Alternative Medicine Use High in Elderly Patients With Cancer

A study published recently in the Journal of Geriatric Oncology found that as many as 1 in 4 senior oncology patients were using complementary or alternative medicines (CAM), and the authors note that few oncology clinicians are sufficiently aware of the alternative medicines their patients take.

A study published recently in the Journal of Geriatric Oncology found that as many as 1 in 4 senior oncology patients were using complementary or alternative medicines (CAM), and the authors note that few oncology clinicians are sufficiently aware of the alternative medicines their patients take.

The research by investigators at the Jefferson College of Pharmacy at Thomas Jefferson University in Philadelphia is based on a comprehensive review of all of the medications taken by senior oncology patients who came in for consultations at the university’s Senior Adult Oncology Multidisciplinary Clinic. Over the course of one visit, patients were seen by professionals from five different areas crucial to maintaining a senior’s health throughout oncology treatment, including a medical oncologist, geriatrician, clinical pharmacist, social worker, and dietician. 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 over the age of 80—a population that hadn’t been captured by previous studies. Among those taking complementary medicine, 68% were in the >80 years range.

Some of the alternative medications that were commonly used in this population were alternative therapies for macular degeneration, stomach probiotics, joint health, and megadose vitamins or minerals. Although 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,” explained study author Ginah Nightingale, PharmD, an assistant professor at Jefferson College of Pharmacy.

“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. 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.”

A number of CAMs are known to interfere with certain cancer treatments, such as St. John’s wort, which can make some cancer therapy less effective, according to the National Institutes of Health. Others can interfere with anesthesia during surgery for cancer; however, not all interactions have been studied.

Because CAMs fall under the category of health supplements, they are not regulated by the FDA, which means that dose and potency (and therefore reaction in the body) can vary widely between products and between patients. For 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 increases the risk for drug–disease interactions in a population that has been reported to take several medications and have several medical conditions,” Nightingale continued.

“The use of CAM in this subpopulation warrants substantial interest 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 G, Haijar E, Guo K, et al. A pharmacist-led medication as- sessment to determine a more precise estimation of the prevalence of complementary and alternative medication (CAM) use among ambu- latory senior adults with cancer [published online August 12, 2015]. J Geriatr Oncol.