The evaluation and risk assessment of complementary medicine use by cancer patients treated at an academic hospital in Johannesburg

Abstract

Introduction: Globally, the use of complementary and alternative medicines (CAMs) is prevalent among cancer patients and well documented. However, limited data exist on the prevalence and patterns of CAM use amongst cancer patients in South Africa. Since most CAMs are not subjected to the normal quality controls and rigorous clinical trials like registered medications they carry a risk for drug interactions and potential adverse effects. Patients use CAM in the belief that they may offer a cure or to alleviate cancer drug adverse effects. This study aimed to investigate the prevalence and types of CAM used by cancer patients receiving treatment at an academic hospital in Johannesburg, and to identify potential drug-CAM interactions. Research design and methods: A cross-sectional, descriptive design was employed, with a convenience sample of 120 participants. Part One of the study comprised of data collection using a researcher-administered questionnaire. Part Two of the research entailed a traditional literature review to identify potential drug-CAM interactions and risks associated with the CAMs identified in part one of the study. Results: CAM usage was reported by a third of respondents (33%; n=40), while the majority (66.7%; n=80) did not utilise CAMs. Among the CAM users, 16 individuals reported using multiple CAMs, resulting in 79 CAMs being reported by 33.3% (n=40) of the respondents. Notably, 21.66% of non-CAM users (n=80) had previously considered using one or multiple CAMs. The data analysis revealed a statistically significant association between CAM use and specific cancer diagnoses. Specifically, respondents with breast cancer (p = 0.027) and haematological cancers (p = 0.039) demonstrated a significantly higher likelihood of using CAMs compared to patients with other cancer diagnoses. Commonly reported CAMs include biologically based practises including fruits, vegetables, vitamins, minerals, dietary supplements, herbs or medicinal plants. The literature review on the selected products revealed the following: (i) product claims are not substantiated by clinical evidence, (ii) pre-clinical and clinical evidence is insufficient v and not standardised, (iii) claims are not supported by clinical trials (iv) in robust clinical trials the potential for drug-CAM interactions were not considered. Recommendations: Healthcare professionals should inquire about CAM use among cancer patients. Decision aids may be utilised to support informed decision-making and further research is needed to investigate the safety and efficacy of the identified CAMs to ensure safe use among cancer patients in South Africa.