The Effects of Ginseng on Cancer-Related Fatigue

The Study Supplement:

Ginseng is an herbal supplement that may affect people's energy level, especially during
times of fatigue or stress. Many people have used ginseng, but its level of effectiveness and
safety has not been clearly studied. In this study, researchers will use questionnaires and
other tests to study how ginseng may affect cancer-related fatigue.

Study Groups and Study Drug Administration:

If you are found to be eligible to take part in this study, you will be assigned to a dose of
the study drug(s), depending on when you join the study. The first 30 participants will take
part in Part 1 of the study. Participants in Part 1 will take ginseng by mouth, in capsule
form, every day for 29 days. You will take it 2 times a day (morning and afternoon), and will
swallow a total of 2 capsules each day.

If you enroll on this study after the first 30 participants, you will take part in Part 2 of
the study. Participants in Part 2 will be randomly assigned (as in the flip of a coin) to 1
of 2 groups:

- Group 1 will take a placebo for 29 days. A placebo is not a drug. It looks like the
study drug but is not designed to treat any disease or illness. It is designed to be
compared with a study drug to learn if the study drug has any real effect. If you are
assigned to this group, you may be able to take ginseng later, in the second part of the
study (described below).

- Group 2 will take ginseng for 29 days, as the Part 1 group did.

You will have an equal chance of being assigned to either group. Neither you nor the study
staff will know which group you are in. However, if needed for your safety, the study staff
will be able to find out what you are receiving.

Both groups in Part 2 will take ginseng or placebo by mouth, every day for 29 days. You will
take it 2 times a day (morning and afternoon), 2 capsules each day.

After your Day 29 ginseng or placebo dose, if you tolerated the doses well, the study doctor
may decide you can take ginseng from Days 29-57, following the same dosing schedule you had
before.

Study Visits:

On Day 15 (± 3 days), Day 29 (± 3 days), Day 36 (+/- 3 days) and Day 57 (± 3 days), you will
fill out questionnaires about the symptoms you may be having, such as fatigue, mood,
depression, anxiety, nausea, appetite problems, sleep problems, and your overall sense of
well-being. This should take about 30 minutes. You will also be asked about any side effects
you may be having. You will also perform a medication review. If you cannot come to the
clinic on these days, the research nurse will call and ask you the questions over the phone.
The strength and stamina of your arm muscle will be measured only if you come to the clinic.
It will not be measured if you are contacted over the phone. Blood (about 1 tablespoon) will
be drawn for routine tests on Day 15 (± 3 days), Day 29 (± 3 days) and Day 57 (± 3 days).

The 6-minute walk test will be performed on baseline, Day 15 (± 3 days), Day 29 (± 3 days),
and Day 57 (± 3 days).

On Day 8 (± 3 days), Day 21 ( +/- 3 days), Day 36 (± 3 days), and Day 43 (± 3 days), the
research nurse will call and ask about the symptoms and side effects you may be having. You
will also perform a medication review. This should take about 30 minutes.

If you are unable to return to MD Anderson for your routine blood draw, your local doctor can
draw the blood and your results will be sent to MD Anderson.

You blood will be drawn weekly if you are taking coumadin to check to see how fast your blood
clots. Liver function tests will also be performed every 2 weeks if you have metastasis to
your liver or are on medication such as acetaminophen statins.

Length of Participation:

If you are the among the first thirty patients you will be assigned to receive/take ginseng
at the beginning of the study for a total 29 days followed by up to 28 days of ginseng, if
the study doctor thinks it is in your best interest. If you are not among the first thirty
patients you may receive up to 29 days of ginseng/placebo followed by up to 28 days of
ginseng, if the study doctor thinks it is in your best interest. Ginseng/placebo will be
stopped early if intolerable side effects occur.

If your main doctor for cancer approves, you may take ginseng after Day 57 (outside of the
study) if you tolerated it well.

This is an investigational study. Ginseng is commercially available. Giving ginseng to
patients with cancer and fatigue is being done for research purposes only.

Up to 158 patients will take part in this study. All will be enrolled at MD Anderson.

Inclusion Criteria:

1. All patients with a histological diagnosis of cancer.

2. Rate fatigue on a numerical scale during the previous 24 hours as >/= 4 on a 0 to 10
scale (0 = no fatigue and 10 = worst possible fatigue).

3. Describe fatigue as being present every day for most of the day for a minimum of 2
weeks.

4. Memorial delirium assessment scale
5. Are 18 years or older.

6. Hemoglobin level of >/=8 g/dL within 2 weeks of enrollment. If the patient has not had
blood drawn for a hemoglobin level in the previous two weeks, one will be performed to
determine eligibility. Patients with a hemoglobin level <9g/dL will be evaluated for
treatment of anemia.

7. Able to understand and sign the informed consent.

8. No concurrent use of chronic systemic steroids (defined as currently on more than 1
week of treatment).

9. Controlled pain and depression symptoms, if present ( defined as no change in the
Morphine equivalent dose of 30% or change in the dose of antidepressant medication in
the past 2 weeks)

10. Patients should have a Zubrod
11. All patients who are receiving chemotherapy and/or radiation therapy are eligible for
study if they have completed at least one cycle of chemotherapy or targeted therapy,
or > 1 week of radiation therapy, and if they have been approved to go on study by
their primary oncologist. The PI/designated research staff of this study will obtain
and document approval from the primary oncologist and principal investigator of the
clinical trial in case the patient is on another clinical trial as referenced in the
patient's study documents.

12. Negative pregnancy test for women of childbearing potential, as defined by intact
uterus and ovaries, and a history of menses within the last 12 months. Pregnancy test
to be performed no greater than 14 days prior to consent in study. In cases of women
with elevated b-HCG, these candidates will be eligible to participate so long as the
level of b-HCG is not consistent with pregnancy. Women of childbearing potential need
to be on or use contraception, or be abstinent during the study period. Their male
partners must also use contraception (condom) or maintain abstinence. Birth controls
specifications: Women who are able to become pregnant must use birth control during
the study and for 30 days after the last ginseng/placebo dose. Acceptable forms of
birth control include barrier methods (such as condom or diaphragm) with spermicide.

Exclusion Criteria:

1. Major contraindication to ginseng: allergy/hypersensitivity to Panax species or their
constituents (history of arrhythmias, agitation, or motor tics, or severe angina
pectoris).

2. Currently taking ginseng, methylphenidate or modafinil or have taken it within the
previous 10 days.

3. Inability to complete the baseline assessment forms or to understand the
recommendations for participation in the study.

4. Currently with a diagnosis of major depression, manic depressive disorder,
obsessive-compulsive disorder, or schizophrenia).

5. Symptomatic tachycardia and uncontrolled hypertension (determined to be clinically
significant by the PI).

6. Currently receiving phenobarbital, diphenylhydantoin, primidone, phenylbutazone,
MAOIs, clonidine and tricyclic antidepressant drugs

7. Uncontrolled diabetes mellitus as defined by a random blood sugar of >200mg/dl not
being monitored by their primary care physician.

8. No concurrent full dose anticoagulant therapy. catheter clots allowed.

9. History of hepatitis A, B and C.

10. Women who are nursing.