Ginseng Fights Fatigue in Cancer

ASCO: Ginseng Fights Fatigue in Cancer

By Crystal Phend, Senior Staff Writer, MedPage Today
Published: June 05, 2012
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania.

CHICAGO -- Ginseng appears to counteract the fatigue often associated with cancer, according to randomized trial results.

After 8 weeks taking supplements of the ground-up root, fatigue scores among cancer patients dropped 20% compared with 10% on placebo pills (P=0.003), Debra Barton RN, PhD, of the Mayo Clinic Cancer Center in Rochester, Minn., and colleagues found.

Ginseng appeared as safe as placebo, at least over the short term, they reported here at the American Society of Clinical Oncology meeting.



"This is an exciting finding because there are no or limited choices at this point" in treating cancer-related fatigue, commented Sriram Yennu MD, MS, of the MD Anderson Cancer Center in Houston.

Nearly all cancer patients experience fatigue, most commonly when starting cancer treatment but often persisting to some degree after completion.

Erythropoietin drugs had been effective but their use was brought to a halt by discovery of serious mortality and cardiovascular or venous thromboembolism risks.

Roughly 80% of cancer patients take some form of complementary medicine, Yennu told MedPage Today in an interview. Ginseng is a popular choice, so the trial results are reassuring in that regard, he noted.

In traditional Chinese medicine, ginseng is seen as a natural energy booster. It's thought to be anti-inflammatory or it may work through control of the stress hormone cortisol.

The minimal side effect profile suggests that trying out ginseng for 4 to 8 weeks to see if a patient benefits is reasonable, he suggested.

"Still I would not say this is a standard therapy yet," Yennu cautioned. "We need further studies to confirm the safety."

Barton's phase III trial included 364 cancer patients at 40 sites who reported at least moderate fatigue (a score of 4 or more on a 10-point fatigue scale) for which other causes like anemia, pain, and insomnia could be ruled out.

Participants received double-blind treatment with 2,000 mg of ground Wisconsin ginseng root taken as two capsules separately before noon or placebo.

At 4 weeks, the ginseng group showed a trend for benefit in Multidimensional Fatigue Symptom Inventory score change. Scores improved by 14.4 points on the 100-point scale with the pills compared with an 8.2-point improvement in the placebo group (P=0.07).

At 8 weeks, the advantage reached statistical significance for this primary endpoint. Scores improved by 20 points over baseline in the ginseng group versus 10.3 points with placebo (P=0.003).

The effect appeared driven by reductions in physical aspects of fatigue with a 3-point improvement on the 10-point physical subscale of the symptom inventory compared with a 1.7-point worsening in the placebo group at 8 weeks (P=0.004).

Mental, emotional, and vigor components weren't significantly changed between groups.

Ginseng appeared most effective among patients currently on cancer treatment. The effect on fatigue compared with placebo was significant at P=0.01 for them but only reached a nonsignificant trend among those with fatigue left after cancer treatment (P=0.07).

The most common side effects reported on ginseng over 8 weeks were an about 5% rate of nausea compared with about 4% in the placebo group and a roughly 4% rate of loose stool versus 3% with placebo.

Vomiting was also reported by 1% to 2% of patients taking ginseng, although trouble sleeping, anxiety, and nervousness were reported somewhat less often with the supplement.

Grade 3 or 4 events, regardless of attributed cause, occurred in 8% of ginseng-treated patients and 6% of placebo-group patients without a significant difference between the two groups. Life-threatening events included dizziness, leukopenia, and neutropenia.

"Wisconsin ginseng is not associated with discernible toxicity," Barton's group concluded.

But further study is needed to determine long-term safety and efficacy, as cancer-related fatigue can persist for a decade, Yennu noted.