Many cancer patients use dietary supplements such as vitamins, minerals, and herbs or other botanicals but often do not tell their health care providers about it.

This gap in communication can happen when patients believe that their health care team is indifferent or negative toward their use of these supplements. As a result, patients may find information about dietary supplements from unreliable sources, exposing themselves to unneeded risks.

Since information on these dietary supplements is limited, researchers from the University of Texas Medical Branch (UTMB) in Galveston describe a practical patient-centered approach to managing dietary supplement use in cancer care. The review is published in Current Oncology Reports (2014; doi:10.1007/s11912-014-0411-3). Improving the communication between patients and clinicians in this area is critical.

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Globally, people spent an estimated $96 billion on dietary supplements in 2012. The National Institutes of Health devoted $855 million during fiscal years 2009-2011 to research on the topic. Despite ongoing research, however, little is known about the effectiveness of dietary supplements in cancer care. Regardless, many studies have confirmed that an estimated 20% to 90% of patients undergoing cancer therapy use self-selected forms of complimentary and integrative medicine such as dietary supplements.

“Doctors need to understand why patients with cancer use dietary supplements in the first place. Patients tend to use these supplements because they want to do everything possible to feel hopeful, empower themselves, enhance the body’s natural defenses, use less toxic treatments, or reduce side effects of mainstream treatments,” said Victor Sierpina, MD, UTMB professor of family medicine. “In fact, most patients choose to use dietary supplements to improve their quality of life rather than seeking a cure for their disease.”

When clinicians fail to communicate effectively with patients who are using dietary supplements, they may lose the patient’s trust, and patients may seek information from a variety of places such as friends and relatives or the Internet. At times this information is not correct and occasionally can be dangerous.

Sierpina and coauthor Moshe Frenkel, MD, UTMB clinical associate professor of family medicine, emphasize that doctor-patient communication is an interactive process, not merely a focused dialogue of questions and answers. The clinician who is open to patient inquiries and is aware of subtle sends nonverbal messages that can create an environment of safety in which a patient feels and is protected.

“Doctors must use a sensitive approach when communicating with a patient who has an interest in the use of dietary supplements,” said Frenkel. “A communication approach that fosters a collaborative relationship that includes ample information exchange, empathy, and compassion, responding to emotional needs and managing uncertainty can lead to informed decisions about dietary supplement use.”