Can the use of complementary and integrative medicines affect the safety of cancer therapy?

From Cancer Guidelines Wiki


Complementary and alternative medicine (CAM) use is common in the cancer population with between 40-60% of patients reporting use, although the true extent of use is thought to be under-reported.[1][2][3]

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Evidence Summary

The use of ingested CAM poses the highest potential risk in cancer patients and CAM use should be thoroughly investigated as part of a comprehensive medical and medication history with all patients.[1][4][5][6][7] The Natural Medicines Comprehensive Database provides useful scientific and clinical information on complementary, alternative and integrative therapies including information on potential interactions.[8]

COSA has developed guiding principles on the use of CAMs by cancer patients.[9]

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Consensus-based recommendationQuestion mark transparent.png

Any use of CAM should be assessed for safety against the patient’s cancer treatment protocol. All CAM should be considered in terms of any potential to interact with the patient’s therapy, thereby causing either an increased risk of toxicity or reduced efficacy of the planned therapy. All CAM use should be recorded in the patient’s health care record.

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  1. 1.0 1.1 Thakerar A, Sanders J, Moloney M, Alexander M, Kirsa S. Pharmacist advice on the safety of complementary and alternative medicines during conventional anticancer treatment. Journal of Pharmacy Practice and Research 2014;44(4):231-7.
  2. Anderson JG, Taylor AG. Use of complementary therapies for cancer symptom management: results of the 2007 National Health Interview Survey. J Altern Complement Med 2012 Mar;18(3):235-41 Abstract available at
  3. Damery S, Gratus C, Grieve R, Warmington S, Jones J, Routledge P, et al. The use of herbal medicines by people with cancer: a cross-sectional survey. Br J Cancer 2011 Mar 15;104(6):927-33 Abstract available at
  4. Schofield P, Diggens J, Charleson C, Marigliani R, Jefford M. Effectively discussing complementary and alternative medicine in a conventional oncology setting: communication recommendations for clinicians. Patient Educ Couns 2010 May;79(2):143-51 Abstract available at
  5. Zeller T, Muenstedt K, Stoll C, Schweder J, Senf B, Ruckhaeberle E, et al. Potential interactions of complementary and alternative medicine with cancer therapy in outpatients with gynecological cancer in a comprehensive cancer center. J Cancer Res Clin Oncol 2013 Mar;139(3):357-65 Abstract available at
  6. DiPalma JR, McMichael R. The interaction of vitamins with cancer chemotherapy. CA Cancer J Clin 1979 Sep;29(5):280-6 Abstract available at
  7. Goey AK, Mooiman KD, Beijnen JH, Schellens JH, Meijerman I. Relevance of in vitro and clinical data for predicting CYP3A4-mediated herb-drug interactions in cancer patients. Cancer Treat Rev 2013 Nov;39(7):773-83 Abstract available at
  8. Natural Medicines Comprehensive Database. Natural Medicines Comprehensive Database. [homepage on the internet] Therapeutic Research Faculty; 2017 Nov 17 [cited 2017 Mar]. Available from:
  9. Clinical Oncology Society of Australia. Position statement. The use of complementary and alternative medicine by cancer patients.; 2013 [cited 2016 Sep] Available from:

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