September 9, 2015
Elderly Cancer Patients Have High Use of Complementary Therapies That Could Affect Treatment

Philadelphia—Alternative and complementary medications are widely used among the elderly with cancer, especially the very old, even though they can sometimes interfere with mainstream treatment, according to a new survey.

In a report published recently in the Journal of General Oncology, researchers performing a comprehensive review of all of the medications taken by older oncology patients found that at least 26% are using complementary or alternative medicines (CAM). The lead author suggested that pharmacists play a larger role in reviewing drugs and other compounds used by cancer patients.

“Oncology healthcare 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,” said Ginah Nightingale, PharmD, an assistant professor in the College of Pharmacy at Thomas Jefferson University, adding, “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.”

Yet, the article points out that some CAMs are known to interfere with specific cancer treatments, citing a National Institutes of Health warning that St. John’s wart can make some cancer therapy less effective. Other compounds can interfere with anesthesia during surgery for cancer, the study authors add, noting that not all interactions have been studied because CAMs are not regulated by the FDA.

They also point out that, for an elderly population of cancer patients, CAMs simply add more medications to an extensive list of drugs already used for various ailments.

“Numerous pills, or what we call polypharmacy in the field, can increase the risk for medication non-adherence, 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,” Nightingale said in a Thomas Jefferson press release. “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.”

For the study, researchers surveyed patients who came to Jefferson for consultations in the Senior Adult Oncology Multi-Disciplinary clinic, which provides treatment with a team including a medical oncologist, geriatrician, clinical pharmacist, social worker, and dietician. As part of their assessment, the patients brought in the contents of their medicine cabinets.

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 over the age of 80. In fact, 68% of patients using complementary therapies were in the over-80-year-old range.

Conditions being treated by alternative medications were macular degeneration, stomach probiotics, joint health, and nutrition. The current study did not examine the potential adverse events caused by the medications, but "we know that some can have a biochemical effect on the body and other drugs,” Nightingale said.

“It is very important to do a comprehensive screen of all of the medications that older cancer patients take, including CAMs,” she suggested. “Clear and transparent documentation of CAM 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.”

The study concludes, “A pharmacist-led comprehensive medication assessment demonstrated a more precise estimation of CAM prevalence in the ambulatory SAO population. CAM use was associated with polypharmacy, ophthalmic and urologic medical conditions. Integrating pharmacists into team-based (geriatric and oncology) care models is an underutilized yet viable solution to optimize medication use.”

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