More than 140 physicians, researchers, physician assistants, nurses, dietitians, pharmacists and other health professionals attended a symposium on the use of nutritional and herbal products during cancer therapy on April 28 in Pelton Auditorium. The workshop featured talks from some of the nation's leading experts in the field, including several who conduct research to evaluate the safety and effectiveness of botanical and nutritional supplements used by cancer patients and survivors.
The workshop was intended to give cancer-care providers from Fred Hutchinson, the University of Washington, Children's Hospital and Regional Medical Center and the Seattle Cancer Care Alliance the most current and evidence-based information on how complementary and alternative medicine (CAM) practices can be integrated with conventional cancer care and treatment. The National Institutes of Health, which supports research on such studies, defines CAM as a group of diverse medical and health-care systems, practices and products that are presently outside the realm of conventional medicine. Complementary medicine augments conventional therapy, while alternative therapy replaces the use of conventional medicine.
Saundra Aker, manager of nutrition and patient food services at the Alliance, said use of complementary therapies among Alliance patients is common.
"We have seen increasing use of complementary medicine by our patients in the last 10 years," said Aker, who organized the conference. "Currently, more than 66 percent of our marrow-transplant patients are using CAM upon admission to the system." The practice is also widespread among general oncology patients.
Indeed, a recent study by Fred Hutchinson scientists indicates that more than 70 percent of adult cancer patients in western Washington use alternative therapies. Almost all reported improved feelings of well-being as a result of CAM use.
In response to this trend, the Alliance nutrition program in 1997 developed complementary therapy guidelines for hematopoietic stem-cell transplant patients and, more recently, for general oncology patients.
"The guidelines identify rationale for use and possible reasons for concern about the use of nutritional supplements during cancer therapy," Aker said. "They specifically address the many commonly used herbal supplements associated with adverse side effects or drug interactions which may be harmful to patients. They also provide recommendations for upper limits for numerous vitamins and minerals. Because there are so many nutritional supplements available to consumers, the guidelines are not comprehensive, but serve as a general foundation."
She added, "As more and more patients are using or requesting information about nutritional supplements, members of our nutrition department felt that we and other clinical disciplines would benefit from more information about the use of CAM therapies so that we can better guide patients toward integrating safe and potentially effective CAM therapies with their conventional treatments."
To achieve this goal, the Alliance is obtaining information from a variety of institutions and sources with expertise in this area, including the Mayo Clinic Medical Oncology program, Memorial Sloan-Kettering Cancer Center Integrative Medicine Services, and Bastyr University. These institutions have developed various types of complementary and integrative medicine programs for their clients who are undergoing conventional cancer therapy. Integrative medicine combines conventional therapy with evidence-based complementary practices.
"We know that many patients will seek unconventional forms of treatment, such as use of herbals, nutritional products and acupuncture, that are not universally practiced in the medical community," said Dr. Marc Stewart, Alliance medical director. "By learning more about the scientific studies that have been conducted to evaluate these practices, it may be possible to assist patients in review of these therapies in order to advise them to a reasonable degree that they are safe or unsafe.
"We have very strong pharmacy and nutrition programs at the Alliance that are very adept at reviewing nutritional supplement products and their compatibility with other medications that patients receive."
The nutrition program will continue to take the lead in evaluating published scientific research on the safety and effectiveness of unconventional therapies during cancer therapy. The number of such studies is increasing, thanks in part to funding that is available through NIH's National Center for Complementary and Alternative Medicine, established in 1998.
In addition to Fred Hutchinson and the Alliance, Amgen, Inc., Athena Partners, Aventis Pharmaceuticals, Eli Lilly and Company, Enzon Pharmaceuticals, Inc., Food Services of America, and Novartis Nutrition Corp provided support for the conference.