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Letters to the Editor
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CAM
Patients will benefit when pharmacists get involved
From Mr M. L. de Lemos, MRPharmS
Edzard Ernst made a strong case (PDF 110K) to get pharmacists involved in complementary
and alternative medicine (CAM) (PJ, 7 August, p197). Here at the British
Columbia (BC) Cancer Agency, pharmacists have been involved in CAM for
some time. We started off with critical appraisals of the more controversial
areas (eg, phytoestrogens in breast cancer)1–4 and of highly publicised
products (eg, PC SPES in prostate cancer).5 The advent of standard references
(eg, the Natural Medicines Comprehensive Database) has enabled us to develop
a more structured approach on how to advise cancer patients on CAM.6 We
are now investigating the impact of this approach on patient satisfaction
in a prospective study using a research grant from the Canadian Association
of Oncology Pharmacy.
We agree with Professor Ernst that misinformation of CAM is common on
the internet. In response, we have posted on our website (www.bccancer.bc.ca)
patient information on the use of natural health products with cancer
therapy and for breast cancer patients in particular. In addition, the
‘BC Cancer Agency unconventional therapy manual’ provides 46
short monographs on the more commonly used CAM (eg, Essiac, vitamins,
teas, shark cartilage) and tips for the patient and family on how unconventional
therapies can be evaluated.
The motivations behind the use of CAM are complex. One unexplored area
has been how to address patients’ other needs (eg, distress, anxiety,
hope) which are not directly related to the products used.7 Patients will
only benefit when more pharmacists become involved in this area.
Mário de Lemos
Provincial Drug Information Co-ordinator
British Columbia Cancer Agency, Canada
References
1. de Lemos ML. Effects of soy phytoestrogens genistein and daidzein on
breast cancer growth. Annals of Pharmacotherapy 2001;35:1118–21.
2. de Lemos ML. Should breast cancer patients and survivors stay away
from phytoestrogens? Current Topics in Nutraceutical Research 2004;2:5–12.
3. de Lemos ML, O’Brien RK. Effects of flaxseed phytoestrogens on
breast cancer growth. Journal of Oncology Pharmacy Practice (in press).
4. de Lemos M. Safety issues of soy phytoestrogens in breast cancer patients.
Journal of Clinical Oncology 2002;20:3040–2.
5. de Lemos ML. Herbal supplement PC-Spes for prostate cancer. Annals
of Pharmacotherapy 2002;36:921–6.
6. de Lemos ML, John L, Nakashima L et al. Advising cancer patients on
natural health products - a structured approach. Annals of Pharmacotherapy
2004;38:1406–11.
7. de Lemos ML. Pharmacist’s role in meeting the psychosocial needs
of cancer patients using complementary therapy. Psychooncology (in press).
Suggested CM reference list needed
From Ms H. Badham
I would like to support and update the news report (PDF 110K) on complementary medicine
(CM) (PJ, 7 August, p176). I recently studied the attitudes and interest
in CM of 113 community pharmacists based in Wales, via a postal questionnaire.
The study found that 80 per cent of pharmacists accepted that CM has a
role in holistic patient care and that this provided an opportunity to
extend the pharmacy services. This was important because some pharmacists
believed that many over-the-counter lines and services have been lost over
recent years. However, the pharmacists asked were aware that responsibility
for CM requires further training, with 88 per cent commenting that this
training should be mandatory. This finding may suggest a wide acceptance
of CM into pharmacy practice.
Another area of interest from the study was the varied CM resources used
within the pharmacy, which it was believed may lead to variable patient
care. Therefore I strongly believe that a suggested CM reference list should
be produced and distributed to pharmacists. Initial entries could include
the University Hospital of Wales national medicine information department
for alternative medicines, and CM reference books written from the pharmacy
perspective.1,2
I believe the profession is aware of the responsibility and challenge that
CM brings to practice. By addressing the present variation in resources
and pharmacist knowledge in a unified and proactive manner the opportunity
to extend our skills in CM will be maximised.
Helen Badham
Preregistration Trainee, Sheffield
References
1. Kayne S. Complementary therapies for pharmacists. London: Pharmaceutical
Press; 2001.
2. Barnes J, Anderson LA, Phillipson JD. Herbal medicines, second edition.
London: Pharmaceutical Press; 2002. |
The
Pharmaceutical Journal