IntroductionComplementary and Alternative Medicine (CAM) include a wide range of products (herbs, vitamins, minerals, and probiotics) and medical practices, developed outside of the mainstream Western medicine. Patients with cancer are more likely to resort to CAM first or then in their disease history; the potential side effects as well as the costs of such practices are largely underestimated.Patients and methodWe conducted a descriptive survey in five Italian hospitals involving 468 patients with different malignancies. The survey consisted of a forty-two question questionnaire, patients were eligible if they were Italian-speaking and receiving an anticancer treatment at the time of the survey or had received an anticancer treatment no more than three years before participating in the survey.RESULTSOf our patients, 48.9% said they use or have recently used CAM. The univariate analysis showed that female gender, high education, receiving treatment in a highly specialized institute and receiving chemotherapy are associated with CAM use; at the multivariate analysis high education (Odds Ratio, (OR): 1.96 95% Confidence Interval, CI, 1.27-3.05) and receiving treatment in a specialized cancer center (OR: 2.75 95% CI, 1.53-4.94) were confirmed as risk factors for CAM use.ConclusionRoughly half of our patients receiving treatment for cancer use CAM. It is necessary that health professional explore the use of CAM with their cancer patients, educate them about potentially beneficial therapies in light of the limited available evidence of effectiveness, and work towards an integrated model of health-care provision.

TO THE EDITOR: The recommendations published in the January issue of the Journal of Clinical Oncology 1 regarding the use of aromatase inhibitors (AIs) confirm the advantages of using this drug in the adjuvant setting, and at the same time, underline the importance of monitoring the possible side effects, particularly for the subgroup of women for whom the risks and inconvenience of AI could outweigh the potential benefits.One of the most common side effects following AI therapy that can have repercussions on the patient's quality of life, is bone fracturing, 2 which is attributed to the reduced level (systemic and local) of estrogen as determined by the treatment. 3,4 In fact, this estrogen deficiency reduces bone mineral density and causes osteoporosis, bone fractures, hot flushes, and arthritic discomfort. It has also recently been reported to have an effect on cognitive status, and in particular, short and long-term memory, which is correlated with estrogen deficiency. 5 Estrogen receptors (ERs), including ER-␣ and ER-␤, are located throughout the brain, especially in the areas involved in learning and memory, such as the hippocampus and amygdala. 6 The enzymes necessary for sex steroid biosynthesis have been identified in these same areas, suggesting that estrogen has an important role in the brain. 7 Estrogen therapy has been one of the most compelling potential strategies for the prevention of dementia. The results from different studies suggest that hormonal therapy exerts its protective effect when used in the very early phases of the disease process or even before the disease begins. At the same time, because mild cognitive impairment frequently progresses to dementia, 8 preventative action becomes a relevant issue, especially for elderly patients. In fact, age itself, through the reduction of estrogen exposure and the presence of comorbidities, can promote cognitive impairment, which is strictly correlated with the loss of independence in elderly patients.The preliminary data on AI assumption suggests a possible impact on cognitive function: 94 women enrolled in the ATAC study and 35 healthy women were evaluated for cognitive function, after controlling for age and the use of hormone-replacement therapy. The women who received hormonal therapy manifested an impairment of verbal memory (P ϭ .026) and task processing speed (P ϭ .032). 9 Preliminary results from the TEAM (tamoxifen versus ex-

Background: To evaluate the effectiveness and tolerability of the long-term treatment bone metastases with pamidronate in older patients. Materials and Methods: Twenty-two ambulatory patients aged 70 or older were included in the study. The median age was 73 (range 70–77). Ten patients (46%) were affected by breast carcinoma, 7 (32%) by prostate carcinoma and 5 (22%) by multiple myeloma. Nine (40%) patients presented co-morbidity. All of the patients presented at least one metastatic lytic bone lesion measuring 1 cm or more in diameter; the median lesion number was 2 (range 1–4). Hormonal therapy or chemotherapy regimen, were allowed as clinically required. Patients were treated with a fixed dose of sodium pamidronate, 90 mg in 3 h infusion every 4 weeks. Results: Partial response was shown in 6 (28%) patients, stable disease in 11 (50%), and progression (PD) in 5 (22%). 2 out of 5 patients with PD presented skeletal-related events (SREs) such as bone fracture. The median treatment duration was 19 months. The treatment was well tolerated; in 5 patients (23%) a GI fever was observed, in 3 patients (18%) G1 nausea, and in 3 patients (14) G1 diarrhea. Two cases (9%) of acute renal insufficiency (creatinine 1.7 and 1.6 mg/dl), and 3 cases (14%) of hypocalcemia (7.6, 7.5 and 7.8 mg/dl) were also registered. The renal dysfunction was reversible and without consequence. Conclusion: Our experience suggests that the bisphosphonates long-term administration is useful and did not cause significant side effects in elderly subjects. Low-grade pyrexia, nausea/vomiting, acute/reversible renal dysfunction and hypo-calcemia were the most frequent side effects reported. However, they were of low grade and in most cases, did not require dose modifications and/or hospitalization.

The schedule is able to control the evolution of hormone-refractory prostate cancer and to give a clinical benefit. These results provide information for further clinical trials in a large series of elderly cancer patients.

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