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

Communication Tools

Most patients who take dietary supplements or CAM do so in conjunction with conventional cancer therapies. This complementary use poses some potential risks. Once a supplement is deemed safe for a patient, efficacy must be addressed. The oncology community is focused on evidence to support efficacy with traditional therapies and supplements. Burstein[196] stated that "the role of CAM extends far beyond the purported medicinal value of any CAM, and in fact, may have little to do with whether or not CAM works as a traditional medicine." In other words, many cancer patients have multiple legitimate needs that are not being met by conventional medical practices, including emotional and existential discomforts. The use of CAM may not be about treating their cancer but rather "feeling better and having greater control over one’s destiny." When looking at our algorithm (Figure 1) for reviewing supplements, this fact is reflected in the recommendation to "accept" practices or supplements that are safe despite the lack of or inconsistent evidence to support efficacy. This reasoning suggests that talking about CAM is of the utmost importance. Ask every patient at every point in his or her care about the use of CAM. Ask why they are using these therapies. When listening to their responses, sensitivity for social, cultural, and ethnic differences is required. While the rate of CAM use was similar among whites, African Americans, Latinos, and Chinese patients in one study, the types of therapies chosen differed substantially.[197] The need to consistently assess patients differently for physical discomfort or emotional distress should be addressed with development of better clinical tools. This is an opportunity to have an open and honest dialogue with patients and empower them to be involved in their conventional medical treatment decisions as well as their complementary ones.


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