Patterns of complementary and alternative medicine use among Tunisian cancer patients

Complementary and alternative medicine in oncology: knowledge, attitude and practice among Tunisian healthcare workers

PURPOSE

Over the past years, there has been a considerable increase in complementary and alternative medicine (CAM) use among cancer patients. However, guidance from health care workers (HCWs) is not always provided. We aimed to determine the knowledge, attitude and practice of Tunisian HCWs regarding the use of CAM in cancer patients.

METHODS

We conducted a multicenter cross-sectional study over 5 months from February to June 2022 among HCWs caring for cancer patients in the Tunisian center region. Data were collected using a self-administered questionnaire developed by our investigators.

RESULTS

The level of knowledge about CAM was declared limited by 78.4% of our population. The best known CAM therapies were herbal medicine and homeopathy while chiropractic and hypnosis where the least. HCWs who had sought information on CAM represented 54.3% of our sample and the main source of information was the Internet (37.1%). A positive attitude towards the use of CAM was found in 56% of HCWs. The integration of CAM into supportive care in oncology was approved by 78% of HCWs. Concerning training on CAM, 78% declared its necessity for HCWs and 73.3% expressed a desire to have it. A personal use of CAM was found in 53% of HCWs while 38.8% had previously used CAM in the treatment of their cancer patients.

CONCLUSION

The majority of HCWs had a positive attitude towards the use of CAM in oncology despite their poor knowledge about it. Our study emphasizes the need to train HCWs dealing with cancer patients on CAM.

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.

In vitro effect of Withania somnifera, AYUSH-64, and remdesivir on the activity of CYP-450 enzymes: Implications for possible herb−drug interactions in the management of COVID-19

Ayurvedic medicines Withania somnifera Dunal (ashwagandha) and AYUSH-64 have been used for the prevention and management of COVID-19 in India. The present study explores the effect of Ashwagandha and AYUSH-64 on important human CYP enzymes (CYP3A4, CYP2C8, and CYP2D6) to assess their interaction with remdesivir, a drug used for COVID-19 management during the second wave. The study also implies possible herb−drug interactions as ashwagandha and AYUSH-64 are being used for managing various pathological conditions. Aqueous extracts of ashwagandha and AYUSH-64 were characterized using LC-MS/MS. A total of 11 and 24 phytoconstituents were identified putatively from ashwagandha and AYUSH-64 extracts, respectively. In addition, in silico studies revealed good ADME properties of most of the phytoconstituents of these herbal drugs and suggested that some of these might possess CYP-450 inhibitory activity. In vitro CYP-450 studies with human liver microsomes showed moderate inhibition of CYP3A4, 2C8, and 2D6 by remdesivir, while ashwagandha had no inhibitory effect alone or in combination with remdesivir. AYUSH-64 also exhibited a similar trend; however, a moderate inhibitory effect on CYP2C8 was noticed. Thus, ashwagandha seems to be safe to co-administer with the substrates of CYP3A4, CYP2C8, and CYP2D6. However, caution is warranted in prescribing AYUSH-64 along with CYP2C8 substrate drugs. Furthermore, preclinical and clinical PK studies would be helpful for their effective and safer use in the management of various ailments along with other drugs.