Most adverse side effects of chemotherapy and radiotherapy are still a big concern for patients and their families. No provisions are made for the side effects of chemotherapy, and sometimes patients are not aware of these effects.

In this respect, to treat the side effects of chemotherapy and radiotherapy, the use of “safe natural” herbs may be more appealing. Insomnia and other sleep disturbances are common in cancer patients. Insomnia is a multifactorial health concern that currently affects at least one out of three cancer patients, and yet most insomnia sufferers do not consult their physician regarding pharmaceutical options for their relief.

In a multicenter study in Baltimore, 44% of breast and lung cancer patients reported experiences of sleep disturbances. In a cross-sectional survey, 31% of patients attending clinics for breast, gastrointestinal, genitourinary, gynaecologic and various skin cancers reported insomnia. Up to 75% of cancer patients visiting an intensive care unit reported sleep disturbances. Since long-term use of hypnotic drugs is associated with dependence and other risks, herbal remedies as sleep aids are required, especially when the disease has become chronic.

Many physicians have expressed the need to educate themselves and their patients to use, 13 Safety and Efficacy of Phytomedicines in Cancer Prevention and Treatment 213 appropriately, these herbs and have questioned whether sufficient research data exist in order to make recommendations for insomnia relief and restoration of normal sleep quality. Some herbal sedatives have a long history of use in Europe but they are yet relatively new in the USA.

Valeriana
Valeriana contains constituents of the essential oil sesquiterpenes, which are of special interest for their sedative effects. Valeriana has shown sedative activity in a meta-analysis of clinical trials for the treatment of insomnia and has been proved useful in sleep, since it is active against anxiety, which may interfere with sleep. Numerous studies have investigated the use of kava in the treatment of anxiety and sleep disorders. A meta-analysis reported that kava was effective in reducing anxiety.

Chamomile
Chamomile is very popular in the USA and Europe for its relaxing effect. Clinical trials on the sedative effects of chamomile are lacking and thus needed. In a pilot study, 10 out of 12 patients immediately entered into a deep sleep lasting an average of 90 min.

Lavender
Lavender is used in aromatherapy as a holistic relaxant and, when inhaled, has been reported to have sedative effects in both animals and humans. Patients undergoing radiation therapy were treated with lavender unscented carrier oil or other essential oils for inhalation: the carrier group experienced less anxiety than did the essential oil group. There are anecdotal and historical accounts of the sleep-enhancing benefits of hops and Lemon balm. Both herbs are purported to have sedative and hypnotic effects, but clinical evidence from MEDLINE is scarce.

Passionflower
Passionflower, another herb with mild sedative effects, is often combined with valerian in the herbal sleep aids found in health food stores. In a double-blind, randomized, placebo-controlled study, the effect on anxiety of passionflower did not differ from that of the oxazepam group.

St. John’s wort
A meta-analysis was conducted on St. John’s wort including 23 randomized trials (N:1757 outpatients) with mild to moderate depressive disorders. St. John’s wort was found to be significantly more effective than placebo. Other authors concluded that St. John’s wort was not effective in 200 adults with major depression.

Aloe vera
Regarding the efficacy of topical Aloe vera in reducing the side effects on skin of radiation therapy, some authors reported no improvement in clinical studies compared to placebo or aqueous cream.

Ginger
Ginger has demonstrated effectiveness with chemotherapy-induced nausea in a meta-analysis of randomized clinical trials. Important adaptogens to consider in oncology include Eleutherococcus senticosus, Panax ginseng, Rhodiola rosea, Schisandra chinensis, Rhaponticum carthamoides and Aralia manchurica. Extensive studies using various cytotoxic therapies in animal and human models with tumours have demonstrated that these adaptogens reduced chemotherapic drug toxicity, in combination with cytotoxic agents, particularly in bone marrow restoration, and they enhanced antitumour and antimetastatic effects.