An assessment of the impact of herb-drug combinations used by cancer patients

Abstract

BackgroundHerb/Dietary Supplements (HDS) are the most popular Complementary and Alternative Medicine (CAM) modality used by cancer patients and the only type which involves the ingestion of substances which may interfere with the efficacy and safety of conventional medicines. This study aimed to assess the level of use of HDS in cancer patients undergoing treatment in the UK, and their perceptions of their effects, using 127 case histories of patients who were taking HDS. Previous studies have evaluated the risks of interactions between HDS and conventional drugs on the basis on numbers of patient using HDSs, so our study aimed to further this exploration by examining the actual drug combinations taken by individual patients and their potential safety.MethodThree hundred seventy-five cancer patients attending oncology departments and centres of palliative care at the Oxford University Hospitals Trust (OUH), Duchess of Kent House, Sobell House, and Nettlebed Hospice participated in a self-administered questionnaire survey about their HDS use with their prescribed medicines. The classification system of Stockley’s Herbal Medicine’s Interactions was adopted to assess the potential risk of herb-drug interactions for these patients.Results127/375 (34 %; 95 % CI 29, 39) consumed HDS, amounting to 101 different products. Most combinations were assessed as ‘no interaction’, 22 combinations were categorised as ‘doubt about outcomes of use’, 6 combinations as ‘Potentially hazardous outcome’, one combination as an interaction with ‘Significant hazard’, and one combination as an interaction of “Life-threatening outcome”. Most patients did not report any adverse events.ConclusionMost of the patients sampled were not exposed to any significant risk of harm from interactions with conventional medicines, but it is not possible as yet to conclude that risks in general are over-estimated. The incidence of HDS use was also less than anticipated, and significantly less than reported in other areas, illustrating the problems when extrapolating results from one region (the UK), in one setting (NHS oncology) in where patterns of supplement use may be very different to those elsewhere.

Use of the Herbal OTC Products and Dietary Supplements by Patients Receiving Chemotherapy: Survey-Based Study

“…Doctors, in contrast to the patients, are aware of the possibility of adverse effects with simultaneous use of synthetic drugs and herbal preparations. 14,20 In the present study, it was shown that most of the respondents (68.5%) informed the doctor about taking herbal preparations. This is a large percentage compared to the results of other surveys, in which only one fourth of patients informed the doctor about simultaneous use of synthetic drugs and herbal products.…”

“…13 Research by Alsanad et al, conducted in the UK, indicate that adult cancer patients use herbal preparations (3.1% -21.8%) simultaneously with pharmacotherapy. 7,14 In less developed countries a higher percentage of patients use herbal OTC drugs or dietary supplements, e.g. in Palestine 69.5%, Malaysia 70.2%, and Ethiopia 79% .…”

Wuzhi capsule regulates chloroacetaldehyde pharmacokinetics behaviour and alleviates high‐dose cyclophosphamide‐induced nephrotoxicity and neurotoxicity in rats

“…Few studies have been conducted to evaluate the safety of herbal medicines and their combinations used as self-medication, or as recommended by herbal medicine practitioners. 34 Fortunately, although HDIs instructions for many Traditional Chinese Medicines (TCMs) are not identified as "well-documented," some chemical drugs list the potential HDIs in the pharmaceutical directions. In addition, the potential for interactions between TCMs and chemical drugs needs to be revealed.…”

Trends in use, pharmacology, and clinical applications of emerging herbal nutraceuticals

“…Nutraceutical use is widespread but more prevalent in certain patient groups-the elderly, cancer sufferers, athletes and those trying to lose weight (Alsanad, Howard, & Williamson, 2016;Agbabiaka, Wider, Watson, & Goodman, 2017;Gurley et al, 2018). Many are taking conventional medicines at the same time and the possibility of drug interactions must be considered (Izzo, Hoon-Kim, Radhakrishnan, & Williamson, 2016;Awortwe, 2017).…”

“…Many are taking conventional medicines at the same time and the possibility of drug interactions must be considered (Izzo, Hoon-Kim, Radhakrishnan, & Williamson, 2016;Awortwe, 2017). In the United Kingdom, Alsanad et al (2016) found a high use (34%) of health supplements in cancer patients. The most popular products taken showed a low potential for drug interaction and few patients reported any adverse events.…”