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Complementary and alternative medicines use by Scottish women with breast cancer. What, why and the potential for drug interactions?

  • Pharmacoepidemiology and Prescription
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Abstract

Background

Despite the increased use of complementary and alternative medicine (CAM) by breast cancer patients, there is little published information regarding CAM use in the Scottish breast cancer population.

Methods

A questionnaire comprising five sections—demographics; perceived health status, prescribed medicines; use, indications, satisfaction and expenditure on CAMs; attitudes towards and factors associated with CAM use; and attitudinal statements—was issued to patients attending the Aberdeen Breast Clinic.

Results

A total of 453 questionnaires were distributed and 360 (79.5%) returned. Respondents were prescribed a mean of 3.2 medicines (95% CI 2.83–3.47). With regard to CAM use, 33.1% of respondents reported current use, 36.4% prior use, and 30.6% reported never having used CAMs. The key indications for use were general well being, boosting immune system and cancer prophylaxis, with high levels of satisfaction reported. The strongest association for CAM use was use by friends and family and higher educational attainment (p < 0.001). Supplements with estrogenic activity, such as soya or red clover, were taken by 29% of respondents. Herbs (echinacea, pomegranate, peppermint, chamomile, grapefruit, garlic, ginseng) that have the potential to interact with adjuvant endocrine therapies (tamoxifen, anastrazole, letrozole, exemestane) were being taken by 38% of treated patients.

Conclusion

The level of CAM use by Scottish breast cancer patients is similar to that reported from other countries, although there are marked differences in the type, nature and frequency of specific CAM therapies. Higher patient education level and use by family and friends were significantly associated with CAM use. The high level of use of potentially disease modifying or interacting herb supplements may be of concern.

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References

  1. The World Health Organisation (2000) http://www.who.int/medicines/areas/traditional/definitions/en/ Accessed 12.09.2010.

  2. Low Dog T (2009) The use of botanicals during pregnancy and lactation. Altern Ther Health Med 15(1):54–61.

    Google Scholar 

  3. Astin AJ (1998) Why patients use alternative medicine. JAMA 279(19):1548–1553

    Article  PubMed  CAS  Google Scholar 

  4. Bensoussan A, Marigliani R, Zorbas H (2008) Use of complementary therapies by Australian women with breast cancer. Breast 17:387–394

    Article  PubMed  Google Scholar 

  5. Barnes PM, Powell-Griner E, McFann K, Nahin RL (2004) Complementary and alternative medicine use among adults: United States, 2002. Adv Data 27(343):1–19

    Google Scholar 

  6. Yamashita H, Tsukayama H, Sugishita C (2002) Popularity of complementary and alternative medicine in Japan: a telephone survey. Complement Ther Med 10(2):84–93

    Article  PubMed  CAS  Google Scholar 

  7. Menniti-Ippolito F, Gargiulo L, Bologna E, Forcella E, Raschetti R (2002) Use of unconventional medicine in Italy: a nation-wide survey. Eur J Clin Pharmacol 58(1):61–64

    Article  PubMed  Google Scholar 

  8. Ernst E, Cassileth BR (1998) The prevalence of complementary/alternative medicine in cancer: a systematic review. Cancer 83(4):777–782

    Article  PubMed  CAS  Google Scholar 

  9. Goldstein MS, Brown ER, Ballard-Barbash R, Morgenstern H, Bastani R, Lee J et al (2005) The use of complementary and alternative medicine among California adults with and without cancer. Evid Based Complement Alternat Med 2(4):557–565

    Article  PubMed  Google Scholar 

  10. Morris KT, Johnson N, Homer L, Walts D (2000) A comparison of complementary therapy use between breast cancer patients and patients with other primary tumor sites. Am J Surg 179(5):407–411

    Article  PubMed  CAS  Google Scholar 

  11. Molassiotis A, Scott JA, Kearney N, Pud D, Magri M, Selekerova S et al (2005) Complementary and alternative medicine use in breast cancer patients in Europe. Support Care Cancer 14(3):260–267

    Article  PubMed  Google Scholar 

  12. Boon H, Stewart M, Kennard MA, Pud D, Magri M, Selvekerova S et al (2000) Use of complementary/alternative medicine by breast cancer survivors in Ontario: prevalence and perceptions. J Clin Oncol 18(13):2515–2521

    PubMed  CAS  Google Scholar 

  13. Nagel G, Hoyer H, Katenkamp D (2004) Use of complementary and alternative medicine by patients with breast cancer: observations from a health-care survey. Support Care Cancer 12(11):789–796

    Article  PubMed  CAS  Google Scholar 

  14. Shen J, Andersen R, Albert PS, Wenger N, Glaspy J, Cole M et al (2002) Use of complementary/alternative therapies by women with advanced-stage breast cancer. BMC Complement Altern Med 2:8

    Article  PubMed  Google Scholar 

  15. Helyer LK, Chin S, Chui BK, Fitzgerald B, Verma S, Rakovitch E et al (2006) The use of complementary and alternative medicines among patients with locally advanced breast cancer—a descriptive study. BMC Cancer 6:39

    Article  PubMed  Google Scholar 

  16. DiGianni LM, Garber JE, Winer EP (2005) Complementary and alternative medicine use among women with breast cancer. J Clin Oncol 20(Suppl 18):34–38

    Google Scholar 

  17. Crocetti E, Crotti N, Feltrin A, Ponton P, Geddes M, Buiatti E (1998) The use of complementary therapies by breast cancer patients attending conventional treatment. Eur J Cancer 34(3):324–328

    Article  PubMed  CAS  Google Scholar 

  18. Rees R, Feigel I, Vickers A, Zollman C, McGurk R, Smith C (2000) Prevalence of complementary therapy use by women with breast cancer: a population-based survey. Eur J Cancer 36:1359–1364

    Google Scholar 

  19. Moschen R, Kemmler G, Schweigkofler H, Holzner B, Dunser M, Richter R et al (2001) Use of alternative / complementary therapy in breast cancer patients—a psychological perspective. Support Care Cancer 9:267–274

    Article  PubMed  CAS  Google Scholar 

  20. Burstein HJ, Gelber S, Guadagnoli E, Weeks JC (1999) Use of alternative medicine by women with early stage breast cancer. N Engl J Med 340(22):1733–1759

    Article  PubMed  CAS  Google Scholar 

  21. Balneaves LG, Bottorff JL, Hislop TG, Herbert C (2006) Levels of commitment: exploring complementary therapy use by women with breast cancer. J Altern Complement Med 12(5):459–466

    Article  PubMed  Google Scholar 

  22. Boon HS, Olatunde F, Zick SM (2007) Trends in complementary/alternative medicine use by breast cancer survivors: comparing survey data from 1998 and 2005. BMC Womens Health 7:4. doi:10.1186/1472-6874-7-4

    Article  PubMed  Google Scholar 

  23. Vickers AJ, Kup J, Cassileth BR (2006) Unconventional anticancer agents; a systematic review of clinical trials. J Clin Oncol 24(1):136e40

    Article  Google Scholar 

  24. Miller DR, Anderson GT, Stark JJ, Granick JL, Richardson D (1998) Phase I/II trial of the safety and efficacy of shark cartilage in the treatment of advanced cancer. J Clin Oncol 16(11):3649–3655

    PubMed  CAS  Google Scholar 

  25. Moertel CG, Fleming TR, Creagan ET, Rubin J, O’Connell MJ, Ames MM (1985) High dose vitamin C versus placebo in the treatment of patients with advanced cancer who have had no prior chemotherapy. A randomised double-blind comparison. N Engl J Med 312(3):137–141

    Article  PubMed  CAS  Google Scholar 

  26. Creagan ET, Moertel CG, O’Fallon JR, Schutt AJ, O’Connell MJ, Rubin J et al (1979) Failure of high-dose vitamin C (ascorbic acid) therapy to benefit patients with advanced cancer. A controlled trial. N Engl J Med 301(13):687–690

    Article  PubMed  CAS  Google Scholar 

  27. Werneke U, Earl J, Seydel C, Horn O, Crichton P, Fannon D (2004) Potential health risks of complementary alternative medicines in cancer patients. Br J Cancer 90(2):408–413

    Article  PubMed  CAS  Google Scholar 

  28. 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):1–3

    Google Scholar 

  29. Labriola D, Livingstone R (1999) Possible interactions between dietary antioxidants and chemotherapy. Oncology 13(7):1003e8

    Google Scholar 

  30. Boyle FM (1997) Adverse interaction of herbal medicine with breast cancer treatment. Med J Aust 167(5):286

    PubMed  CAS  Google Scholar 

  31. Bairati I, Meyer F, Gelinas M, Fortin A, Nabid A, Brochet F et al (2005) A randomized trial of antioxidant vitamins to prevent second primary cancers in head and neck cancer patients. J Natl Cancer Inst 97(7):481–488

    Article  PubMed  CAS  Google Scholar 

  32. Cassidy A (2003) Are herbal remedies and dietary supplements safe and effective for breast cancer patients? Breast Cancer Res 5(6):300–302

    Article  PubMed  Google Scholar 

  33. Meijerman I, Beijnen JH, Schellens (2006) Herb-drug interactions in oncology: focus on mechanisms of induction. Oncologist 11(7):742–752

    Article  PubMed  CAS  Google Scholar 

  34. Baum M, Ernst E, Lejeune S, Horneber M (2006) Role of complementary and alternative medicine in the care of patients with breast cancer: report of the European Society of Mastology (EUSOMA) Workshop, Florence, Italy, December 2004. Eur J Cancer 42:1702–1710

    Article  PubMed  Google Scholar 

  35. Therapeutic Research Faculty (2011) Natural medicines comprehensive database. http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND. Accessed August 2011

  36. Dong JY, Qin LQ (2011) Soy isoflavones consumption and risk of breast cancer incidence or recurrence: a meta-analysis of prospective studies. Breast Cancer Res Treat 125:315–323

    Article  PubMed  CAS  Google Scholar 

  37. Patisaul HB, Jefferson W (2010) The pros and cons of phytoestrogens. Front Neuroendocrinol 31:400–419

    Article  PubMed  CAS  Google Scholar 

  38. Wallston KA (2007) The multidimensional health locus of control. http://www.vanderbilt.edu/nursing/kwallston/mhlcscales.htm. Accessed 2011

  39. Myers CD, Jacobsen PB, Huang Y, Frost MH, Patten CA, Cerhan JR, Sellers TA (2008) Familial and perceived risk of breast cancer in relation to use of complementary medicine. Cancer Epidemiol Biomarkers Prev 17(6):1527–1534

    Article  PubMed  Google Scholar 

  40. Mueller CM, Mai Pl, Bucher J, Peters JA, Loud JT, Greene MH (2008) Complementary and alternative medicine use among women at increased genetic risk of breast and ovarian cancer. BMC Complement Altern Med 8:17

    Article  PubMed  Google Scholar 

  41. Werneke U, Earl J, Seydel C, Horn O, Crichton P, Fannon D (2004) Potential health risks of complementary alternative medicines in cancer patients. Br J Cancer 90:408–413

    Article  PubMed  CAS  Google Scholar 

  42. Monroe KR, Murphy SP, Kolonel LN, Pike MC (2007) Prospective study of grapefruit intake and risk of breast cancer in postmenopausal women: the Multiethnic Cohort Study. Br J Cancer 97:440–445

    Article  PubMed  CAS  Google Scholar 

  43. Spencer EA, Key TJ, Appleby PN, van Gils CH, Olsen A, Tjonneland A, Clavel-Chapelon F, Boutron-Ruault MC, Touillaud M, Sanchez MJ, Bingham S, Khaw KT, Slimani N, Kaaks R, Riboli E (2009) Prospective study of the association between grapefruit intake and risk of breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC). Cancer Causes Control 20(6):803–809

    Article  PubMed  Google Scholar 

  44. Schmidt K, Ernst E (2004) Assessing websites on complementary and alternative medicine for cancer. Annal Oncol 15:733–742

    Article  CAS  Google Scholar 

  45. Helferich WE, Andrade JE, Hoagland MS (2008) Phytoestrogens and breast cancer: a complex story. Inflammopharmacology 16:219–226

    Article  PubMed  CAS  Google Scholar 

  46. Kamdem LK, Liu Y, Stearns V et al (2010) In vitro and in vivo oxidative metabolism and glucuronidation of anastrozole. Br J Clin Pharmacol 70(6):854–869

    Article  PubMed  CAS  Google Scholar 

  47. Desta Z, Ward BA, Flockhart DA (2005) In vitro letrozole N-dealkylation is mainly catalyzed by human cytochrome P450 (CYP) 3A. Clin Pharm Ther 77:79

    Google Scholar 

  48. Kamdem LK, Flockhart DA, Desta Z (2011) In vitro cytochrome P450-mediated metabolism of exemestane. Drug Metab Dispos 39(1):98–105

    Article  PubMed  CAS  Google Scholar 

  49. Crewe HK, Notley LM, Wunsch RM et al (2002) Metabolism of tamoxifen by recombinant human cytochrome P450 enzymes: formation of the 4-hydroxy, 4′-hydroxy and N-desmethyl metabolites and isomerization of trans-4-hydroxytamoxifen. Drug Metab Dispos 30(8):869–874

    Article  PubMed  CAS  Google Scholar 

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All authors state that they have no conflicts of interest to declare.

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Correspondence to J. S. McLay.

Appendix 1

Appendix 1

Table 4 Multidimensional health locus of control. Comparison of “Ever Users” with “Never Users”

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McLay, J.S., Stewart, D., George, J. et al. Complementary and alternative medicines use by Scottish women with breast cancer. What, why and the potential for drug interactions?. Eur J Clin Pharmacol 68, 811–819 (2012). https://doi.org/10.1007/s00228-011-1181-6

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  • DOI: https://doi.org/10.1007/s00228-011-1181-6

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