Is ginseng effective for cancer-related fatigue?
| Response from Joanna M. Pangilinan, PharmD
Pharmacist, Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan
Cancer-related fatigue (CRF) is one of the most disabling and distressing sequelae of cancer and its treatments. Fatigue occurs in about 60%-100% of patients undergoing chemotherapy or radiation and can persist for up to 10 years after diagnosis and treatment. This side effect can be "paralyzing" and develop suddenly, with no relief from sleep.
Treatment for CRF includes management of contributory factors (eg, anemia), energy conservation (eg, scheduling rest and prioritization), proper nutrition, and exercise. Pharmacologic agents, primarily psychostimulants, have been evaluated, with mostly negative results. Certain dietary supplements and herbal preparations have also been studied (eg, coenzyme Q10, L-carnitine), with no success.
Interest in treating CRF with ginseng stems from positive results from preclinical data and pilot studies. Asian (Panaxginseng) and American (Panax quinquefolius) ginsengs are the 2 major species of ginseng. These species contain different amounts, strengths, and types of ginsenosides, the primary active ingredients of ginseng. Asian ginseng is grown in Korea, China, Japan, and Russia. American ginseng is grown primarily in the United States.
Although ginseng has been used for thousands of years, its pharmacotherapeutic properties are unclear. For many reasons, research evaluating ginseng for management of CRF can be very challenging.
Barton and colleagues performed a phase 3, multisite, double-blind, randomized trial evaluating the use of Wisconsin ginseng (P quinquefolius) (3% ginsenosides) 2000 mg daily vs placebo for 8 weeks in 364 patients with CRF. Fatigue was evaluated using the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF).
At 4 weeks, change from baseline MFSI-SF score in the ginseng group (n = 147) was 14.4 vs 8.2 in the placebo group (n = 153) (P = .07). At 8 weeks, the ginseng group (n = 138) had a change in score of 20 vs 10.3 in the placebo group (n = 133) (P = .003). Patients receiving active cancer therapy reported greater benefit than those who had completed treatment. Self-reported toxicities were similar between groups.
If ginseng use is considered, the authors suggest that 2 months of ginseng therapy may be required for "clinically meaningful results" to occur. In addition, because patients on active treatment had better results, ginseng may be better for prevention of CRF.
Controversy exists as to whether or not ginseng is estrogenic.[1,5] Barton and colleagues address this controversy and explain that in vitro studies found that ginseng derived from water extraction or pure ground root does not exhibit estrogenic properties, whereas ginseng derived with methanol extraction does.
Herbal products should be used with caution. Dietary supplements are not regulated for safety and efficacy by the US Food and Drug Administration. Patients should consult their healthcare provider before administration of ginseng or any dietary supplement. This is especially important in patients with cancer, because they may be susceptible to adverse effects and drug interactions, such as that between ginseng and warfarin. Because ginseng is a natural product, potency (and resulting efficacy and tolerability) may vary between lots.[1,6]
When possible, check whether a dietary supplement has been manufactured using good manufacturing practices or is verified by the US Pharmacopeial (USP) Convention. Products that have been voluntarily submitted to the Dietary Supplement Verification Program and meet testing and auditing criteria are awarded a USP Verified Mark. A Website is available to view USP Verified products.
Medscape Pharmacists © 2014 WebMD, LLC
Cite this: Joanna M. Pangilinan. Is Ginseng Effective for Cancer-Related Fatigue? - Medscape - Aug 01, 2014.