The prevalence and predictors of using herbal medicines among Iranian cancer patients

Complementary and alternative medicine use among cancer patients in Iran: A systematic review

Background

Cancer patients frequently turn to complementary and alternative medicine (CAM) to mitigate the adverse effects of conventional cancer treatments, alleviate stress, manage comorbidities, and address the cancer itself. This systematic review aims to investigate descriptive studies conducted in Iran, focusing on the prevalence and methods of CAM use among cancer patients.

Methods

A thorough search of PubMed, Scopus, Google Scholar, Web of Science, Magiran, and the Scientific Information Database (SID) was conducted in both English and Persian from inception to July 2023. Inclusion criteria targeted studies exploring the frequency and patterns of CAM utilization among Iranian patients across diverse cancer types.

Results

A total of 604 articles were found in the preliminary search, and 14 were included in this review. Among the 3,990 participants in the included studies, a weighted average of 51.83% (range 4.6%-100%) had used at least one CAM method. The most commonly used CAM methods were prayer (41.8%), medicinal herbs (30.1%), traditional and folk treatments (27.2%), bloodletting (17.3%), and hydrotherapy (13%). Patients reported using CAM for various reasons, including their beliefs, desire to cure the disease, reduce stress, positive past experiences, and improve physical condition. On average, 39% of patients informed their physicians about their CAM use.

Conclusion

The findings underscore the relatively prevalent adoption of CAM by Iranian cancer patients. Given the low rate of disclosure to physicians, there is a compelling need for healthcare system vigilance and monitoring to ensure comprehensive patient care.

The Use of Herbal Medicines Among Cancer Patients

Background and objective The use of herbal medicines has been increasing among cancer patients, as a way to control cancer and treatment-related symptoms; however, many patients are reluctant to disclose this use to their medical practitioners. The fact that oncological treatments have a narrow therapeutic margin, associated with the lack of control and clinical evidence concerning these supplements, makes medication-herbal interactions a reality. These interactions could lead to increased toxicity or a decreased effectiveness of oncological treatment. In light of this, we aimed to assess the prevalence of herbal medicine use in a patient population at a Portuguese central hospital: Centro Hospitalar Lisboa Ocidental. Materials and methods Patients with breast, prostate, or colorectal cancer diagnoses between August 2022 and July 2023 and undergoing oncological treatment were included. Data were collected through a survey during their first appointment, as well as by consulting the patients' clinical files. An interaction evaluation was carried out to assess potential medication-herbal interactions. Finally, a statistical analysis was performed to identify predictive factors for the use of herbal medicines. Results Among the 65 patients included in the study, 52% were females, and the median age of the cohort was 65 years. Breast cancer was the most prevalent diagnosis and the majority of the patients were undergoing palliative treatment. We found that 46% of patients used herbal medicines regularly: to strengthen the immune system, detoxification of the body, and treat insomnia and constipation. A medication-herbal interaction was found in 37% of the cases, the most frequent being doxorubicin-vitamin C, through an antioxidant mechanism. The univariable analysis failed to show any predictive factors associated with the use of herbal medicines. Conclusions This study sheds light on herbal medicine use among cancer patients and the reality of medication-herbal interactions. There is an urgent need for further research and evidence-based medical protocols regarding herbal medicine use, especially in complex cases such as cancer patients, to provide better and safer care.

Non-pharmacological interventions for chemotherapy-induced diarrhoea and constipation management: A scoping review

PURPOSE

Chemotherapy-induced diarrhoea (CID) and constipation (CIC) are among the most common and severe gastrointestinal symptoms related to chemotherapy. This review aimed to identify and describe the evidence for non-pharmacological interventions for the management of CID and CIC.

METHODS

The scoping review was based on the Joanna Briggs Institute methodology and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Evidence from five databases were included: CINAHL, MEDLINE, Embase, PubMed, and APA PsycInfo. Data were systematically identified, screened, extracted and synthesised narratively to describe the evidence for non-pharmacological interventions and their effects on CID and CIC.

RESULTS

We included 33 studies, of which 18 investigated non-pharmacological interventions for CID management, six for CIC management, and nine for both CID and CIC management. Interventions were categorized into five groups, including (1) digital health interventions, (2) physical therapies, (3) diet and nutrition therapies, (4) education, and (5) multimodal. Diet and nutrition therapies were the most common to report potential effectiveness for CID and CIC outcomes. Most of the interventions were implemented in hospitals under the supervision of healthcare professionals and were investigated in randomised control trials.

CONCLUSIONS

The characteristics of non-pharmacological interventions were diverse, and the outcomes were inconsistent among the same type of interventions. Diet and nutritional interventions show promise but further research is needed to better understand their role and to contribute to the evidence base. Nurses are well placed to assess and monitor for CIC and CID, and also deliver effective non-pharmacological interventions.

Synergistic Combination of Letrozole and Berberine in Ascorbic Acid-Stabilized AuNPs: A Promising Solution for Breast Cancer

Breast cancer is a deadly disease that affects countless women worldwide. The most conventional treatments for breast cancer, such as the administration of anticancer medications such as letrozole (LTZ), pose significant barriers due to the non-selective delivery and low bioavailability of cytotoxic drugs leading to serious adverse effects and multidrug resistance (MDR). Addressing these obstacles requires an innovative approach, and we propose a combined strategy that synergistically incorporates LTZ with berberine (BBR) into stabilised AuNPs coated with ascorbic acid (AA), known as LTZ-BBR@AA-AuNPs. The LTZ-BBR@AA-AuNPs, a novel combined drug delivery system, were carefully designed to maximise the entrapment of both LTZ and BBR. The resulting spherical nanoparticles exhibited remarkable efficiency in trapping these two compounds, with rates of 58% and 54%, respectively. In particular, the average hydrodynamic diameter of these nanoparticles was determined to be 81.23 ± 4.0 nm with a PDI value of only 0.286, indicating excellent uniformity between them. Furthermore, their zeta potential was observed to be -14.5 mV, suggesting high stability even under physiological conditions. The release profiles showed that after being incubated for about 24 h at pH levels ranging from acidic (pH = 5) to basic (pH = 7), the percentage released for both drugs ranged from 56-72%. This sustained and controlled drug release can reduce any negative side effects while improving therapeutic efficacy when administered directly to cancer. MDA-MB-231 cells treated with LTZ-BBR@AA-AuNPs for 48 h exhibited IC50 values of 2.04 ± 0.011 μg/mL, indicating potent cytotoxicity against cells. Furthermore, the nanoparticles demonstrated excellent stability throughout the duration of the treatment.

Pain Self-management Strategies in Patients With Cancer: A Qualitative Study

Successful pain management in patients with cancer is a significant challenge, and paying more attention to patients' experiences of pain self-management strategies has particular importance. This study aimed to explore pain self-management strategies in Iranian patients with cancer. This qualitative study was conducted on 14 patients with cancer. Data were collected using semistructured interviews and analyzed through the Graneheim and Lundman content analysis approach. Two main categories emerged from data analysis: (1) psychological pain self-management strategies, and (2) behavioral pain self-management strategies. Psychological strategies included pain distraction techniques, spiritual tendencies, increasing social interactions and support networks, pain tolerance and self-control, and resistance to pain. Behavioral strategies included massage and touch, heat and cold therapy, opium (Taryak in Persian) and tobacco use, herbal and home remedies, and proper diet.

The prevalence and predictors of herb-drug interactions among Iranian cancer patients during chemotherapy courses

BACKGROUND

The concurrent usage of herbal medicines with conventional therapies is an important concern in cancer treatment which can lead to unexpected consequences like herb-drug interactions. This study aimed to determine the prevalence of potential herb-drug interactions and to predict factors associated with herb-drug interactions for cancer patients.

METHODS

This cross-sectional study was conducted among a convenience sample of 315 cancer patients referring to the oncology clinics of Kerman city in 2018. Data were collected via comprehensive face-to-face interviews and medical chart reviews. A drug interaction checker was used to determine herb-drug interactions. The information of patients was compared based on herb-drug interactions using bivariable logistic regression models, and predictors were determined by the multivariable logistic regression model. All analyses were performed by Stata software version 16.

RESULTS

Of 262 patients (83.2% of the patients) who used herbal medicines, 209 patients [79.8% (95% Confidence Intervals (CI): 75.2 - 85.1)] had potential herb-drug interactions. Chamomile was the most popular herbal medicine (n = 163, 78.0%), and minor and moderate herb-drug interactions were caused by green tea (n = 34, 16.3%) and peppermint (n = 78, 37.5%). The number of chemotherapeutic agents (OR: 1.92, 95% CI: 1.43-2.58; P-value < 0.0001) and the experienced of pain during chemotherapy courses (OR = 2.22, 95%CI:1.00-4.94; P-value = 0.04) were some of the predictors of herb-drug interactions among cancer patients.

CONCLUSION

Herbal medicine use during chemotherapy was found prevalent among cancer patients; of them, the experience of potential herb-drug interactions was highly frequent. Oncologists and clinical pharmacologists are recommended to take into account challenges associated with herb-drug interactions in their routine practices, particularly during chemotherapy among these patients.

Efficacies and side effects of medicinal plants used by patients with cancer in Morocco: A retrospective treatment-outcome study

ETHNOPHARMACOLOGICAL RELEVANCE

Medicinal plants have long been used as traditional medicines in Morocco. Patients with cancer frequently use medicinal plants, with a frequency ranging from 11% to 39%. No studies have evaluated these patients in the Beni Mellal-Khenifra region.

AIM OF STUDY

We investigated the beneficial and adverse effects of medicinal plants used by patients with cancer in this region.

METHODS

We conducted a retrospective study of the outcomes of traditional treatment with medicinal plants (retrospective treatment-outcome study: RTO) in 194 patients with cancer at the regional oncology centre of Béni Mellal.

RESULTS

Beneficial effects were reported by 39% of patients. All users of the seeds of Prunus armeniaca L. reported beneficial effects (100%), followed by Curcuma longa L. (50%). We did not observe any significant difference in efficacies between the most commonly used plants (P > 0.05). Patients with cancer who had a low socioeconomic level experienced greater benefits from herbal medicines (p < 0.05). The prevalence of adverse effects was 16%. Juniperus oxycedrus L. was perceived as the most toxic plant (13 patients), as it induced significantly greater toxicity than the other plants (P < 0.05). Patients with a cancer duration of more than 12 months reported more adverse effects (p = 0.05).

CONCLUSIONS

The frequency of beneficial effects was higher than that of adverse effects. Health professionals should be aware of these effects in the process of therapeutic education. Preclinical and clinical research are considered necessary for the in-depth evaluation of the efficacies and toxicities of certain plants that have shown toxic or therapeutic potential.

Use of Medicinal Plants by Cancer Patients Under Chemotherapy in the Northwest of Morocco (Rabat Area) : Cross-Sectional Study

BACKGROUND

Variety of conventional treatments are used to treat cancer. Cancer patients adopt other alternative therapies including medicinal plants. Their curative power results in the presence of secondary metabolites in its different parts. However, they can have toxic effects and interactions with conventional treatment and even chemosensitivity of the cancer cells.

OBJECTIVES

This study aims to determine the prevalence of the use of medecinal plants by cancer patients undergoing chemotherapy, list the medecinal plants used, identify the most consumed, present the reported adverse effects and determine the predictive factors of their use.

MATERIALS AND METHODS

This was a cross-sectional study of 203 patients followed at the National Institute of Oncology in Rabat from 01 October 2018 to 30 November 2018. Regarding socio-demographic and clinical characteristics and data on the use of medicinal plants were collected from a questionnaire.

FINDINGS

of 203 patients, 37% used medicinal plants. 30 plants also the honey were identified during this study. The "euphorbia honey"was consumed at (40%), The most used plants were garlic (13%), turmeric, fenugreek and thyme (11% each). 5% of patients presented side effects related to the consumption of medicinal plants. There is a significant association between the use of medicinal plants and socio-economic level (p  =  0.004) and duration of illness (p  =  0.048).

CONCLUSION

This study revealed a high prevalence of medicinal plants used by cancer patients receiving chemotherapy at National Institute of Oncology. The more clinical studies are desirable to demonstrate the efficacy of medicinal plants and their therapeutic effects to encourage their consumption or prohibit them.

Use of Herbal Medicine Is Associated With Late-Stage Presentation in Tanzanian Patients With Cancer: A Survey to Assess the Utilization of and Reasons for the Use of Herbal Medicine

PURPOSE

In Tanzania, patients with cancer present late with advanced stages. Among other reasons, the use of herbal medicine (HM) might contribute to delay in diagnosis and treatment. This study aims to understand the utilization of HM and the reasons for its' use.

METHODS

A semistructured 30-item questionnaire with closed- and open-ended questions was applied to a cohort of patients with cancer at Kilimanjaro Christian Medical Centre. Content analysis was performed for answers to open-ended questions.

RESULTS

Three hundred two patients were interviewed, 50.9% males and 49.1% females. The mean age was 64 years. 71.6% were in stages III/IV. 70.5% patients used HM and 67.1% started conventional medicine after stopping HM, 7.5% started HM after conventional medicine, and 24.9% combined both. Stage IV patients used HM as first line significantly more often in comparison: stage I 55.6%; II 58.1%; III 57.2%; and IV 70.6%. 77.5% did not tell their doctors about the use of HM. Commonest reasons to use HM were belief in cure, hope of symptom relief, lack of cancer services, and tradition.

CONCLUSION

The majority of patients used HM before consulting a doctor, which contributes to stage IV presentation. Use of HM alongside with chemotherapy is mostly not known to the treating physician and may lead to interactions. These findings must alert health care workers and health policymakers to further foster health education about cancer and its treatment. Further research is needed to understand the wide use of HM among Tanzanian patients with cancer and the role that traditional and spiritual healers play in the field of cancer care.

Use of herbal medicines is common in Tanzania and leads to delays in cancer diagnosis that impedes curative treatment.

Extraction of phenol compound from Mentha piperita by ultrasonic waves based on a response surface methodology

In this study, optimization of the extraction of phenol compounds from Mentha piperita using ultrasonic waves with response surface methodology (RSM) was assessed. In this regard, a central composite design with three independent variables of time (5, 27.5, and 50 min), temperature (25, 45, and 65°C), and concentrations of ethanol in the water-ethanol solution (0%, 50%, and 100%) was used. Besides, the antioxidant activity tests (DPPH radical scavenging assay, ferric reducing antioxidant power [FRAP], and oxidative stability indexes [OSI]) were examined. Significant effects of independent variables on the extraction of phenol compound, DPPH radical scavenging power, and OSI of M. piperita extract, with the regression coefficients of 0.89, 0.92, and 0.94, respectively, were noted. However, no significant difference in terms of the FRAP among different treatments was noted. Also, the best antioxidant activity of M. piperita was obtained by using the ultrasonic wave for 50 min at 65°C and 59.6% v/v ethanol/water solution. While the findings of RSM confirmed the experimental results, due to the favored properties of M. piperita extract by the proposed method, further research to investigate possible applications in the food industry is recommended.

Prevalence of the Use of Herbal Medicines among Patients with Cancer: A Systematic Review and Meta-Analysis

Background

Although herbal medicines are used by patients with cancer in multiple oncology care settings, the magnitude of herbal medicine use in this context remains unclear. The purpose of this review was to establish the prevalence of herbal medicine use among patients with cancer, across various geographical settings and patient characteristics (age and gender categories).

Methods

Electronic databases that were searched for data published, from January 2000 to January 2020, were Medline (PubMed), Google Scholar, Embase, and African Index Medicus. Eligible studies reporting prevalence estimates of herbal medicine use amongst cancer patients were pooled using random-effects meta-analyses. Studies were grouped by World Bank region and income groups. Subgroup and meta-regression analyses were performed to explore source of heterogeneity.

Results

In total, 155 studies with data for 809,065 participants (53.95% female) met the inclusion criteria. Overall, the pooled prevalence of the use of herbal medicine among patients with cancer was 22% (95% confidence interval (CI): 18%–25%), with the highest prevalence estimates for Africa (40%, 95% CI: 23%–58%) and Asia (28%, 95% CI: 21%–35%). The pooled prevalence estimate was higher across low- and middle-income countries (32%, 95% CI: 23%–42%) and lower across high-income countries (17%, 95% CI: 14%–21%). Higher pooled prevalence estimates were found for adult patients with cancer (22%, 95% CI: 19%–26%) compared with children with cancer (18%, 95% CI: 11%–27%) and for female patients (27%, 95% CI: 19%–35%) compared with males (17%, 95% CI: 1%–47%).

Conclusion

Herbal medicine is used by a large percentage of patients with cancer use. The findings of this review highlight the need for herbal medicine to be integrated in cancer care.

In vitro effects of aqueous extract of fermented rooibos (Aspalathus linearis) on human sperm function

Aspalathus linearis (rooibos) is a herbal medicinal plant originally from South Africa's fynbos and well known for its medicinal effects in treating different medical conditions. Rooibos contains significant levels of antioxidants capable of inhibiting the production of reactive oxygen species, which may improve seminal parameters. This study focussed on investigating the direct effect of fermented rooibos on human sperm functions in vitro. Semen samples collected by masturbation from unproven fertile donors (n = 25) and infertile patients (n = 25) after 3-5 days' abstinence were liquefied and centrifuged (300 × g; 10 min) in human tubular fluid medium containing 1% bovine serum albumin. Afterwards, semen samples (7.5 × 10⁶ /ml) were incubated at 37°C for one hour with aqueous extract of fermented extract in sperm preparation medium (0, 0.10, 1.0, 10 and 100 μg/ml) and assessed. Our data showed that fermented rooibos did not affect functional sperm parameters (motility, vitality, intracellular reactive oxygen species and acrosome reaction, p > .05), in vitro except in the reduced percentage of intact mitochondrial membrane potential and DNA fragmentation (p < .05). The decrease in DNA fragmentation generates the possibility of using the extract in patients prior to assisted reproductive techniques.