Dietary Supplements in Patients With Cancer: Risks and Key Concepts, Part 2

Laura Boehnke Michaud, Julie Phillips Karpinski, Kellie L. Jones and Janet Espirito


Am J Health Syst Pharm. 2007;64(5):467-480. 

In This Article

CAM References

The ability to identify and locate reliable information regarding dietary supplements is vital. There are numerous resources that clinicians can consult when caring for patients who wish to use dietary supplements. There are a few systematic reviews and evaluations of dietary supplement references that are useful to consult when making a decision regarding the purchase and use of such resources.[192,193,194,195] However, these references are continuously updated, especially the electronic resources, and the conclusions may subsequently change.

For clinical practice, the Natural Medicines Comprehensive Database (Therapeutic Research Faculty), Natural Standard (Natural Standard, Inc.) (, and Review of Natural Products (component of Facts and Comparisons 4.0, are useful databases. The Natural Medicines Comprehensive Database is also available as a print reference, which is useful in some clinical settings. All databases require a subscription, and practicality will vary for different practice sites. There are advantages and disadvantages associated with each database, so access to more than one database or another reference is essential. The scope of products included in the Natural Medicines Comprehensive Database is extensive and a very valuable asset of the database. Another very helpful feature is the ability to search by proprietary name to identify product ingredients, often eliminating the need to track down the product through an Internet search engine. It provides very useful information for each supplement, including its scientific name, safety profile, adverse reactions, interactions with drugs and diseases (known and theoretical), mechanism of action, and dosage and ranks the efficacy for proposed indications. The Natural Standard offers similar sections within each monograph, but there are fewer products in the database. The strength of the Natural Standard database is the extensive evidence-based review for proposed indications. The Review of Natural Products database provides similar sections within each monograph; however, the clinical information may not always be as detailed. The AltMedDex System of Micromedex (Thomson Healthcare Inc.) is also useful.

These references are useful as first-line resources but are not the only good references available. It is important to understand that none of them offers "one-stop shopping," and the use of more than one reference is necessary to complete the analysis of dietary supplements for a patient. Searches of secondary databases, other tertiary references, and an Internet search engine are also necessary. The other caveat is that not all information will be explicitly stated in the reference (or even known), necessitating making professional judgment and extrapolation based on pharmacologic actions and available evidence.


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