Skip to main content

Advertisement

SpringerLink
Log in

Complementary and alternative medicine in cancer patients: characteristics of use and interactions with antineoplastic agents

  • Research
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Our objectives were to analyze the use of complementary and alternative medicine (CAM) in cancer patients and to describe the incidence and characteristics of interactions between CAM and antineoplastic agents.

Methods

We performed an observational study in cancer outpatients at a university hospital. Variables were collected through a 22-item questionnaire. Potential interactions between CAM and antineoplastic agents were analyzed using the Lexicomp®, the About Herbs®, and the summary of product characteristics. Mechanism of action, reliability, and the potential clinical effect of interactions were analyzed.

Results

The study population comprised 937 patients, of whom 65% used CAM (70.6% herbal products, 25.8% dietary supplements, and 3.6% homeopathy). Female sex, younger age, and breast cancer were associated with more frequent use of CAM. The primary source of information about CAM was friends and family (43.5%). A total of 335 (57.1%) patients did not tell their doctor that they took CAM. The five most common CAM were chamomile, green tea, pennyroyal mint, linden, and rooibos. At least one interaction between CAM and antineoplastic agents was reported by 65.0% of CAM users (33.9% of all patients). Depending on the mechanism of action, 80% of CAM diminished the metabolism of the antineoplastic agents.

Conclusion

Our results reveal a high incidence of interactions between CAM and antineoplastic agents. The most frequent CAM were herbal products. Family and friends were the primary sources of information that led patients to start taking CAM, and more than half of the patients did not tell their doctor that they were taking CAM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

The data can be obtained upon a reasonable request from the corresponding author.

References

  • Asher GN, Corbett AH, Hawke RL (2017) Common herbal dietary supplement-drug interactions. Am Fam Physician 96(2):101–107

    PubMed  Google Scholar 

  • Bahall M (2017) Prevalence, patterns, and perceived value of complementary and alternative medicine among HIV patients: a descriptive study. BMC Complement Altern Med 17(1):422

    Article  PubMed  PubMed Central  Google Scholar 

  • Ben-Arye E, Samuels N, Goldstein LH, Mutafoglu K, Omran S, Schiff E, Charalambous H, Dweikat T, Ghrayeb I, Bar-Sela G, Turker I, Hassan A, Hassan E, Saad B, Nimri O, Kebudi R, Silbermann M (2016) Potential risks associated with traditional herbal medicine use in cancer care: a study of middle eastern oncology health care professionals. Cancer 122(4):598–610

    Article  PubMed  Google Scholar 

  • Benoist GE, van Oort IM, Smeenk S et al (2018) Drug–drug interaction potential in men treated with enzalutamide: mind the gap. Br J Clin Pharmacol 84(1):122–129

    Article  CAS  PubMed  Google Scholar 

  • Brooks SL, Rowan G, Michael M (2018) Potential issues with complementary medicines commonly used in the cancer population: a retrospective review of a tertiary cancer center’s experience. Asia Pac J Clin Oncol 14(5):e535–e542

    Article  PubMed  Google Scholar 

  • Cao L, Wang X, Zhu G, Li S, Wang H, Wu J, Lu T, Li J (2021) Traditional Chinese medicine therapy for esophageal cancer: a literature review. Integr Cancer Ther 20:15347354211061720

    Article  PubMed  PubMed Central  Google Scholar 

  • Cassileth BR, Vickers AJ (2005) High prevalence of complementary and alternative medicine use among cancer patients: implications for research and clinical care. J Clin Oncol 23(12):2590–2592

    Article  PubMed  Google Scholar 

  • Cheng YY, Hsieh CH, Tsai TH (2018) Concurrent administration of anticancer chemotherapy drug and herbal medicine on the perspective of pharmacokinetics. J Food Drug Ana 26(2S):S88–S95

    Article  CAS  Google Scholar 

  • Ciarlo G, Ahmadi E, Welter S, Hübner J (2019) Factors influencing the usage of complementary and alternative medicine by patients with cancer. Complement Ther Clin Pract 44:101389

    Article  Google Scholar 

  • Clement YN, Mahase V, Jagroop A, Kissoon K, Maharaj A, Mathura P, Quan CM, Ramadhin D, Mohammed C (2016) Herbal remedies and functional foods used by cancer patients attending specialty oncology clinics in Trinidad. BMC Complement Altern Med 16(1):399

    Article  PubMed  PubMed Central  Google Scholar 

  • Collado-Borrell R, Escudero-Vilaplana V, Calles A, Garcia-Martin E, Marzal-Alfaro B, Gonzalez-Haba E, Herranz-Alonso A, Sanjurjo-Saez M (2018) Oncology patient interest in the use of new technologies to manage their disease: cross-sectional survey. J Med Internet Res 20(10):e11006

    Article  PubMed  PubMed Central  Google Scholar 

  • Crichton M, Strike K, Isenring E, McCarthy AL, Marx W, Lohning A, Marshall S (2021) “It’s natural so it shouldn’t hurt me”: chemotherapy patients’ perspectives, experiences, and sources of information of complementary and alternative medicines. Complement Ther Clin Pract 43:101362

    Article  PubMed  Google Scholar 

  • Davis EL, Oh B, Butow PN, Mullan BA, Clarke S (2012) Cancer patient disclosure and patient-doctor communication of complementary and alternative medicine use: a systematic review. Oncologist 17(11):1475–1481

    Article  PubMed  PubMed Central  Google Scholar 

  • Engdal S, Klepp O, Nilsen OG (2009) Identification and exploration of herb-drug combinations used by cancer patients. Integr Cancer Ther 8(1):29–36

    Article  PubMed  Google Scholar 

  • Escudero-Vilaplana V, Collado-Borrell R, Hoyo-Muñoz A, Gimenez-Manzorro A, Calles A, Osorio S, Herranz-Alonso A, Sanjurjo-Sáez M (2020) Potential drug interactions between targeted oral antineoplastic agents and concomitant medication in clinical practice. Expert Opin Drug Saf 19(8):1041–1048

    Article  CAS  PubMed  Google Scholar 

  • European Public Assessment Reports. Amsterdam: European Medicines Agency. Available at: https://www.ema.europa.eu/en/medicines. Accessed 25 Oct 2021

  • Fasinu PS, Rapp GK (2019) Herbal interaction with chemotherapeutic drugs-a focus on clinically significant findings. Front Oncol 9:1356

    Article  PubMed  PubMed Central  Google Scholar 

  • Firkins R, Eisfeld H, Keinki C, Buentzel J, Hochhaus A, Schmidt T, Huebner J (2018) The use of complementary and alternative medicine by patients in routine care and the risk of interactions. J Cancer Res Clin Oncol 144(3):551–557

    Article  CAS  PubMed  Google Scholar 

  • Fritz H, Seely D, Kennedy DA, Fernandes R, Cooley K, Fergusson D (2013) Green tea and lung cancer: a systematic review. Integr Cancer Ther 12(1):7–24

    Article  CAS  PubMed  Google Scholar 

  • Ge J, Tan BX, Chen Y, Yang L, Peng XC, Li HZ, Lin HJ, Zhao Y, Wei M, Cheng K, Li LH, Dong H, Gao F, He JP, Wu Y, Qiu M, Zhao YL, Su JM, Hou JM, Liu JY (2011) Interaction of green tea polyphenol epigallocatechin-3-gallate with sunitinib: potential risk of diminished sunitinib bioavailability. J Mol Med (berl) 89(6):595–602

    Article  CAS  PubMed  Google Scholar 

  • Huebner J, Prott FJ, Micke O, Muecke R, Senf B, Dennert G, Muenstedt K (2014) PRIO (Working Group Prevention and Integrative Oncology - German Cancer Society) online survey of cancer patients on complementary and alternative medicine. Oncol Res Treat 37(6):304–308

    Article  PubMed  Google Scholar 

  • Jazieh AR, Abuelgasim KA, Ardah HI, Alkaiyat M, Da’ar OB (2021) The trends of complementary alternative medicine use among cancer patients. BMC Complement Med Ther 21(1):167

    Article  PubMed  PubMed Central  Google Scholar 

  • Kanimozhi T, Hindu K, Maheshvari Y, Khushnidha YG, Kumaravel M, Srinivas KS, Manickavasagam M, Mangathayaru K (2021) Herbal supplement usage among cancer patients: a questionnaire-based survey. J Cancer Res Ther 17(1):136–141

    Article  PubMed  Google Scholar 

  • Keene MR, Heslop IM, Sabesan SS, Glass BD (2019) Complementary and alternative medicine use in cancer: a systematic review. Complement Ther Clin Pract 35:33–47

    Article  PubMed  Google Scholar 

  • Lapidari P, Djehal N, Havas J, Gbenou A, Martin E, Charles C, Dauchy S, Pistilli B, Cadeau C, Bertaut A, Everhard S, Martin AL, Coutant C, Cottu P, Menvielle G, Dumas A, Andre F, Michiels S, Vaz-Luis I, Di Meglio A (2021) Determinants of use of oral complementary-alternative medicine among women with early breast cancer: a focus on cancer-related fatigue. Breast Cancer Res Treat 190(3):517–529

    Article  PubMed  Google Scholar 

  • Lexicomp. Drug interactions. Wolters Kluwer Clinical Drug Information. Hudson, Ohio: Lexi-Comp, Inc. www.lexi.com/online. Accessed 15 Nov 2021

  • Lyman GH, Greenlee H, Bohlke K, Bao T, DeMichele AM, Deng GE, Fouladbakhsh JM, Gil B, Hershman DL, Mansfield S, Mussallem DM, Mustian KM, Price E, Rafte S, Cohen L (2018) Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. J Clin Oncol 36(25):2647–2655

    Article  CAS  PubMed  Google Scholar 

  • Mao JJ, Pillai GG, Andrade CJ, Ligibel JA, Basu P, Cohen L, Khan IA, Mustian KM, Puthiyedath R, Dhiman KS, Lao L, Ghelman R, Caceres Guido P, Lopez G, Gallego-Perez DF, Salicrup LA (2022) Integrative oncology: addressing the global challenges of cancer prevention and treatment. CA Cancer J Clin 72(2):144–164

    Article  PubMed  Google Scholar 

  • Memorial Sloan Kettering Cancer Center’s About Herbs database. Memorial Sloan Kettering Cancer Center, New York. https://www.mskcc.org/cancer-care/diagnosis-treatment/symptom-management/integrative-medicine/herbs/search. Accessed 7 Oct 2021

  • Mohamed ME, Frye RF (2011) Effects of herbal supplements on drug glucuronidation. Review of clinical, animal, and in vitro studies. Planta Med 77(4):311–321

    Article  CAS  PubMed  Google Scholar 

  • Molassiotis A, Fernández-Ortega P, Pud D, Ozden G, Scott JA, Panteli V, Margulies A, Browall M, Magri M, Selvekerova S, Madsen E, Milovics L, Bruyns I, Gudmundsdottir G, Hummerston S, Ahmad AM, Platin N, Kearney N, Patiraki E (2005) Use of complementary and alternative medicine in cancer patients: a European survey. Ann Oncol 16(4):655–663

    Article  CAS  PubMed  Google Scholar 

  • Pezzani R, Salehi B, Vitalini S, Iriti M, Zuñiga FA, Sharifi-Rad J, Martorell M, Martins N (2019) Synergistic effects of plant derivatives and conventional chemotherapeutic agents: an update on the cancer perspective. Medicina (kaunas) 55(4):110

    Article  PubMed  Google Scholar 

  • Ramos-Esquivel A, Víquez-Jaikel Á, Fernández C (2017) Potential drug-drug and herb-drug interactions in patients with cancer: a prospective study of medication surveillance. J Oncol Pract 13(7):e613–e622

    Article  PubMed  Google Scholar 

  • Sáez-Garrido M, Espuny-Miró A, Ruiz-Gómez A, Díaz-Carrasco MS (2021) Drug-drug interactions in patients undergoing hematopoietic stem cell transplantation: systematic review. Farm Hosp 45(4):184–192

    PubMed  Google Scholar 

  • Scripture CD, Figg WD (2006) Drug interactions in cancer therapy. Nat Rev Cancer 6(7):546–558

    Article  CAS  PubMed  Google Scholar 

  • Segal R, Pilote L (2016) Warfarin interaction with Matricaria chamomilla. Can Med Assoc J 174(9):1281–1282

    Article  Google Scholar 

  • Simpson E, Bernaitis N, Khan S, Grant G, Forster K, Anoopkumar-Dukie S (2022) An education on pharmacologically active complementary and alternative medicine and its effects on cancer treatment: literature review. Support Care Cancer 30(4):3057–3072

    Article  PubMed  Google Scholar 

  • Teschke R, Xuan TD (2019) How can green tea polyphenols affect drug metabolism and should we be concerned? Expert Opin Drug Metab Toxicol 15(12):989–991

    Article  CAS  PubMed  Google Scholar 

  • Theuser AK, Hack CC, Fasching PA, Antoniadis S, Grasruck K, Wasner S, Knoll S, Sievers H, Beckmann MW, Thiel FC (2021) Patterns and trends of herbal medicine use among patients with gynecologic cancer. Geburtshilfe Frauenheilkd 81(6):699–707

    Article  PubMed  PubMed Central  Google Scholar 

  • Tuna S, Dizdar O, Calis M (2013) The prevalence of usage of herbal medicines among cancer patients. J BUON 18(4):1048–1051

    CAS  PubMed  Google Scholar 

  • Vogel J, Zomorodbakhsch B, Stauch T, Josfeld L, Hübner J (2022) The role of the general practitioner in cancer care in general and with respect to complementary and alternative medicine for patients with cancer. Eur J Cancer Care (engl) 31(1):e13533

    Article  PubMed  Google Scholar 

  • Wolf CPJG, Rachow T, Ernst T, Hochhaus A, Zomorodbakhsch B, Foller S, Rengsberger M, Hartmann M, Hübner J (2022) Interactions in cancer treatment considering cancer therapy, concomitant medications, food, herbal medicine and other supplements. J Cancer Res Clin Oncol 148(2):461–473

    Article  PubMed  Google Scholar 

Download references

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Pharmacy Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain

    Vicente Escudero-Vilaplana, Roberto Collado-Borrell, Patricia Gómez Martínez-Sagrera, Cristina Villanueva-Bueno, José Luis Revuelta-Herrero, Eva Gonzalez-Haba, Ángela Hoyo-Muñoz, Belén Marzal-Alfaro, Ana Herranz & María Sanjurjo

  2. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain

    Vicente Escudero-Vilaplana, Roberto Collado-Borrell, Patricia Gómez Martínez-Sagrera, Cristina Villanueva-Bueno, José Luis Revuelta-Herrero, Eva Gonzalez-Haba, Ángela Hoyo-Muñoz, Yolanda Jerez Gilarranz, Belén Marzal-Alfaro, Ana Herranz, Miguel Martin & María Sanjurjo

  3. Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    Yolanda Jerez Gilarranz & Miguel Martin

  4. CiberOnc, Madrid, Spain

    Yolanda Jerez Gilarranz & Miguel Martin

Authors
  1. Vicente Escudero-Vilaplana
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roberto Collado-Borrell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patricia Gómez Martínez-Sagrera
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cristina Villanueva-Bueno
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. José Luis Revuelta-Herrero
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eva Gonzalez-Haba
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ángela Hoyo-Muñoz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yolanda Jerez Gilarranz
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Belén Marzal-Alfaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ana Herranz
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Miguel Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. María Sanjurjo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

VEV, RCB, YJG, BMA, and MM: contributed to the study conception and design. Material preparation, data collection and analysis were performed by VEV, RCB, PGMS, ÁH-M, CVB, and JRH. The first draft of the manuscript was written by VEV and RCB, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Vicente Escudero-Vilaplana.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest related to the research.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 47 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Escudero-Vilaplana, V., Collado-Borrell, R., Gómez Martínez-Sagrera, P. et al. Complementary and alternative medicine in cancer patients: characteristics of use and interactions with antineoplastic agents. J Cancer Res Clin Oncol 149, 2855–2882 (2023). https://doi.org/10.1007/s00432-022-04172-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-022-04172-1

Keywords

Search

Navigation