Withania Somnifera

Withania Somnifera

PEP Topic 

Withania somnifera, also known as ashwagandha or Indian ginseng, is a plant that contains multiple chemical components that have antioxidant, anti-inflammatory, and anticancer properties. It has been used as part of traditional Indian medicine for centuries to improve general well-being. A withania somnifera root extract was tested among patients with cancer for its effect on fatigue, anorexia, sleep-wake disturbances, and quality of life.

Effectiveness Not Established

Research Evidence Summaries

Biswal, B.M., Sulaiman, S.A., Ismail, H.C., Zakaria, H., & Musa, K.I. (2013). Effect of Withania somnifera (ashwagandha) on the development of chemotherapy-induced fatigue and quality of life in breast cancer patients. Integrative Cancer Therapies, 12, 312–322. 

doi: 10.1177/1534735412464551

Study Purpose:

To examine the effects of Withania somnifera (WS) on fatigue and quality of life among patients with breast cancer receiving chemotherapy

Intervention Characteristics/Basic Study Process:

WS was supplied as a powder in 500 mg capsules. Patients was asked to take four capsules three times daily for total daily dose of 6 g. Patients were followed for six cycles of chemotherapy. Study measures were conducted at baseline and periodically through treatment. Some measures were conducted on the first day of every cycle, and others were conducted on the first day of cycle 1, 3, and 6. Consecutive patients were alternately assigned to treatment or usual care groups.

Sample Characteristics:

  • N = 100  
  • MEAN AGE = 50.75 years (range = 32–72)
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: All had breast cancer. Chemotherapy was done as either adjuvant or palliative treatment. Most patients had stage II or III disease. Patients were either on regimens of cyclophosphamide, epirubicin, and 5FU, or taxotere, adriamycin, and 5FU.


  • SITE: Single site  
  • SETTING TYPE: Not specified  
  • LOCATION: Malaysia

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Active anti-tumor treatment
  • APPLICATIONS: Palliative care 

Study Design:

  • Non-random, open label, two-group comparison

Measurement Instruments/Methods:

  • Piper Fatigue Scale
  • Schwartz Cancer Fatigue Scale


Several QOL measures were significantly better in the treatment group compared to controls: physical functioning (p < .001), role functioning (p < .001), insomnia (p < .001), loss of appetite (p = .011), emotional functioning (p < .001), and social functioning (p < .001). Fatigue scores were significantly better as shown by repeated measures ANOVA in the intervention group (p ≤ .003). Ninety-eight percent of intervention patients found the intervention acceptable.


Findings suggest that the herbal treatment of WS is beneficial for the management of fatigue in patients with breast cancer undergoing chemotherapy.


  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Other limitations/explanation: No information on adherence to the WS regimen; therefore, it is unclear if patients took all of the substance as planned. At baseline, the control group had significantly lower QOL scores.

Nursing Implications:

The herbal treatment of WS, which has been used in Ayurveda medicine, may be beneficial to reduce fatigue in patients with cancer. This particular study has several important limitations; however, results are promising. Additional well-designed research with this herbal remedy is warranted.