title: Tolerability of the combination of ginger (Zingiber officinalis), gentian (Gentiana lutea) and turmeric (Curcuma longa) in patients with cancer-associated anorexia.
abstract: BACKGROUND
  Anorexia is a common symptom for patients with advanced cancer. Gentian, ginger, and turmeric have traditionally been used to stimulate appetite. We tested these agents in combination, in a pilot study to assess tolerability in patients indicating 4/10 or worse anorexia on the Edmonton Symptom Assessment System, and who were not currently on chemotherapy. We collected exploratory data on the patient's appetite using a visual analogue scale.
  
  
  METHODS
  Between 2009 and 2012, 17 patients were enrolled in arm 1 (turmeric 1 g and ginger 1 g orally twice daily, and gentiana lutea tincture 1 mL three times a day, for 14 days). The three patients enrolled in arm 2 received the same doses of ginger and turmeric but no gentian. All patients completed a daily appetite diary and a weekly symptom assessment.
  
  
  RESULTS
  In arm 1, seven patients (41%) completed treatment. Seven patients (41%) stopped early because of unacceptable toxicity or patient-initiated discontinuation, and 3 stopped because of other reasons. All patients in arm 2 stopped taking the study medication within few days of starting the treatment, leading the study committee to recommend stopping the trial. The most common adverse effects attributed to study drugs were nausea (6 patients), vomiting (3), fatigue (3), diarrhea (2) and bloating (2). There was no statistically significant effect seen on appetite.
  
  
  CONCLUSIONS
  At the doses used in this study, the combination of ginger, turmeric, and gentian is not tolerated well in cancer patients. Future studies should use fewer agents or lower doses.
authors.forename: Michael
authors.initials: M
authors.lastname: Sanatani
authors.forename: Jawaid
authors.initials: J
authors.lastname: Younus
authors.forename: Larry
authors.initials: L
authors.lastname: Stitt
authors.forename: Nazish
authors.initials: N
authors.lastname: Malik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000855:Anorexia / Q000188:drug therapy* / Q000209:etiology; D030024:Curcuma / Q000009:adverse effects*; D005221:Fatigue / Q000209:etiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology; D030012:Gentiana / Q000009:adverse effects*; D020939:Zingiber officinale / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D008517:Phytotherapy / Q000009:adverse effects*; D010865:Pilot Projects; D010936:Plant Extracts / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D010936:Plant Extracts