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Published in: BMC Complementary Medicine and Therapies 1/2016

Open Access 01-12-2016 | Research article

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

Authors: Saud M. Alsanad, Rachel L. Howard, Elizabeth M. Williamson

Published in: BMC Complementary Medicine and Therapies | Issue 1/2016

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Abstract

Background

Herb/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.

Method

Three 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.

Results

127/375 (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.

Conclusion

Most 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.
Literature
1.
go back to reference Abebe W. Herbal medication: potential for adverse interactions with analgesic drugs. J Clin Pharm Ther. 2002;27:391–401.CrossRefPubMed Abebe W. Herbal medication: potential for adverse interactions with analgesic drugs. J Clin Pharm Ther. 2002;27:391–401.CrossRefPubMed
2.
go back to reference Afifi FU, Wazaify M, Jabr M, Treish E. The use of herbal preparations as complementary and alternative medicine (CAM) in a sample of patients with cancer in Jordan. Complement Ther Clin Pract. 2010;16:208–12.CrossRefPubMed Afifi FU, Wazaify M, Jabr M, Treish E. The use of herbal preparations as complementary and alternative medicine (CAM) in a sample of patients with cancer in Jordan. Complement Ther Clin Pract. 2010;16:208–12.CrossRefPubMed
3.
go back to reference Alsanad SM, Williamson EM, Howard RL. Cancer patients at risk of herb/food supplement–drug interactions: a systematic review. Phytother Res. 2014;28:1749–55.CrossRefPubMed Alsanad SM, Williamson EM, Howard RL. Cancer patients at risk of herb/food supplement–drug interactions: a systematic review. Phytother Res. 2014;28:1749–55.CrossRefPubMed
4.
go back to reference Champy P, Melot A, Guérineau Eng V, Gleye C, Fall D, Höglinger GU, Ruberg M, Lannuzel A, Laprévote O, Laurens A, Hocquemiller R. Quantification of acetogenins in Annona muricata linked to atypical parkinsonism in Guadeloupe. Mov Disord. 2005;20:1629–33.CrossRefPubMed Champy P, Melot A, Guérineau Eng V, Gleye C, Fall D, Höglinger GU, Ruberg M, Lannuzel A, Laprévote O, Laurens A, Hocquemiller R. Quantification of acetogenins in Annona muricata linked to atypical parkinsonism in Guadeloupe. Mov Disord. 2005;20:1629–33.CrossRefPubMed
5.
go back to reference Chrystal K, Allan S, Forgeson G, Isaacs R. The use of complementary/alternative medicine by cancer patients in a New Zealand regional cancer treatment centre. NZ Med J. 2003;116:875–903. Chrystal K, Allan S, Forgeson G, Isaacs R. The use of complementary/alternative medicine by cancer patients in a New Zealand regional cancer treatment centre. NZ Med J. 2003;116:875–903.
6.
go back to reference Cui Y, Shu XO, Gao Y, Wen W, Ruan ZX, Jin F, Zheng W. Use of complementary and alternative medicine by Chinese women with breast cancer. Breast Cancer Res Treat. 2004;85:263–70.CrossRefPubMed Cui Y, Shu XO, Gao Y, Wen W, Ruan ZX, Jin F, Zheng W. Use of complementary and alternative medicine by Chinese women with breast cancer. Breast Cancer Res Treat. 2004;85:263–70.CrossRefPubMed
7.
go back to reference Ernst E. The current position of complementary/alternative medicine in cancer. Eur J Cancer. 2003;39:2273–7.CrossRefPubMed Ernst E. The current position of complementary/alternative medicine in cancer. Eur J Cancer. 2003;39:2273–7.CrossRefPubMed
8.
go back to reference Engdal S, Klepp O, Nilsen OG. Identification and exploration of herb-drug combinations used by cancer patients. Integr Cancer Ther. 2009;8:29–36.CrossRefPubMed Engdal S, Klepp O, Nilsen OG. Identification and exploration of herb-drug combinations used by cancer patients. Integr Cancer Ther. 2009;8:29–36.CrossRefPubMed
10.
go back to reference Goey A, Beijnen J, Schellens J. Herb–Drug Interactions in Oncology. Clin Pharmacol Ther. 2014;95:354–5.CrossRefPubMed Goey A, Beijnen J, Schellens J. Herb–Drug Interactions in Oncology. Clin Pharmacol Ther. 2014;95:354–5.CrossRefPubMed
11.
go back to reference Gratus C, Damery S, Wilson S, Warmington S, Routledge P, Grieve R, Steven N, Jones J, Greenfield S. The use of herbal medicines by people with cancer in the UK: a systematic review of the literature. QJM. 2009;102:831–42.CrossRefPubMed Gratus C, Damery S, Wilson S, Warmington S, Routledge P, Grieve R, Steven N, Jones J, Greenfield S. The use of herbal medicines by people with cancer in the UK: a systematic review of the literature. QJM. 2009;102:831–42.CrossRefPubMed
12.
go back to reference Heinrich M, Barnes J, Gibbons S, Williamson EM. Fundamentals of Pharmacognosy and Phytotherapy. 2012. Elsevier Health Sciences. Heinrich M, Barnes J, Gibbons S, Williamson EM. Fundamentals of Pharmacognosy and Phytotherapy. 2012. Elsevier Health Sciences.
13.
go back to reference Hermann R, von Richter O. Clinical evidence of herbal drugs as perpetrators of pharmacokinetic drug interactions. Planta Med. 2012;78(13):1458–77.CrossRefPubMed Hermann R, von Richter O. Clinical evidence of herbal drugs as perpetrators of pharmacokinetic drug interactions. Planta Med. 2012;78(13):1458–77.CrossRefPubMed
14.
go back to reference Hübner J. Complementary and alternative medicine in oncology. Versicherungsmedizin. 2013;65:79–83.PubMed Hübner J. Complementary and alternative medicine in oncology. Versicherungsmedizin. 2013;65:79–83.PubMed
15.
go back to reference Izzo AA. Interactions between herbs and conventional drugs: overview of the clinical data. Med Princ Pract. 2012;21:404–28.CrossRefPubMed Izzo AA. Interactions between herbs and conventional drugs: overview of the clinical data. Med Princ Pract. 2012;21:404–28.CrossRefPubMed
16.
go back to reference Izzo AA, Kim SH, Radhakrishnan R, Williamson EM. A critical approach to evaluating clinical efficacy, adverse events and drug interactions of commonly used herbal remedies. Phytother Res. 2016;30:691–700.CrossRefPubMed Izzo AA, Kim SH, Radhakrishnan R, Williamson EM. A critical approach to evaluating clinical efficacy, adverse events and drug interactions of commonly used herbal remedies. Phytother Res. 2016;30:691–700.CrossRefPubMed
17.
18.
go back to reference Lee AH, Ingraham SE, Kopp M, Foraida MI, Jazieh AR. The incidence of potential interactions between dietary supplements and prescription medications in cancer patients at a Veterans Administration Hospital. Am J Clin Oncol. 2006;29:178–82.CrossRefPubMed Lee AH, Ingraham SE, Kopp M, Foraida MI, Jazieh AR. The incidence of potential interactions between dietary supplements and prescription medications in cancer patients at a Veterans Administration Hospital. Am J Clin Oncol. 2006;29:178–82.CrossRefPubMed
19.
go back to reference Mathijssen RH, Verweij J, DE Bruijn P, Loos WJ, Sparreboom A. Effects of St. John’s wort on irinotecan metabolism. J Natl Cancer Inst. 2002;94:1247–9.CrossRefPubMed Mathijssen RH, Verweij J, DE Bruijn P, Loos WJ, Sparreboom A. Effects of St. John’s wort on irinotecan metabolism. J Natl Cancer Inst. 2002;94:1247–9.CrossRefPubMed
20.
go back to reference McCune JS, Hatfield AJ, Blackburn AA, Leith PO, Livingston RB, Ellis GK. Potential of chemotherapy-herb interactions in adult cancer patients. Support Care Cancer. 2004;12:454–62.CrossRefPubMed McCune JS, Hatfield AJ, Blackburn AA, Leith PO, Livingston RB, Ellis GK. Potential of chemotherapy-herb interactions in adult cancer patients. Support Care Cancer. 2004;12:454–62.CrossRefPubMed
21.
go back to reference Mclay J, Stewart D, George J, Rore C, Heys S. Complementary and alternative medicines use by Scottish women with breast cancer. What, why and the potential for drug interactions? Eur J Clin Pharmacol. 2012;68:811–9.CrossRefPubMed Mclay J, Stewart D, George J, Rore C, Heys S. Complementary and alternative medicines use by Scottish women with breast cancer. What, why and the potential for drug interactions? Eur J Clin Pharmacol. 2012;68:811–9.CrossRefPubMed
22.
go back to reference Meijerman I, Beijnen JH, Schellens JH. Herb-drug interactions in oncology: focus on mechanisms of induction. Oncologist. 2006;11:742–52.CrossRefPubMed Meijerman I, Beijnen JH, Schellens JH. Herb-drug interactions in oncology: focus on mechanisms of induction. Oncologist. 2006;11:742–52.CrossRefPubMed
23.
go back to reference Molassiotis A, Panteli V, Patiraki E, Ozden G, Platin N, Madsen E, Browall M, Fernandez-Ortega P, Pud D, Margulies A. Complementary and alternative medicine use in lung cancer patients in eight European countries. Complement Ther Clin Pract. 2006;12:34–9.CrossRefPubMed Molassiotis A, Panteli V, Patiraki E, Ozden G, Platin N, Madsen E, Browall M, Fernandez-Ortega P, Pud D, Margulies A. Complementary and alternative medicine use in lung cancer patients in eight European countries. Complement Ther Clin Pract. 2006;12:34–9.CrossRefPubMed
24.
go back to reference Rotblatt M, Ziment I. Evidence-based herbal medicine. Philadelphia: Hanley & Belfus; 2002. Rotblatt M, Ziment I. Evidence-based herbal medicine. Philadelphia: Hanley & Belfus; 2002.
25.
go back to reference Russo E, Scicchitano F, Whalley BJ, Mazzitello C, Ciriaco M, Esposito S, Patanè M, Upton R, Pugliese M, Chimirri S. Hypericum perforatum: pharmacokinetic, mechanism of action, tolerability, and clinical drug–drug interactions. Phytother Res. 2014;28:643–55.CrossRefPubMed Russo E, Scicchitano F, Whalley BJ, Mazzitello C, Ciriaco M, Esposito S, Patanè M, Upton R, Pugliese M, Chimirri S. Hypericum perforatum: pharmacokinetic, mechanism of action, tolerability, and clinical drug–drug interactions. Phytother Res. 2014;28:643–55.CrossRefPubMed
26.
go back to reference Suchard JR, Wallace KL, Gerkin RD. Acute cyanide toxicity caused by apricot kernel ingestion. Ann Emerg Med. 1998;32:742–4.CrossRefPubMed Suchard JR, Wallace KL, Gerkin RD. Acute cyanide toxicity caused by apricot kernel ingestion. Ann Emerg Med. 1998;32:742–4.CrossRefPubMed
27.
go back to reference Tian R, Koyabu N, Morimoto S, Shoyama Y, Ohtani H, Sawada Y. Functional induction and de-induction of P-glycoprotein by St. John’s wort and its ingredients in a human colon adenocarcinoma cell line. Drug Metab Dispos. 2005;33:547–54.CrossRefPubMed Tian R, Koyabu N, Morimoto S, Shoyama Y, Ohtani H, Sawada Y. Functional induction and de-induction of P-glycoprotein by St. John’s wort and its ingredients in a human colon adenocarcinoma cell line. Drug Metab Dispos. 2005;33:547–54.CrossRefPubMed
28.
go back to reference Thomsen M, Schmidt M, Vitetta L, Sali A. Do herbs increase the risk of herb–drug interactions for patients with arthritis? Ann Rheumatic Dis. 2005;64:1527–28. Thomsen M, Schmidt M, Vitetta L, Sali A. Do herbs increase the risk of herb–drug interactions for patients with arthritis? Ann Rheumatic Dis. 2005;64:1527–28.
29.
go back to reference Tuna S, Dizdar O, Calis M. The prevalence of usage of herbal medicines among cancer patients. System. 2011;83:32. Tuna S, Dizdar O, Calis M. The prevalence of usage of herbal medicines among cancer patients. System. 2011;83:32.
30.
go back to reference Vickers KA, Jolly KB, Greenfield SM. Herbal medicine: women’s views, knowledge and interaction with doctors: a qualitative study. BMC Complement Altern Med. 2006;6:40.CrossRefPubMedPubMedCentral Vickers KA, Jolly KB, Greenfield SM. Herbal medicine: women’s views, knowledge and interaction with doctors: a qualitative study. BMC Complement Altern Med. 2006;6:40.CrossRefPubMedPubMedCentral
31.
go back to reference Werneke U, Earl J, Seydel C, Horn O, Crichton P, Fannon D. Potential health risks of complementary alternative medicines in cancer patients. Br J Cancer. 2004;90:408–13.CrossRefPubMedPubMedCentral Werneke U, Earl J, Seydel C, Horn O, Crichton P, Fannon D. Potential health risks of complementary alternative medicines in cancer patients. Br J Cancer. 2004;90:408–13.CrossRefPubMedPubMedCentral
33.
go back to reference Williamson EM. Interactions between herbal and conventional medicines. Expert Opin Drug Saf. 2005;4:355–78.CrossRefPubMed Williamson EM. Interactions between herbal and conventional medicines. Expert Opin Drug Saf. 2005;4:355–78.CrossRefPubMed
34.
go back to reference Williamson EM, Driver SB, Baxter K, Lee CR. Stockley’s Herbal Medicine’s Interactions: a guide to the interactions of herbal medicines. London: Pharmaceutical Press; 2013. Williamson EM, Driver SB, Baxter K, Lee CR. Stockley’s Herbal Medicine’s Interactions: a guide to the interactions of herbal medicines. London: Pharmaceutical Press; 2013.
35.
go back to reference Wold RS, Lopez ST, Yau CL, Butler LM, Pareo-Tubbeh SL, Waters DL, Garry PJ, Baumgartner RN. Increasing trends in elderly persons’ use of non-vitamin, non-mineral dietary supplements and concurrent use of medications. J Am Diet Assoc. 2005;105:54–63.CrossRefPubMed Wold RS, Lopez ST, Yau CL, Butler LM, Pareo-Tubbeh SL, Waters DL, Garry PJ, Baumgartner RN. Increasing trends in elderly persons’ use of non-vitamin, non-mineral dietary supplements and concurrent use of medications. J Am Diet Assoc. 2005;105:54–63.CrossRefPubMed
36.
go back to reference Zachariae R, Johannessen H. A methodological framework for evaluating the evidence for Complementary and Alternative Medicine (CAM) for cancer. Cancers. 2011;3:773–88.CrossRefPubMedPubMedCentral Zachariae R, Johannessen H. A methodological framework for evaluating the evidence for Complementary and Alternative Medicine (CAM) for cancer. Cancers. 2011;3:773–88.CrossRefPubMedPubMedCentral
37.
go back to reference Zeller T, Muenstedt K, Stoll C, Schweder J, Senf B, Ruckhaeberle E, Becker S, Serve H, Huebner J. Potential interactions of complementary and alternative medicine with cancer therapy in outpatients with gynecological cancer in a comprehensive cancer center. J Cancer Res Clin. 2013;139:357–65.CrossRef Zeller T, Muenstedt K, Stoll C, Schweder J, Senf B, Ruckhaeberle E, Becker S, Serve H, Huebner J. Potential interactions of complementary and alternative medicine with cancer therapy in outpatients with gynecological cancer in a comprehensive cancer center. J Cancer Res Clin. 2013;139:357–65.CrossRef
Metadata
Title
An assessment of the impact of herb-drug combinations used by cancer patients
Authors
Saud M. Alsanad
Rachel L. Howard
Elizabeth M. Williamson
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Complementary Medicine and Therapies / Issue 1/2016
Electronic ISSN: 2662-7671
DOI
https://doi.org/10.1186/s12906-016-1372-x

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