By: Nicollette Pacheco, Staff Editor [Graphics-focused]

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With an increase in the use of alternative medicine in the United States, the field of oncology is seeing a rise in the use of unconventional methods to treat symptoms in a wide range of cancers. Since 1990, it has been found that an increasing number of patients seek alternative treatment instead of mainstream medical care. It is imperative that oncologists become familiar with the risks and benefits involved with alternative treatments to provide the most appropriate and individualized care to their patients.¹ An estimated average of 35.9% of cancer patients reported using alternative therapy throughout treatment.² Most of these patients used alternative medicine to improve physical and emotional well-being as an adjunct to traditional chemotherapy. The most common therapies used include herbalism, homeopathy, hypnotherapy, and visualization. Patients turned to these methods due to their ability to improve overall sentiments of well-being and hope, both of which have been proven to extend survival.²

The benefits of complementary and alternative medicine (CAM) have been observed for thousands of years, and the benefits of particular therapies have been studied extensively. Aloe vera has been shown to possess antioxidant, anti-inflammatory, and even anti-proliferative effects when taken orally.³ Qigong is a form of energy therapy that has been examined for its mood-enhancing effects that improve quality of life for many patients.⁴ Long pepper is an agent used in ayurvedic therapy, a form of alternative medicine that has been used for thousands of years and focuses on plant-based medications. Long pepper has recently undergone studies that confirm its anticancer activity in colon cancers.⁵ The search for less toxic oncolytic agents frequently points to such alternative treatments.

The barrier that exists between CAM and modern medicine is due to the lack of clinical trials to evaluate the efficacy of CAM therapy. A large portion of the alternative medicine market involves herbal supplements, many of which are not regulated by the FDA – meaning their efficacy and toxicity has not been extensively studied. Patients often hear of such therapies from resources that are not credible. This creates a sense of reluctance among prescribers when it comes to recommending CAM as an adjunct to chemotherapy. 58.8% of prescribers report they are not adequately educated in alternative therapies, and 79.2% of prescribers state they are not up to date with the most current studies involving alternative therapy methods.⁶ When treating an oncology patient, only 17.2% of prescribers recommended continuation of CAM therapy.⁶ Health care professionals that use CAM themselves were also found more likely to recommend CAM to their patients.⁶ A survey of healthcare professionals revealed that 38.2% were asked about CAM use in the last 6 months, indicating a large increase in demand for knowledge about these therapies.⁶ With adequate education of both patients and prescribers, the synergistic use of complementary and conventional medicine may propel oncology from a world of treating disease to curing it.

Pharmacists play an essential role in educating both patients and prescribers alike and in closing the information gap that often prevents the use of CAM. When using CAM in an oncology patient, several factors must be considered to determine the agent that will best supplement the patient’s regimen. Agents should only be used if they have high efficacy, low toxicity, and an adequate amount of supporting research. While assessing the benefits of adding CAM to a patient’s therapy may seem simple, it is also important to recognize the associated risks. Before adding an agent to a patient’s regimen, it should be screened for drug interactions and possible adverse affects. For example, Aloe vera proved to have several beneficial properties that warrant its use in an oncology patient. However, it is metabolized by CYP3A4 and CYP2D6, which can cause severe interactions with several other drugs that the patient may be taking.³ Despite its obvious benefit, long pepper has also been shown to affect liver function, which may also limit its use in therapy.⁵

To gather accurate and pertinent information on CAM therapies, pharmacists should refer to credible sources that provide objective information. The Integrative Medicine Service at Memorial Sloan Kettering Cancer Center provides a free resource which contains information on herbal supplements and their usage in oncology patients that is extracted from unbiased studies. Databases such as Facts and Comparisons and Pharmacist’s Letter also contain information on natural medicines and may help screen for drug interactions.^7,8

 

SOURCES:

1. Astin JA. Why patients use alternative medicine: results of a national study. JAMA. 1998;279(19):1548-53.
2. Molassiotis A, Fernandez-Ortega P, Pud D, et al. Use of complementary and alternative medicine in cancer patients: a European survey. Ann Oncol. 2005;16(4):655-63.
3. Aloe Vera. The ASCO Post. http://www.ascopost.com/issues/december-15,-2014/aloe-vera.aspx. Published December 15, 2014. Accessed December 30, 2014.
4. Oh B, Butow P, Mullan B, et al. A critical review of the effects of medical qigong on quality of life, immune function, and survival in cancer patients. Integr Cancer Ther. 2012;11(2):101-10.
5. Ovadje P, Ma D, Tremblay P, et al. Evaluation of the efficacy & biochemical mechanism of cell death induction by piper longum extract selectively in In-vitro and in-vivo models of human cancer cells. PLoS One. 2014;9(11).
6. Chang HK, Brodie R, Choong MA, et al. Complementary and alternative medicine use in oncology: a questionnaire survey of patients and health care professionals. BMC Cancer. 2011;11(196).
7. Review of Natural Products. Facts & Comparisons [Database online]. St. Louis, MO: Wolters Kluwer Health, Inc: June 2009. Available at: http://online.factsandcomparisons.com.jerome.stjohns.edu:81/References.aspx?book=NP. Accessed December 30, 2014.
8. Natural Medicines. Pharmacist’s Letter. Available at: http://pharmacistsletter.therapeuticresearch.com/cat3539-Natural-Medicines/Browse.aspx?s=PL. Accessed December 30, 2014.

Published by Rho Chi Post