Incorporating Astragalus in Palliative Care

This Chinese herb, also known as Huang Qi or Astragalus membranaceus, has been used for centuries to support the immune system, restore Qi, and invigorate the spleen. (1) The dried root of astragalus is traditionally used, as compounds such as astragalus polysaccharide can be extracted from it. There are numerous pharmacological actions of astragalus polysaccharides, including regulating the immune system, anti-aging, antitumor effects, reducing blood sugar and lipids, antifibrotic, antibacterial, antiviral, radioprotective, and neuroprotective. (1,2) Traditional indications include weakened individuals with night sweats, frequent infectious illnesses, lack of vitality, poor digestion, and poor nutritional status. (3) Due to its multitude of physiological actions that have a widespread benefit throughout the body, Astragalus is often useful in the palliative care patient, where it has been found to benefit numerous issues. (4-10)

Cancer-related side-effects where Astragalus may be of benefit (4-10):

• Neutropenia 
• Anemia
• Thrombocytopenia 
• Anorexia 
• Fatigue

The injectable form of astragalus called PG2, has numerous studies demonstrating its benefit in cancer-related fatigue. (11) A double-blind, multi-center, randomized study in 2019 found a 10% improvement in fatigue (using the Karnofsky Performance Status) in 65% of patients after only one treatment. (12) With the positive evidence, PG2 injection is now a part of the standard of care in Taiwan for cancer-related fatigue. (13)

A retrospective study published in 2021 found that patients with metastatic lung cancer being treated with immune checkpoint inhibitors who used injectable astragalus polysaccharide had an improvement in their neutrophil-to-lymphocyte ratio (NLR). (14)

The mechanisms of how astragalus exerts its benefits are multi-factorial, including its role in modulating the immune system, cytokines, and, therefore, the tumor microenvironment. For example, astragalus has been shown to facilitate the maturation of dendritic cells, leading to production of IL-12, shift Th2 towards Th1, and active T cells and NK cells, which subsequently leads to downstream changes in many cytokines.  (15, 16) It is assumed that these changes in cytokine expression, especially inflammatory cytokines, may be way astragalus induces an improvement in quality of life. (17)  These benefits to the immune system from astragalus have also led to investigations on its use in COVID-19 and various neurodegenerative diseases. (18, 19) Lastly, there have been studies demonstrating astragalus’ anticancer mechanisms, including inducing apoptosis in cancer cells, cell-cycle disruption, and inhibition of signal transduction. (15) 

For more information on astragalus and how it may be of benefit to your patients, consider the Advanced Integrative Oncology Palliative Care Course by the Integrative Oncology Institute.