Open Access Highly Accessed Research article

Estrogenic botanical supplements, health-related quality of life, fatigue, and hormone-related symptoms in breast cancer survivors: a HEAL study report

Huiyan Ma1*, Jane Sullivan-Halley1, Ashley W Smith2, Marian L Neuhouser3, Catherine M Alfano2, Kathleen Meeske4, Stephanie M George5, Anne McTiernan3, Roberta McKean-Cowdin6, Kathy B Baumgartner7, Rachel Ballard-Barbash2 and Leslie Bernstein1

Author Affiliations

1 Division of Cancer Etiology, Department of Population Sciences, Beckman Research Institute, City of Hope, Duarte, CA 91010, USA

2 Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA

3 Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA

4 Childrens Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA

5 Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA

6 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA

7 Epidemiology and Clinical Investigation Sciences, School of Public Health & Information Sciences, University of Louisville, Louisville, KY 40202, USA

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BMC Complementary and Alternative Medicine 2011, 11:109  doi:10.1186/1472-6882-11-109

Published: 8 November 2011



It remains unclear whether estrogenic botanical supplement (EBS) use influences breast cancer survivors' health-related outcomes.


We examined the associations of EBS use with health-related quality of life (HRQOL), with fatigue, and with 15 hormone-related symptoms such as hot flashes and night sweats among 767 breast cancer survivors participating in the Health, Eating, Activity, and Lifestyle (HEAL) Study. HRQOL was measured by the Medical Outcomes Study short form-36 physical and mental component scale summary score. Fatigue was measured by the Revised-Piper Fatigue Scale score.


Neither overall EBS use nor the number of EBS types used was associated with HRQOL, fatigue, or hormone-related symptoms. However, comparisons of those using each specific type of EBS with non-EBS users revealed the following associations. Soy supplements users were more likely to have a better physical health summary score (odds ratio [OR] = 1.66, 95% confidence interval [CI] = 1.02-2.70). Flaxseed oil users were more likely to have a better mental health summary score (OR = 1.76, 95% CI = 1.05-2.94). Ginseng users were more likely to report severe fatigue and several hormone-related symptoms (all ORs ≥ 1.7 and all 95% CIs exclude 1). Red clover users were less likely to report weight gain, night sweats, and difficulty concentrating (all OR approximately 0.4 and all 95% CIs exclude 1). Alfalfa users were less likely to experience sleep interruption (OR = 0.28, 95% CI = 0.12-0.68). Dehydroepiandrosterone users were less likely to have hot flashes (OR = 0.33, 95% CI = 0.14-0.82).


Our findings indicate that several specific types of EBS might have important influences on a woman's various aspects of quality of life, but further verification is necessary.