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Researchers estimate CAM use among elderly patients with cancer
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More than a quarter of elderly patients with cancer used complementary and alternative medications, according to results of a pharmacist-led medication assessment.
Complimentary or alternative medication (CAM) products are considered health supplements, which are not regulated by the FDA. Thus, the dose and potency can vary widely between these supplements and lead to differing reactions among patients, according to researchers.
“Currently, few oncologists are aware of the alternative medicines their patients take,” Ginah Nightingale, PharmD, assistant professor at Thomas Jefferson University, said in a press release. “Patients often fail to disclose the CAMs they take because they think they are safe, natural, nontoxic and not relevant to their cancer care, because they think their doctor will disapprove, or because the doctor doesn't specifically ask.”
Nightingale and colleagues evaluated data from 248 elderly patients (mean age, 79.9 years; 64% women) with cancer who received a comprehensive geriatric oncology assessment at Jefferson’s senior adult oncology multidisciplinary clinic between January 2011 and June 2013.
As part of the assessment, patients were seen by a team of professionals — including a medical oncologist, geriatrician, clinical pharmacist, social worker and dietician — focused on maintaining the patient’s health throughout their cancer treatment.
Patients were asked to bring the contents of their medicine cabinets to the consultation and all medications were reviewed and recorded.
The investigators found the 26.5% of the patients (n = 62) took CAMs at some point during their cancer treatment, with the greatest usage among women aged older than 80 years (68%).
Overall, 19.2% of the cohort used one CAM, 6.4% used two CAMs and 0.4% used three CAMs.
Vision impairment supplements (6.4%), gastrointestinal probiotics (4.3%) and supplements for joint health (3.9%) were the most commonly used CAM products.
The most prevalent non-prescription medication included non-mega dose vitamins and minerals, taken by 59% of the patients using CAMs.
CAM usage appeared associated with polypharmacy (P = .045), vision impairment (P = .048) and urologic comorbidities (P = .021).
“We know that some [of these CAMs] can have a biochemical effect on the body and other drugs,” Nightingale said in the release. “It is very important to do a comprehensive screen of all the medications that older cancer patients take, including CAMs. Clear and transparent documentation of CAM use should be recorded in the patient's medical record.
“This documentation should indicate that patient-specific communication and/or education was provided so that shared and informed decisions by the patient can be made regarding the continued use of these medications,” Nightingale added.
Team-based care models are crucial to best serve this population of patients, according to researchers.
“Oncology healthcare is undergoing a significant transformation in the delivery of effective clinical services and is ripe for greater engagement of pharmacists to reduce drug-related problems and unnecessary medications in order to optimize medication prescribing,” Nightingale said. – by Anthony SanFilippo
Disclosure: The researchers report no relevant financial disclosures.
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