Use of Complementary and Alternative Medicines in Older Oncology Patients

Many older adult oncology patients are using complementary and alternative medicines (CAMs) that could compromise the safety and efficacy of cancer treatments. One approach to optimize medication management in the oncology population is the utilization of pharmacists as part of a team-based healthcare model. 

In a recent study, Ginah Nightingale, PharmD, assistant professor, Jefferson College of Pharmacy at Thomas Jefferson University (Philadelphia, Pennsylvania), and colleagues used a pharmacist-led medication assessment of older adult cancer patients to determine a more precise estimation of the prevalence of CAM and to assess whether polypharmacy and potentially inappropriate medication influence CAM use. The authors published their results in the Journal of Geriatric Oncology. 

The researchers surveyed 248 patients who received an initial comprehensive geriatric assessment between January 2011 and June 2013. The cohort had a mean age of 79.9 years and a mean comorbidity rate of 7.69, with 87% having a solid tumor. During the visit, patients were seen by professionals from six different areas key to maintaining seniors’ health throughout oncology treatment, including a medical oncologist, geriatrician, patient navigator, clinical pharmacist, social worker, and dietician. As part of this assessment, patients brought all of their medications (prescription, nonprescription, herbals, and supplements) for the pharmacist–patient session, and the medications that were actively used were reviewed and updated in the electronic health record (EHR). CAM was defined as an herbal medication, minerals or other dietary supplement, excluding vitamins.

Dr. Nightingale and her team found that 86 of 2163 medications being used were classified as CAM; the prevalence of CAM use was 26.5%. The proportion of patients using one, two, or three CAMs was 19.2%, 6.4%, and 0.4%, respectively. 

Among those taking CAMs, 68% were 80 years and older—a population that had not been captured in previous studies. CAM use was also higher among older adults with solid tumors, specifically breast, lung, colorectal, and cancers of the urinary tract. The most commonly used CAMs were medications for eye health (6.4%), gastrointestinal health (4.3%), and joint health (3.9%). Nonmega dose vitamin/mineral use was identified as the most prevalent nonprescription medication in 59% of patients, followed by aspirin (44%).

Additionally, the researchers found that CAM use versus non-CAM use was associated with polypharmacy (P=.045), and certain medical comorbidities including age-related macular degeneration (P=.048) and urologic comorbidities (P=.021) such as urinary incontinence, benign prostatic hypertrophy, and erectile dysfunction.

“Clear and transparent documentation should be recorded in the EHR,” said the authors. “This documentation should indicate that specific communication and/or education was provided so that shared and informed decisions can be made regarding the continued use of these medications.” They noted that additional research centered on medication use is needed to determine potential contraindications or benefits of continued CAM use during cancer treatment.—Eileen Koutnik-Fotopoulos

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Nightingale G, Hajjar E, Guo K, et al. A pharmacist-led medication assessment used to determine a more precise estimation of the prevalence of complementary and alternative medication (CAM) use among ambulatory senior adults with cancer [published online ahead of print August 12, 2015]. J
Geriatr Oncol
. doi:10.1016/j.jgo.2015.07.003.