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Application of Aloe Vera in Cancer Patients

Sep 19, 2020

Highlights

Studies indicate that the use of aloe vera mouthwash may help in reducing chemotherapy-induced stomatitis in leukemia and lymphoma patients, and radiation-induced mucositis in head and neck cancer patients. However, the scientific evidence suggesting the benefits of oral ingestion of aloe vera juice by cancer patients is minimal. A 2009 study suggested potential benefits of oral aloe in reducing tumor size, controlling disease and improving the 3-year survival. However, larger studies are needed to establish these findings as well as evaluate the toxicity and safety of oral ingestion of Aloe before recommending its use.

What is Aloe Vera?

Aloe Vera is a succulent medicinal plant that grows in the dry and tropical climates in Africa, Asia, Europe and some parts of the United States. The name Aloe vera was derived from the Arabic word “Alloeh”which means “shining bitter substance,” and Latin word “vera” which means “true”. 

aloe vera use in cancer

The juice and the gel extracted from Aloe vera plants are known for their healing properties. Aloe vera has been used as a medicinal plant for centuries for treating various health and skin conditions. Some of its key active compounds include:

  • Anthraquinones such as Barbaloin (Aloin A), Chrysophanol, Aloe-emodin, Aloenin, Aloesaponol
  • Naphthalenones
  • Polysaccharides such as Acemannan
  • Sterols such as Lupeol
  • Proteins and Enzymes
  • Organic Acids 

Benefits of Topical Application of Aloe Vera Gel

Aloe vera exhibits a range of therapeutic properties including anti-inflammatory, anti-microbial, anti-viral, and antioxidant properties. Aloe vera gel is used topically for healing and soothing wounds/skin abrasions, minor burns, sunburns, radiation induced skin injury, skin conditions associated with psoriasis, acne, dandruff and hydrating skin. The gel helps in soothing the inflamed skin. It has sterols which can promote the production of collagen and hyaluronic acid that may help rejuvenate the skin and improve the skin texture, thereby reducing the appearance of wrinkles.

Benefits of drinking Aloe Vera Juice

The potential benefits of drinking Aloe vera juice by cancer patients is unknown. However, following are some of its other potential health benefits.

  • Using Aloe vera juice as mouthwash reduces plaque build up and gingival gum inflammation
  • Keeps skin hydrated, improve skin health, reduce acne leading to clear skin
  • Helps in reducing constipation 
  • Aids in controlling blood sugar levels
  • Helps in natural detoxification of the body
  • Helps in relieving heartburn/acid reflux 

Side Effects of Aloe Vera Juice Ingestion

Despite the potential benefits mentioned before, ingestion of Aloe vera juice is associated with many side-effects which include:

  1. Cramping and diarrhea- if the extract contains high amounts of aloin, a compound found between the outer leaf of the Aloe vera plant and the gel inside, with laxative effects.
  2. Nausea and vomiting
  3. Low potassium levels when Aloe vera is taken along with chemotherapy
  4. Aloe vera induced toxicity resulting in seizures and electrolyte imbalances.
  5. Interactions with drugs which are substrates of Cytochrome P450 3A4 and 2D6.

As with aloe vera juice ingestion, Aloe vera injections are also not recommended in cancer patients. Back in the 1990s, many cancer patients died post receiving Aloe vera (acemannan) injections as part of cancer therapy.

Studies associated with the Use of Aloe Vera in Cancer

There aren’t any evidence suggesting possible benefits of drinking aloe vera juice by cancer patients. However, some of the benefits of aloe vera mouthwash and topical applications in cancer patients are elaborated below.

Impact of Aloe Vera Mouthwash on Chemotherapy-Induced Stomatitis in Lymphoma and Leukemia Patients 

Chemotherapy is the first line therapy for leukemia and lymphoma. One of the most common side effects of chemotherapy is stomatitis. Stomatitis, also known as oral mucositis, is the painful inflammation or ulceration that occurs in the mouth. Stomatitis or oral mucositis often lead to problems such as infection and mucosal bleeding resulting in difficulties in food intake, nutritional disturbances and restlessness.

In a clinical trial done by the researchers of Shiraz University of Medical Sciences, Iran in 2016, they evaluated the effect of Aloe vera solution on stomatitis and related pain intensity in 64 patients with Acute Myeloid Leukemia (AML) and Acute Lymphocytic Leukemia (ALL) undergoing chemotherapy. A subgroup of these patients were asked to use Aloe vera mouthwash for two minutes thrice a day for 2 weeks, while the rest of the patients used the ordinary mouthwashes recommended by cancer centers. (Parisa Mansouri et al, Int J Community Based Nurs Midwifery., 2016)

The study found that patients who used Aloe vera mouthwash solution had a significant reduction in stomatitis and related pain intensity compared to those who used ordinary mouthwashes. The researchers concluded that Aloe vera mouthwashes may be beneficial in reducing stomatitis or oral mucositis and related pain intensity in leukemia and lymphoma patients undergoing chemotherapy, and may improve the patients’ nutritional status.

Impact of Aloe vera mouthwash on  Radiation-induced Mucositis in Head and Neck Cancer Patients

Mucositis refers to the painful inflammation or ulceration of the mucous membranes anywhere along the gastrointestinal tract, not restricted to the mouth. In a clinical trial done and published by the researchers of Tehran University of Medical Sciences (TUMS), Iran in 2015, they evaluated the efficacy of Aloe vera mouthwash in reducing radiation-induced mucositis in 26 head and neck cancer patients who were scheduled to receive conventional radiation therapy and compared it with a benzydamine mouthwash. (Mahnaz Sahebjamee et al, Oral Health Prev Dent., 2015)

The study found that the periods between radiation therapy and the onset of mucositis as well as maximum severity of mucositis were similar for the patient group using Aloe vera (15.69±7.77 days and 23.38±10.75 days respectively) as well as the group using benzydamine (15.85±12.96 days and 23.54±15.45 days respectively). 

The researchers concluded that Aloe vera mouthwash may be as effective as benzydamine mouthwash in delaying radiation-induced mucositis, with no side effects.

Impact of Aloe arborescens in Patients with Metastatic Cancer 

Aloe arborescens, is another succulent plant that belongs to the same genus Aloe, which is shared by Aloe vera. 

In a clinical study published by the researchers of the St. Gerardo Hospital in Italy, the researchers evaluated 240 patients with metastatic solid tumor who received chemotherapy with or without Aloe. Among the patients included for the study, lung cancer patients received cisplatin and etoposide or vinorelbine, colorectal cancer patients received oxaliplatin along with 5-FU, gastric cancer patients received 5-FU and pancreatic cancer patients received Gemcitabine. A subgroup of these patients also received Aloe orally. (Paolo Lissoni et al, In Vivo., Jan-Feb 2009)

This study found that patients who received both chemotherapy as well as Aloe had a high percentage of tumor size reduction, disease control and patients who survived for at least 3-years.

However, larger studies are recommended to evaluate the toxicity and confirm the safety of oral ingestion of Aloe.

Impact of Topical Application on Radiation-induced Dermatitis in Cancer Patients

Dermatitis refers to the inflammation of the skin. Radiation induced dermatitis is common in cancer patients receiving radiotherapy.

  1. In a previous clinical trial done by the researchers of Tehran University of Medical Sciences in Iran, they studied the impact of Aloe vera lotion on radiation-induced dermatitis in 60 cancer patients including those with breast cancer, pelvic cancer, head-and-neck cancer and other cancers, who were scheduled to receive radiotherapy. 20 of these patients also received chemotherapy concurrently. Based on the results from this study, the researchers concluded that the use of Aloe vera may help in reducing the intensity of radiation-induced dermatitis.  (P Haddad et al, Curr Oncol., 2013)
  1. In a study published in 2017, the researchers of Shiraz University of Medical Sciences in Iran did a similar study on 100 patients diagnosed with breast cancer to evaluate the impact of Aloe vera gel on radiation-induced dermatitis. However, the findings from this study found that Aloe vera gel application had no positive impact on prevalence or severity of radiation-induced dermatitis in the breast cancer patients. (Niloofar Ahmadloo et al, Asian Pac J Cancer Prev., 2017)

Due to conflicting results, we cannot conclude whether topical aloe vera application is beneficial in reducing the radiation-induced dermatitis in cancer patients, especially the breast cancer patients. 

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Impact of Topical Application on Radiation-induced Proctitis in Pelvic Cancer Patients 

Proctitis refers to the inflammation of the lining of the inner rectum. 

In a study published in 2017, the researchers of the Mazandaran University of Medical Sciences in Iran evaluated the impact of topical application of Aloe vera ointment on radiation-induced proctitis in 20 pelvic cancer patients. These cancer patients exhibited one or more of the symptoms including rectal bleeding, abdominal/rectal pain, diarrhea or fecal urgency. The study found a significant improvement in diarrhea, fecal urgency and lifestyle. However, the results didn’t show any significant improvement in hemorrhage and abdominal/rectal pain. (Adeleh Sahebnasagh et al, J Altern Complement Med., 2017)

The researchers concluded that application of Aloe vera ointment may be beneficial in reducing few of the symptoms associated with radiation-induced proctitis such as diarrhea and fecal urgency.

In vitro studies assessing anti-cancer properties of the active component (Aloe-emodin)

An in vitro study found that Aloe-emodin, a phytoestrogen present in Aloe vera with estrogenic properties, may help in suppressing breast cancer cell proliferation. (Pao-Hsuan Huang et al, Evid Based Complement Alternat Med., 2013)

Another in vitro study also found that Aloe-emodin may induce stress-dependent apoptosis (cell death) in colorectal cancer cells. (Chunsheng Cheng et al, Med Sci Monit., 2018)

However, there is no scientific evidence supporting the use of Aloe-emodin in humans for cancer treatment.

Conclusion

Key findings of the studies indicate that the use of aloe vera mouthwash may help in reducing chemotherapy-induced stomatitis in leukemia and lymphoma patients, and radiation-induced mucositis in head and neck cancer patients. Scientific evidence suggesting the benefits of oral ingestion of aloe vera juice in cancer patients is minimal. A study which evaluated the impact of ingesting aloe extracted from Aloe arborescens (another plant which belongs to the same genus “Aloe” which is shared by Aloe vera) on metastatic cancer patients treated with chemotherapy, suggested a potential benefit of oral aloe in reducing tumor size, controlling disease and improving the number of 3-year survival patients. However, larger studies are needed to establish these findings as well as evaluate the toxicity and safety of oral ingestion of Aloe. While the scientific evidence suggests that the topical application of Aloe vera may help in reducing some of the symptoms of radiation-induced proctitis in pelvic cancer patients, its impact in radiation-induced dermatitis is inconclusive.


Cancer patients often have to deal with different chemotherapy side effects which affect their quality of life and look out for alternative therapies for cancer.Taking the right nutrition and supplements based on scientific considerations (avoiding guesswork and random selection) is the best natural remedy for cancer and treatment related side-effects.


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