Lee, J.J., & Lee, J.J. (2010). A phase II study of an herbal decoction that includes Astragali Radix for cancer-associated anorexia in patients with advanced cancer. Integrative Cancer Therapies, 9, 24–31.
To assess the efficacy and safety of an herbal decoction including Astragali Radix in improving appetite and body weight and changing cytokine levels in patients with advanced cancer experiencing anorexia
The herbal decoction consisted of a combination of herbs including Astragali Radix made in the hospital pharmacy every week. The decoction was administered 30 minutes after meals, three times a day for three weeks. The decoction was stopped for treatment refusal, the aggravation of anorexia or weight loss in the midst of therapy, or physician decision. Assessments of appetite were performed at baseline and then weekly until termination of the study. Cytokines were checked at baseline and at the third week.
A prospective, phase II trial design was used.
Toxicity was assessed as well as tumor response using Recist criteria.
Primary endpoint: VAS anorexia scores before and after the herbal decoction were significantly improved (p = 0.008). Secondary endpoints: 55% of patients had improvements in both anorexia and body weight at the third week (p = 0.009). The correlation of improvement of anorexia and body weight at the best point was also significantly positive (p = 0.003). The changes in skinfold thickness of the triceps, subscapula, and suprailiac did not significantly change (p = 0.182). The cytokines did not significantly change. Lactate and lactate dehydrogenase (LDH) levels were significantly worse at three weeks. Eight patients were administered the full treatment of the herbal decoction, three patients had the decoction for two weeks, one patient had treatment stopped due to toxicity of concomitant chemotherapy, and two patients had disease progression. Grades 1/2 diarrhea occurred in two patients. Grade 1 dyspepsia occurred in two patients. Grade 1 alanine transaminase abnormality occurred in one patient. Grade 2 neutropenia and grade 2 anemia occurred in two patients who also received concomitant chemotherapy.
This small study demonstrated potential for a combination herbal product to improve anorexia in patients with advanced cancers. Although patients showed significant improvements in anorexia scores and weight gain, cytokine and lactate and LDH values did not improve significantly and in some cases worsened, which is contrary to current thinking regarding the chemical picture of anorexia. Results of this study should be interpreted with caution.
Anorexia is a common symptom in patients with cancer. There are some drugs such as corticosteroids and megestrol acetate that can help to control anorexia. Complementary and alternative medicines may help treat cancer-related symptoms. Nurses need to remain knowledgeable about potential medications and complementary agents that may be useful in managing patients’ symptoms.