Complementary and alternative medicines (CAM)

Interactions Between Cancer Therapy and Complementary and Alternative Medicine (CAM)

Around 33% of adults in the United States use complementary and alternative medicine (CAM). "Natural" supplements such as probiotics, fish oil, herbs, and other goods are the most prevalent supplemental products. Cancer patients, however, must not conflate the terms "natural" with "effectiveness" (Greenlee et al, 2017).

Increased Risk and Negative Side Effects

According to National Institutes of Health reports, CAM is more likely to endanger the lives of cancer patients since the efficacy of therapy will be lowered. According to the findings, CAM has negative side effects. Furthermore, many of these supplements can trigger direct interactions with other medicines. More importantly, most of the CAM treatments can inhibit the conventional therapies by changing the process in which drug metabolism takes place in the body, especially cancer treatments. Other natural drugs can impede radiation treatment among cancer patients (Padayatty, et al, 2010).

Research has also revealed that most cancer patients normally use CAM products such as reishi mushroom, astragalus, licorice, lactobacillus, ginger, green tea, milk thistle, coenzyme Q10, turmeric, and fish oil as extra treatments. Scientists have discovered that these products cause drug interactions when administered with other traditional cancer therapy (McLay, et al, 2012). Complementary and alternative medicines have larger proportions of possibly harmful substances when co-used with evidence-based cancer treatments. Most notably, these products are less likely to reduce the effectiveness of conventional therapy when used wholesomely in a healthy diet (Cheng, et al, 2010). Besides, CAM products have the capacity to modify the impacts of chemotherapy, hence increasing the vulnerability of risk to a cancer patient.

Pharmacokinetic Interactions

Based on the evidence presented by various scholars, it is clear that interactions between cancer therapy and self-prescribed CAM products can be dangerous to the health of the patient. Most of these CAM products have the ability to considerably lessen the activity of enzymes that metabolize the drugs (Meijerman, Beijnen & Schellens, 2006). The direct interactions are able to affect the proper functioning of the cytochrome P450 isozymes. Herbs such as kava, ginseng, Echinacea, ginkgo, and other herbs have the capacity to change the activity of P-glycoprotein and CYP450 isozymes. The P-glycoprotein is the transporter of drugs (McLay, et al, 2012).

Therefore, CAM prompts pharmacokinetic collaboration with anticancer medication. Furthermore, the possible induction of orphan nuclear receptors engaged in the initiation of ATP BC and metabolizing enzymes for transportation of drugs by CAM implore extra mechanism for possible interactions with chemotherapy treatments (Greenlee et al, 2017). The effects on enzyme are more likely to minimize pharmacological effects of the drugs. In addition, utilization of herbal medicines in combination with chemotherapy can cause adverse health effects (Cheng, et al, 2010). Systematic review has established that CAM such as kava, St John's wort, ginseng, Echinacea, ginkgo, and garlic can engage in possible pharmacokinetic interactions with anticancer medications.

Vitamin Supplements and CAM

The excessive intake of vitamin supplements is essentially dangerous, particularly during radiotherapy and chemotherapy. Both vitamin E and C share the cytochrome P3A4 pathway. The CYP3A4 is one of the enzymes of CYP450, which is very crucial in drug metabolism (Chan, et al, 2010). Additionally, drug-drug interaction affects this pathway, hence reducing the usefulness of the conventional drug. Co-administration of such drugs affects the biotransformation and bioavailability of active ingredients, which may cause death or slow the healing process (Meijerman, Beijnen & Schellens, 2006). Therefore, it is essential for a cancer patient using both the CAM products and cancer therapy to inform the oncologist irrespective of how harmless or insignificant a product may appear. CAM products with a huge content of antioxidants, such as vitamin supplements, are more likely to inhibit radiation treatment and chemotherapy. About 25% of cancer patients using chemotherapeutic and herb products are susceptible to the development of clinically related Drug-CAM interactions (Olaku & White, 2011).

Increased Risk for Cancer Patients

Persons suffering from cancer are unaware that many natural supplements and drugs impede the effectiveness of surgical, radiation, and chemotherapy interventions. In this regard, CAM puts such patients at a higher risk because of precarious interaction with their other drugs and diseases (McLay, et al, 2012). For instance, some of the herbal supplements such as turmeric, cumin, and acai berry are more likely to interfere with the absorption of chemotherapy drugs (Padayatty, et al, 2010). Consequently, they decrease the effectiveness or cause greater toxicity arising from those drugs, which are prudently dosed depending on recognized metabolism.

St. John's wort is a form of complimentary and alternative medicine, which is applied to manage depression. However, when used in combination with chemothe,r^y, it can reduce the effectiveness of some of these anti-cancer drugs (Chan, et al, 2010). Similarly, they have the capacity to encourage photosensitivity, which can lead to serious irritations of the skin, especially in the process of radiation therapy (Cheng, et al, 2010). Research has noted that garlic supplements have the ability to cause thrombocytopenia, which refers to a condition that is characterized by a decline in the number of platelets in the blood. It is also referred to as thin blood. Platelets are an important component of blood since they offer viscosity and enable blood clotting (Olaku & White, 2011). Subsequently, the patient is at a greater risk of extreme bleeding, especially in the process of cancer surgery because of a lower amount of platelets. For these reasons, it endangers the life of a patient in the theater.

Effects of CAM on Radiation and Chemotherapy

Furthermore, McLay et al. (2012) have noted that huge doses of self-prescribed vitamins, especially vitamin C, can alter the process in which radiation and chemotherapy function. The researcher also suggested that other herbal components such as green tea could inhibit the metabolism of chemotherapy drugs. Some of the most common types of CAM supplements that have similar effects include vision impairment products such as PreserVision, Ocuvite, and ICAPs (Greenlee et al, 2014). Others include mineral-vitamin herbal combinations, glucosamine alternatives for joint health, as well as Probiotics for digestive health such as Zypan and GI-revive. Other combinations include those of fish oil and cod liver oil that reduce the effectiveness of the product by diluting the active constituent of conventional medicine in the most critical stages of cancer treatment (Padayatty, et al, 2010).

Older Patients and CAM

The research by Geriatric Oncology examined 234 elder patients suffering from cancer between the ages of 61 and 98 years. The researcher established that nearly 27% of the patients were utilizing complementary and alternative medicine in the form of mineral, herbal, or other dietary products, exclusive of multivitamins (Cheng, et al, 2010). Among the persons using alternative or complementary treatments, approximately 69% were over 80 years of age. Most notably, this group of patients was already taking a wide range of medications. At this point, the patients run the risk of severe interactions that can lead to serious health impacts (Olaku & White, 2011). Furthermore, the study established that white women who were over 80 years old were the most common users of the CAM drugs.

Side Effects of CAM

The use of CAM can also cause a wide range of side effects in cancer patients. Research has revealed that some forms of complementary and alternative medicines may aggravate the side effects of evidence-based cancer treatments. For instance, complementary medicines during cancer treatment such as acupuncture lead to various side effects such as worsening of present symptoms, bleeding, pain, and bruising (Padayatty, et al, 2010). Other complimentary treatments such as massage also exhibit numerous side effects. For instance, although massage therapy is a non-toxic option, it is not completely risk-free. Intensive or deep massage must be avoided by cancer patients taking anticoagulation therapy or have a low level of platelets or suffer from bleeding disorders (Hennessy, et al, 2002). Massage causes excessive bleeding if it is performed in certain parts of the body, which are afflicted by latest surgery, weakened bones, skin infections, healing and open wounds, fractures, and blood clots (Cheng, et al, 2010).

The use of herbs and vitamin or mineral supplements among cancer patients is also likely to cause a wide range of side effects such as abnormal menstruation, constipation, gastric discomfort, nausea, vomiting, exhaustion, diarrhea, and loss of appetite (Werneke, et al, 2004). Further, cancer patients may suffer from serious side effects such as nausea and constipation, hence restraining their capability to adhere to treatments. Cancer patients may also record unending pain, anxiety, higher levels of pain, mood, and rise in sleep levels from the use of CAM (McLay, et al, 2012).

The use of herbal medicines among cancer patients also leads to a broad range of side effects. Substances such as St John's wort, ginseng, Echinacea, ginkgo, and garlic cause side effects such as renal failure, hepatotoxicity, endocrine effects, coagulation disorders, electrolyte disturbances, and cardiovascular instability (Meijerman, Beijnen & Schellens, 2006). For instance, Echinacea causes side effects such as dizziness, headache, and gastrointestinal disturbances. Ephedra causes a number of side effects such as seizures, stroke, tachycardia, hypertension, and palpitations. Garlic exposes a cancer patient to effects such as allergy, hypotension, and nausea, as well as bleeding challenges while ginger prolongs bleeding period (McLay, et al, 2012).

Ginseng also exposes patients to side effects such as GI disturbances, insomnia, and irritability (Baum, et al, 2006). The use of Kava among cancer patients increases the risk of side effects such as dystonic reactions, dermatological changes, and hepatotoxicity reactions. It also raises the sedative impacts, which are dangerous prior to cancer surgery. On the other hand, St John's wort also heightens the risk of photosensitivity, headache, confusion, dizziness, fatigue, and GI upset (Cheng, et al, 2010).

Conclusion

The use of complementary and alternative medicines (CAM) poses numerous challenges to cancer patients. Firstly, co-administration of CAM and traditional cancer therapy may lead to drug interaction, which interferes with the work of cytochrome P450 isozymes, especially CYP3A4 enzymes. Therefore, they may interfere with normal drug metabolism in the body affecting bioavailability or biotransformation (Meijerman, Beijnen & Schellens, 2006). In addition, CAM has various side effects that cannot be encouraged. They include gastrointestinal disturbances, insomnia, skin rash, dizziness, and seizures. Therefore, patients must be advised not to co-use the conventional drugs with other CAM products because it increases chances of death and slows recovery as the drugs cause interactions. They should also seek advice from the doctor before using them.

References

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. European journal of cancer, 42(12), 1702-1710.

Chan, E., Tan, M., Xin, J., Sudarsanam, S., & Johnson, D. E. (2010). Interactions between traditional Chinese medicines and Western. Curr Opin Drug Discov Devel, 13(1), 50-65.

Cheng, C. W., Fan, W., Ko, S. G., Song, L., & Bian, Z. X. (2010). Evidence-based management of herb-drug interaction in cancer chemotherapy. Explore: The Journal of Science and Healing, 6(5), 324-329.

Greenlee, H., Balneaves, L. G., Carlson, L. E., Cohen, M., Deng, G., Hershman, D., ... & Zick, S. M. (2014). Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. JNCI Monographs, 2014(50), 346-358.

Greenlee, H., DuPont‐Reyes, M. J., Balneaves, L. G., Carlson, L. E., Cohen, M. R., Deng, G., ... & Boyce, L. M. (2017). Clinical practice guidelines on the evidence‐based use of integrative therapies during and after breast cancer treatment. CA: A Cancer Journal for Clinicians.

Hennessy, M., Kelleher, D., Spiers, J. P., Barry, M., Kavanagh, P., Back, D., ... & Feely, J. (2002). St John's Wort increases expression of P‐glycoprotein: Implications for drug interactions. British journal of clinical pharmacology, 53(1), 75-82.

McLay, J. S., Stewart, D., George, J., Rore, C., & Heys, S. D. (2012). Complementary and alternative medicines use by Scottish women with breast cancer. What, why and the potential for drug interactions?. European journal of clinical pharmacology, 68(5), 811-819.

Meijerman, I., Beijnen, J. H., & Schellens, J. H. (2006). Herb-drug interactions in oncology: focus on mechanisms of induction. The oncologist, 11(7), 742-752.

Olaku, O., & White, J. D. (2011). Herbal therapy use by cancer patients: a literature review on case reports. European journal of cancer, 47(4), 508-514.

Padayatty, S. J., Sun, A. Y., Chen, Q., Espey, M. G., Drisko, J., & Levine, M. (2010). Vitamin C: intravenous use by complementary and alternative medicine practitioners and adverse effects. PLoS One, 5(7), e11414.

Werneke, U., Earl, J., Seydel, C., Horn, O., Crichton, P., & Fannon, D. (2004). Potential health risks of complementary alternative medicines in cancer patients. British journal of cancer, 90(2), 408.