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American Ginseng in Treating Patients With Fatigue Caused by Cancer

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT00719563
Recruitment Status : Completed
First Posted : July 21, 2008
Results First Posted : August 6, 2014
Last Update Posted : February 9, 2017
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Alliance for Clinical Trials in Oncology

Study Description
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Brief Summary:

RATIONALE: American ginseng may reduce fatigue in patients with cancer. It is not yet known whether American ginseng is more effective than a placebo in treating cancer-related fatigue.

PURPOSE: This randomized phase III trial is studying American ginseng to see how well it works in treating patients with fatigue caused by cancer.


Condition or disease Intervention/treatment Phase
Chronic Myeloproliferative Disorders Fatigue Leukemia Lymphoma Lymphoproliferative Disorder Multiple Myeloma and Plasma Cell Neoplasm Myelodysplastic Syndromes Myelodysplastic/Myeloproliferative Neoplasms Precancerous Condition Unspecified Adult Solid Tumor, Protocol Specific Drug: American ginseng Other: placebo Phase 3

Detailed Description:

OBJECTIVES:

Primary

  • To evaluate the efficacy of American ginseng (Panax quinquefolius) as therapy for cancer-related fatigue as measured by the general subscale of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF).

Secondary

  • To evaluate toxicities and tolerability of American ginseng when used for cancer-related fatigue.
  • To examine stress as a mediating variable on the effects of American ginseng on cancer-related fatigue.
  • To explore the impact of American ginseng on various dimensions of fatigue as measured by the other subscales of the MFSI-SF, functional interference as measured by the Brief Fatigue Inventory (BFI), stress as measured by the Perceived Stress Scale, and well being as measured by the Profile of Mood States (POMS), as well as the single measure of fatigue.
  • To determine clinically significant changes in fatigue scores using the global impression of change.
  • To evaluate whether there are differences in the efficacy of American ginseng for fatigue based on minority populations.

Tertiary

  • To describe cortisol and cytokine values in fatigued cancer survivors and to evaluate the relationship of cortisol and cytokines to fatigue severity as well as to patterns of alterations previously documented in fatigued breast cancer survivors.
  • To evaluate whether Wisconsin Ginseng impacts the expression of cortisol and cytokine in fatigued cancer survivors.
  • To evaluate the role of cortisol and cytokine changes as the mechanism by which Wisconsin Ginseng can ameliorate cancer related fatigue.
  • To evaluate the relationships between cytokine and cortisol levels with secondary outcomes such as mood and stress.

OUTLINE: This is a multicenter study. Patients are stratified according to baseline fatigue score (4-7 vs 8-10), disease status of current cancer (initial diagnosis vs recurrent disease), current treatment (chemotherapy, radiation, endocrine therapy [i.e., tamoxifen or aromatase inhibitors], or other targeted therapy) ( yes vs no), duration of all prior cancer treatment in patient's lifetime (none vs ≤ 180 days vs > 180 days), and current tumor type (hematologic vs solid tumor malignancy). Patients are randomized to 1 of 2 treatment arms.

  • Arm I: Patients receive oral American ginseng twice daily for 14 days. Treatment repeats every 2 weeks for 4 courses until disease progression or unacceptable toxicity.
  • Arm II: Patients receive oral placebo twice daily for 14 days. Treatment repeats every 2 weeks for 4 courses.

Patients are instructed to complete the Ginseng Symptom Experience Diary and the Linear Analogue Scale weekly. Patients also complete the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), the Profile of Mood States (POMS), and the Brief Fatigue Inventory (BFI) questionnaires at baseline and periodically during study therapy.

Patients who are not actively receiving chemotherapy or radiation therapy undergo blood and saliva sample collection at baseline and periodically during study therapy for correlative studies.

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 364 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Supportive Care
Official Title: The Use of American Ginseng (Panax Quinquefolius) to Improve Cancer-Related Fatigue: A Randomized, Double-Blind, Placebo-Controlled Phase III Study
Study Start Date : October 2008
Actual Primary Completion Date : August 2011
Actual Study Completion Date : August 2013

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Fatigue
Drug Information available for: Ginseng
Genetic and Rare Diseases Information Center resources: Primary Myelofibrosis Chronic Myeloproliferative Disorders Polycythemia Vera Essential Thrombocythemia Lymphosarcoma Multiple Myeloma B-cell Lymphoma Mycosis Fungoides Sezary Syndrome Chronic Lymphocytic Leukemia Myeloid Leukemia Acute Myeloid Leukemia Acute Non Lymphoblastic Leukemia Myelodysplastic Syndromes Myelodysplastic/myeloproliferative Disease Diffuse Large B-Cell Lymphoma Chronic Graft Versus Host Disease Acute Lymphoblastic Leukemia Lymphoblastic Lymphoma Peripheral T-cell Lymphoma Cutaneous T-cell Lymphoma Hodgkin Lymphoma Mantle Cell Lymphoma Follicular Lymphoma Acute Graft Versus Host Disease Aggressive NK Cell Leukemia Hairy Cell Leukemia Chronic Myeloid Leukemia Juvenile Myelomonocytic Leukemia Chronic Myelomonocytic Leukemia Marginal Zone Lymphoma AL Amyloidosis Extranodal Nasal NK/T Cell Lymphoma Monoclonal Gammopathy of Undetermined Significance Angioimmunoblastic T-cell Lymphoma Angioimmunoblastic Lymphadenopathy With Dysproteinemia Burkitt Lymphoma Post-transplant Lymphoproliferative Disease Anaplastic Large Cell Lymphoma Waldenstrom Macroglobulinemia Plasmablastic Lymphoma Lymphoma, Large-cell, Immunoblastic T-cell Large Granular Lymphocyte Leukemia Adult T-cell Leukemia/lymphoma Plasmacytoma Chronic Neutrophilic Leukemia Leukemia, T-cell, Chronic Lymphomatoid Granulomatosis

Arms and Interventions
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Arm Intervention/treatment
Experimental: Arm I
Patients receive oral American ginseng twice daily for 14 days. Treatment repeats every 2 weeks for 4 courses.
 Drug: American ginseng
Given orally
Placebo Comparator: Arm II
Patients receive oral placebo twice daily for 14 days. Treatment repeats every 2 weeks for 4 courses.
 Other: placebo
Given orally


Outcome Measures
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Primary Outcome Measures :
  1. Change From Baseline to Week 4 in the General Subscale of the MFSI-SF [ Time Frame: Baseline and week 4 ]
    Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) general subscale is a six-item subscale to measure the subjective experience of fatigue. The items include feeling "pooped, worn out, fatigued, sluggish, run down and tired". Answers are on a 5-point scale, ranging from 0 (not at all) to 4 (extremely). The subscale scores were the sum of all six items. The scores were converted to a 100-point scale, with higher numbers indicating less fatigue. Change from baseline to week 4 was calculated by subtracting the baseline scores from the scores at week 4.


Secondary Outcome Measures :
  1. Number of Treatment Related Grade 2 to 3 Adverse Events >=1% Incidence [ Time Frame: Week 1 to Week 8 ]
    Adverse events were assessed by Common Terminology Criteria for Adverse Events (CTCAE) v3.0. Grading: Grade 1=Mild, Grade 2=Moderate, Grade 3=Severe, Grade 4=Life-threatening, Grade 5=Death.

  2. Change From Baseline to Week 4 in the Impact on Physical, Mental, and Emotional States and Vigor as Measured by Other Subscales of the MFSI-SF [ Time Frame: Baseline and Week 4 ]
    Each MFSI-SF subscale consist of 6 items on a 5-point scale, ranging from 0 (not at all) to 4 (extremely). The subscale scores were the sum of all six items. The scores were then converted to a 100-point scale, with higher numbers indicating less fatigue. Change from baseline to week 4 was calculated by subtracting the baseline scores from the scores at week 4.

  3. Change From Baseline to Week 4 Fatigue as Measured by the BFI and Linear Analogue Scale of Fatigue [ Time Frame: Baseline and Week 4 ]
    Brief Fatigue Inventory (BFI) consist of 3 items that assess the severity of fatigue and 6 items that assess the impact of fatigue on daily functioning in a 10-points scale with 0 as no fatigue or does not interfere with daily functioning and 10 as bad fatigue or completely interferes. The scores for the six items were summed up to form a total interference score. The linear analogue scale of fatigue was a 10-points scale with 0 as no fatigue and 10 as bad fatigue. All scores were then transformed into 0 to 100 scale, with 100 as less fatigue/less interference. Change from baseline to week 4 was calculated by subtracting the baseline scores from the scores at week 4.

  4. Change From Baseline to Week 4 Vigor/Activity and Fatigue-inertia as Measured by POMS [ Time Frame: Baseline and Week 4 ]
    Profile of Mood States (POMS) measures a variety of mood states including tension/anxiety, depression/dejection, anger/hostility, vigor/activity, fatigue/inertia and confusion/bewilderment. Each subscale consist of 5 items with a 5 points-scale (0=not at all, 1=a little, 2=moderately, 3=quite a bit and 4=extremely). The subscale scores were the sum of all five items. The scores were then transformed into a 100-point scale with higher numbers indicating less fatigue. Change from baseline to week 4 was calculated by subtracting the baseline scores from the scores at week 4.

  5. Change From Baseline to Week 4 for the Impact on Stress as Measured by Perceived Stress Scale (PSS) [ Time Frame: Baseline and Week 4 ]
    PSS consist of 14 items that assess the impact on stress in a 5-points scale (0=never, 1=almost never, 2=sometimes, 3=fairly often and 4=very often). The total scores were the sum of all 14 items. The scores were then transformed into a 100-point scale with higher numbers indication less stress. Change from baseline to week 4 was calculated by subtracting the baseline scores from the scores at week 4.

  6. Change From Baseline to Week 8 in the Impact on General, Physical, Mental, and Emotional States and Vigor as Measured by Other Subscales of the MFSI-SF [ Time Frame: Baseline and week 8 ]
    Each MFSI-SF subscale consist of 6 items on a 5-point scale, ranging from 0 (not at all) to 4 (extremely). The subscale scores were the sum of all six items. The scores were then converted to a 100-point scale, with higher numbers indicating less fatigue. Change from baseline to week 8 was calculated by subtracting the baseline scores from the scores at week 8.

  7. Change From Baseline to Week 8 Fatigue as Measured by the BFI and Linear Analogue Scale of Fatigue [ Time Frame: Baseline and Week 8 ]
    Brief Fatigue Inventory (BFI) consist of 3 items that assess the severity of fatigue and 6 items that assess the impact of fatigue on daily functioning in a 10-points scale with 0 as no fatigue or does not interfere with daily functioning and 10 as bad fatigue or completely interferes. The scores for the six items were summed up to form a total interference score. The linear analogue scale of fatigue was a 10-points scale with 0 as no fatigue and 10 as bad fatigue. All scores were then transformed into 0 to 100 scale, with 100 as less fatigue/less interference. Change from baseline to week 8 was calculated by subtracting the baseline scores from the scores at week 8.

  8. Change From Baseline to Week 8 Vigor/Activity and Fatigue-inertia as Measured by POMS [ Time Frame: Baseline and week 8 ]
    Profile of Mood States (POMS) measures a variety of mood states including tension/anxiety, depression/dejection, anger/hostility, vigor/activity, fatigue/inertia and confusion/bewilderment. Each subscale consist of 5 items with a 5 points-scale (0=not at all, 1=a little, 2=moderately, 3=quite a bit and 4=extremely). The subscale scores were the sum of all five items. The scores were then transformed into a 100-point scale with higher numbers indicating less fatigue. Change from baseline to week 8 was calculated by subtracting the baseline scores from the scores at week 8.

  9. Change From Baseline to Week 8 for the Impact on Stress as Measured by Perceived Stress Scale (PSS) [ Time Frame: Baseline and Week 8 ]
    PSS consist of 14 items that assess the impact on stress in a 5-points scale (0=never, 1=almost never, 2=sometimes, 3=fairly often and 4=very often). The total scores were the sum of all 14 items. The scores were then transformed into a 100-point scale with higher numbers indication less stress. Change from baseline to week 8 was calculated by subtracting the baseline scores from the scores at week 8.

  10. Average Change From Baseline to Week 4 in Fatigue for Those Who Perceive a Change of +2 and +3 [ Time Frame: Baseline and Week 4 ]
    Changes in fatigue as measured using subscales of MFSI-SF, the interference scale of the BFI and the linear analogue scale (LASA) fatigue question were compared between arms for those participants who express a perceived change in fatigue via the global impression score of a +2 (moderately better) and +3 (very much better).

  11. Average Change From Baseline to Week 8 in Fatigue for Those Who Perceive a Change of +2 and +3 [ Time Frame: Baseline and Week 8 ]
    Changes in fatigue as measured using subscales of MFSI-SF, the interference scale of the BFI and the linear analogue scale fatigue question were compared between arms for those participants who express a perceived change in fatigue via the global impression score of a +2 (moderately better) and +3 (very much better).

  12. Change From Baseline to Week 4 in the General Subscale of the MFSI-SF for Minority Populations [ Time Frame: Baseline and Week 4 ]
    Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) general subscale is a six-item subscale to measure the subjective experience of fatigue. The items include feeling "pooped, worn out, fatigued, sluggish, run down and tired". Answers are on a 5-point scale, ranging from 0 (not at all) to 4 (extremely). The subscale scores were the sum of all six items. The scores were converted to a 100-point scale, with higher numbers indicating less fatigue. Change from baseline to week 4 was calculated by subtracting the baseline scores from the scores at week 4.


Eligibility Criteria
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Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

  1. Required characteristics

    • ≥ 18 years of age
    • Men or women with a history of cancer-related fatigue as defined by an average score ≥ 4 over the past 30 days on the numeric analogue scale (1 - 10)
    • The presence of fatigue ≥ 1 month prior to randomization
    • ECOG performance score 0, 1, or 2

    • Histologic or cytologic proven cancer other than brain cancer or CNS lymphoma, undergoing curative intent therapy (including anti-hormonal therapies such as tamoxifen or leuprolide) or those having completed curative intent therapy who were diagnosed within the past 2 years

      • Note: If a patient is receiving treatment for their disease such as chemotherapy, targeted therapies, immunotherapy or radiation therapy then, the patient must have completed ≥ 1 cycle of chemotherapy, targeted therapy, or ≥ 1 week of radiation treatment.

    • Laboratory values obtained prior to randomization:

      • Hgb ≥ 11 (must be obtained ≤ 30 days; patients must not be transfused ≤ 30 days to meet this criterion)
      • Creatinine ≤ 1.2 x UNL (must be obtained ≤ 180 days prior to randomization)
      • AST (SGOT) or ALT (SGPT) ≤ 1.5 x UNL (must be obtained ≤ 180 days prior to randomization)
    • Negative pregnancy test done ≤ 7 days prior to registration, for women of childbearing potential only
    • Ability to complete patient questionnaires alone or with assistance

    • Controlled:

      • Pain (≤ 4 on Linear Analogue Scale)
      • Insomnia (≤ 4 on Linear Analogue Scale)

    • Willingness to provide blood/saliva samples for correlative studies.

      • Note: These samples are only required for those not receiving active treatment for their disease. Active treatment is defined as chemotherapy, radiation therapy, or immunotherapy, not anti-hormone therapy such as tamoxifen, aromatase inhibitors or leuprolide.

  2. Contraindications

    • Hypersensitivity to ginseng

    • Prior use of ginseng capsules for fatigue in the past year

      • Note: Prior use of teas or drinks containing ginseng is allowed, however, patients will be asked to avoid these beverages while on the study.
    • Uncontrolled hypertension on more than one occasion (diastolic blood pressure > 100, systolic > 160) measured ≤ 90 days prior to randomization

    • Currently using any other pharmacologic agents or nonpharmacologic interventions to specifically treat fatigue including psychostimulants, antidepressants, acupuncture, etc.

      • Note: Antidepressants used to treat items other than fatigue (such as hot flashes) are allowed if the patient has been on a stable dose for ≥ 1 month and plans to continue for ≥ 1 month. Erythropoietin agents to treat anemia are allowed. Exercise is allowed.
    • Known brain metastasis or primary CNS malignancy
    • Chronic systemic steroid use (including CHOP therapy or as part of any regular cancer treatment, however, steroids used as prophylaxis for nausea and vomiting are allowed) to prevent rash with Alimta, low dose dexamethasone will be allowed.
    • Diabetes Type I or II (defined by being on oral hypoglycemics or insulin).
    • Psychiatric disorder such as severe depression, manic depressive disorder, obsessive compulsive disorder or schizophrenia. (Defined per medical history).
    • ≤ 4 weeks from major surgery to randomization, including any procedure that requires general anesthetic

    • Any of the following:

      • Pregnant women
      • Nursing women
      • Women of childbearing potential who are unwilling to employ adequate contraception
    • Pain requiring opioid pain medication, however, over the counter analgesics such as Tylenol or ibuprofen are allowed.
    • Use of full dose of anticoagulant therapy (Exception: 1 mg/day of Coumadin for preventing catheter clots is allowed).
    • Use of MAO inhibitors.
    • Planning to start or complete any type of cancer therapy during the 8 week, double blind, course of the study, once randomized on the study. Note: If not currently getting treatment, no chemotherapy agents ≤ 21 days prior to randomization. Combination treatment regimens that have components ending at different times are allowed, as long as any part of the initially started treatment continues through the double blind portion of the study.
    • Malnutrition, active infection, significant pulmonary disease and cardiovascular disease as determined by the physician, as they could impact fatigue.
    • Use of any over the counter herbal/dietary supplement marketed for fatigue or energy (for example, products containing any type of ginseng, rhodiola rosea, high doses of caffeine, guarana, or anything called an "adaptogen").
    • Uncontrolled nausea or vomiting or any symptom that would prevent the ability to comply with daily oral ginseng/placebo treatment.
    • Uncontrolled thyroid disorder.
    • Currently receiving single agent on blinded placebo controlled treatment trials.
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00719563


Locations
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Sponsors and Collaborators
Alliance for Clinical Trials in Oncology
National Cancer Institute (NCI)
Investigators
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Study Chair: Debra Barton, RN, PhD, AOCN, FAAN University of Michigan
More Information
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Publications of Results:
Barton DL, Liu H, Dakhil SR, et al.: Phase III evaluation of American ginseng (panax quinquefolius) to improve cancer-related fatigue: NCCTG trial N07C2. [Abstract] J Clin Oncol 30 (Suppl 15): A-9001, 2012.

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Responsible Party: Alliance for Clinical Trials in Oncology
ClinicalTrials.gov Identifier: NCT00719563    
Other Study ID Numbers: NCCTG-N07C2
NCI-2009-00872 ( Registry Identifier: CTRP (Clinical Trials Reporting System) )
CDR0000597665 ( Registry Identifier: PDQ (Physician Data Query) )
First Posted: July 21, 2008    Key Record Dates
Results First Posted: August 6, 2014
Last Update Posted: February 9, 2017
Last Verified: December 2016
Keywords provided by Alliance for Clinical Trials in Oncology:
fatigue
unspecified adult solid tumor, protocol specific
accelerated phase chronic myelogenous leukemia
acute undifferentiated leukemia
adult acute lymphoblastic leukemia in remission
adult acute myeloid leukemia in remission
adult acute myeloid leukemia with 11q23 (MLL) abnormalities
adult acute myeloid leukemia with inv(16)(p13;q22)
adult acute myeloid leukemia with t(15;17)(q22;q12)
adult acute myeloid leukemia with t(16;16)(p13;q22)
adult acute myeloid leukemia with t(8;21)(q22;q22)
atypical chronic myeloid leukemia, BCR-ABL1 negative
blastic phase chronic myelogenous leukemia
chronic myelomonocytic leukemia
chronic phase chronic myelogenous leukemia
 mast cell leukemia
progressive hairy cell leukemia, initial treatment
prolymphocytic leukemia
recurrent adult acute lymphoblastic leukemia
recurrent adult acute myeloid leukemia
recurrent adult T-cell leukemia/lymphoma
refractory chronic lymphocytic leukemia
refractory hairy cell leukemia
relapsing chronic myelogenous leukemia
secondary acute myeloid leukemia
stage 0 chronic lymphocytic leukemia
stage I adult T-cell leukemia/lymphoma
stage I chronic lymphocytic leukemia
stage II adult T-cell leukemia/lymphoma
stage II chronic lymphocytic leukemia
Additional relevant MeSH terms:
Layout table for MeSH terms
Lymphoma
Leukemia
Neoplasms
Multiple Myeloma
Neoplasms, Plasma Cell
Preleukemia
Plasmacytoma
Precancerous Conditions
Myelodysplastic Syndromes
Myeloproliferative Disorders
Lymphoproliferative Disorders
Myelodysplastic-Myeloproliferative Diseases
Disease
Syndrome
 Fatigue
Pathologic Processes
Neoplasms by Histologic Type
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Hemostatic Disorders
Vascular Diseases
Cardiovascular Diseases
Paraproteinemias
Blood Protein Disorders
Hematologic Diseases
Hemorrhagic Disorders
Bone Marrow Diseases