High Use of Complementary or Alternative Medicines in Older Patients With Cancer
Alternative medicines are widely thought to be at least harmless, and very often helpful, for a wide range of discomforts and illnesses. However, although they’re marketed as “natural,” they often contain active ingredients that can react chemically and biologically with other therapies. Researchers performed a comprehensive review of all of the medications taken by senior oncology patients and found that as many as 26% were using complementary or alternative medicines. These findings were published by Nightingale et al in the Journal of Geriatric Oncology.
“Currently, few oncologists are aware of the alternative medicines their patients take,” said Ginah Nightingale, PharmD, Assistant Professor in the Jefferson College of Pharmacy at Thomas Jefferson University. “Patients often fail to disclose the complementary or alternative medicines they take because they think they are safe, natural, nontoxic, and irrelevant to their cancer care; because they think their doctor will disapprove; or because the doctor doesn’t specifically ask.”
Potential for Interference
There are a number of complementary or alternative medicines that are known to interfere with certain cancer treatments. For example, St. John’s wort can make some cancer therapy less effective, according to the National Institutes of Health. Others can interfere with anesthesia during surgery for cancer. However, not all possible interactions have been studied, since complementary medicine falls under the category of health supplements—which means the U.S. Food and Drug Administration (FDA) does not regulate them. Thus, dose and potency (and therefore reaction in the body) can vary widely between products and patients.
Moreover, in an elderly population of cancer patients, alternative medicines can simply add medications to an already long list of drugs taken for various ailments. “Numerous pills, or what we call polypharmacy, can increase the risk for medication nonadherence and potential drug-drug interactions,” said Dr. Nightingale. “The use of complementary or alternative medicine in this subpopulation warrants substantial interest and concern on behalf of medical oncologists and allied health professionals because of the potential clinical implications associated with complementary or alternative medicine use. Patients may be combining these agents—while receiving concurrent systemic chemotherapy, radiation therapy, and/or surgical interventions—that have the potential to compromise the safety and efficacy of treatment interventions.”
Large Percentage Identified
Dr. Nightingale and colleagues surveyed the senior oncology patients who came to Jefferson for consultations in the Senior Adult Oncology Multidisciplinary Clinic. Over the course of one visit, patients were seen by professionals from five different treatment areas, including a medical oncologist, a geriatrician, a clinical pharmacist, a social worker, and a dietician. As part of this assessment, the patients brought in the contents of their medicine cabinets, and the medications that were actively used were reviewed and recorded.
The research team found that 26% of patients were taking complementary or alternative medicine at some point during the continuum of their cancer care, with the highest usage among women over the age of 80—a population that hadn’t been captured by previous studies. Among those taking complementary medicine, 68% were over age 80.
Some of the alternative medications that were commonly used in this population were alternative therapies for macular degeneration, stomach probiotics, joint health, and megadose vitamins or minerals. While the current study did not examine the potential adverse events caused by these medications, “we know that some can have a biochemical effect on the body and other drugs,” said Dr. Nightingale.
Future Interventions
“It is very important to do a comprehensive screen of all of the medications that older cancer patients take, including complementary or alternative medicines,” said Dr. Nightingale. “Clear and transparent documentation of complementary or alternative medicine use should be recorded in the patient’s medical record. This documentation should indicate that patient-specific communication and/or education was provided, so that shared and informed decisions by the patient can be made regarding the continued use of these medications,” he added.
“Oncology health care is undergoing significant transformation in the delivery of effective clinical services and is ripe for greater engagement of pharmacists to reduce drug-related problems and unnecessary medications, in order to optimize medication prescribing,” concluded Dr. Nightingale.
Dr. Nightingale is the corresponding author for the Journal of Geriatric Oncology article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
