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The use of medical marijuana in cancer care presents a dilemma for both patients and physicians. The scientific evidence is evolving, yet much of the known information is still insufficient to adequately inform patients as to risks and benefits. In addition, evidence-based dosing and administration information on medical marijuana is lacking. Medical marijuana is now legal, on some level, in 24 states plus the District of Columbia, yet is not legal on the federal level. This review addresses the current state of the research, including potential indications, risks and adverse effects, preliminary data on anticancer effects, as well as legal and quality issues. A summary of the clinical trials underway on medical marijuana in the oncology setting is discussed.
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Dor do Câncer/tratamento farmacológico , Maconha Medicinal/uso terapêutico , Neoplasias/tratamento farmacológico , Dor do Câncer/etiologia , Humanos , Neoplasias/complicações , Resultado do TratamentoRESUMO
CONTEXT: The quality of dietary supplements is highly variable and, therefore, may pose unique risks to cancer patients, who increasingly use these products. Although they are highly regulated, the US Food and Drug Administration (FDA) has reported extensive noncompliance with current Good Manufacturing Practices (cGMPs), which further heightens concerns. OBJECTIVE: The study intended to investigate the dietary supplements quality practices of current and prospective suppliers of supplements. DESIGN: Thirteen manufacturers, marketing 19 dietary supplement brands, were selected for inclusion, and 9 participated. SETTING: This study took place at and was supported by the Cancer Treatment Centers of America (Boca Raton, FL, USA). OUTCOME MEASURES: To ensure patients' safety, the research team established a dietary supplement formulary committee at the Cancer Treatment Centers of America. A proprietary survey tool was used to measure clinically critical quality markers and compliance with FDA regulations. Information was obtained from suppliers via nondisclosure agreements. Manufacturing documents were audited and compared with responses to the survey. The FDA's audit reports were obtained by request under the Freedom of Information Act. Several site audits were conducted, and third-party analytical testing was performed as needed. RESULTS: Although all companies claimed full compliance with cGMPs as of the survey's date, (1) 3 had received warning letters from the FDA for GMP violations, (2) 2 had recalled a product within the preceding 5 y, (3) 4 had reported products that failed independent testing for potency and purity, (4) 1 did not have product specifications, (5) 1 was found by the FDA to have inadequate testing, (6) 1 was found to have a lack of sufficient controls throughout the supply chain to guard against microbial contamination, and (7) 2 had confirmed melamine contamination or lack of melamine testing for protein powders. CONCLUSIONS: These findings confirm the concern of variable dietary supplement quality and describe a rational process others can use to assess products' quality and ensure patients' safety. Although the current study focused on practitioners' branded products used in an oncology setting, the results are relevant to the use of all dietary supplements in both oncological and nononcological settings.
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BACKGROUND: An increasing number of clinics offer complementary or integrative medicine services; however, clear guidance about how complementary medicine could be successfully and efficiently integrated into conventional health care settings is still lacking. Combining conventional and complementary medicine into integrative medicine can be regarded as a kind of merger. In a merger, two or more organizations - usually companies - are combined into one in order to strengthen the companies financially and strategically. The corporate culture of both merger partners has an important influence on the integration. PURPOSE: The aim of this project was to transfer the concept of corporate culture in mergers to the merging of two medical systems. METHODS: A two-step approach (literature analyses and expert consensus procedure) was used to develop practical guidance for the development of a cultural basis for integrative medicine, based on the framework of corporate culture in "mergers," which could be used to build an integrative medicine department or integrative medicine service. RESULTS: Results include recommendations for general strategic dimensions (definition of the medical model, motivation for integration, clarification of the available resources, development of the integration team, and development of a communication strategy), and recommendations to overcome cultural differences (the clinic environment, the professional language, the professional image, and the implementation of evidence-based medicine). CONCLUSION: The framework of mergers in corporate culture provides an understanding of the difficulties involved in integrative medicine projects. The specific recommendations provide a good basis for more efficient implementation.
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OBJECTIVES: Use of naturopathic and nutritional supplements (NNS) with antioxidant activity is controversial in patients receiving radiation therapy. The effects of concomitant use of NNS with antioxidant activity during radiation therapy for prostate cancer were investigated in terms of clinical tumor responsiveness, kinetics, and durability. MATERIALS AND METHODS: A retrospective investigation was done of 134 patients treated with curative intent for limited-stage prostate cancer by radiation therapy. Patients self-selected to receive NNS as part of their treatment and maintenance during an extended post-treatment interval of at least 2 years. The outcome measures were the following: prostate-specific antigen (PSA) nadir; ≥24 months post-treatment PSA; time to reach nadir; and time to last follow-up were compared across +NNS and -NNS. RESULTS: Sixty-nine (69) patients elected to receive NNS while 65 did not. Seventy-seven (77) (+NNS 39, -NNS 38) patients received hormone therapy while 57 (+NNS 30, -NNS 27) did not. In the nonhormone cohort, median pretreatment PSA, nadir, post-treatment PSA, time to reach nadir, and time to follow-up were 5.5 ng/mL, 0.56 ng/mL, 0.61 ng/mL, 25 months, and 39.7 months for the -NNS group and 5.1 ng/mL, 0.32 ng/mL, 0.44 ng/mL, 27 months, and 50.1 months for the +NNS group, respectively (p>0.05 for all). Similarly, no significant differences were observed between +NNS and -NNS in the hormone-receiving cohort. CONCLUSIONS: The clinical tumor response to radiation therapy in patients with limited-stage prostate cancer is not inhibited by concomitant NNS based on the magnitude of the PSA response, the velocity of the PSA nadir, and the duration of PSA normalization.
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Antioxidantes/farmacologia , Suplementos Nutricionais , Antígeno Prostático Específico/metabolismo , Neoplasias da Próstata/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Hormônios/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Naturologia , Avaliação de Resultados em Cuidados de Saúde , Neoplasias da Próstata/metabolismo , Neoplasias da Próstata/radioterapia , Estudos RetrospectivosAssuntos
Neoplasias Ósseas/terapia , Neoplasias da Mama/terapia , Carcinoma Lobular/terapia , Terapias Complementares , Terapia Nutricional , Radioterapia (Especialidade) , Neoplasias Ósseas/secundário , Carcinoma Lobular/secundário , Prestação Integrada de Cuidados de Saúde , Feminino , Humanos , Pessoa de Meia-Idade , Conselhos de Especialidade Profissional , Estados UnidosRESUMO
GOALS OF WORK: There is little data on the prevalence of use of dietary supplements in cancer, especially in light of the growing evidence that some dietary supplements can have adverse interactions with conventional cancer treatment. The purpose of this study was to investigate the use of dietary supplements among adult cancer patients in a community hospital comprehensive cancer center. PATIENTS AND METHODS: A survey of 227 new adult cancer patients presenting for treatment for the first time at Cancer Treatment Centers of America at Midwestern Regional Medical Center, between November 2001 and October 2003. Patients completed the McCune Questionnaire, a validated instrument that captures information on the use of 56 dietary supplements in cancer, at admission to the hospital. RESULTS: Of the 227 patients, 73% used some form of dietary supplements during the 30 day period before the survey was conducted. Dietary supplement use was significantly higher (p = 0.04) in patients with colorectal (80%) and breast (75%) cancer as compared to patients with lung cancer (53%). Patients with stage II (86%) and III (76%) disease at diagnosis were more likely (p = 0.02) to use dietary supplements as compared to those with stage I (71%) disease at diagnosis, while those with stage IV (61%) disease at diagnosis were least likely to use them. Of the 80 patients who had received chemotherapy within the last 30 days, 71% had also used dietary supplements in that timeframe and 25% had consumed one or more herbal therapies that are suspected to have adverse interactions with chemotherapy. Of the 57 patients combining chemotherapy with dietary supplements, 52.6% did not consult a healthcare professional. CONCLUSIONS: In our study, twenty-five percent of patients receiving chemotherapy were concurrently using dietary supplements suspected to have adverse interactions with chemotherapy, usually relying on information sources other than healthcare professionals. Given the prevalence rates of these agents, healthcare providers should systematically inquire about them, and consider the potential for drug-dietary supplement interactions in treatment planning.