Ginseng has significant activity against fatigue in adults with cancer, according to a randomized trial.1 Eight weeks of treatment with ginseng significantly improved fatigue scores by 20% versus 10% for patients treated with placebo (P = .003). Moreover, ginseng was as safe as placebo in this preliminary trial.
Fatigue is almost universally common in patients treated for cancer, and many patients continue to experience fatigue for up to 10 years after their treatments are completed, explained lead author Debra Barton, RN, PhD, of the Mayo Clinic Cancer Center in Rochester, Minnesota. Erythropoietin had been used to treat cancer-related fatigue, but it is no longer used because serious adverse events were found to outweigh the benefits.
The trial enrolled 364 cancer patients being treated with curative intent at 40 sites; all patients reported at least moderate fatigue, reflected by a score of 4 or higher on a 10-point fatigue scale. Other causes of fatigue were ruled out, including anemia, pain, and insomnia.
Patients received double-blind, randomized assignment to 2000 mg/day of ground Wisconsin ginseng root in the form of 2 capsules or to placebo taken before noon for 8 weeks. Mean age was 55 years, about 80% were female, and about 90% were white. About 60% had breast cancer, and about 10% had colon cancer.
Pain scores improved over the course of treatment. At 4 weeks, a trend was seen favoring ginseng, according to change on the 100-point Multidimensional Fatigue Symptom Inventory score: an improvement of 14.4 points was reported with ginseng versus an 8.2 improvement in placebo patients (P = .07). By 8 weeks, scores improved by 20 points from baseline in the ginseng group versus 10.3 points with placebo (P = .003).
Rates of nausea, diarrhea, and vomiting were quite low and were similar in the 2 groups. Insomnia and anxiety were reported less often in the ginseng group than in the placebo patients. Grade 3 or 4 adverse events were reported in 8% and 6% of patients, respectively.
Formal discussant of this trial, Karen M. Mustian, PhD, MPH, of the University of Rochester, New York, commended the authors for using well-validated measures of cancer-related fatigue. “Ginseng has no discernible toxicity. This is only the second nutritional supplement to show effectiveness in reducing cancer-related fatigue,” she said.
The NCCN guidelines for cancerrelated fatigue recommend psychological intervention, physical activity, psychostimulants, and steroids.2 Mustian said, “It may be time to recommend specific nutritional supplements, such as ginseng.”
- Barton DL, Liu H, Dakhil SR, et al. Phase III evaluation of American ginseng (panax quinquefolius) to improve cancer-related fatigue: NCCTG trial N07C2. Presented at: 2012 Annual Meeting of the American Society of Clinical Oncology; June 2012; Chicago, IL. Abstract 9001.
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Cancer-Related Fatigue. Version 1.2012. http://www.nccn.org/professionals/physician_gls/pdf/fatigue.pdf. Accessed June 12, 2012.