Use of ginseng for cancer-related fatigue shows mixed results
Fatigue is one of the most distressing and common symptoms cancer patients experience. An estimated 80% of patients receiving chemotherapy, and 65% to 100% receiving radiation, experience cancer-related fatigue (CRF). Fatigue may continue for up to 10 years following treatment, affecting quality of life and daily functioning.
Nonpharmacologic therapy is essential in managing CRF. These approaches include careful planning of activities by setting priorities, conserving energy through use of elevators, limiting naps to less than 1 hour, and so on. Exercise and resistance training, psychosocial therapy, and nutrition consultation may improve CRF. In addition, underlying conditions such as pain should also be addressed. The use of drug therapy for CRF has not had positive outcomes. When a benefit has been identified, the studies were generally open label or not randomized.
American ginseng (Panax quinquefolius) has been investigated for treatment of CRF. Preclinical data support the efficacy of ginseng, which is largely attributed to its proposed tempering effects on cortisol and inflammation.
A pilot study conducted by the North Central Cancer Treatment Group randomized 290 patients who were completing, or had previously completed, cancer treatment to placebo or three different dosages of American ginseng for 8 weeks. As measured by the Brief Fatigue Inventory (BFI) scale, daily dosages of 1,000 mg and 2,000 mg demonstrated some efficacy.
These preliminary data led to a double-blind, placebo-controlled trial that enrolled 364 patients from 40 treatment centers.1 The ginseng dosage was 2,000 mg, divided twice daily. Eligibility requirements were the presence of fatigue for at least 1 month, with a fatigue score of at least 4 on a scale of 0 to 10 (10 indicating fatigue “as bad as it can be”). Patients were either undergoing or had completed curative intent treatment. The primary outcome measure used the Multidimensional Fatigue Symptom Inventory–Short Form (MFSI–SF), a six-item scale that assesses the subjective fatigue experience. Other assessments included the BFI and the Profile of Mood States. Assessments were conducted at baseline, at 4 weeks, and at 8 weeks. Patients also assessed fatigue, pain, and sleep using the 0 to 10 scale each week.
At baseline, the groups were similar: most participants were women, the mean age was 55, half were still receiving treatment, and fatigue assessments were similar between groups. The MFSI–SF improved in the ginseng arm at 4 weeks compared with the placebo group; however, the results were not statistically significant (primary endpoint). At 8 weeks, the differences in MFSI–SF showed statistically significant improvements with ginseng.
Other scales did not show an improvement. Patients who were still receiving cancer treatment had a greater improvement than those who experienced continued fatigue following cancer treatment.
The authors concluded that benefits from ginseng may take 2 months to be clinically relevant. Of concern, however, was that the results were not consistent among the different fatigue assessments used. A 6-minute walk test, which can also greatly assist in fatigue assessment, was not conducted. Further research into the effects of ginseng is warranted.
Studies of ginseng for CRF have had mixed results. Although generally safe, ginseng has been demonstrated to possess estrogenic properties and therefore may not be appropriate to use in hormone-sensitive cancers such as breast cancer. Ginseng has antioxidant effects that might interfere with hormonal therapy and with some chemotherapy drugs that have oxidation mechanisms, such as bleomycin and anthracyclines. Counsel patients to discuss their interest in this botanical with their oncology team. Nonpharmacologic therapies should always be maximized.
- J Natl Cancer Inst. 2013;105:1230–8.