Feb. 24, 2000 (Washington) -- When she practiced in Texas, some of the patients who came to Vivian von Gruenigen, MD, took shark cartilage and charcoal enemas. When she relocated to Ohio, the favorites switched to green tea and vitamin supplements.
While von Gruenigen, a gynecological oncologist, sat at her patient's bedside, the woman's story tumbled out. She'd been drinking "super-tonic," an unappetizing and seemingly noxious elixir concocted of tea chaparral, apple cider vinegar, horseradish root, hot peppers, garlic, ginger, radish, onion -- and vodka. But that wasn't all. She'd also taken wheat grass juice, red clover, and something called Fen LB.
"I had a patient overdose on botanicals," von Gruenigen tells WebMD, still sounding flabbergasted some time after the incident. It was then that von Gruenigen knew she had to take action. What were her patients consuming that she didn't know about, and what possible danger were they exposing themselves to? Were they possibly counteracting the effects of other standard therapies they were getting?
Von Gruenigen vowed to find out which alternative and complementary medicines her patients were using, but instead she went a step further -- surveying 452 patients seen by herself and her colleagues. The results, presented at the Society of Gynecological Oncologists meeting earlier this month, showed that 56% of typical gynecology patients were using such supplements or engaging in practices considered therapeutically unproven for their particular diagnoses.
But though the patients might have felt comfortable taking such supplements or engaging in these practices, they usually didn't tell their physician. In the gynecology group, approximately one-fourth told their physician, while about 40% in the cancer group shared such information.
"This is why it is so important [for physicians] to be asking patients what they are using," says von Gruenigen, also an assistant professor in the College of Medicine at Northeastern Ohio School of Medicine in Akron. Physicians also have a responsibility to help patients sort out which therapies might be harmful.
"Physicians should get on the web and research every product their patients are using. As patient advocates, you don't want them throwing away their money, per se. And when they are getting chemo or radiation, it is not recommended that they have any alternative therapies."
Von Gruenigen also asked the cancer patients how much they estimated spending for such activities during the course of their illness; they reported spending between $35 and $3,000 -- an average of $711. Only about 18% was covered by insurance.
"I think this is great information," says Mary Richardson, MD, director of the University of Texas Center for Alternative Medicine Research in Cancer in Houston. "I am thrilled to see this, for physicians and patients. These kinds of surveys get on the radar screen of people." Richardson was not involved in this study but reviewed it for WebMD. She says that a recent survey she and her colleagues undertook also found a high rate of complementary and alternative medicine use among cancer patients, particularly women and people with higher levels of education. In addition to these therapies, many patients also prayed.
Richardson agrees that physicians should more routinely delve deeper to find out which other products or supplements their patients might be taking. But Richardson stops short of saying that all supplements would counteract the effects of chemotherapy or radiation. "The bottom line is we need to conduct a great deal of research to answer these questions," she says.
In the survey, a majority of people also reported that they believed they were being helped by the supplements or practices. And it is easy to understand their motivation, Richardson says.
"People want to do everything they can to maximize their options, especially [terminal] patients who have no options," she says. "Just the fact of having some sense of control over your life and feeling like you are doing something" can be their motivation. "People have become very proactive, and there is information flying all over the place."
She suggests that if people are going to consult alternative medicine practitioners, they inform their primary physician and should even ask the two to consult with one another about the person's progress.
- In a cancer specialists' survey, more than half of the female patients used nutritional supplements and other alternative therapies in addition to their standard treatment. Most of these patients did not tell their doctors.
- Cancer patients often turn to alternative therapies for help, but doctors note these extra treatments should not be used if a patient is receiving chemotherapy or radiation without consulting them first.
- Doctors need to know about all the therapies their patients are receiving. Doctors and patients should discuss the subject and even include the alternative therapists in the conversations