Pharmacist advice on the safety of Complementary and Alternative Medicines during conventional anticancer treatment

Background Complementary and alternative medicines (CAM) use is increasing, particularly in patients with a cancer diagnosis. When taken alone, many CAM are safe, but when taken concurrently with chemotherapy, radiotherapy or prior to surgery, serious side effects or interactions may occur. Aim To determine the magnitude of CAM use among patients receiving chemotherapy at a metropolitan hospital. To assess the impact of pharmacists providing patients with personalised evidence-based information regarding CAM safety with conventional anticancer treatment. Method Between April and June 2013 all patients commencing their first cycle of intravenous chemotherapy on the Chemotherapy Day Unit were interviewed by the pharmacist to evaluate ingested and injected CAM use. All patients using CAM were given comprehensive, personalised verbal information on safety and potential drug interactions with their conventional treatment. Consenting patients were followed up to evaluate adherence to pharmacist recommendations. Results A total of 152 patients were interviewed regarding CAM use; 39% (95% confidence interval (CI) 32–47%) of patients were taking CAM; median number taken was 2 (range: 1–11) and total number of CAM was 141; 41% of CAM investigated had identified interactions with conventional anticancer treatments; 98% (95% CI 96–100%) of patients followed pharmacist recommendations relating to the safety of (dis)continuing CAM. Conclusion Nearly 40% of patients commencing chemotherapy were concurrently taking CAM. Of the investigated CAM, over 40% had identified interactions, presenting a significant risk to patients both in terms of toxicities and treatment efficacy. Provision of personalised advice from an oncology pharmacist is a highly effective intervention to improve patient safety.