Perioperative Herbal Supplement Use in Cancer Patients: Potential Implications and Recommendations for Presurgical Screening

Nagi B. Kumar, PhD, RD, FADA; Kathy Allen, MA, RD; Heather Bell, MS, RD

Disclosures

Cancer Control. 2005;12(3):149-157. 

In This Article

Conclusions and Recommendations

Herbal supplements possess significant pharmacologic activity and, consequently, potential adverse effects and drug interactions. Awareness and documentation of the use of herbal medicines by surgical healthcare staff are critical in identifying, preventing, and treating potential problems that may arise from herbal supplements taken either alone or combined with conventional medications during the perioperative period. For presurgical patients, it is ideal to incorporate specific screening criteria during the preoperative visit screening completed by the anesthesiologist or nursing assessment. Surgical staff must include an open-ended question regarding use of herbal or other nutritional supplements during this visit. Once these are identified, patients must be directed to stop taking these supplements and schedule the surgical date accordingly. Current data suggest that all herbal medicines should be ceased 2 weeks before surgery.[56] The American Society of Anesthesiologists suggests that all herbal medications should be discontinued 2 to 3 weeks before an elective surgical procedure.[57] When patients are unsure of the contents of the herbal medicine, they should be urged to bring the container so that the healthcare team can review the contents of the herb or preparation. Although this recommendation is promising and feasible in elective-care settings, anesthetic care in emergency settings should be based on a thorough supplement and drug-intake history from the patient or a relative.

Many herbal supplements have the potential to cause serious health problems and drug-herb interactions, specifically in vulnerable and compromised cancer patients. Since the use of herbal supplements is well documented in cancer patients, current clinical practice guidelines must address these complementary and alternative supplements, specifically in the perioperative and treated patient populations.

The print version of this article was originally certified for CME credit. For accreditation details, contact the publisher H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612. Telephone: (813) 632-1349. Fax: (813) 903-4950. Email: ccjournal@moffitt.usf.edu .

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