There is increasing evidence of patient use of herbal supplements during all phases of the cancer trajectory.1-4 Patients may choose to utilize herbs and botanicals for numerous reasons. It gives them a sense of engagement in their treatment and recovery. They may take them or to enhance their general health in order to deal with cancer therapies.5 Yet most patients do not disclose their use of supplements to their professional caregivers. This may be problematic during active cancer treatment as these nonprescription, over-the-counter entities are not without their problems.
Unregulated in their manufacturing and processing, herbs and botanicals may have significant quality control issues. Supplements may be contaminated, have toxic ingredients, and cause organ compromise (i.e., renal, hepatic).6 Of special note are supplements’ potential interaction with the cytochrome P450 enzyme system which is crucial to the metabolism of many chemotherapeutic agents. Some supplements may either up- or down-regulate the activity of numerous P450 isozymes influencing chemotherapy pharmacokinetics.
Other interfaces between herbs, botanicals, and drugs within the oncology paradigm include potential altered coagulation, and changes within the hormonal milieu of hormone-sensitive malignancies due to supplements’ estrogenic and/or androgenic properties. These factors are responsible for most oncologists recommending avoidance of herbs and botanicals during cancer treatment.7
Oncology nurses may be asked their views about use of these supplements. Foremost is to inform patients about the absence of clinical trial data for many of these supplements to guide decision-making.8 The common use of internet-based search engines also is not a trustworthy source. However, there are two key reliable databases that nurses should be aware of both for themselves and also for referring their patients. The websites include:
National Center for Complementary and Alternative Medicine (NCCAM): A Division of the National Institute of Health (NIH), this is the federal government’s lead agency for scientific research on CAM; offers up-to-date summaries on CAM and information on clinical trials.
Memorial Sloan Kettering Cancer Center: Comprehensive listing of herbs, botanicals, and other products which describes uses, mechanism of action, and potential interactions.
Yates JS, Mustian KM, Morrow GR, et al. Prevalence of complementary and alternative medicine use in cancer patients during treatment. Support Care Cancer, 2005 Oct;13(10):806-11.
Vapiwala N, Mick R, Hampshire MK, et al. Patient initiation of complementary and alternative medical therapies (CAM) following cancer diagnosis. Cancer J, 2006 Nov-Dec;12(6):467-74.
Gupta D, Lis CG, Birdsall TC, Grutsch JF. The use of dietary supplements in a community hospital comprehensive cancer center: Implications for conventional cancer care. Support Care Cancer, 2005 Nov;13(11):912-9.
Hlubocky FJ, Ratain MJ, Wen M, Dautherty CK. Complementary and alternative medicine among advanced cancer patients enrolled on phase I trials: A study of prognosis, quality of life, and preferences for decision making. J Clin Oncol, 2007 Feb 10;25(5):548-54.
Poonthananiwatkul B, Howard RL, Williamson EM, Lim RH. Cancer patients taking herbal medicines: A review of clinical purposes, associated factors, and perceptions of benefit or harm. Journal Ethnopharmacol, 2015 Dec 4;175:58-66.
Hardy ML. Dietary supplement use in cancer care: help or harm. Hematol Oncol Clinics North Amer, 2008 Aug;22(4):581-617.
D’Andrea GM. Use of antioxidants during chemotherapy and radiotherapy should be avoided. CA Cancer J Clin, 2005 Sep-Oct;55(5):319-21.
Boddy K, Ernst E. Review of reliable information sources related to integrative oncology. Hematol Oncol Clinics North Amer, 2008 Aug;22(4):619-30.
FDA Approves Onivyde for Advanced Pancreatic Cancer Marijke Vroomen Durning, RN, 10/27/2015 3 On October 22, 2015, the US Food and Drug Administration (FDA) approved Onivyde (irinotecan liposome injection, Merrimack Pharmaceuticals, Inc.), in combination with fluorouracil ...