According to Burstein, "the interest in CAM is an understandable expression of the hopes, concerns and symptoms experienced by our patients." In our approach to this conundrum, we have tried to take the emotional and overwhelming process of reviewing individual products and make it more manageable and objective without negating the beliefs and hopes of our patients. By focusing first on safety, we leave the question of efficacy to the patient. Only in light of convincing evidence of lack of efficacy would a suggestion to discourage use be made if a product were safe. The reasons for a patients use of a dietary supplement and the clinical setting should also be taken into account when addressing risks and benefits. Individual patient goals and prognosis should always be addressed in the context of the available evidence, as the perception of risk versus benefit may differ greatly from one patient to another and from one clinical setting to another (e.g., curative versus palliative setting). This approach allows for open discussion of the available evidence, utilizing objective information and theoretical conjecture when available. If the information is presented to the patient as it stands, with gaps and inconsistencies, patients remain empowered to make informed health care decisions and do not feel ignored or dismissed.
The difficulties surrounding this issue are apparent in both the complex nature of the information and the enormous emotional investment patients have in seeking to help themselves through the use of dietary supplements. Harpham, physician and cancer survivor, wrote, "When faced with a life-threatening disease requiring highly toxic treatments with no guarantees, or when dying because there are no effective conventional treatments, it takes guts to reject something or someone claiming to be able to save you, just in case you might be wrong." As pharmacists, we need to remember this statement when counseling patients on dietary supplements and respect their views and beliefs. This open communication with patients makes them more likely to divulge all of the CAM therapies they are using. At the same time, Harpham wrote that "not all hope is equal. Realistic hopehope based on factis stronger than that born of wishful thinking." It is our job to give each patient the facts as we know them, recognizing that this requires more time and effort on our part. However, this time is well spent and will encourage patients to continue to ask for information about CAM before using it, further reducing the chances for a serious interaction with a drug or disease. We believe that this approach allows patients to make informed, objective decisions while maintaining their realistic hope for the future.
Am J Health Syst Pharm. 2007;64(5):467-480. © 2007 American Society of Health-System Pharmacists
Cite this: Dietary Supplements in Patients With Cancer: Risks and Key Concepts, Part 2 - Medscape - Mar 01, 2007.