Use of complementary and alternative medicines (CAMs) is high among elderly oncology patients

Alternative medicines are widely thought to be harmless, at the least, and very often helpful for a wide range of discomforts and illnesses. However, although they are marketed as natural, they often contain active ingredients that 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 (CAM).

"Currently, few oncologists are aware of the alternative medicines their patients take," said Ginah Nightingale, PharmD, an assistant professor in the Jefferson College of Pharmacy at Thomas Jefferson University in Philadelphia, Pennsylvania. The report was published in the Journal of Geriatric Oncology (2015; doi:10.1016/j.jgo.2015.07.003).

"Patients often fail to disclose the CAMs they take because they think they are safe, natural, nontoxic, and not relevant to their cancer care; because they think their doctor will disapprove; or because the doctor doesn't specifically ask," said Nightingale.

A number of CAMs are known to interfere with certain cancer treatments. For example, St. John's wart can make some cancer therapies less effective, according to the National Institutes of Health. Others can interfere with anesthesia during surgery for cancer. But not all interactions have been studied.

CAMs fall under the category of health supplements and are therefore not regulated by the Food and Drug Administration (FDA), which means that dose and potency—and, in turn, reaction in the body—can vary widely between products and between patients.

In addition, in a population of elderly patients with cancer, CAMs can simply add additional medications to an already long list of drugs taken for various ailments.

"Numerous pills, or what we call polypharmacy in the field, can increase the risk for medication nonadherence, potential drug-drug interactions, and increase the risk for drug-disease interactions in a population that has been reported to take several medications and have several medical conditions," said Nightingale.

"The use of CAM 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 CAM use. Patients may be combining these agents while receiving concurrent systemic chemotherapy, radiation therapy, and/or surgical interventions which have the potential to compromise the safety and efficacy of treatment interventions."

Nightingale and colleagues surveyed the senior oncology patients who came to Jefferson for consultations in the Senior Adult Oncology Multi-Disciplinary clinic. 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 CAMs at some point during the continuum of their cancer care, with the highest usage among women older than 80 years, a population that had not been captured by previous studies. Among those taking complementary medicines, 68% were age 80 years and older.

Commonly used alternative medications in this population included alternative therapies for macular degeneration, stomach probiotics, joint health, and mega-dose 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 Nightingale.

"It is very important to do a comprehensive screen of all of the medications that older cancer patients take, including CAMs," said Nightingale. "Clear and transparent documentation of CAM use should be recorded in the patient's medical record.”

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