Re: Sriram Yennurajalingam, Nizar M. Tannir, Janet L. Williams, et al. A Double-Blind, Randomized, Placebo-Controlled Trial of Panax Ginseng for Cancer-Related Fatigue in Patients with Advanced Cancer. J Natl Compr Canc Netw 2017;15(9):1111–1120.
We enjoyed reading the article, “A Double-Blind, Randomized, Placebo-Controlled Trial of Panax Ginseng for Cancer-Related Fatigue in Patients with Advanced Cancer” by Yennurajalingam et al.1 This study did not prove ginseng to be effective for cancer-related fatigue. We suggest an additional study limitation based on a traditional use of ginseng not cited in the research.
In traditional Chinese medicine, ginseng is used in the form of tea. This makes us question whether there is some component to the use of ginseng in this form, compared with extract, that is lost in the manufacturing process. Traditionally, ginseng root is chopped and placed into an empty cup. Water is boiled and allowed to cool. The water is then poured into the cup and steeped for 5 to 10 minutes or longer, depending on desired strength. Finally, the ginseng is strained out and the tea is ready for consumption.2
This study and other similar studies involve the process of manufacturing ginseng extract into capsule form. Although this process of creating a pill ensures a standardized dose of ginseng, it does not use the traditional mode of administration through tea. A phase III study similar to this one by Barton et al3 used capsules containing a standardized amount of American ginseng to treat cancer-related fatigue. The results showed no measurable difference in fatigue between the placebo and ginseng groups at 4 weeks, but there was a statistically significant difference at 8 weeks. Another randomized, double-blind, controlled clinical trial by Kim et al4 compared the use of Panax ginseng versus placebo in patients with idiopathic chronic fatigue, with negative results. Similarly, Barton et al5 performed a phase III trial using Ginkgo biloba extract capsules in patients with cancer and cognitive dysfunction which did not show efficacy.
We hypothesize that if the herbals used in these studies had been prepared in the traditional manner, they may have been more efficacious. A traditional homeopathic remedy used in the United States for illness is chicken noodle soup. Would a capsule of lyophilized chicken noodle soup offer the same comforting effect as a warm, hearty bowl of it? Perhaps using ginseng in the traditional manner would deliver benefits beyond its capacity in extract form.
Call for Correspondence
JNCCN is committed to providing a forum to enhance collaboration between academic medicine and the community physician. We welcome comments about the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines), articles published in the journal, or any other topic relating to cancer prevention, detection, treatment, supportive care, or survivorship.
Letters should be no more than 400 words, with no more than 5 references if included. Please include the full names, degrees, and affiliations of all letter authors and a phone number or e-mail address for contact.
Letters are considered for publication as space allows. NCCN reserves the right not to publish correspondence for any reason it deems appropriate. All letters are subject to editing and/or abridgment.
Yennurajalingam S, Tannir NM, Williams JL et al.. A Double-blind, randomized, placebo-controlled trial of Panax ginseng for cancer-related fatigue in patients with advanced cancer. J Natl Compr Canc Netw 2017;15:1111–1120.
How to Make American Ginseng. www.wikihow.com. Available at: https://www.wikihow.com/Make-American-Ginseng-Tea. Accessed October 17, 2017.
Barton D, Liu H, Dakhil S et al.. Wisconsin ginseng (Panax quinquefolius) to improve cancer-related fatigue: a randomized, double-blind trial, N07C2. J Natl Cancer Inst 2013;105:1230–1238.
Kim HG, Cho JH, Yoo SR et al.. Antifatigue effects of Panax ginseng C.A. Meyer: a randomised, double-blind, placebo-controlled trial. PLoS ONE 2013;8:e61271.
Barton DL, Burger K, Novotny PJ et al.. The use of Ginkgo biloba for the prevention of chemotherapy-related cognitive dysfunction in women receiving adjuvant treatment for breast cancer, N00C9. Support Care Cancer 2013;21:1185–1192.