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Ashrafizadeh H, Rassouli M. Traditional, complementary, and alternative medicine in cancer care: Challenges and opportunities. Asia Pac J Oncol Nurs 2024; 11:100321. [PMID: 38111680 PMCID: PMC10727935 DOI: 10.1016/j.apjon.2023.100321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/12/2023] [Indexed: 12/20/2023] Open
Affiliation(s)
- Hadis Ashrafizadeh
- School of Nursing, Student Research Committee, Dezful University of Medical Sciences, Dezful, Iran
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Toukabri I, Said AB, Hamdi A, Mokrani A, Gabsi A, Ayed WB, Tounsi K, Limayem I. Patterns of complementary and alternative medicine use among Tunisian cancer patients. J Oncol Pharm Pract 2020; 27:1948-1957. [PMID: 33323022 DOI: 10.1177/1078155220980131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The use of complementary and alternative medicine (CAM) among cancer patients is prevalent worldwide as cancer patient are perpetually seeking for a way to improve their quality of life and to cure their disease. Unfortunately, the majority ignore the danger that can resort when they use CAM currently with conventional therapies. The purpose of this study is to assess prevalence and predictors of CAM use in cancer patients. METHODS Cross-sectional study using a questionnaire administered to cancer patients, who were attending Salah Azaiz institute, Tunis, Tunisia. The study took place from September to December 2018. RESULTS In 222 cancer patients, the overall prevalence of CAM use was 40.54%. On univariate analysis, patients who had university education level were less likely to use CAM (p = 0.05). Based on multivariate analysis, CAM users had more likely metastatic tumor (p = 0.047; OR = 1.913).It is reported that the majority of the population used herbal medicine. The most common herbal products consuming by patients, included Ephedra foeminea (51.8%), Annona muricata (12%) and Curcuma longa L. (10.84%).The main source of information was entourage (family, friends, hospital entourage) (74.44%).The majority of CAM users (61.11%) reported to consume CAM currently with conventional therapies. CONCLUSION This survey revealed a high prevalence of CAM use. The most common type of CAM use is herbal products. Some of the used herbal products are known to interact with conventional anticancer medication. This emphasizes the importance of patients disclosure of CAM use to health professionals in order to avoid herb-medications interactions.
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Affiliation(s)
- Imen Toukabri
- Department of Pharmacy, Salah Azaiez Institute, Tunis, Tunisia
| | - Azza Ben Said
- Department of Pharmacy, Salah Azaiez Institute, Tunis, Tunisia.,Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Adel Hamdi
- Department of Pharmacy, Salah Azaiez Institute, Tunis, Tunisia.,Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Amina Mokrani
- Department of Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Azza Gabsi
- Department of Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Wiem Ben Ayed
- Department of Pharmacy, Salah Azaiez Institute, Tunis, Tunisia
| | | | - Imen Limayem
- Department of Pharmacy, Salah Azaiez Institute, Tunis, Tunisia.,Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
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Foster K, Oyenihi O, Rademan S, Erhabor J, Matsabisa M, Barker J, Langat MK, Kendal-Smith A, Asemota H, Delgoda R. Selective cytotoxic and anti-metastatic activity in DU-145 prostate cancer cells induced by Annona muricata L. bark extract and phytochemical, annonacin. BMC Complement Med Ther 2020; 20:375. [PMID: 33302945 PMCID: PMC7727144 DOI: 10.1186/s12906-020-03130-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/22/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Annona muricata L. was identified as a popular medicinal plant in treatment regimens among cancer patients in Jamaica by a previously conducted structured questionnaire. Ethnomedically used plant parts, were examined in this study against human prostate cancer cells for the first time and mechanisms of action elucidated for the most potent of them, along with the active phytochemical, annonacin. METHODS Nine extracts of varying polarity from the leaves and bark of A. muricata were assessed initially for cytotoxicity using the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay on PC-3 prostate cancer cells and the ethyl acetate bark (EAB) extract was identified as the most potent. EAB extract was then standardized for annonacin content using High-performance Liquid Chromatography - Mass Spectrometry (HPLC-MS) and shown to be effective against a second prostate cancer cell line (DU-145) also. The mode of cell death in DU-145 cells were assessed via several apoptotic assays including induction of increased reactive oxygen species (ROS) production, reduction of mitochondrial membrane potential, activation of caspases and annexin V externalization combined with morphological observations using confocal microscopy. In addition, the potential to prevent metastasis was examined via inhibition of cell migration, vascular endothelial growth factor (VEGF) and angiogenesis using the chorioallantoic membrane assay (CAM). RESULTS Annonacin and EAB extract displayed selective and potent cytotoxicity against the DU-145 prostate carcinoma cells with IC50 values of 0.1 ± 0.07 μM and 55.501 ± 0.55 μg/mL respectively, without impacting RWPE-1 normal prostate cells, in stark contrast to chemotherapeutic docetaxel which lacked such selectivity. Docetaxel's impact on the cancerous DU-145 was improved by 50% when used in combination with EAB extract. Insignificant levels of intracellular ROS content, depolarization of mitochondrial membrane, Caspase 3/7 activation, annexin V content, along with stained morphological evaluations, pointed to a non-apoptotic mode of cell death. The extract at 50 μg/mL deterred cell migration in the wound-healing assay, while inhibition of angiogenesis was displayed in the CAM and VEGF inhibition assays for both EAB (100 μg /mL) and annonacin (0.5 μM). CONCLUSIONS Taken together, the standardized EAB extract and annonacin appear to induce selective and potent cell death via a necrotic pathway in DU-145 cells, while also preventing cell migration and angiogenesis, which warrant further examinations for mechanistic insights and validity in-vivo.
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Affiliation(s)
- Kimberley Foster
- Natural Products Institute, University of the West Indies, Mona, Kingston 7, Jamaica
- Biotechnolgy Centre, University of the West Indies, Mona, Kingston 7, Jamaica
| | - Omolola Oyenihi
- Pharmacology Department, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Sunelle Rademan
- Pharmacology Department, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Joseph Erhabor
- Pharmacology Department, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Motlalepula Matsabisa
- Pharmacology Department, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - James Barker
- School of Life Sciences, Pharmacy and Chemistry, Kingston University, Penrhyn Road, Kingston-upon-Thames, Surrey, UK
| | - Moses K Langat
- Jodrell Laboratory, Department of Natural Capital and Plant Health, Royal Botanic Gardens, Kew, Richmond, TW9 3DS, UK
| | - Amy Kendal-Smith
- Jodrell Laboratory, Department of Natural Capital and Plant Health, Royal Botanic Gardens, Kew, Richmond, TW9 3DS, UK
- Faculty of Biological Sciences, University of Leeds, Leeds, England
| | - Helen Asemota
- Biotechnolgy Centre, University of the West Indies, Mona, Kingston 7, Jamaica
| | - Rupika Delgoda
- Natural Products Institute, University of the West Indies, Mona, Kingston 7, Jamaica.
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Ben-Arye E, Lavie O, Samuels N, Khamaisie H, Schiff E, Raz OG, Mahajna J. Safety of herbal medicine use during chemotherapy in patients with ovarian cancer: a "bedside-to-bench" approach. Med Oncol 2017; 34:54. [PMID: 28238155 DOI: 10.1007/s12032-017-0910-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/18/2017] [Indexed: 10/20/2022]
Abstract
In this study, we explored herbal supplements used by patients during chemotherapy and test for herb-drug interactions and response of cancer cells to treatment. Patients with gynecological cancer referred to a complementary and integrative medicine (CIM) service were asked about their use of herbal medicine during chemotherapy. The leading five clinically relevant herbs selected for cytotoxicity analysis included the following: wheatgrass (Triticum aestivum), European mistletoe (Viscum album), ginger (Zingiber officinale), Ephedra (Ephedra campylopoda), and Oriental mistletoe (Viscum cruciatum). Cytotoxicity was examined using XTT assays in cisplatin-sensitive and resistant ovarian cancer cell lines (A2780, A2780CisR), and non-cancer kidney cells (HEK-293). The effect of the selected herbs on carboplatin and paclitaxel cytotoxicity was tested as well. Pro-apoptotic effects were tested using Poly(ADP-ribose) polymerase (PARP) cleavage. Of 98 patients referred to the CIM service, 42 (42.9%) reported using/intending to use herbal products during chemotherapy. European mistletoe and ginger exhibited significant anti-cancer activity in cisplatin-sensitive and resistant ovarian cells. Wheatgrass and ephedra reduced cytotoxicity of carboplatin on cisplatin-sensitive ovarian cancer cells, while ginger, European and Oriental mistletoe increased chemosensitivity in both cancer cell lines. Wheatgrass, European mistletoe, and ginger increased sensitivity to cisplatin-resistant cells treated with carboplatin and paclitaxel. No effect was observed with the addition of any of the herbs on non-cancerous embryonic kidney cells (HEK-293). Herbal medicine use by patients with ovarian cancer may influence anti-cancer activity of chemotherapy. Integrative physicians can provide "bedside-to-bench" guidance on the safety of these products.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, Oncology Service, Lin Medical Center, Clalit Health Services, 35 Rothschild St., Haifa and Western Galilee District, Israel. .,Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Ofer Lavie
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Gynecologic Oncology Service, Carmel Medical Center, Haifa, Israel
| | - Noah Samuels
- Integrative Oncology Program, Oncology Service, Lin Medical Center, Clalit Health Services, 35 Rothschild St., Haifa and Western Galilee District, Israel.,Tal Center for Integrative Oncology, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Hazem Khamaisie
- Cancer Drug Discovery Program, Galilee Technology Center (Migal), Kiryat Shmona, Israel
| | - Elad Schiff
- Departments of Internal Medicine and Integrative Surgery Service, Bnai Zion Hospital, Haifa, Israel
| | - Orit Gressel Raz
- Integrative Oncology Program, Oncology Service, Lin Medical Center, Clalit Health Services, 35 Rothschild St., Haifa and Western Galilee District, Israel
| | - Jamal Mahajna
- Cancer Drug Discovery Program, Galilee Technology Center (Migal), Kiryat Shmona, Israel.,Nutritional Sciences Department, Tel Hai College, Kiryat Shmona, Israel
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Ben-Arye E, Mahajna J, Aly R, Ali-Shtayeh MS, Bentur Y, Lev E, Deng G, Samuels N. Exploring an herbal "wonder cure" for cancer: a multidisciplinary approach. J Cancer Res Clin Oncol 2016; 142:1499-508. [PMID: 27155666 DOI: 10.1007/s00432-016-2175-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 04/27/2016] [Indexed: 11/26/2022]
Abstract
CONTEXT AND OBJECTIVES The unmonitored use of herbal medicinal remedies by patients with cancer presents a significant challenge to oncology healthcare professionals. We describe an increasingly popular herbal "wonder drug," Ephedra foeminea (Alanda in Arabic), whose use has spread from the Palestinian patient population throughout the Middle East. We conducted a multicentered and multidisciplinary collaborative research effort in order to understand the potential benefits and harms of this popular herbal remedy. METHODS We conducted an in-depth search of the medical literature, both traditional and modern, for any mention of the clinical use of Alanda for the treatment of cancer. We then tested the remedy, first for toxic ephedra alkaloid components and then for anticancer effects, as well as effects on the cytotoxic activity of chemotherapy agents (cisplatin and carboplatin) on breast cancer cell cultures. RESULTS We found no mention in the literature, both conventional and traditional, on the use of Alanda for the treatment of cancer. Laboratory testing did not find any toxic components (i.e., ephedra alkaloids) in the preparation. However, in vitro exposure to Alanda led to a reduced cytotoxic effect of chemotherapy on breast cancer cell cultures. CONCLUSIONS The use of an integrative ethnobotanical, laboratory and clinical research-based approach can be extremely helpful when providing nonjudgmental and evidence-based guidance to patients with cancer, especially on the use of traditional herbal medicine. The effectiveness and safety of these products need to be examined by integrative physicians who are dually trained in both complementary medicine and supportive cancer care.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, Haifa and Western Galilee Oncology Service, Clalit Health Services, Haifa, Israel.
- Lin Medical Center, Affiliated with the Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
- Complementary and Traditional Medicine Unit, Department of Family Medicine, Affiliated with the Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
- The Oncology Service, Lin Medical Center, 35 Rothschild St., Haifa, Israel.
| | - Jamal Mahajna
- Cancer Drug Discovery Program, Galilee Technology Center, Kiryat Shmona, Israel
| | - Radi Aly
- Department of Plant Pathology and Weed Research, ARO, Newe-Yaar Research Center, Ramat Yishay, Israel
| | - Mohammed Saleem Ali-Shtayeh
- Biodiversity and Biotechnology Research Unit, Biodiversity and Environmental Research Center, BERC, Til, Nablus, Palestine
| | - Yedidia Bentur
- Israel Poison Information Center, Section of Clinical Pharmacology and Toxicology, Rambam Health Care Campus, The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Efraim Lev
- Department of Eretz Israel Studies, University of Haifa, Haifa, Israel
| | - Gary Deng
- Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Noah Samuels
- Integrative Oncology Program, Haifa and Western Galilee Oncology Service, Clalit Health Services, Haifa, Israel
- Lin Medical Center, Affiliated with the Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Tal Center for Integrative Medicine, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel
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Analytical techniques combined with chemometrics for authentication and determination of contaminants in condiments: A review. J Food Compost Anal 2015. [DOI: 10.1016/j.jfca.2015.05.004] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Alleviating gastro-intestinal symptoms and concerns by integrating patient-tailored complementary medicine in supportive cancer care. Clin Nutr 2015; 34:1215-23. [DOI: 10.1016/j.clnu.2014.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 12/14/2014] [Accepted: 12/16/2014] [Indexed: 01/04/2023]
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Ben-Arye E, Samuels N, Goldstein LH, Mutafoglu K, Omran S, Schiff E, Charalambous H, Dweikat T, Ghrayeb I, Bar-Sela G, Turker I, Hassan A, Hassan E, Saad B, Nimri O, Kebudi R, Silbermann M. Potential risks associated with traditional herbal medicine use in cancer care: A study of Middle Eastern oncology health care professionals. Cancer 2015; 122:598-610. [DOI: 10.1002/cncr.29796] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/09/2015] [Accepted: 10/19/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services; Haifa and Western Galilee District Israel
- Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology; Haifa Israel
| | - Noah Samuels
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services; Haifa and Western Galilee District Israel
- Tal Center for Integrative Oncology, Institute of Oncology, Sheba Medical Center; Tel Hashomer Israel
| | | | - Kamer Mutafoglu
- Center for Palliative Care Research and Education, Dokuz Eylul University; Inciralti Izmir Turkey
| | - Suha Omran
- Faculty of Nursing; Jordan University of Science and Technology; Irbid Jordan
| | - Elad Schiff
- Department of Internal Medicine and Integrative Medicine Service; Bnai-Zion Hospital; Haifa Israel
- Department for Complementary Medicine, Law and Ethics, The International Center for Health, Law and Ethics; Haifa University; Israel
| | | | - Tahani Dweikat
- Sheikh Khalifa Medical City; Abu Dhabi United Arab Emirates
| | | | - Gil Bar-Sela
- Division of Oncology, Rambam Health Care Campus; Haifa Israel
| | - Ibrahim Turker
- Dr. A.Y Ankara Oncology Training and Research Hospital; Ankara Turkey
| | - Azza Hassan
- National Center for Cancer Care and Research; Doha Qatar
| | - Esmat Hassan
- Botany Department; National Research Centre; Dokki Giza Egypt
| | - Bashar Saad
- Qasemi Research Center, Al-Qasemi Academy; Baqa El-Gharbia Israel
- Faculty of Arts and Sciences; Arab American University; Jenin Palestinian Authority
| | - Omar Nimri
- Department of Cancer Prevention; Ministry of Health; Amman Jordan
| | - Rejin Kebudi
- Cerrahpasa Medical Faculty; Istanbul University; Istanbul Turkey
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The kitchen as therapy: qualitative assessment of an integrative cuisine workshop for patients undergoing chemotherapy. Support Care Cancer 2015; 24:1487-95. [DOI: 10.1007/s00520-015-2934-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/31/2015] [Indexed: 10/23/2022]
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