significant difference between groups which indicates the effectivness of intervention (p<0.015); however, the obtained mean of vomiting in the ice group (0.406±0.2) and control group (0.449±0.226) indicated no significant difference between groups (P>0.549).
4. Conclusion
According to the results of this study, using ice containing plain water  is recommended as a non-invasive, simple, and inexpensive, method with no side effects along with pharmacotherapy to reduce nausea in breast cancer patients. However, our findings on vomiting showed no effect of sucking ice containing plain water. Hence, further studies with larger sample sizes are recommended.
This study had some limitations. For example, due to the course of the disease and the condition of the patients with breast cancer, they felt a sense of belonging and ownership of their environment and medical staff; therefore, establishing communication with patients to carry out a research project was very difficult. It was resolved somehow by the collaboration of experienced chemotherapy personnel. Also, in this study, patients were not homogenized in terms of the number of chemotherapy sessions, which should be noted.
Ethical Considerations
Compliance with ethical guidelines
This study was extracted from a research proposal approved by the Research Ethics Committee of Sabzevar University of Medical Sciences (Code: IR.MEDSAB.REC.1394.53). It is also a registered clinical trial (code: IRCT20160606028293N2).
Funding
This study received financial support from the Sabzevar University of Medical Sciences.
Authors' contributions
Conceptualization, sampling and draft preparation by Mohammad Haddadi, Hamid Robat Sarpooshi and Javad Ganjloo; consulting for the identification and evaluation of patients by Hamid Reza Hashemifard; Data analysis by Yasser Tabarraie.

Conflicts of interest
The authors declare no conflict of interest.
Acknowledgements
The authors would like to thank the patients and the emergency department staff of the Omid Hospital in Mashhad, Iran for their valuable cooperation and support.