Record ID: MS-N093
Family: Traditional and botanical medicine
Clinical question: Does ashwagandha root extract reduce fatigue during chemotherapy for breast cancer?
Evidence label: Nonrandomized comparative study; promising but very uncertain
Evidence at a glance
Benefit: Fatigue and some quality-of-life scores favored ashwagandha in one study.
Certainty: Very low because treatment was open label and nonrandomized, with subjective outcomes.
Risk: Sedation, gastrointestinal effects, thyroid effects and rare liver injury are concerns; medication interactions are plausible.
Cancer control: The study did not establish better tumor response or survival.
What was studied
A prospective open-label, nonrandomized study compared 100 people with breast cancer receiving chemotherapy with or without oral Withania somnifera root extract. The research regimen was 2 g every eight hours throughout chemotherapy.
Fatigue was measured with the Piper Fatigue Scale and Schwartz Cancer Fatigue Scale; quality of life used EORTC QLQ-C30. Most participants had stage II or III disease.
What the results mean
Estimated fatigue scores were lower in the ashwagandha group (P<.001 on Piper and P<.003 on SCFS-6), and 7 of 18 EORTC symptom comparisons favored the intervention.
At a median 26 months, reported 24-month overall survival was 72% versus 56%, but the difference was not statistically significant (P=.176). It must not be presented as a survival benefit.
Limits and uncertainty
Participants and clinicians knew the treatment, allocation was not randomized, and fatigue is especially vulnerable to expectancy and selection effects. The published abstract does not provide every absolute score or missing-data detail.
One formulation in one setting does not validate commercial “adaptogen” claims, cancer treatment claims or use in other cancers.
Safety and practical context
NCCIH reports rare cases of liver injury and possible interactions with diabetes and blood-pressure medicines, immunosuppressants, sedatives, anticonvulsants and thyroid hormone. Ashwagandha may affect thyroid function and is not recommended during pregnancy.
Fatigue can reflect anemia, infection, endocrine problems, sleep disturbance, depression or cancer progression. Assessment should come before self-treatment.
Questions for the care team
- Could a reversible medical cause be contributing to fatigue?
- How was allocation handled, and was the study blinded?
- Do liver, thyroid or medication factors make this unsafe for me?
- Are exercise, sleep or symptom-management options supported by stronger evidence?
Sources
Funding and conflicts
PubMed classifies the study as non-U.S. government research support. Detailed sponsor influence and conflicts were not verified from full text.
Last literature search: October 21, 2026
Record appraised: October 21, 2026
This educational record is not individualized medical advice. Research doses and schedules are not personal prescriptions; do not delay or replace evidence-based cancer care.
