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Perceptions, opinions and knowledge of pharmacists towards the use of complementary medicines by people living with cancer

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Background Biologically-based complementary medicine (BB-CM) use is prevalent amongst people living with cancer. Pharmacists play an important role in the provision of standard treatments for cancer. Less is known about pharmacist’s provision of BB-CM information. Objective This study investigated the opinions, perceptions and knowledge of pharmacists regarding the use of BB-CMs by people living with cancer and the facilitators and barriers to providing information and advice. Setting Australia. Method A cross-sectional 53-item survey was developed and the survey link distributed in two professional associations newsletters. The associations represent ~29,000 pharmacists. Questions were categories into pharmacist’s perceptions, opinions, and knowledge towards the use of BB-CM in cancer. Main Outcome Measure Scores obtained from responses to perception, opinion and knowledge statements and responses to demographic questions Results Respondents (n=70) were predominantly female (73%), Caucasian (66%) and under 40 years of age (78%). Respondents estimated that 19% of daily inquiries related to BB-CMs. Seventy-two per cent of respondents believed they had a responsibility to advise about the concomitant use of BB-CM with standard cancer treatments despite 60% reporting a lack of confidence in their knowledge. There was a moderate positive association (Spearman’s rho 0.41 p= 0.001) between a pharmacists confidence in their level of knowledge and their total knowledge scores. The main barriers to providing information about BB-CMs reported were inadequate training in BB-CMs (94%) and reservations about the evidence base for efficacy and safety (50%). Conclusion Pharmacists have a role to play in counselling people living with cancer about their use of BB-CMs and this role could be maximized with further training and education in this area.

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  1. Alsanad SM, Williamson EM, Howard RL. Cancer patients at risk of herb/food supplement–drug interactions: a systematic review. Phytother Res. 2014;28(12):1749–55.

    Article  Google Scholar 

  2. Ernst E. The prevalence of complementary/alternative medicine in cancer. Cancer. 1998;83(4):777–82.

    Article  CAS  Google Scholar 

  3. Verhoef MJ, Balneaves LG, Boon HS, Vroegindewey A. Reasons for and characteristics associated with complementary and alternative medicine use among adult cancer patients: a systematic review. Integr Cancer Ther. 2005;4(4):274–86.

    Article  Google Scholar 

  4. Braun L, Tiralongo E, Wilkinson J, Spitzer O, Bailey M, Poole S, et al. Perceptions, use and attitudes of pharmacy customers on complementary medicines and pharmacy practice. BMC Complement Altern Med. 2010;10:38.

    Article  Google Scholar 

  5. Braun L, Harris J, Katris P, Cain M, Dhillon H, Koczwara B, et al. Clinical Oncology Society of Australia position statement on the use of complementary and alternative medicine by cancer patients. Asia Pac J Clin Oncol. 2014;10(4):289–96.

    Article  Google Scholar 

  6. Templeman K, Robinson A, McKenna L. Student identification of the need for complementary medicine education in Australian medical curricula: a constructivist grounded theory approach. Complement Ther Med. 2015;23(2):257–64.

    Article  Google Scholar 

  7. Ung COL, Harnett J, Hu H. Development of a strategic model for integrating complementary medicines into professional pharmacy practice. Res Soc Adm Pharm. 2017.

    Article  Google Scholar 

  8. Tiralongo E, Wallis M. Attitudes and perceptions of Australian pharmacy students towards complementary and alternative medicine—a pilot study. BMC Complement Altern Med. 2008;8:2.

    Article  Google Scholar 

  9. Tiralongo E, Wallis M. Integrating complementary and alternative medicine education into the pharmacy curriculum. Am J Pharm Educ. 2008;72(4):74.

    Article  Google Scholar 

  10. Cooke M, Mitchell M, Tiralongo E, Murfield J. Complementary and alternative medicine and critical care nurses: a survey of knowledge and practices in Australia. Aust Crit Care. 2012;25(4):213–23.

    Article  Google Scholar 

  11. Ung COL, Harnett J, Hu H. Key stakeholder perspectives on the barriers and solutions to pharmacy practice towards complementary medicines: an Australian experience. BMC Complement Altern Med. 2017;17(1):394.

    Article  Google Scholar 

  12. Le TQ, Smith L, Harnett J. A systematic review: biologically-based complementary medicine use by people living with cancer—is a more clearly defined role for the pharmacist required? Res Soc Adm Pharm. 2017;13:1037–44.

    Article  Google Scholar 

  13. Pharmaceutical Society of Australia. Position statement on complementary medicines. 2016. Accessed 29 Jan 2018.

  14. Culverhouse S, Wohlmuth H. Factors affecting pharmacists’ recommendation of complementary medicines—a qualitative pilot study of Australian pharmacists. BMC Complement Altern Med. 2012;12(1):183.

    Article  Google Scholar 

  15. Morgan TK. A national census of medicines use: a 24-hour snapshot of Australians aged 50 years and older. Med J Aust. 2012;196(1):50–3.

    Article  Google Scholar 

  16. Hunter D, Oates R, Gawthrop J, Bishop M, Gill S. Complementary and alternative medicine use and disclosure amongst Australian radiotherapy patients. Support Care Cancer. 2014;22(6):1571–8.

    Article  Google Scholar 

  17. Braun L, Spitzer O, Tiralongo E, Wilkinson J, Bailey M, Poole S, et al. The prevalence and experience of Australian naturopaths and Western herbalists working within community pharmacies. BMC Complement Altern Med. 2011;11:41.

    Article  Google Scholar 

  18. National Herbalists Association. Regulation of practitioners. 2016. Accessed 26 Jan 2019.

  19. Kerridge IH, McPhee JR. Ethical and legal issues at the interface of complementary and conventional medicine. Med J Aust. 2004;181(3):164–6.

    PubMed  Google Scholar 

  20. Kheir N, Gad HY, Abu-Yousef SE. Pharmacists’ knowledge and attitudes about natural health products: a mixed-methods study. Drug Healthc Patient Saf. 2014;6:7.

    Article  Google Scholar 

  21. Sullivan A, Gilbar P, Curtain C. Complementary and alternative medicine use in cancer patients in rural Australia. Integr Cancer Ther. 2015;14(4):350–8.

    Article  Google Scholar 

  22. Du M, Yang X, Hartman JA, Cooke PS, Doerge DR, Ju YH, et al. Low-dose dietary genistein negates the therapeutic effect of tamoxifen in athymic nude mice. Carcinogenesis. 2012;33:895–901.

    Article  CAS  Google Scholar 

  23. Liu B, Edgerton S, Yang X, Kim A, Ordonez-Ercan D, Mason T, et al. Low-dose dietary phytoestrogen abrogates tamoxifen-associated mammary tumor prevention. Cancer Res. 2005;65(3):879–86.

    CAS  PubMed  Google Scholar 

  24. Haefeli WE, Carls A. Drug interactions with phytotherapeutics in oncology. Exp Opin Drug Metabol Toxicol. 2014;10(3):359–77.

    Article  CAS  Google Scholar 

  25. El Haouari M, Rosado JA. Medicinal plants with antiplatelet activity. Phytother Res. 2016;30(7):1059–71.

    Article  Google Scholar 

  26. Brown AC. Liver toxicity related to herbs and dietary supplements: online table of case reports. Part 3 of 6. Food Chem Toxicol. 2016;107:502–19.

    Article  Google Scholar 

  27. Marx W, McCarthy AL, Ried K, McKavanagh D, Vitetta L, Sali A, et al. The effect of a standardized ginger extract on chemotherapy-induced nausea-related quality of life in patients undergoing moderately or highly emetogenic chemotherapy: a double blind, randomized, placebo controlled trial. Nutrients. 2017;9(8):867.

    Article  Google Scholar 

  28. Conklin KA. Coenzyme Q10 for prevention of anthracycline-induced cardiotoxicity. Integr Cancer Ther. 2005;4(2):110–30.

    Article  CAS  Google Scholar 

  29. Swarnakar NK, Thanki K, Jain S. Enhanced antitumor efficacy and counterfeited cardiotoxicity of combinatorial oral therapy using doxorubicin- and coenzyme Q10-liquid crystalline nanoparticles in comparison with intravenous Adriamycin. Nanomedicine. 2014;10(6):1231–41.

    Article  CAS  Google Scholar 

  30. Chen PY, Hou CW, Shibu MA, Day CH, Pai P, Liu ZR, et al. Protective effect of co-enzyme Q10 On doxorubicin-induced cardiomyopathy of rat hearts. Environ Toxicol. 2017;32(2):679–89.

    Article  CAS  Google Scholar 

  31. Cortes EP, Gupta M, Chou C, Amin VC, Folkers K. Adriamycin cardiotoxicity: early detection by systolic time interval and possible prevention by coenzyme Q10. Cancer Treat Rep. 1978;62(6):887–91.

    CAS  PubMed  Google Scholar 

  32. Tsubaki K, Horiuchi A, Kitani T, Taniguchi N, Masaoka T, Shibata H, et al. Investigation of the preventive effect of CoQ10 against the side-effects of anthracycline antineoplastic agents. Gan to kagaku ryoho Cancer Chemother. 1984;11(7):1420–7.

    CAS  Google Scholar 

  33. Iarussi D, Auricchio U, Agretto A, Murano A, Giuliano M, Casale F, et al. Protective effect of coenzyme Q10 on anthracyclines cardiotoxicity: control study in children with acute lymphoblastic leukemia and non-Hodgkin lymphoma. Mol Aspects Med. 1994;15(Suppl):s207–12.

    Article  Google Scholar 

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The authors would like to thank the Pharmaceutical Society of Australia and The Society of Hospital Pharmacists for their support in recruitment for this study and their members for participating.


There is no funding associated with this study.

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Correspondence to Joanna Harnett.

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Harnett, J., Le, T.Q., Smith, L. et al. Perceptions, opinions and knowledge of pharmacists towards the use of complementary medicines by people living with cancer. Int J Clin Pharm 40, 1272–1280 (2018).

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