Exploring Herbal Medicine Use during Palliative Cancer Care: The Integrative Physician as a Facilitator of Pharmacist–Patient–Oncologist Communication

Abstract

Oncology patients frequently use herbal and other forms of complementary medicine, often without the knowledge of oncologists, pharmacists, and other healthcare professionals responsible for their care. Oncology healthcare professionals may lack the knowledge needed to guide their patients on the safe and effective use of herbal medicinal products, a number of which have potentially harmful effects, which include direct toxicity and negative herb–drug interactions. The current review addresses the prevalence and expectations of oncology patients from herbal medicine, as well as evidence for the beneficial or harmful effects of this practice (potential and actual), especially when the herbal products are used in conjunction with anticancer agents. Models of integrative oncology care are described, in which open and effective communication among oncologists, pharmacists, and integrative physicians on the use of herbal medicine by their patients occurs. This collaboration provides patients with a nonjudgmental and multidisciplinary approach to integrative medicine, echoing their own health-belief models of care during conventional cancer treatments. The role of the integrative physician is to facilitate this process, working with oncologists and pharmacists in the fostering of patient-centered palliative care, while ensuring a safe and effective treatment environment. Case scenario: W. is a 56 year old female artist who was recently diagnosed with localized hormone receptor-positive breast cancer. Following lumpectomy and sentinel node dissection, she is scheduled to begin adjuvant chemotherapy with a regimen which will include adriamycin, cyclophosphamide, and paclitaxel (AC-T protocol). She is worried about developing peripheral neuropathy and its impact on her ability to paint, and she asks about a number of dietary supplements which she heard could prevent this from happening: omega-3, vitamin E, alpha-lipoic acid, and acetyl-l-carnithine. She is concerned, however, that the supplements may negatively interact with her chemotherapy regimen.

Efficacy and safety of herbal medicines intervention for cachexia associated with cancer: A systematic review and meta‐analysis

“…Although there are few studies on the interaction and safety of HMs (Samuels & Ben-Arye, 2020), the results of our meta-analysis showed that the efficacy of the combination of HMs and Western medicine group was better than that of the Western medicine group, indicating that the simultaneous use of HMs would not cause serious toxic reactions or reduce the efficacy of western medicine.…”

Exploring primary care physician feedback following an integrative oncology consultation

“…These studies have been followed by the creation of clinical practice guidelines, recommendations, and training programs geared toward improving patient-HCP communication in the IO setting [22][23][24][25]. Little research has been conducted addressing other communication-related aspects of the IO setting, such as that between the oncology healthcare provider and IO practitioner, within the context of traditional medicine [26]; IP-patient communication in the IO setting [27], including where the IP is also a PCP [28]; and communication between the IO practitioner and oncology physician [29], nurse [30], psycho-oncologist [31], and pharmacist [32]. In the primary care setting, the PCP may also play a role as one of the patient's oncology healthcare providers, in both a medical as well as supportive and palliative care capacity.…”

Allopathic Medicine Practitioners’ perspectives on facilitating disclosure of traditional medicine use in Gauteng, South Africa: a qualitative study

“…According to available evidence from this study, AMP acceptance of TM and allowing it to be freely addressed in a non-judgemental manner may develop trust and enable disclosure to promote safe and dependable treatments for patients [ 47 , 48 ]. Other studies have found that patients who take both TM and AM should reveal their TM use to improve their overall treatment outcomes [ 49 , 50 ]. AMPs, on the other hand, should embrace their patients’ decisions to use TM and endeavour to give them all of their available options because they, too, are people with diverse perspectives [ 51 ].…”