If you’re undergoing chemotherapy and taking herbal supplements at the same time, you’re not alone. In fact, surveys have shown that a significant percentage of cancer patients using chemotherapy also take herbal supplements. For example, a 2009 UK systematic review of published studies found that the usage of herbal medicines ranged from 3.1% to 24.9% of cancer sufferers.1
The reasons for this are many. An Australian survey of breast cancer patients published in 2008 shed some light on the reasons for the use of vitamin and herbal remedies:2
- To improve physical well-being (major reason)
- To boost the immune system (major reason)
- To reduce chemotherapy side effects (major reason for herbs only)
- To improve emotional well-being
- To prevent recurrence
- To assist in treating the cancer
- To reduce symptoms
In my clinical experience the reason most patients decide to take herbs during chemotherapy is simple… empowerment. Using herbs allows them to take some control back by being an active participant and trying to do everything possible to achieve the best outcome. A key part of this goal is to minimise the often terrible and debilitating side effects of the drug treatment.
But is such a practice safe and beneficial? Do herbal treatments interfere with the chemotherapy? In the light of such uncertainties it is best to take an evidence-based approach. In an article featured in the June 2011 issue of Nutrition & Healing, I examined the evidence for milk thistle to protect the liver during chemotherapy and suggested that it did have value. There are a few other herbs also worth discussing in this context. Tonic and adaptogenic herbs have always been thought to have non-specific (whole body) antitoxic effects. Because they improve the resistance of the whole body to the stressor, in this case the chemotherapy, they are unlikely to interfere with its effects at a cellular level. The adaptogenic herb with the best evidence supporting it is ginseng.
In a key long-term Korean study, the impact of red ginseng (Panax ginseng) therapy on postoperative immunity and survival was investigated in patients with gastric cancer.3 Forty-nine patients who had undergone gastric resection with lymph node removal by the same surgeon for histologically-proven AJCC (American Joint Committee on Cancer) stage III gastric adenocarcinoma were enrolled in the trial. After the application of predefined exclusion criteria, 22 patients were given ginseng (4.5 g/day) for the first six months after surgery and 20 acted as placebo controls. All patients were also treated with chemotherapy each month for 6 months after surgery. The study demonstrated five-year disease-free survival and overall survival rates that were significantly higher in patients taking ginseng compared to controls (68.2% versus 33.3%; 76.4% versus 38.5% respectively, p<0.05). In other words, the patients taking ginseng during their chemotherapy lived longer!
Ginseng has also been shown to improve energy and quality of life (QOL) during chemotherapy. Sun ginseng is a red ginseng extract manufactured under a patented process in Korea. A randomised, placebo-controlled, double-blind trial in 53 cancer patients undergoing ‘usual medical treatment’ found that 12 weeks of 3g/day of sun ginseng significantly improved QOL (p=0.02) and general health (p<0.01).4 A well-publicised study in 282 cancer patients on American ginseng root (Panax quinquefoliums), found that 750 to 2000 mg/day for eight weeks significantly reduced cancer-related fatigue.5
I also recommend other adaptogenic herbs during chemotherapy. Two key herbs here are ashwagandha and astragalus. There is certainly evidence of benefit for the latter, which is commonly used in China (often in combination) during chemotherapy. A meta-analysis of 34 randomised clinical trials involving patients with non smallcell lung cancer treated with platinum-based chemotherapy and astragalus-based Chinese products suggested a benefit from the combination.6 Most trials involved formulas featuring astragalus, but two were of astragalus alone. The herbs were administered by injection in around one third of the trials. Twelve trials measuring such outcomes reported significantly lower mortality rates after 12 months when astragalus was combined with chemotherapy (risk ratio 0.67). Nine studies reported significantly lower mortality rates after 24 months when astragalus was combined with chemotherapy (risk ratio 0.73). Most of the studies included were of low methodological quality.
A Cochrane Review identified four relevant trials where a decoction of astragalus and a formulation featuring astragalus were combined with chemotherapy regimens in patients with colorectal cancer.7 Chemotherapy-induced nausea, vomiting, and low white cell count were all decreased by administration of astragalus decoction, and immune function was improved. The trials were of low quality, suggesting larger, more rigorous trials are needed to confirm these results.
Nausea is a common side effect of chemotherapy. A randomised, controlled trial compared ginger root powder 1,000mg with the anti-nausea drugs metoclopramide and ondansetron in 50 cancer patients. Ginger was as effective as metoclopramide and slightly less effective than ondansetron in controlling vomiting and relieving nausea.8 Chemotherapy-induced delayed nausea was significantly reduced by a high protein meal and drink in conjunction with ginger (1,000mg root powder) twice a day in a controlled clinical trial.9
In a large clinical study funded by the US National Cancer Institute, 744 cancer patients, mostly with breast cancer, were included in a double-blind trial.10 Patients were either given a placebo or 3 different doses of ginger root as 250mg capsules for six days, starting three days before chemotherapy. On the day of chemotherapy they were also given a standard antiemetic drug. All the tested doses of ginger significantly reduced nausea compared with the placebo, and surprisingly the largest reduction occurred for the lower ginger doses (500 mg and 1,000mg).
A final word of caution: any herbal supplements other than the ones mentioned above are best used cautiously during chemotherapy (unless you have good evidence that they will not interfere). If there seems to be a good reason for taking them, it’s best to not use them within a 24 to 48-hour window on either side of the actual chemotherapy treatments.
To your better health,
Nutrition & Healing
Volume 6, Issue 6 – June 2012
Full references and citations for this article are available in the downloadable PDF version of the monthly Nutrition and Healing issue in which this article appears.