dietary supplement use during cancer treatment: issues and tools for success

Jennifer Barrickman, PhD StudentWalden University

PUBH 8165-10Instructor: Howard Rubin, PhD

Winter, 2010

DefinitionBackgroundIssuesTools

Objectives

Background

Miller , M.F ., Bellizzi, K.M., Sufian, M., Ambs, A.H., Goldstein, M.S., &Ballard-Barbash, R. (2008). Dietary supplement use in individuals living with cancer and other chronic conditions: a population-based study. Journal of the American Dietary Association, 108(3), 483-494.

Definition

National Center for Complementary and Alternative Medicine [NCCAM]. (2009). Using dietary supplements wisely. (NCCAM Publication No. D426). Bethesda, MD.

Regulation

FDA. (2009). Overview of dietary supplements. Retrieved January 20, 2010, from http://www.fda.gov/Food/DietarySupplements/ConsumerInformation/ ucm110417.htm#what

NCCAM. (2009). Using dietary supplements wisely. (NCCAM Publication No. D426). Bethesda, MD.

1963 1994 2005 2008-2010

The Market$23.7 billion industry (Gorski, 2008)Approximately 80% use supplements

(Werneke et al., 2004)

Consumer Healthcare Product Association. (2010). Dietary supplement facts and figures. Retrieved January 24, 2010, from http://www.chpa-info.org/pressroom/DS_ FactsFigures.aspx

Gorski, D. (2008). The Dietary Supplement Safety Act of 2010: A long overdue correction to the DSHEA of 1994. Retrieved January 16, 2011, from http://www.sciencebasedmedicine.org/?p=3772

Werneke, U., Earl, J., Seydel, C., Horn, O., Crichton, P., & Fannon, D. (2004). Potential health risks of complementary alternative medicines in cancer patients. British Journal of Cancer, 90, 408-413.

IssuesGeneral Public HealthCancer Patients

American Cancer Society. (2010). Dietary supplements: How to know what is safe. Retrieved January 17, 2011, from http://www.cancer.org/acs/groups/cid/documents/webcontent/002385-pdf.pdf

FDA. (2010). Dietary supplements. Retrieved January 15, 2010, from http://www.fda.gov/Food/DietarySupplements/

Gardiner, P., Phillips, R., & Shaughnessy, A. P. (2008). Herbal and dietary supplement-drug interactions in patients with chronic illness. American Family Physician, 77 (1), 73-78.

NCCAM. (2010). Herbs at a glance: Ephedra. Retrieved February 5, 2011, from http://nccam.nih.gov/health/ephedra/#cautions.

van der Voet, G. B., Sarafanov, A., Todorov, T. I., Centeno, J. A., Jonas, W. B., Ives, J. A., & Mullick, F. G. (2008). Clinical and analytical toxicology of dietary supplements: A case study and a review of the literature. Biology Trace Element Research. 125, 1-12. doi: 10.1007/s12011-008-8157-0

Impact of Weak Regulation

RisksNatural ≠ safe (NCCAM,

2009)Examples of interactions

FDA. (2009). Overview of dietary supplements. Retrieved January 20, 2010, from http://www.fda.gov/Food/DietarySupplements/ConsumerInformation/ ucm110417.htm#what

National Library of Medicine. (2010). Dietary supplements labels database. Retrieved January 18, 2011, from http://dietarysupplements.nlm.nih.gov/dietary/

Potential Adverse Effects Supplement Warning

St. John’s Wort Can interfere with many medications

Ginkgo Increased bleeding risk

Mistletoe Safety during cancer treatment unknown; should only be used in clinical trial

Black Cohosh Hepatitis, liver failure, possibly contraindicated for hormone-sensitive conditions

Astragalus May interact with immune suppressors, affects blood sugar and blood pressure

NCCAM. (2011). Herbs at a glance. Retrieved February 5, 2011, from http://nccam.nih.gov/health/herbsataglance.htm

False claims

Office of Dietary Supplements. (n.d.). Dietary Supplements: Background information. Retrieved January 15, 2011, from http://ods.od.nih.gov/factsheets/dietarysupplements/

Oh, V. (1998). The powerful placebo: From ancient priest to modern physician/complementary medicine: A research perspective. British Medical Journal. 316, 1397.

Lack of DialogueAwarenessEmbarrassmentReliable informationTime

Gardiner, P., Phillips, R., & Shaughnessy, A. P. (2008). Herbal and dietary supplement-drug interactions in patients with chronic illness. American Family Physician, 77 (1), 73-78.

Progress

American Cancer Society. (2010). Dietary supplements: How to know what is safe. Retrieved January 17, 2011, from http://www.cancer.org/acs/groups/cid/documents/webcontent/002385-pdf.pdf

U.S. Pharmacopeia. (2011). About USP. Retrieved January 17, 2011, from http://www.usp.org/aboutUSP/

Tools“Time to Talk”RSS feedEducationSupport groupsMentorsValid websites

FDA. (2010). Dietary supplements. Retrieved January 15, 2010, from http://www.fda.gov/Food/DietarySupplements/

National Center for Complementary and Alternative Medicine. (2009). Using dietary supplements wisely. (NCCAM Publication No. D426). Bethesda, MD.

Call to ActionTalkListenUse tools

ReferencesAmerican Cancer Society. (2010). Dietary supplements: How to know what is safe. Retrieved January 17, 2011, from

http://www.cancer.org/acs/groups/cid/documents/webcontent/002385-pdf.pdf

Consumer Healthcare Product Association. (2010). Dietary supplement facts and figures. Retrieved January 24, 2010, from http://www.chpa-info.org/pressroom/DS_ FactsFigures.aspx

FDA. (2009). Overview of dietary supplements. Retrieved January 20, 2010, from http://www.fda.gov/Food/DietarySupplements/ConsumerInformation/ ucm110417.htm#what

FDA. (2010). Dietary supplements. Retrieved January 15, 2010, from http://www.fda.gov/Food/DietarySupplements/

Gardiner, P., Phillips, R., & Shaughnessy, A. P. (2008). Herbal and dietary supplement-drug interactions in patients with chronic illness. American Family Physician, 77 (1), 73-78.

Gorski, D. (2008). The Dietary Supplement Safety Act of 2010: A long overdue correction to the DSHEA of 1994. Retrieved January 16, 2011, from http://www.sciencebasedmedicine.org/?p=3772

Miejerman, I., Beijnan, J. H., Schellens, J. H. M. (2006). Herb-drug interactions in oncology: Focus on mechanisms of induction. The Oncologist, 11(7), 742-752.. Retrieved January 18, 2011, from http://theoncologist.alphamedpress.org/cgi/content/full/11/7/742

Miller , M.F ., Bellizzi, K.M., Sufian, M., Ambs, A.H., Goldstein, M.S., &Ballard-Barbash, R. (2008). Dietary supplement use in individuals living with cancer and other chronic conditions: a population-based study. Journal of the American Dietary Association, 108(3), 483-494.

National Center for Complementary and Alternative Medicine. (2009). Using dietary supplements wisely. (NCCAM Publication No. D426). Bethesda, MD.

National Institutes of Health, Office of Dietary Supplements. (2010). About dietary supplements. Retrieved from http://dietary-supplements.info.nih.gov/pubs/ partnersbrochure.asp

National Library of Medicine. (2010). Dietary supplements labels database. Retrieved January 18, 2011, from http://dietarysupplements.nlm.nih.gov/dietary/

Office of Dietary Supplements. (n.d.). Dietary Supplements: Background information. Retrieved January 15, 2011, from http://ods.od.nih.gov/factsheets/dietarysupplements/

Oh, V. (1998). The powerful placebo: From ancient priest to modern physician/complementary medicine: A research perspective. British Medical Journal. 316, 1397.

U.S. Pharmacopeia. (2011). About USP. Retrieved January 17, 2011, from http://www.usp.org/aboutUSP/

van der Voet, G. B., Sarafanov, A., Todorov, T. I., Centeno, J. A., Jonas, W. B., Ives, J. A., & Mullick, F. G. (2008). Clinical and analytical toxicology of dietary supplements: A case study and a review of the literature. Biology Trace Element Research. 125, 1-12. doi: 10.1007/s12011-008-8157-0

Werneke, U., Earl, J., Seydel, C., Horn, O., Crichton, P., & Fannon, D. (2004). Potential health risks of complementary alternative medicines in cancer patients. British Journal of Cancer, 90, 408-413.

References (cont.)

For Further Information…http://nccam.nih.gov/timetotalk/http://www.fda.gov/food/dietarysupplements/default.htmhttp://www.cancer.gov/ncicancerbulletin/081109/page6http://dietarysupplements.nlm.nih.gov/dietary/http://www.fda.gov/Food/DietarySupplements/Alerts/default.htmwww.nci.govwww.cancer.orgwww.asco.orghttp://www.fda.gov/AboutFDA/ContactFDA/StayInformed/RSSFeeds/TDS/

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