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Alternative and Integrative Medicine
Editorial
Cui, Altern Integ Med 2013, 2:1
http://dx.doi.org/10.4172/2327-5162.1000e107
Open Access
Open Communication between Patients and Doctors about Complimentary
and Alternative Medicine Use: The Key to Avoiding Harmful Herb-Drug
Interactions among Cancer Patients
Yong Cui*
Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Complementary and alternative medicine (CAM) is defined by
the National Center for Complimentary and Alternative Medicine
(NCCAM) as a group of diverse medical and healthcare systems,
practices, and products that are not generally considered to be part of
conventional medicine, including biologically based therapies, mindbody medicine practices, manipulative and body-based practices, and
alternative medical system [1]. Over the past two decades, CAM has
become widely used in the United States. For instance, the 2007 National
Health Interview Survey by the NCCAM and the National Center for
Health Statistics showed that overall 38% of adults in the United States
were using some forms CAM, and accordingly, total expenditures for
CAM therapies were estimated at $34 billion in 2007 [2].
Research has shown that cancer patients are much more likely to use
CAM therapies than the general population. During disease trajectory,
as many as 50-83% of adult patients with cancer and 84% of children
with cancer in the United States report using CAM at least once after the
diagnosis of cancer [3,4]. The vast majority of cancer patients use CAM
as complimentary therapies in conjunction with conventional cancer
treatments, rather than alternative therapies which are used in place
of conventional cancer treatments. The main reasons cited by cancer
patients for CAM use include treating the cancer, relieving cancerrelated symptoms, alleviate side-effects caused by conventional cancer
treatments, managing co-morbidities, and boosting their immune
system, with the expectation of improved quality of life (QOL) [3,5-7].
Of various CAM therapies, herbal/natural products and special diets
(herein referred to as herbal medicines) are among the most commonly
used forms by cancer patients, and nearly half of users take more than
one type of herbal medicines [7,8].
Interestingly, although improving QOL is a major motivation
or expectation for using herbal medicine by cancer patients, several
population-based studies have reported that herbal medicine use was
associated with a lower QOL score and a poorer survival among cancer
patients [9,10]. The underlying reason, however, is unclear. It is possible
that the lower QOL scores of the herbal medicine users might result
from some of the users using herbal medicines inappropriately. If
herbal medicines are used multiply and/or together with conventional
medicines inappropriately, it may expose users to harmful herb-drug
and herb-herb interactions, which may in turn result in serious adverse
consequences and worsen QOL.
Although many herbal medicines have been used for hundred
years, research on its use in cancer medicine is a relatively new
field. There is very limited scientific evidence available on the safety
and efficacy of herbal medicine use among cancer patients. Since
herbal medicines often contain multiple pharmacologically active
constituents, its extensive use with conventional medicines by cancer
patients has raised a serious safety concern, especially about harmful
herb-drug and herb-herb interactions. Evidence has shown that many
popular herbal medicines can affect the metabolism of anticancer
agents and other prescription or over-the-counter medicines via
cytochrome P450 (CYP) and/or P-glycoprotein induction, and such
Altern Integ Med
ISSN: 2327-5162 AIM, an open access journal
interactions often lead to increased toxicity and/or sub-therapeutic
effects [11-14]. Research on interactions of commonly used herbal
medicines with chemotherapy has suggested that concurrent use of
chemotherapeutic agents with certain herbal medicines should be
avoided [15]. For instance, cyclophosphamide, epipodophyllotoxins,
and vinca alkaloids can interact with Ginkgo biloba and ginseng
(CYP3A4 and CYP2C19 inhibition) or with Echinacea, kava kava, and
grape seed (CYP3A4 induction); dacarbazine with garlic (CYP2E1
inhibition); alkylating agents, antitumor antibiotics, and platinum
analogs with Ginkgo biloba or grape seed (free-radical scavenging);
cyclophosphamide with valerian (CYP2C19 inhibition); and Imatinib
with St. John’s wort (CYP3A4). Furthermore, cancer patients often
have other chronic medical conditions, such as cardiovascular diseases,
diabetes, and depression, while many medications for these diseases
may also interact with certain herbal medicines [11,14]. For instance,
Ginkgo biloba has antiplatelet activity and is a platelet-activating
factor receptor antagonist; patients take ginkgo biloba and drugs with
effects on platelet function and/or coagulation (e.g., warfarin, aspirin,
ibuprofen) concurrently may experienced bleeding. In addition, many
cancer patients tend to use more than one herbal medicine. Thus, herbherb interactions may occur if concurrently used herbal medicines
have the same side effects. For instance, garlic, Ginkgo biloba, and
American ginseng all have antiplatelet or anticoagulant activity; if being
concurrently used, the risk of bleeding will increase [16].
Thus, the risk of potentially harmful herb-drug interaction will
increase if doctors are not aware that their patients are taking herbal
medicines. Open communication between patients and doctors about
herbal medicine use is critical in avoiding such interactions. However,
only a few studies to date have explored this issue. Existing data shows
that around 40-50% (with a range of 20-77%) of cancer patients did not
disclose CAM use to their doctors [17]. The most common reasons for
nondisclosure were the doctor’s lack of inquiry, patient’s anticipation
of the doctor’s disapproval, doctor disinterest, or inability to provide
information on CAM, and patient’s perception that their CAM use is
irrelevant to their conventional care [17]. Studies also found that when
patients perceived their doctor to be respectful, open-mind, willing
*Corresponding author: Yong Cui, Division of Epidemiology, Department of
Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, 8th Floor,
Nashville, TN 37203, USA, Tel: (615) 936-8323; Fax: (615) 936-8241; E-mail:
[email protected]
Received January 24, 2013; Accepted January 24, 2013; Published January 28,
2013
Citation: Cui Y (2013) Open Communication between Patients and Doctors about
Complimentary and Alternative Medicine Use: The Key to Avoiding Harmful HerbDrug Interactions among Cancer Patients. Altern Integ Med 2: e107. doi:10.4172/
2327-5162.1000e107
Copyright: © 2013 Cui Y. This is an open-access article distributed under the
terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.
Volume 2 • Issue 1 • 1000e107
Citation: Cui Y (2013) Open Communication between Patients and Doctors about Complimentary and Alternative Medicine Use: The Key to Avoiding
Harmful Herb-Drug Interactions among Cancer Patients. Altern Integ Med 2: e107. doi: 10.4172/2327-5162.1000e107
Page 2 of 2
to listen, they were more like to reveal the use of CAM [17]. These
suggest that to effectively establish patient-doctor communication,
doctors should actively screen about the use of CAM in each patient
and encourage patients to provide detailed information on their
use, especially herbal medicine use. Furthermore, doctors need to
know enough about commonly used herbal medicines, as well as
potentially harmful herb-drug and herb-herb interactions, to provide
reliable information to guide appropriate use. We believe that herbal
medicine use is a double-edged sword; appropriate use will help cancer
treatments and improve QOL, whereas inappropriate use may result in
harmful herb-drug or herb-herb interactions and in turn worsen health
status and QOL. The key to avoiding harmful herb-drug or herb-herb
interactions, maintaining patient safety and improving patient wellbeing is open communication between patients and doctors about
CAM use.
6. Helyer LK, Chin S, Chui BK, Fitzgerald B, Verma S, et al. (2006) The use
of complementary and alternative medicines among patients with locally
advanced breast cancer-a descriptive study. BMC Cancer 6: 39.
In conclusion, given that a high prevalence of CAM use and the
high risk of potentially harmful herb-drug interaction among cancer
patients, patient-doctor communication about CAM use is an extremely
important part of cancer care. The development and evaluation of
effective interventions to improve the disclosure of CAM use should be
an integral part of the future research in this area.
11. Izzo AA, Ernst E (2009) Interactions between herbal medicines and prescribed
drugs: an updated systematic review. Drugs 69: 1777-1798.
References
1. National centre for complementary and alternative medicine (2013) What is
complementary and alternative medicine?
2. National center for complementary and alternative medicine (2013) Statistics
on complementary and alternative medicine national health interview survey.
3. Richardson MA, Sanders T, Palmer JL, Greisinger A, Singletary SE (2000)
Complementary/alternative medicine use in a comprehensive cancer center
and the implications for oncology. J Clin Oncol 18: 2505-2514.
4. Myers C, Stuber ML, Bonamer-Rheingans JI, Zeltzer LK (2005) Complementary
therapies and childhood cancer. Cancer Control 12: 172-180.
5. Shen J, Andersen R, Albert PS, Wenger N, Glaspy J, et al. (2002) Use of
complementary/alternative therapies by women with advanced-stage breast
cancer. BMC Complement Altern Med 2: 8.
7. Wyatt G, Sikorskii A, Wills CE, Su H (2010) Complementary and alternative
medicine use, spending, and quality of life in early stage breast cancer. Nurs
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8. Greenlee H, Kwan ML, Ergas IJ, Sherman KJ, Krathwohl SE, et al. (2009)
Complementary and alternative therapy use before and after breast cancer
diagnosis: the Pathways Study. Breast Cancer Res Treat 117: 653-665.
9. Buettner C, Kroenke CH, Phillips RS, Davis RB, Eisenberg DM, et al. (2006)
Correlates of use of different types of complementary and alternative medicine
by breast cancer survivors in the nurses’ health study. Breast Cancer Res Treat
100: 219-227.
10. Ma H, Carpenter CL, Sullivan-Halley J, Bernstein L (2011) The roles of herbal
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12. Ben-Arye E, Attias S, Tadmor T, Schiff E (2010) Herbs in hemato-oncological
care: an evidence-based review of data on efficacy, safety, and drug
interactions. Leuk Lymphoma 51: 1414-1423.
13. McCune JS, Hatfield AJ, Blackburn AA, Leith PO, Livingston RB, et al. (2004)
Potential of chemotherapy-herb interactions in adult cancer patients. Support
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14. Tachjian A, Maria V, Jahangir A (2010) Use of herbal products and potential
interactions in patients with cardiovascular diseases. J Am Coll Cardiol 55: 515525.
15. Sparreboom A, Cox MC, Acharya MR, Figg WD (2004) Herbal remedies in the
United States: potential adverse interactions with anticancer agents. J Clin
Oncol 22: 2489-2503.
16. Bent S, Ko R (2004) Commonly used herbal medicines in the United States: a
review. Am J Med 116: 478-485.
17. Davis EL, Oh B, Butow PN, Mullan BA, Clarke S (2012) Cancer patient
disclosure and patient-doctor communication of complementary and alternative
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Citation: Cui Y (2013) Open Communication between Patients and Doctors about
Complimentary and Alternative Medicine Use: The Key to Avoiding Harmful Herb-Drug
Interactions among Cancer Patients. Altern Integ Med 2: e107. doi:10.4172/2327-5162.1000e107
Altern Integ Med
ISSN: 2327-5162 AIM, an open access journal
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Volume 2 • Issue 1 • 1000e107