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- Reishi Mushroom (Ganoderma lucidum)
- Breast Cancer
- Fatigue
| Date:
09-14-2012 | HC# 051265-456
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Re: Reishi Mushroom Spore Powder Lessens Fatigue in Breast Cancer Patients Taking Hormone Replacement Therapyy
Zhao
H, Zhang Q, Zhao L, Huang X, Wang J, Kang X. Spore powder of Ganoderma lucidum improves
cancer-related fatigue in breast cancer patients undergoing endocrine therapy:
a pilot clinical trial. Evid Based
Complement Alternat Med. 2012;2012:809614. doi:10.1155/2012/809614.
Cancer-related
fatigue (CRF) includes persistent physical, emotional, and cognitive tiredness
and affects many breast cancer patients. It results from chemotherapy, radiotherapy,
and endocrine therapy, as well as from conditions such as heart disease, anxiety,
and depression. Patients with persistent CRF may have elevated concentrations
of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), inflammation-related
cytokines.1 Although exercise has been shown to be somewhat
effective, not all CRF patients are able to exercise, and there are no well-established
pharmaceutical interventions for CRF; thus, alternative therapies for CRF are
needed. The spore powder of reishi mushroom (Ganoderma lucidum) is used in traditional Chinese medicine, and
previous studies have found it to be an antihistamine and a modulator of the
immune system. In addition, reishi mushroom triterpenoids have been shown to
inhibit the expression of IL-6 and TNF-α. This randomized, placebo-controlled
trial investigated the potential beneficial effects of reishi mushroom spore
powder on CRF and quality of life in breast cancer patients receiving endocrine
therapy.
Patients were
recruited from the Third Affiliated Hospital of Harbin Medical University in
Harbin, China, and had cancer that was either estrogen and progesterone receptor-positive,
or estrogen receptor-positive and progesterone receptor-negative. Included in
the study were patients over 18 years of age without any serious mental health problems,
who were diagnosed with stage I-IIIA breast cancer, but did not have any other
cancer history or other fatigue-related disease. All participants had previous surgery
for breast cancer, and had completed at least 6 months of endocrine therapy or were
currently using endocrine therapy. Patients were excluded if they had anemia,
hemoglobin concentrations of <9 g/dL, platelets <80,000/mL, and unusual
concentrations of the liver and renal markers serum alanine transaminase (ALT),
aspartic acid transaminase (AST), blood urea nitrogen (BUN), and creatinine.
Also, those with thyroid disorders were excluded.
The study consisted
of an experimental and control group. The experimental group took 1000 mg of reishi
mushroom spore powder 3 times per day for 4 weeks; the control group took a
placebo for 4 weeks. The reishi mushroom spore powder was prepared by Beijing
Great Wall Pharmaceutical Factory; Beijing,
China. CRF,
anxiety and depression, quality of life, TNF-α and IL-6, as well as liver and
kidney functions for tolerability assessment, were measured at both the baseline
and endpoint of the study. The Functional Assessment of Cancer Therapy: Fatigue
(FACT-F) scale was used to measure CRF and included questions about 13 aspects
of fatigue with a scale ranging from 0 ("not at all") to 4
("very much"). The Hospital Anxiety and Depression Scale (HADS) was
used to assess anxiety and depression with a scale ranging from 0-21. A score
between 0-7 indicates a "normal" state; scores 8-10 define a
"mild disorder"; and scores ≥11 are indicative of a "moderate to
severe disorder." Finally, the European Organization for Research and
Treatment of Cancer Core Quality of Life Questionnaire C30 (EORTC QLQ-C30) was
used for quality of life measurements. This consists of questions about
physical, emotional, and cognitive aspects of quality of life ranging from 0
("not at all") to 4 ("very much"), with some questions
rated from 0 to 7 ("very much").
From 48 enrolled
patients, n=25 were randomized to the experimental group and n=23 into the
control group, and all randomized patients finished the study. There were no
significant differences in the baseline assessments between groups. In general,
the total FACT-F score of the experimental group significantly improved after 4
weeks as compared to baseline (141.09 vs. 120.31, P<0.01) and to the control
(141.09 vs. 121.01, P<0.01). After 4 weeks, the FACT-F scores of the
experimental group were significantly different in the physical well-being
category from both baseline (24.62 ± 3.27 vs. 20.35 ± 4.07, P<0.01) and as
compared to control after 4 weeks (24.62 ± 3.27 vs. 20.65 ± 3.97, P<0.01).
This was also true for the fatigue category as compared to baseline (46.78 ±
5.07 vs. 39.76 ± 5.10, P<0.01) and the control group after 4 weeks (46.78 ±
5.07 vs. 40.92 ± 5.64, P<0.01). The emotional and functional aspects of the
FACT-F also improved significantly in the experimental group as compared to
both baseline and with the control group after 4 weeks (P<0.05).
The total HADS
score for the experimental group significantly improved at the end of the study
both as opposed to baseline (7.1 ± 3.1 vs. 10.9 ± 4.1, P<0.01) and in
comparison to the control group (7.1 ± 3.1 vs. 9.8 ± 3.4, P<0.01). Both the
depression and anxiety categories improved in the experimental group from
baseline to endpoint and in comparison to the control group after 4 weeks
(P<0.05). Also, the "global" quality of life EORTC QLQ-C30 score
was improved significantly in the experimental group both as opposed to
baseline (68.9 ± 21.4 vs. 55.8 ± 22.9, P<0.01) and in comparison to the
control group (68.9 ± 21.4 vs. 57.7 ± 24.2, P<0.01). Notably, the physical
and emotional functioning significantly improved in the experimental group both
in comparison to baseline and the control group after 4 weeks (P<0.01).
Cognitive functioning also improved similarly in the experimental group
(P<0.05). Additionally, fatigue, sleep disturbance, and appetite loss scores
were significantly improved in the experimental group (P<0.05).
At the end of the
study, the concentration of TNF-α in the experimental group decreased
significantly from 128.70 pg/mL to 71.89 pg/mL (P<0.01). This was also true
for the IL-6 concentrations of the experimental group (62.43 pg/mL vs. 37.62
pg/mL, P<0.05). The most frequent adverse side effects reported in the
experimental group were dizziness and dry mouth, but gastrointestinal problems,
epistaxes (nosebleeds), and sore throat were also reported. [Note: Adverse side
effects for the control group were not included.]
The reishi mushroom
spore powder significantly improved aspects of fatigue in breast cancer
patients in this study. As beneficial effects were noted in both physical and
psychological symptoms of fatigue, there may be multiple mechanisms of action
behind the bioactivity of reishi mushroom. It is also suggested that depression
may have improved due to the ability of patients to resume normal physical
activities. Although the immune markers measured showed significant reductions
at the end of the study, no attempt was made to more broadly monitor the immune
response, or adverse side effects associated with potential fungus allergies.
In addition, there is no explanation for excluding the placebo group reports of
any adverse effects. Other shortcomings mentioned include a small sample size
and lifestyle variables that may have impacted fatigue. Furthermore, the study
was not blinded, leaving room for investigator bias. Additionally, neither the
type of endocrine therapy nor the nature of the placebo was specified in this
study. Lastly, the variability of the type and timing of conventional treatment
(including the endocrine therapy) make the significance of the findings
difficult to interpret. Future clinical studies will ideally include a more
rigorous study design to further investigate the role of reishi in the
management of CRF in breast cancer survivors. —Amy
C. Keller, PhD
Reference
1Barsevick A, Frost M,
Zwinderman A, Hall P, Halyard M; GENEQOL Consortium. I'm so tired: biological
and genetic mechanisms of cancer-related fatigue. Qual Life Res. 2010;19(10):1419-1427.
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