Many patients diagnosed with cancer are interested in using botanicals and other integrative medicine approaches to manage the symptoms from their disease, as well as from its treatment with chemotherapy and radiation. Multiple botanicals have been studied for supportive and palliative care. Withania somnifera may have benefits for fatigue and quality of life, while astragalus may have short-term effects on fatigue, anorexia and quality of life. Multiple studies have compared ginger as an add-on therapy to standard anti-emetic agents in patients receiving highly emetogenic chemotherapy. Milk thistle has also been evaluated for several areas of supportive care in small studies. Despite its interesting pharmacology, randomized clinical trials of resveratrol have not been conducted in oncology or supportive care. Turmeric/curcumin may have the most promising role in supportive care, while evidence with Essiac and mistletoe remains minimal. The potential for interactions with drugs, especially chemotherapy agents, and with radiation should be carefully considered, since clinicians frequently have inadequate information to guide their decision-making with botanicals. Although relief from the adverse effects of treatment is important, the potential that botanicals might alter the benefit of the anticancer treatment should also be carefully considered.364