1. ¹Homerton Hospital, East Wing, Department of Psychiatry, Homerton Row, London E9 6SR, UK
2. ²Centre for the Economics in Mental Health, Institute of Psychiatry, De Crespigny Park, London SE5 8AJ, UK
3. ³Pharmacy Department, Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK
4. ⁴Pharmacy Department, Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK
5. ⁵Academic Department of Psychological Medicine, King's College School of Medicine and Dentistry and Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK
6. ⁶Department of Psychological Medicine, Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK
7. ⁷Maudsley Hospital & Division of Psychological Medicine, Institute of Psychiatry, Denmark Hill London SE5 8AZ, UK

Correspondence: Dr U Werneke, Homerton Hospital, East Wing, Department of Psychiatry, Homerton Row, London E9 6SR, UK. E-mail: Ursula.Werneke@elcmht.nhs.uk

⁸Ursula Werneke has received a grant form Pfizer Ltd and honoraria and speaker fees from Ely Lilly Ltd, all unrelated to this particular study and unrelated to the topic of CAMs in general.

Received 27 August 2003; Revised 13 November 2003; Accepted 13 November 2003.

Abstract

Many cancer patients use complementary alternative medicines (CAMs) but may not be aware of the potential risks. There are no studies quantifying such risks, but there is some evidence of patient risk from case reports in the literature. A cross-sectional survey of patients attending the outpatient department at a specialist cancer centre was carried out to establish a pattern of herbal remedy or supplement use and to identify potential adverse side effects or drug interactions with conventional medicines. If potential risks were identified, a health warning was issued by a pharmacist. A total of 318 patients participated in the study. Of these, 164 (51.6%) took CAMs, and 133 different combinations were recorded. Of these, 10.4% only took herbal remedies, 42.1% only supplements and 47.6% a combination of both. In all, 18 (11.0%) reported supplements in higher than recommended doses. Health warnings were issued to 20 (12.2%) patients. Most warnings concerned echinacea in patients with lymphoma. Further warnings were issued for cod liver/fish oil, evening primrose oil, gingko, garlic, ginseng, kava kava and beta-carotene. In conclusion, medical practitioners need to be able to identify the potential risks of CAMs. Equally, patients should be encouraged to disclose their use. Also, more research is needed to quantify the actual health risks.