Herbal remedies for cancer prevention -
To overcome these problems, current research is emphasized to explore herbal remedies that selectively targets cancer cells. Besides this, unlike other cancer types, breast cancer has diverse genetic mutations that affect several pathways [ 2 ]. These complexities aid to distinct pathological types with different clinical outcomes [ 3 ].
Therefore, response to a certain chemotherapeutic drug may differ in different patients and lack of proper treatment plan may increase the toxicity furthermore. One of the encouraging approaches to overcome drug toxicity is to look for alternative medicines that have less or selective toxicity toward cancer cells [ 4 ].
In recent years, many studies have demonstrated selective cytotoxicity of a variety of herbal compounds that can be used as potential chemotherapeutics [ 4 ].
These objectives will be achievable only if the herbal compounds that showed promising anticancer activity can be successfully transferred to clinical trials.
Cancer of the breast is among the most frequently diagnosed cancer and the leading cause of cancer-related deaths in females globally. At the current rate, the number of incident cases is expected to rise to 3.
Approximately 1 in 10 women is diagnosed with breast cancer at some time in their lives [ 3 ]. Epidemiological observation shows that the incidence of breast cancer is continuously raising in both industrialized and developing countries [ 7 ].
In addition, prolonged use of oral contraceptive and hormone replacement therapy are also known risk factors of this disease among postmenopausal women [ 10 ].
The onset of cancer is a result of several sequential molecular events. Most common of them is a mutation in a DNA molecule that codes for a protein that either triggers cell division, proliferation, and growth or that signals termination of all these molecular events [ 11 ].
Therefore, damage to DNA or a protein that regulates cell cycle may lead to uncontrolled division and growth of cells, the condition is cancer. It is a hyperproliferative disease that involves molecular alteration resulting in apoptosis dysregulation, proliferation, angiogenesis, and metastasis [ 12 ].
Breast cancer is one of the commonest types of cancer and characterized by distinct pathological types with different clinical outcomes. It has different stages that arise from ductal hyperproliferation, which changes into ductal carcinoma in situ DCIS , invasive carcinoma, and metastatic stage.
In addition, based on the molecular mechanism of occurrence, breast cancer can be divided into estrogen receptor ERα and progesterone receptor PR expression and amplification of human epidermal growth factor receptor HER2 , also known as epidermal growth factor receptor 2 ErbB2 [ 3 ].
Breast cancer 1 BRCA1 and breast cancer 2 BRCA2 are the two most important genes that code the proteins BRCA-1 and BRCA-2, which play a key role in DNA damage repair and in maintaining genomic stability [ 3 ]. Mutation in these genes leads to 15—20 fold increases the risk of breast cancer occurrence [ 13 ].
Additionally, tumor suppressor TP53 is another important gene that codes for the protein p53 that plays a major role in the regulation of cell cycle and in apoptosis induction. Mutation in the TP53 gene increases the risk of breast cancer as well as other cancer types.
Breast cancer cell survival, proliferation, motility, and cell metabolism are controlled by various signaling cascades. Classification of breast cancer based on the molecular expression has therapeutic implication as it helps in deciding the treatment plan.
The most promising way of dealing with cancer is to interfere with modulation stages of carcinogenesis—initiation, promotion, and progression as well as altering the carcinogenesis signaling pathways [ 15 , 16 ].
Breast cancer therapeutics include drugs that protect genomic stability by preventing DNA damage, inhibit the cell cycle by disrupting cellular integrity or by inducing apoptotic cell death, and block certain pathways that are responsible for abnormal cell growth Table 1. Majority of breast cancer cases express the estrogen hormone receptor, which helps the cancer cells to proliferate rapidly by the growth-promoting effects of circulatory estrogens [ 17 ].
Therefore, current therapies are targeted at abrogating estrogen dependence for estrogen receptor ER -positive breast cancers [ 17 ]. One of the successful and efficient approaches is the employment of a selective estrogen receptor modulator SERM like tamoxifen, which binds to the ER that induces a conformational change in the receptor resulting in obstruction of estrogenic expression [ 18 , 19 ].
However, tamoxifen like SERMs exhibits many notable side effects including—secondary cancer, cardiovascular diseases by their estrogenic activity in other tissues and organs. The efficiency of tamoxifen is challenged by the development of highly potent third-generation aromatase inhibitors AIs that represents a promising approach in endocrine therapy of breast cancer [ 20 ].
The aromatase inhibitor drugs like anastrozole and letrozole reduce estrogen production by competitive inhibition of the enzyme aromatase, although the long-term health effects of AIs are doubtful [ 21 ].
Another effective strategy in breast cancer treatment is the implementation of a growth factor inhibitor. One of the first identified targets of these growth inhibitors was the epidermal growth factor receptor EGFR that plays a vital role in the survival of cancer cells and developing multidrug resistance [ 22 ].
The effectiveness of the small molecule EGFR tyrosine kinase inhibitor like gefitinib is highly appreciated for the treatment of breast cancer; however, it failed to produce notable improvement in advance stages of breast cancer [ 23 ]. Commonly used breast cancer chemotherapeutic drugs, their targets, and mechanism of action [ 26 ].
In present, trastuzumab and lapatinib are the only marketed drugs used to inhibit the HER2-mediated growth and proliferation signaling [ 17 ]. Other than this, enzyme-mediated DNA damage is an effective approach used in cancer chemotherapy.
Doxorubicin, an anthracycline drug, binds with DNA by intercalation with base pairs, which results in an elevated level of DNA-topoisomerase II covalent complexes inhibiting topoisomerase II activity [ 24 ].
Other anticancer drugs inhibit mitosis by interrupting the microtubule stability, hence blocking the transition from metaphase to anaphase [ 25 ].
Subsequently, the cell undergoes mitotic arrest or programmed cell death apoptosis. For instance, vincristine and vinorelbine inhibit the polymerization of microtubules by binding to either the vinca domain or taxoid-binding domain that interferes between β- and α-subunit of tubulin [ 25 ].
On the other hand, microtubule-stabilizing drugs like paclitaxel hyperstabilizes the microtubule assembly by binding to the inner surface of the microtubule at a taxoid-binding site on β-tubulin resulting in mitotic arrest in the cell [ 25 ].
All these strategies helped in reducing mortality due to breast cancer and increased the survival rate; however, they appear with certain side effects that may be either low and short term or high and life threatening. The role of chemotherapy in curing cancer is still doubtful [ 27 ]. Even it decreases the risk of recurrence and helps the patient to live longer with improved quality of life in case of metastatic breast cancer.
But its use associated with certain risk factors or side effects—some of the side effects are short term and minor, whereas others may become more serious and life threatening [ 27 ]. Table 2 describes a few commonly used chemotherapeutic drugs and their side effects. Frequently used chemotherapeutic drugs in breast cancer treatment and their common side effects associated with them [ 26 , 28 , 29 , 30 ].
Among the most common side effects of chemotherapeutic drugs is its nonselective toxicity, where it destroys the normal body cells such as those in the hair follicle, bone marrow, and cells of other important organs along with the cancer cells.
Quite a few chemotherapeutic drugs affect the nerve endings or synaptic gaps in hands and feet that may result into numbness, pain, burning or tingling, sensitivity to cold or heat, or weakness in your extremities [ 31 ].
Besides, chemotherapeutic drugs may severely damage the immune cells as wells as the brain cells, making the patient vulnerable to infectious diseases and impaired cognitive functions [ 32 ]. These side effects may be temporary and may disappear after a few months of completion of chemotherapy.
Other critical side effects that arise due to certain chemotherapeutic drugs may last longer—infertility is one of them [ 33 ].
Chemotherapeutics that damage ovaries may lead to menopause symptoms, like hot flashes and vaginal dryness, where menstrual cycle becomes irregular or permanently ceases making pregnancy impossible [ 34 ].
Further, early menopause in premenopausal women due to the use of aromatase inhibitor agents in adjuvant therapy causes a hypoestrogenic condition that negatively impacts bone density resulting in osteopenia or osteoporosis [ 35 ]. Besides, long-term chemotherapeutic toxicity results in cardiac diseases and may trigger secondary cancer such as marrow neoplasm or leukemia [ 36 , 37 ].
Chemotherapy-linked cardiotoxicity is another major setback of cancer therapy that increases the mortality rate because of the high prevalence of cardiovascular diseases in cancer patients [ 38 ]. The cardiotoxicity leads to congestive heart failure CHF , which is more prevalence in young and elderly patients.
It has been reported that the breast cancer patients aged between 65 and 70 years, who received adjuvant anthracycline chemotherapy, had significantly higher rates of CHF [ 39 ]. Additionally, it was observed that 0. The risk of developing MN is higher in the first few years after chemotherapy.
Furthermore, chemotherapeutic drugs may also disrupt the normal psychological state of patients in certain cases [ 43 , 44 ]. The side effects that arise due the conventional chemotherapy is mainly due to lack of specificity of the drugs for cancer cells.
Majority of the widely used chemotherapeutic drugs causes adverse damage to normal cells and key organs, which limits the dose of a drug that can be used [ 45 ]. This explains the reason why cancer drugs have a low therapeutic index.
Several approaches are being considered to address this issue in order to improve the effectiveness of anticancer drugs. One of the popular approaches among them is searching for natural compounds that inhibit cancer cell growth without disrupting the functioning of healthy cells.
Plants have played a key role in the survival and evolution of human beings as they have provided the basic need of mankind like food, clothing, shelter, and medicine since the beginning of the human race. Plants have formed the basis of traditional medicine systems like Ayurveda, Unani, and Chinese traditional medicines that have served mankind with their health needs.
A larger part of the population in developing and underdeveloped countries relies on herbal medicine for solving treating their primary health issues. Traditional herbal medicines become popular because of their cost-effectiveness, abundancy, and less or no side effects.
In recent years, global emphasis on plant research has increased to find out drug-like substances from traditionally used medicinal plants.
Moreover, several naturally occurring plant-based compounds like curcumin, resveratrol, quercetin, and many more showed promising anticancerous effects and are gaining interest as an adjuvant chemotherapeutic agent. Besides, naturally occurring compounds cause less toxicity to healthy cells and in certain cases show selective toxicity against abnormal or diseased cells [ 46 ].
This might be the reason that today a large number of drugs being marketed are structurally similar to the structure of naturally occurring compounds. Herbal compounds show a variety of anticancer activity mainly antioxidant, anti-inflammatory, antimutagenic, and apoptosis-inducing activity that may help prevent cancer development in the early stage Figure 1.
Dietary consumption of adequate quantity of these herbal products may help in prevention and treatment of breast cancer by cell cycle arrest, induction of apoptosis, regulating carcinogen metabolism and oncogenic expression, inhibiting cell adhesion, proliferation and migration, and blocking signaling pathways that are essential for cancer progression [ 47 ].
Features of herbal compounds that attribute to their anticancer activity. A number of anticancer drugs have already in use for the treatment of breast cancer—including vincristine, vinblastine, paclitaxel, and docetaxel [ 49 ]. Despite the success of herbal products in curing breast cancer and its associated complexities, not many herbal products are making through preclinical or clinical trials.
Hence, greater effort is necessary to successfully transfer these agents to an ideal clinical setting to assess their potential for herbal therapies. Breast cancer is a preventable disease [ 50 ]. Estrogens play a major role in promoting the proliferation of normal breast cells as well as neoplastic breast epithelium [ 51 ].
Hence, blocking the estrogen receptor for the treatment and chemoprevention of breast cancer is one of the significant approaches. Plant-based estrogen-like compounds or phytoestrogens were originally proposed as cancer-protective agents.
This claim was strongly supported by an epidemiological study that revealed a low breast cancer incidence in the soy-consuming population [ 53 , 54 ]. Phytoestrogens are structural analogues of the mammalian hormone, estrogen, and thus can bind weakly to the hormone receptor [ 55 ].
Structurally, phytoestrogen can be grouped into flavones, flavanones, lignans, coumestans, and stilbenes [ 56 ]. The structure of important members of different classes of phytoestrogens is given in Figure 2. Soybean and soy product is a rich source of isoflavones [ 57 ].
Other phytoestrogen classes are legumes and lignans found in seeds, nuts, whole grains, fruit, and vegetables [ 57 ]. Therefore, consumption of phytoestrogen-rich diet is one of the many potential protective lifestyles against breast cancer.
Recently, there are increasing pieces of evidence that phytoestrogen activity inhibits key steroidogenic enzymes activity involved in the synthesis of estradiol from circulating androgens and estrogen sulfate [ 7 ].
Consequently, this activity could play a major role in protection against breast cancer. Besides inhibiting the estrogenic activity, phytoestrogens were also reported to activate the G-protein coupled receptor, GPR30 or GPER-1, described as a novel estrogen receptor and play a significant role in estrogen-dependent diseases like breast cancer [ 59 ].
However, the activity of phytoestrogens is unclear and depends on more than one factors that include—its structure, metabolism, its relative availability compared to that of endogenous estrogen [ 60 , 57 ]. Some important members of different classes of phytoestrogens [ 61 ].
These phenolic compounds are ubiquitous and rich in medicinal herbs and dietary plants. Several phenolic compounds contribute toward inhibiting carcinogenesis mechanism and show chemopreventive activities by their diverse range of biological activities [ 62 ] Table 4.
Herbal remedies are the most common and popular form of alternative medicine among them, which is frequently used by women suffering from breast cancer.
Here is some evidence that can help to treat breast cancer and its associated toxicity:. One of the interesting features for herbal remedies is their selective toxicity toward cancer cells. There are a number of phytocompounds reported that have selective toxicity toward breast cancer cells.
Artemisinin is one among them, isolated from Artemisia annua L. proved to be selectively cytotoxic toward breast cancer cells when an adequate amount of iron i. Because cancer cells have a higher iron influx, therefore, artemisinin and its analogues can selectively destroy cancer cells under high iron concentration [ 64 ].
Besides, polyphenols from Artemisia annua L. were reported to inhibit the adhesion and epithelial-mesenchymal transition EMT of highly metastatic breast cancer cells, MDA-MB [ 65 ]. Other than this, polyphenol-rich extracts of Hibiscus sabdariffa and aqueous extract of Brucea javanica were also reported to show selective cytotoxicity toward MCF7 and HTB breast cancer cell lines, respectively [ 66 , 67 ].
However, further exploration is necessary to isolate the selective cytotoxic ingredients of these plants Table 3. Plant-based cancer therapeutics in different stages of clinical trials and research [ 68 ].
Combination therapy of herbal therapy and synthetic drugs possibly be the last resource for patients in the final stage of breast cancer, where surgery is not possible [ 69 ].
The combinatory effect of a herbal drug with conventional cancer drugs might improve the bioavailability of one of them making the treatment more effective [ 69 , 70 ].
Additionally, the combinatory use of herbal remedies with chemotherapy will reduce the dose of standard medicine resulting in lower toxicity and side effects [ 71 ].
Several researchers have suggested that herbal compounds can be used in a therapeutic modality as it enhances the anticancer activity of current drugs. Curcumin, a renowned anticancer herbal compound down-regulated the expression of breast cancer markers in vivo and in vitro when administered along with chemotherapeutic drugs cyclophosphamide and paclitaxel that made the cancer cells more viable to the drugs [ 72 , 73 ].
Similarly, 20S-protopanaxadiol, a metabolite of ginsenosides, inhibited cell proliferation in MCF-7 cells by interfering with estrogenic gene expression when used in combination with tamoxifen [ 74 ]. Besides, this combination asynergistically improved the cytotoxicity of tamoxifen in an ER-independent manner [ 74 ].
Hence, the benefits of these herbal compounds in synergistic therapy are considerable, and this might help to overcome chemotherapeutic drug resistance and toxicity in breast cancer treatment. Cancer has been shown to be a preventable disease with changes in nutrition and dietary changes.
There are several confirmations from epidemiological and laboratory studies that sufficient intake of fruit, vegetables, and herbal supplements is inversely linked with breast cancer occurrence. A diet composed of adequate quantity of phytoestrogens, polyphenols, and rich sources of other chemopreventive agents helps in reducing breast cancer risk.
Dietary supplements of the herbal source are less toxic and easily metabolized. Besides, dietary consumption of these herbal remedies helps in fighting side effects in postchemotherapy patients.
One of the primary symptoms of adjuvant chemotherapeutic damage in posttherapy breast cancer patients is hot flushes.
Black cohosh or Actaea racemosa plant is popularly used by patients of breast cancer to treat hot flushes, which gives conflicting but promising results [ 76 ]. As discussed in the earlier section, herbal compounds show a verity of anticancer actions—including antioxidant, cytotoxic, antiproliferative, apoptotic activity, etc.
Plant-based cancer agents broadly classified into five groups that include—methyltranferase inhibitors, DNA protecting agents, antioxidants, histone deacetylases inhibitors, and mitosis disruptors.
Generally, plant-derived compounds contribute toward the anticarcinogenesis mechanism by their antioxidant, cytotoxic, antimitotic, and apoptotic activity Table 4. Others help in chemoprevention by preventing DNA damage, modulating carcinogenesis signaling, and inducing apoptotic cell death Table 4.
Several in vitro and in vivo investigations support the activity of herbal compounds that linked with their anticancer activity. Some novel compounds from herbal sources that showed promising anticancerous activity in both in vivo and in vitro studies.
Antioxidant activity of herbal compounds of oxidative stress is developed when the balance between the production of reactive oxygen species free radicals and antioxidant defense is disturbed [ 77 ]. Oxidative stress development and consequent reactive oxygen species ROS generation are linked with several disease pathogenesis including cancer.
For instance, curcumin enhances the activity of antioxidant enzymes resulting in enhanced cellular resistance to oxidative damage [ 78 ]. In addition, curcumin was also found to rise hepatic GSH, SOD, GPx, GR, GST, and CAT activities in paracetamol-treated rats [ 79 ].
Other plant-based compounds like epigallocatechin gallate, a component of in green tea, found to reduce the levels of lipid peroxidation and protein carbonyl content in rats, possibly by enhancing the GSH redox status significantly when administered orally [ 80 ].
Likewise, several herbal compounds help to reduce oxidative stress, hence play a preventive role against cancer onset. Quite a few herbal compounds help to inhibit angiogenesis in breast cancer. Genistein, a flavonoid phytoestrogen, is the most potent angiogenesis inhibitor linked with reduced expression of VEGF, PDGF, uPA, and MMP-2 and MMP-9 [ 81 ].
Curcumin was even found to be an effective inhibitor of angiogenesis that reduces the expression of various proangiogenic proteins such as vascular endothelial growth factor VEGF and basic fibroblast growth factor [ 82 ]. Resveratrol and quercetin inhibited the migration and tube formation in bovine aorta endothelial cells consequently inhibiting angiogenesis in those cells [ 83 , 84 ].
In addition, catechin derivatives, such as epicatechin EC , epigallocatechin EGC , epicatechingallate ECG , and epigallocatechingallate EGCG , present in green tea are potent angiogenesis inhibitors [ 85 ].
The anti-angiogenic activity of EGCG was demonstrated by inhibition of vascular endothelial growth factor VEGF production and reduction of matrix metalloproteinase-2 MMP-2 activity in MDA-MB breast cancer cells [ 85 ]. The apoptosis-inducing activity of herbal compounds is another favorable feature that contributes toward their anticancer effect.
Curcumin was found to inhibit the proliferation and inducing apoptosis in several cancer cell lines including breast cancer cells such as T47D, MCF7, MDA-MB, and MDA-MB [ ].
Protocatechuic acid was also found to be a potent apoptosis inducer in five types of human cancer cell lines including breast, lung, liver, cervix, and prostate cancer cells [ ], which was confirmed by DNA fragmentation, changes in mitochondrial membrane potential, and measurement of caspase activity.
The flavonoid 8-prenylnaringenin 8PN , a constituent of Humulus lupulus , is an effective phytocompound known for its growth-inhibiting and apoptotic activity in various human cancer types including breast cancer [ ].
This activity of 8PN in MCF7 breast cancer cells was possibly mediated by interference with an ER-associated PI3K pathway [ ]. Other herbal compounds like lycopene inhibit cell cycle progression by reducing cyclin D expression and retention of p27 in cyclin E—cdk2, thus leading to inhibition of G1 CDK activities in human breast cell line MCF-7 and TD along with endometrial ECC-1 cancer cells [ ].
Interestingly, artemisinin, which is an ancient Chinese herbal compound for malarial fevers, has been recently found to have potent and selective toxicity against cancer cells. It reacts with iron to form free radicals with alkylating capacity that can kill cells.
As cancer cells require a large quantity of iron uptake to proliferate, making them more susceptible to the cytotoxic effect of artemisinin [ ]. Besides, oral administration of artemisinin delayed the onset of breast cancer in 7, dimethylbenz [a] anthracene DMBA -induced rats [ ].
This encouraging results might lead to design novel chemotherapeutics with effective anticancer property and low toxicity. Though, advances in healthcare research lead to the identification and characterization of most breast cancer types and corresponding cure.
However, incidence and prevalence of breast cancer is rising in terrifying rate in both developed and developing countries because of various risk factors. Improved synthetic drugs and hormonal therapy emerged in a decline in breast cancer incidences, increased survival, and better life quality.
However, prolonged use of synthetic anticancer drugs is linked with several health risks or side effects that consequence from the toxic effect of these drugs in normal cells.
Chemoprevention by herbal compounds is of great interest and is considered to be an inexpensive, readily applicable, acceptable, and accessible approach to cancer control and management.
Herbal remedies play a significant role in the management of breast cancer and the associated therapeutic toxicity. The adjunct use of herbal products and chemotherapy can be an efficient and cost-effective way to treat breast cancer.
Such adjuvant therapy proved to produce a synergistic anticancer effect that reduced the drug toxicity, suppresses drug resistance, and provides quick drug action enhancing the quality of treatment. Besides, combinatory therapy might also increase the therapeutic index of the synthetic partner by improving the efficiency of the drug.
Plant-derived anticancer drugs such as vinblastine, vincristine, taxols, etc. showed encouraging chemotherapeutic potential that is currently used in breast cancer treatment and a large number of them are in preclinical or in clinical trials. In the last decade, a vast number of phytochemicals were identified that showed encouraging anticancer activity in vivo and in vitro breast cancer models.
Interestingly, several compounds like artemisinin and isothiocyanates showed selective toxicity toward cancer cells, which recommend clinical trials of these compounds. Furthermore, phytoestrogens with affinity and capacity to produce functional responses through estrogen receptors revealed unique possibilities of using them in hormone replacement therapy.
Overall, this chapter can conclude that understanding the molecular mechanism of interaction between herbal compounds and cancer cells in the tumoral environment can help us to design novel anticancer drugs that are less toxic and affordable.
This reflects the fact that these goals will only be attainable if the herbal compounds that showed promising anticancer activity can be successfully transferred to an ideal clinical setting for the use of herbal therapies.
Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution 3. Again, a significant proportion of users We therefore focused on these patients who indicated their use of herbal remedies and functional foods as complementary treatment.
The survey was descriptive and cross-sectional in design using a de novo pilot-tested questionnaire Additional file 1 and adult patients were conveniently chosen at two specialized cancer treatment centres in Trinidad during the period June to August All participating patients signed their informed consent and the survey instrument was interviewer-administered, and we assumed that non-response was not a critical factor.
Additionally, we recorded the mode of preparation of herbal remedies and functional foods. The Statistical Package for the Social Sciences SPSS Program, Version Although a significant number of patients 44 or Most patients or Fifty-five herbal remedies, supplements and functional foods were identified in the survey.
On average, patients used 2. Soursop Annona muricata L. was the most common herb or The leaves, bark and seeds were used to make infusions and decoctions, and the ripe fruit was eaten raw, juiced or blended.
Two patients consumed either boiled or steeped soursop seeds. Other commonly used herbs included wheatgrass Triticum aestivum L.
Burm f. and ginger Zingiber officinale Roscoe. A significant number of patients used blended or pureed mixed vegetable juices, which included beetroot Beta vulgaris L. The highest levels of herbal remedy and functional foods use was observed amongst patients with breast cancer; whereas prostate cancer patients had the lowest levels of use with no reported use of either carrot Daucus carota L.
or saffron Crocus sativus L. However, only a small number of patients 39 or And, in 59 patients Most of the information was obtained from family members and friends 54 or Despite this, patients or And this was supported by the significant number of patients or Just about half the number of patients in the survey 77 or Most patients believed that their understanding of the scientific evidence and positive testimonials from other cancer patients were sufficient to support their use of this form of complementary medicine.
To our knowledge this is the first observational study in Trinidad to determine the complementary use of medicinal herbs and functional foods among patients diagnosed with breast, prostate and colorectal cancer.
We found a wide range of herbal remedies and functional foods being used by respondents for cancer treatment, health maintenance and to counteract side effects of conventional treatment. As in other studies [ 10 , 15 ], most patients in our survey believed that herbs would destroy cancer cells, with fewer side effects than conventional therapy.
Most patients used herbal medicines and functional foods on a daily basis in the diet alongside conventional therapies. The herbal treatments were usually consumed as a juice or a tea infusion using the leaves. Some patients use the herbs concomitantly with conventional therapy and some take it before and after the course of conventional treatment.
A review of the literature revealed limited clinical evidence to support the use of most of the herbal remedies and functional foods cited in this survey. However, we assessed the literature with regards to in vitro and ex vivo research to determine whether the herbal remedies and functional foods demonstrate anticancer properties that may lend support to their use in our patient sample.
was the most popular medicinal plant among respondents; with the leaves, bark, fruit and seeds being used. The seeds, leaves and bark were boiled to made decoctions, and the ripe fruit was eaten fresh or juiced. Several studies have identified cytotoxic acetogenins in the leaves and fruit of Annona muricata L [ 17 — 19 ].
Various extracts of Annona muricata L. have shown anti-proliferative activity in vitro by cell cycle arrest and apoptosis in prostate, colon and breast cancer cell lines [ 20 — 22 ].
However, to date there is no evidence from placebo-controlled clinical trials to support its use in the treatment of any type of cancer. Beetroot Beta vulgaris L. An extract of beetroot was shown to be cytotoxic in androgen-independent human prostate cancer cells and estrogen receptor-positive human breast cancer cells [ 23 ].
Additionally, a synergistic anti-proliferative effect was observed in breast and prostate cancer cell lines when treated with a combination of red beetroot extract and doxorubicin [ 24 ].
It has been suggested that betanine and betalain, major pigment constituents of beetroot, may be responsible for the cytotoxic activity. Again, there are no published clinical studies to establish a role for beetroot in the treatment of cancer.
Like beetroot, a common trend is the use of carrot juice for the prevention and treatment of a variety of cancer types. It has been suggested that bioactive compounds, such as β-carotene and polyacetylenes, are responsible for its cancer-protective properties.
One of the first observational studies by Longnecker and colleagues [ 25 ] established an association between carrot consumption and a reduced risk of breast cancer.
This study included cases and controls and it showed that consumption of carrots more than twice weekly reduced the odds of developing cancer by almost half.
A recent meta-analysis of observational studies also showed that carrot intake was inversely related to the incidence of prostate cancer [ 26 ]. Oxidative stress is known to induce cancer and a recent study in overweight breast cancer survivors showed that the daily consumption of carrot juice increased plasma carotenoid levels, this would subsequently reduce oxidative stress and it has been postulated that this would reduce the risk of recurrence of cancer [ 27 ].
Studies in human colon and breast cancer cell lines demonstrated anti-proliferative effects of extract of carrot oil by modulating various mediators of apoptosis and cell cycle arrest [ 28 , 29 ]. Wheatgrass Triticum aestivum L. was another popular remedy used mostly by breast and colorectal cancer patients in our study.
Although there were no clinical studies to support its use, there are a few in vitro studies using breast and colorectal cancer cell lines. Wheatgrass is fermented by gut microflora to secondary products, and it has been proposed that these compounds possess significant antineoplastic activity.
Non-fermented and fermented wheatgrass extract significantly decreased growth in a colon cancer cell line [ 30 ]. These results were corroborated in another laboratory study which showed that fermented wheatgrass extract inhibited growth and increased apoptosis in two different colon cancer cell lines [ 31 ].
More recently, it was shown that the combination of cisplatin and wheatgrass extract had a synergistic effect to inhibit growth in a breast cancer cell line and modulate apoptosis and proliferation-associated genes [ 32 ]. The use of papaya Carica papaya L.
was also common among our patients with leaves being used to make a tea and the fruit being juiced or blended. The aqueous extract of fresh papaya leaves was tested against various cancer cell lines and human peripheral blood mononuclear cells to determine whether it exhibited cytotoxic activity and inhibitory effects on various biomarkers of inflammation and apoptosis [ 33 ].
The results showed that papaya extract significantly inhibited growth of cancer cells and down-regulated the expression of pro-inflammatory cytokines IL-2 and IL Although the use of papaya in cancer treatment is commonly practiced, a review of the literature did not unearth any observational or interventional clinical studies which supported the use of papaya in cancer treatment.
Although the Indian spice saffron Crocus sativus L. Crocin, the major constituent of saffron, was shown to have a dose-dependent anti-proliferative effect against three colorectal cancer cell lines and a non-small cell lung cancer cell line whilst not having any effect on normal cells [ 34 ].
In another in vitro experiment crocetin, the main metabolite of crocin, was anti-proliferative and prevented the migration of a highly invasive breast cancer cell line by down-regulating the expression of matrix metalloproteinases [ 35 ]. Extracts have also been shown to have anti-proliferative effects against aggressive prostate cancer cell lines by mechanisms which include down-regulation of metalloproteinases, DNA fragmentation and induction of mediators of apoptosis [ 36 , 37 ].
This study was limited due to its cross-sectional nature and the short time frame and we were not able to follow-up patients to determine the impact of supplementation on clinical outcomes. We also limited our target population to breast, prostate and colorectal cancer patients and there may be differences in the pattern of herbal remedy and functional food use in patients with other types of cancers.
However, despite these limitations the study highlighted the most common herbal remedies and functional foods used in the most common cancers in patients accessing public healthcare in Trinidad.
This study unearthed the herbal remedies and functional foods used by patients with the most prevalent cancers in Trinidad. It was not surprising that soursop Annona muricata L.
was the most common herbal remedy, as the herb has strong traditional use on the island. We also found high use of juices made from vegetables, which were used on a daily basis by most patients. Most of the scientific evidence of antineoplastic activity of these plants and functional foods comes from in vivo and ex vivo studies.
However, despite the lack of clinical evidence most patients felt or believed that these remedies are equally or more efficacious than conventional treatments.
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Complementary medicine use among cancer patients receiving radiotherapy and chemotherapy: methods, sources of information and the need for counselling. Eur J Cancer Care Engl. For example, marijuana may help with nausea. But it may also interfere with immunotherapy treatment.
It is vital for patients to talk with their doctors before taking these or other herbal treatments. Potential benefits and concerns with herbal medicine vary on a case-by-case basis. Turmeric is a flowering plant with a vibrant, orange-colored root.
This plant contains the chemical compound curcumin, which is available as an herbal supplement. Evidence from cancer studies suggests curcumin may:.
A study of curcumin in non-mesothelioma cancers found various benefits. Some patients with solid tumors took curcumin while receiving chemotherapy.
They experienced significantly lower rates of chemotherapy-related side effects. These patients also needed fewer medications to manage chemotherapy side effects. These studies are not mesothelioma-focused but may still interest patients. These study findings are encouraging, but they cannot replace the guidance of an oncologist.
For their own safety, patients should talk with a mesothelioma doctor before taking any herbal medicine. Mistletoe is a plant that grows on several different types of trees. Its extracts can vary because of the specific species of mistletoe and the tree it grows on.
As a result, efficacy for treating conditions may be inconsistent. Some experts criticize the methods and parameters of many mistletoe extract studies. These weaknesses may call their results into question. Reishi is a large, dark mushroom used in several traditional medical systems.
This mushroom has been a popular supplement in recent years. It has many claims of health benefits and abilities to treat serious conditions. But the actual evidence of its effects on cancer indicates reishi:.
The positive effects of reishi mushrooms may be due to the presence of beta-glucans. Beta-glucans are natural substances found in items like mushrooms, grains and yeasts. Some research suggests that mushroom beta-glucans may help fight cancer, enhance memory and reduce infection frequency and severity.
Reported side effects of reishi are relatively mild and include nausea and insomnia. These side effects and risks may seem low.
But doctors can decide if taking reishi is safe for mesothelioma patients. Black cohosh is a member of the Buttercup family of plants, native to North America. It is commonly used in Europe. Black cohosh may be used to treat many conditions, including menopausal symptoms and irregular heartbeat.
Mood disorders like irritability, anxiety and depression may also be treated with the herb. Experts say the data for black cohosh is inconclusive.
But as a relatively safe herb, it warrants more research. In general, black cohosh is very well-tolerated and rarely causes serious side effects. Serious side effects likely result from product quality issues, not the herb itself.
But black cohosh may interfere with statins for cholesterol management. This is a good example of why patients should speak with their doctors before taking any herbal products. The dried leaves and flowers of Cannabis plants, also called marijuana, contain cannabinoids.
These are popular for a variety of recreational and medicinal uses. Evidence suggests marijuana may:. Reported side effects of marijuana use include bloodshot eyes, dizziness, increased heart rate and sleepiness. Some evidence suggests cannabis use may limit the efficacy of immunotherapy.
This may be a serious risk for mesothelioma patients receiving this cutting-edge treatment. Doctors can explain if marijuana is a safe addition to their treatment plans. Other herbs have some studies and evidence of their use against cancer.
These have less evidence than others but may still offer some benefit. Other herbs with potential benefits include:. Other studies have found clear evidence of harm when using certain herbs. These concerns may be both general and cancer-specific. Herbs that may harm cancer patients include:.
Regardless of how promising an herb seems, there may be risks. It is best to speak with healthcare teams before beginning any herbal supplementation. Questions About Alternative Mesothelioma Treatments? Ask experienced mesothelioma advocate Jennifer Lucarelli Ask a Question. Side effects vary by the type of herb.
These effects may be more common with some herbs than others. Mesothelioma specialists can explain which herbs may have negative side effects. Common herbal side effects include chills, diarrhea, insomnia, nausea and skin irritation. Doctors can also determine if any herbs may interact negatively with other treatments.
There are other serious risks with some herbs that may impact patients. For example, some herbs may increase the effects of anticoagulant drugs blood thinners. Herbs that sometimes cause this effect include dang gui, curcumin, ginger and reishi.
Cancer patients who take blood thinners may face this risk. Herbs may seem like a natural and safe way to improve health. But herb and drug interactions are complex and varied. Some herbs have both potential benefits and risks to cancer patients. But other herbs may be dangerous or offer little to no proven benefits.
It may be safest for some cancer patients to avoid these herbs altogether.
Katy Moncivais, Ph. Medical Editor. Linda Molinari Lentils and vegan recipes in Chief. Some chemotherapy drugs rrmedies derived Injury nutrition guidelines Catharanthus Herbal remedies for cancer preventionalso remediee as Vinca rosea. Herbal medicine uses plant-derived substances to treat illnesses. It is a complementary therapy some cancer patients may add to their treatment plans. Research does not show any evidence that herbal medicines can treat or cure cancer.
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