PURLs

Finally, a way to relieve cancer-related fatigue

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WHAT'S NEW: The first evidence-based therapy for cancer-related fatigue

We now have good evidence that American ginseng 1000 mg twice daily is safe and effective for ameliorating cancer-related fatigue. Before this study, no other effective treatments had been identified.

CAVEATS: Ginseng may not help patients who've finished cancer treatment

In this study, ginseng did not improve fatigue at 4 weeks, which was the primary outcome, although benefits were noted after 8 weeks of treatment. Interestingly, though, participants who were receiving radiation and/or chemotherapy during the study experienced significant improvements at 4 and 8 weeks, while those with previous (but not current) treatment did not significantly improve at either time point.

Coadministration of ginseng and warfarin may reduce both warfarin concentrations and a patient's INR.It may be that ginseng works best to ameliorate cancer-related fatigue in patients simultaneously receiving cancer treatment, but not in those who have completed treatment. The findings also suggest that patients who have completed treatment may wish to try ginseng for longer than 8 weeks to see if it offers any benefit.

Because this study excluded patients with brain cancer, CNS lymphoma, moderate to severe pain, or insomnia and those taking steroids, it is not known if ginseng would help them.

In one study, a low-dose methanolic extract of American ginseng caused a breast cancer cell line to proliferate; however, it was later discovered that this extract had been contaminated with Fusarium fungi containing zearalenone, which has strong estrogenic activity.9,10 However, higher doses of a similar methanolic extract, as well as other water-based extracts, have reduced proliferation of breast cancer cells.11

Proceed carefully if a patient is taking warfarin. Coadministration of ginseng and warfarin may reduce both warfarin concentrations and a patient’s international normalized ratio (INR).12 Therefore, carefully monitor INR in patients concurrently taking ginseng and warfarin. Furthermore, ginseng may lower blood glucose in patients with diabetes, so carefully monitor blood glucose in these patients when initiating or discontinuing ginseng.13

CHALLENGES TO IMPLEMENTATION: With ginseng, it's hard to know exactly what you're getting

Advise patients to obtain American ginseng products that contain at least 3% ginsenosides.Regulating dietary supplements has been a challenge for the US Food and Drug Administration, especially verifying ingredients and potency. Although ginseng commonly is adulterated, much of the adulteration occurs with the Asian species (Panax ginseng) rather than the American species (Panax quinquefolius) used in this study.10 Physicians who want to recommend ginseng for cancer-related fatigue should advise patients to use American ginseng root products produced in the United States. Additionally, ginseng products should contain at least 3% ginsenosides to match the dose used in this study.

ACKNOWLEDGEMENT
The PURLs Surveillance System was supported in part by Grant Number UL1RR024999 from the National Center For Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center For Research Resources or the National Institutes of Health.

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