Complementary Medicine Use Puts Older Pts at Risk

[CaroleHammett]

Neither this article nor the ASCO abstract specify how and when patients are put at risk; i.e., is it only during chemo treatments? I think this is relevant because, in my case at least, I ceased use of almost all of my supplements during the 5-10 days prior to beginning chemo and radiation, and for at least 5-10 days after treatment was completed. I also ceased use of glucosamine and chondroiton immediately following my diagnosis (I no longer recall why), but continue to use omega-3 supplements and have increased fish and egg intake (both high in omega-3).

I will try to research this further, and in the meantime, the article follows:

http://www.oncologystat.com/home/news/P ... k__US.html

Prevalent Complementary, Alternative Medicine Use Puts Older Cancer Patients at Risk

Elsevier Global Medical News. 2008 Jun 18, LS Zoeller

OncologySTAT™ One Source, Many Resources

CHICAGO (EGMN) - More than one-third of older U.S. patients with cancer are at risk for drug interactions because of widespread use of biologically based complementary and alternative medicine in the United States, according to population-based data presented at the annual meeting of the American Society of Clinical Oncology.

In what is believed to be the first detailed study on the prevalent use of biologically based complementary and alternative medicine (BB-CAM) in this patient population, Dr. Richard T. Lee of the University of Chicago and his coinvestigators analyzed responses of 373 older cancer survivors regarding their use of nutritional supplements, herbal medicines, and nutraceuticals.

The survivors included in study made up 12% of 3,005 people surveyed in the National Social Life, Health, and Aging Project conducted from 2005 to 2006. They had a median age of 71 years and had survived a mean of 12 years since diagnosis.

Sponsored by the National Institutes of Health, the new study found nearly two-thirds of the survivors, 62%, used BB-CAM within the past 12 months. More than half, 54%, used nutritional products; 24% herbal products, and 15% nutraceutical products. The patients were taking an average of 5.8 medications, 3.7 prescription drugs, and 1.4 BB-CAMs.

The most commonly used products were glucosamine (37%), chondroitin (25%), and omega-3 fatty acids (21%).

Dr. Lee reported a subgroup analysis of 75 BB-CAM users showed that 42 (56%) were at risk for drug interactions: 12% of these related to nutraceuticals/herbal products, 43% to nutritional supplements, and 45% to other medications. Interactions were ranked as major (life threatening or serious, 9%), moderate (exacerbation of the patient's condition, 71%), and minor (limited clinical effects, 20%).

Multivariate logistic regression analysis showed that female gender (odds ratio = 2.3, P = .001), having more than three close relatives (OR = 2.3, P = .007) and high self-esteem (OR = 2.2, P = .01) were predictive of BB-CAM use, he said. The family ties were considered an indication that the person had a social network.

In addition to these factors, Dr. Lee reported more than nine health visits per year was predictive of nutritional supplement use (OR = 2.4, P = .028). Nutraceutical use was associated with having a body mass index greater than 30 kg/m² (OR = 2.5, P = .014). Herbal medication use was associated with female gender (OR = 2.0, P = .05) and college level education or higher (OR = 14.9, P = .002).

CAM-based products require a lower burden of proof for efficacy, dosage, safety, and quality control. However, the results demonstrated that more than half of all potential medication interactions were related to BB-CAM use.

Moreover, oncologists are largely uninformed about their patients' use of BB-CAM during treatment. According to Dr. Lee, "The reason for underreporting BB-CAM use by patients to their physicians is that patients do not consider these products to be medications. We need to educate them in this regard." Of 36 current herbal medicine users surveyed, 15 did not report taking them when asked.

"The next step," said Dr. Lee "is to look at these results in hospitalized patients and to figure out the perspective of what these potential interactions contribute to clinical outcomes."

Julia H. Rowland, Ph.D., director of the National Cancer Institute's Office of Cancer Survivorship, commented that there is concern that most studies on CAM use are not done in ethnically diverse populations.

According to Dr. Lee's presentation, 88% of the participants in his study were white and 84% had a high school or higher educational status. "These are demographic factors that correlate to BB-CAM use," he said.

"The challenge going forward," said Dr. Rowland, "will be to understand the rationale behind BB-CAM use and the perceived efficacy. ... We need to research both sides [adverse events and efficacy]."

Two future studies are planned, according to Dr. Lee, recipient of an ASCO Young Investigator Award: one evaluating BB-CAM use by patients receiving systemic cancer treatment and another surveying U.S. oncologists about perceptions about CAM.

...

-------

Carole