CAM in UME Project
http://www.caminume.ca
CAM for Cancer: Natural Health Products
CAM in UME Project Section: CAM in Clinical Practice
Author: Doreen Oneschuk, MD
Institution: University of Alberta
Creation Date: February 25, 2008
Synonyms and Related Terms: herbal products, vitamins, minerals, dietary supplements, botanicals,
nutraceuticals
Descriptors: cancer, oncology, pain, fatigue, anxiety, antioxidants, herbal medicine / herbal therapy,
vitamins, minerals, nutraceuticals, supplements, essential fatty acid, amino acids, probiotics, mistletoe,
green tea, soy, essiac, mushrooms, evidence, efficacy
This CAMpod is a comprehensive but succinct overview of the use of natural health products
(NHPs) for cancer prevention, treatment, and symptom palliation. It will focus the use of NHPs
(green tea, soy, lycopene, essiac, mistletoe, reishi mushrooms) for pain, nausea and vomiting,
dyspnea, loss of appetite, fatigue, and selected psychosocial and spiritual distress. The CAMpod
is intended for to be used as a teaching aid for undergraduate medical education instructors by
providing instructors with a synopsis of information well as ideas for student discussion around
the points contained within. Instructors can use the points and references to generate their
own curriculum materials. Additional references on this topic are also suggested;
teaching/learning resources that are available in the CAM in UME Digital Resource Repository
are hyperlinked to the document.
.
1. Purpose
This CAMPod highlights selected research articles that investigated the use of NHPs for cancer.
Mechanism of action, efficacy, safety, and the “bottom line” are summarized for each NHPs. Potential
benefits and risks in taking NHPs also are reviewed. Please refer to the CAMPod, CAM for Cancer
Symptoms for information on the use of CAM practices for selected cancer symptoms.
1.1
Rationale for including this topic in UME
Natural Health Products are a popular CAM modality used by cancer patients. In five recent surveys of
cancer patients, dietary supplement use was prevalent.(1-5) Patients in all stages of cancer have been
known to use NHPs and occasionally patients may take NHPs at the time of chemotherapy and radiation
therapy to reduce side effects. Patients with advanced cancer may use NHPs to alleviate symptoms and
improve quality of life.(5) While these products may exert some beneficial effects on cancer cells, and
reduce chemotoxicity and radiation toxicities, concerns exist regarding the potential for NHPs-drug
interactions leading to adverse efficacy or side effect related outcomes. Given the prevalence of NHPs
use, physicians should become familiar with some of the more commonly used natural health products
for the prevention, treatment, and palliation of cancer.
1.2
Key CAM Competencies
The information in this CAMpod will contribute to enhancing CanMEDS competencies in the roles of
Health Advocate, Communicator, Scholar, and Professional. The CAMpod will also contribute to
meeting CAM-focused educational objectives from the list of core CAM competencies for undergraduate
medical education available at http://www.caminume.ca/documents/competencies.pdf.
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Specific Learning Objectives
1. Discuss the controversial use of NHPs during chemotherapy and radiation administration.
2. Describe some of the unique or special pathophysiological features of cancer patients that may make
them more sensitive to NHPs and increase their risk of NHPs related side effects.
3. Discuss the following topics: Mechanism of action, adverse effects, and effectiveness (evidence
based) as they apply to the following more commonly used herbal products:
Prevention: Green Tea, Soy Products, Lycopene
Treatment and Palliation: Mistletoe, Essiac, Reishi Mushrooms
2.
Overview
2.1 Use of NHPs in the Treatment of Chemotherapy and Radiation Induced Side Effects.
Potential Pro and Con Effects- A conundrum exists as to whether NHPS, particularly those with
antioxidant properties, should be taken along side of chemotherapy and/or radiation therapy. Proponents
and opponents of the practice exist.
2.1.1 Potential Benefits of NHP Use on Cancer Cells, Chemotherapy, and Radiation Therapy
Reactive oxygen species (ROS) are normal metabolic byproducts, and are essential for life. Although ROS
are essential for various cell defense mechanisms, they can cause oxidative damage to DNA, proteins,
and lipids. An elaborate antioxidant defense system hold ROS in check, but under conditions of organism
stress, the antioxidant defense system becomes depleted.(6,7) Administration of antineoplastic agents
during cancer chemotherapy results in a much greater degree of oxidative stress that is induced by the
cancer itself.(8) Oxidative stress reduces the rate of cell proliferation, and that occurring during
chemotherapy may interfere with the cytotoxic effects of antineoplastic drugs, which depend on rapid
proliferation of cancer cells for optimal activity. The high level of oxidative stress during chemotherapy
may overcome the oxidative defenses of the cancer cell, which has specialized systems to reduce lipid
peroxidation. Increasing lipid peroxidation reduces or halts cancer cell proliferation, and interferes with
the activity of chemotherapy.(9) Oxidative stress induced lipid peroxidation generates electrophilic
aldehydes that can attack cellular targets, and can slow cell cycle progression of cancer cells. The
aldehydes also inhibit drug induced apoptosis diminishing the effect of cancer chemotherapy.
Proponents of antioxidant use during chemotherapy suggest that supportive nutritional therapy with
antioxidants during chemotherapy reduces the generation of lipid peroxides, and subsequently, the
generation of oxidative stress-induced aldehydes which may overcome the growth inhibiting effects of
oxidative stress maintaining responsive to chemotherapeutic agents.(8,10,11) Drugs of many classes of
antineoplastic agents are known to generate a high level of oxidative stress in biological systems such as
anthracyclines, most alkylating agents, platinum coordination complexes, epipodophyllotoxins, and
camptothecins. Other agents generate low levels of oxidative stress such as taxanes, vica alkaloids,
antifolates, and nucleoside and nucleotide analogues.(10)
The limited literature on use of antioxidants in chemotherapy suggests that nutrients decrease side
effects of treatment, produce higher response rates, and higher survival rates.(12-14) However, reported
inconsistencies in studies preclude a definitive conclusion as to the effect of chemotherapy on antioxidant
status in patients undergoing anticancer therapy.(15) The studies on antioxidants and radiation therapy
are even more limited. In regards to radiation therapy, radiotherapy is most effective in well oxygenated
tissues, and antioxidants may improve blood flow within tumors and surrounding tissues.
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Sagar SM. Antioxidants during anticancer therapy. FACT. 2004; 9: 96-106.
Sager SM. Should patients take or avoid antioxidant supplements during anticancer therapy? An
evidence-based review. Current Oncology 2005;12(2):44-54.
2.1.2 Risks Associated with Cancer Patients Taking NHPs
The main concern with NHP use during chemotherapy involves the potential effect of various NHPs on
hepatic metabolizing enzymes resulting in Herb/Drug interactions. The potential interactions are
summarized as follows:
1. An herbal component can be a substrate of one or several isoforms of CYP enzymes and/or efflux
systems (P-gp, MPR, and BCRP). One substrate can compete for another substrate for either
metabolism by the same CYP isozyme and/or efflux systems resulting in higher plasma
concentrations due to competitive inhibition.
2. An herbal constituent can also be an inducer of one or several CYP isoforms, and /or efflux
systems, thereby lowering plasma concentrations due to either higher metabolism, and or higher
efflux. Such interactions may produce subtherapeutic plasma drug concentrations.
3. A compound can also be an inhibitor of CYP450 enzymes resulting in reduced activity of one or
several isoforms of CYPs. If a compound is an inhibitor of the efflux system, it will reduce drug
efflux resulting in improved absorption. (16)
Further in regards to herb-drug interactions, some NHPs possess antiplatelet activity, adversely interact
with corticosteroids and central nervous system depressant drugs, have gastrointestinal manifestations,
produce hepatotoxicty and nephrotoxicity, and produce additive effects when used with opioid
analgesics.(17) Herbs such as gingko, garlic, and ginseng have potential anticoagulant effects, and it is
recommended their use be avoided by patients who are thrombocytopenic, are taking medications with
anticoagulant effects, or are in their preoperative period.(18)
During midcycle chemotherapy, when myelosuppression is most pronounced, NHPs may increase the risk
of infection due to product contamination, and bleeding due to the anticoagulant properties of many
NHPs.

Sparreboom A, Cox MC, Acharya MR, Figg WD. Herbal remedies in the United States: potential
adverse interactions with anticancer agents. J Clin Oncol. 2004 Jun 15;22(12):2489-503.
2.2 Prevention
2.2.1 Green Tea
Background and Mechanism of Action: Green tea is made by steaming the fresh cut leaves of an
evergreen bush (Camellia sinensis). The fermentation process does not occur so there is no oxidation of
active constituents in the polyphenols. Of the phenolics, flavonoids are a main class with Epigallocatechin
gallate (EPCG) appearing to be the most important flavonoid. The proposed mechanism of action of
green tea includes the inhibition of inflammatory cytokines related to carcinogenesis, inhibition of
angiogenesis, inhibition of urokinase involved in metastases, and antioxidant reducing damage.
Evidence Based Efficacy: 18 studies have revealed a decrease in the risk of general cancer incidence of
digestive tract, lung, esophagus, ovaries, prostate, rectal cancer in women, bladder and urinary tract
cancers. Twelve studies showed no association between green tea and cancer of the breast, colon, liver,
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lung, esophagus, pancreas, rectum, stomach, and bladder. Three studies revealed an increased risk of
cancer of the bladder and lung.
Safety: One study (Jatoi et al., 2003) commented on the potential for the following side effects: nausea,
vomiting, insomnia, fatigue, diarrhea, abdominal pain, and/or moderate to severe confusion. Safety
during pregnancy and lactation is not established.
Bottom Line: Most of the research on green tea prevention consists of case control and cohort studies.
These suggest that green tea has a protective effect for the prevention of many cancers. More research
is required to determine how much is needed to achieve these effects and identify for which cancers it is
most effective.

Sartippour M, Heber D, Ma J, Lu Q, Go V, Nguyen M. Green Tea and Its Catechins Inhibit Breast
Cancer Xenografts. Nutrition and Cancer 2001; 40: 149-156.

Fujiki H. Two Stages of Cancer Prevention with Green Tea. J Cancer Res Clin Oncol 1999; 125: 589597.

Sun CL, Yuan JM, Koh WP, Yu MC. Green tea, black tea and breast cancer risk: a meta-analysis of
epidemiological studies. Carcinogenesis 2006; 27: 1310-1315.

Cooper R, Morre DJ, Morre DM. Medicinal Benefits of Green Tea: Part II. Review of Anticancer
Properties. J of Altern Complement Med 2005; 11: 639-652.

Schmidt K, Horneber M, Borrelli F, Ernst E. Green tea (Camellia sinensis) for the prevention of cancer
(Protocol). Cochrane Database of Systematic Review 2004; Issue 4.

Jatoi A, Ellison N, Burch Pa, et al. A Phase II trial of green tea in the treatment of patients with
androgen independent metastatic prostate carcinoma. Cancer 2003; 97: 1442-1446.
2.2.2 Soy Products
Background and Mechanism of Action: The active consistuents of soy include phytoestrogens, lignans,
isoflavanes, notably genistein. Genistein, is believed responsible for the anticancer effects. Use is
controversial in regards to breast cancer in that isoflavones may act as mixed estrogen receptor
promoters (agonists), and blockers (antagonists) i.e. may decrease lifetime exposure of estradiol. Soy
appears to have antioxidant and anti-angiogenesis properties, and the ability to increase cell death.
Evidence Based Efficacy: Of 31 clinical trials of use of soy in preventing cancers and 17 case-control and
cohort studies, the evidence suggests the decreased the occurrence of breast cancer, lung cancer in
women, stomach, endometrium, prostate, and thyroid cancers. Ten studies showed no bearing on
general cancer incidence, colorectal, stomach cancer in women, lung cancer in men, and prostate cancer.
Four studies revealed an increased risk of bladder and prostate cancer.
Safety: Soy is generally considered safe. Potential side effects include constipation, diarrhea, bloating,
nausea, and/or allergic skin rash. Precautions are advised with hormone sensitive malignancies (breast,
ovary, uterine), hypothyroidism, renal calculi, bladder cancer, and endometriosis. High doses of soy are
not recommended in pregnancy, and breastfeeding. Soy may increase or decrease the effects of
estrogen. Soy taken with Selective Estrogen Receptor Modulators (SERMs) or Aromatase Inhibitors may
interfere with these medications’ antitumor effects. Soy taken with warfarin may lower the INR, and soy
may decrease the absorption of iron.
Bottom Line: Soy appears to have a protective effect for a variety of cancers but evidence is not clear for
any specific dose or cancer type. Soy intake may be associated with a small reduction in breast cancer
risk, especially if commenced during adolescence. However there is some preliminary evidence that
isoflavones may increase breast cancer risk especially in older patients and when ingested as purified
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isoflavones rather than whole food. High dose isoflavone supplements are not recommended for
prevention of breast cancer or in women who have been diagnosed with the disease.

Lu L-J, Anderson K, Grady J, Kohen F, Nagamani M. Decreased Ovarian Hormones during a Soya
Diet: Implications for Breast Cancer Prevention 2000: Cancer Research 60: 4112-4121.

Xu X, Duncan a. Wangen K, Kurzer M. Soy Consumption Alters Endogenous Estrogen Metabolism in
Postmenopausal Women. Cancer Epidemiology, Biomarkers & Prevention 2000; 9: 781-786.

Trock BJ, Hilakivi-Clarke L, Clarke R. Meta-analysis of Soy Intake and Breast cancer Risk. J of the
National Cancer Institute 2006; 98: 459-471.

McCarty MF. Isoflavones made simple-Genistein’s agonist activity for the beta-type estrogen receptor
mediates health benefits. Medical Hypotheses 2006; 66: 1093-1114.

Messina MJ, Loprinzi CL. Soy for breast cancer survivors: a critical review of the literature. J. Nutr.
2001; 131:3095S-3108S.
2.2.3 Lycopene (Tomatoes—a source of Lycopene)
Background and Mechanism of Action: Lycopene is the most abundant carotenoid in the body. It is
present in many different organs in the body including the lungs, colon, and liver. However, the body
does not produce it. It must be obtained through the diet. Tomato or tomato products provide 85% of
dietary intake. Other fruits and vegetables such as pink grapefruit, carrots, and watermelon provide some
as well. The availability to the body is increased if it has been processed first i.e. tomato paste, ketchup.
The proposed mechanism of action includes free oxygen radical scavenger, inhibition of cell proliferation,
reduction of oxidative DNA damage, and potentiation of the immune system.
Evidence Based Efficacy: 16 Studies ( 13 case control and 3 prospective cohort studies) with dietary
intakes of tomatoes ranging from a few times/year to 17 grams/day revealed a decreased risk of cancers
of the bladder, colon, larynx, lung, esophagus, ovaries, prostate, stomach, thyroid, and upper digestive
tract. Twelve case control studies showed dietary intake of tomatoes did not affect lung, bladder,
gastrointestinal tract, and prostate cancer.
Safety: Lycopene ingestion is generally considered safe, although drug interactions can occur with
grapefruit ingestion. A review of safety studies showed no significant adverse effects. However, no clear
doses have been established.
Bottom Line: Ingestion of tomatoes appears to have a protective effect for multiple cancers, but more
scientific evidence is needed before strict recommendations can be made.

Pohar K, Gong M, Bahnson R, Miller E, Clinton S. Tomatoes, lycopene and prostate cancer: a
clinician’s guide for counseling those at risk for prostate cancer. World Journal of Urology 2003; 21;
9-14.

Etminan M, Takkouche B, Cassmano-Isorna R. The role of tomato products and lycopene in the
prevention of prostate cancer: a meta-analysis of observational studies. Cancer Epidemiology,
Biomarkers and Prevention 2004; 13: 340-345.

Djuric Z, Powell L. Antioxidant capacity of lycopene-containing foods. Int J Food Sci Nutr 2001; 52:
143-149.

Lycopene (Monograph online) Available from http://www.lycopene.org
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2.3 Treatment
2.3.1 Essiac
Background and Mechanism of Action: Essiac is a widely used herbal mixture used in Canada for > 70
years. It was originally an Ojibwa herbal tea. An Ontario based RN, Rene Caisse (her last name spelled
backwards is ‘Essiac’), obtained the recipe in the 1920s. The original recipe contains 4 main herbs:
burdock root, Indian rhubarb, sheep sorrel, inner bark of slippery elm. Four new herbs were added over
time-watercress, red clover, blessed thistle, and kelp. This formula has been modified many times. The
proposed mechanisms of action include anti-carcinogenic, antioxidant, and cytotoxic/anti-tumor effects. It
is most commonly ingested as a tea.
Evidence Based Efficacy: Laboratory Essiac demonstrates some anticancer effects. However, there are no
published clinical trials of Essiac. Most evidence in support of is anecdotal. An unpublished 1977 report of
a phase II clinical study revealed no clinical benefit for survival or tumor regression, but some
improvement in symptoms and well being. A 1997 abstract presented at an ASCO meeting involved a
retrospective review Of 59/360 patients who took Essiac with breast, prostate, and gastrointestinal
cancers, 30% felt it helped them.
A consumer satisfaction survey was performed in 1998/99. Of 1588 subjects who completed the survey,50% reported symptom improvement which included decreased fatigue, nausea, pain, improved appetite.
A recent retrospective cohort study of 510 Ontario women with breast cancer showed some effect on
physical well being, but not on health related quality of life or mood.
Safety: Essiac is generally well tolerated and safe (except when injected). It is not believed likely to cause
serious side effects when used as direct. However, potential side effects include allergic reactions.
nausea, vomiting, diarrhea, high blood pressure, ootential renal damage, electrolyte disturbances
including hypokalemia, altered glucose levels, reduced iron levels, and decreased calcium absorption.
Bottom Line: There is a lack of evidence for use with no published clinical trials. However, because of few
adverse effects it may provide some comfort and hope.

Kaegi E. Unconventional therapies for cancer. I. Essiac. Canadian Medical Association Journal 1998;
158: 897-901.

Richardson M et al. Flor-Essence Herbal Tonic Use in North America: A profile of general consumption
and cancer patients. Herbalgram 2000; 50: 40-46.

Leonard SS, Keil D, Mehlman T, et al. Essiac Tea: Scavenging of Reactive Oxygen Species and
Effects on DAN Damage. J of Ethnopharmacology 2006; 103: 288-296.

Cheung S, Lim K, Tai J. Antioxidant and Anti-Inflammatory Properties of Essiac and Flor-Essence.
Oncology Reports 2005; 14; 1345-1350.

Leonard BJ, Kennedy Da, Cheng FC, et al. An in vivo analysis of the herbal compound essiac.
Anticancer Res 2006; 26: 3057-3063.

Zick SM, Sen A, Feng Y, et al. Trial of Essiac to ascertain its effect in women with breast cancer (TEABC). J Altern Complement Med 2006; 12: 971-980.
2.3.2 Mistletoe
Background and Mechanism of Action: Mistletoe is the most common anticancer herbal therapy
prescribed in Germany. It is a plant that lives symbiotically with different tree species such as the pine,
apple, and oak tree. Various types of mistletoe treat different types of cancer. The proposed mechanism
of action includes stimulation of the immune system by increasing cytokine production, white blood cells,
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and secretion of tumor necrosis factor. It may have a cytotoxic effect on tumor cells. It is administered as
a subcutaneous injection into the abdomen wall or into the tumor 3-7 times/week.
Evidence Based Efficacy: Three retrospective case analyses and 2 prospective randomized trials showed a
potential survival advantage. A retrospective study of 320 pancreatic patients showed better survival
times compared with stage related survival. Studies of multiple tumor types showed mean survival time
was approximately 40% longer than in control groups. Five different studies showed no significant effect
on various disease parameters or overall survival. For treatment of adverse effects for cytotoxic
therapies, mistletoe lowered symptom scores, provided a longer mean time to relapse, led to fewer
adverse events, and improved quality of life.
Safety: The potential exists for multiple adverse effects including skin problems, pain, fatigue, fever,
sweating, dehydration, confusion, diarrhea, vomiting, blood pressure changes, and others. Mistletoe can
enhance the effects of antihypertensive drugs, cardiac suppressants, and CNS depressants. Use during
pregnancy and lactation has not been established. It is toxic when taken orally.
Bottom Line: There is insufficient evidence to support the use of mistletoe, but careful selection of tumor
type and disease stage in properly designed randomized trials may reveal some promising possibilities. If
it is used, monitor patient for dehydration and warn of toxicities.
Bottom Line: Every study is biased due to selectivity. There is no evidence outside of lab rats that
mistletoe or any of its commercial preparations is clinically helpful for cancer patients.

Grossath-Maticek, Kiene H, Baumgartner S, Siegler R. Use of Iscador, an extract of European
mistletoe (viscum album), in cancer treatment: prospective nonrandomized and randomized
matched-paired studies nested within a cohort study. Alternative Therapies in Health and Medicine
2001; 7: 57-66.

Kleijen J, Knipschild P. Mistletoe treatment in cancer: review of controlled trials in humans.
Phytomedicine 1994; 1:255-260.
2.3.3 Reishi Mushrooms
Background and Mechanism of Action: Reishi mushrooms have been used as dietary supplement in
Chinese medicine to promote health and longevity for centuries. It is also known as the Ling Zhi or
‘Mushroom of Immortality’. Many species are available, but only 6 have been investigate for health
benefits. Red and black species have been the most promising medicinally. There are 2 active
compounds: triterpenes, and β-glucans. The proposed mechanism of action includes the inhibition of
cancer cell adhesion, invasion, and cell motility. It has immunostimulating and antioxidant properties.
Evidence Based Efficacy: There are few human studies. Two human studies on Reishi extract both
assessing the immune function of cancer in those treated noted improvement in the immune stimulating
effects for these patients .Most of the evidence is for chemotherapeutic support i.e. reduction of
chemotherapy and radiotherapy side effects.
Safety: Reishi mushrooms can cause respiratory allergic reactions, dry mouth, throat, and nasal
passages, bloody diarrhea, dizziness, itchy skin. It can interact with many medications including
antibiotics, anticoagulants, antihypertensives, and sedatives. Use in pregnancy and lactation is not
established.
Bottom Line: There are very few human studies. Reishi mushrooms may have some immune enhancing
effect but more research required. There is a risk for multiple drug interactions.

Silva D. Ganoderma Lucidum (Reishi) in Cancer Treatment. Integrative Cancer Therapies 2003; 2;
358-364.
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
Wang S, Hsu M, Hsu H, Lee S, Shiao M, Ho C. The antitumor effect of Ganoderma lucidum is
mediated by cytokines released from activated macrophages and T lymphocytes. International
Journal of Cancer 1997; 70: 699-705.

Gao Y, Zhou S, Jiang W, Huang M, Dai X. Effects of ganopoly (a Ganoderma lucidum polysaccharide
extract) on the immune functions in advanced-stage cancer patients.
3.
Discussion
3.1 Questions for Student Discussion and/or Reflection
1. A 58 year old woman with early stage breast cancer is contemplating taking a number of
different herbs to help lessen side effects associated chemotherapy and radiation therapy she
will be receiving. How would you approach your discussions with her on this topic? (It may
be helpful to refer to the CAMpods, CAM for Cancer Symptoms and Patient-Physician
Communication about CAM as well as the article, Cohen L, Cohen MH, Kirkwood C, Russell
NC. Discussing Complementary Therapies in an Oncology Setting. J Soc Integr Oncol.
2007;5(1):18-24.
2. A 65 year-old gentleman with advanced colon cancer read that taking ginseng could
potentially boost his immune system and lessen his cancer related fatigue. He is in your
office today, and mentions that he started taking this herb several days ago. His past
medical history includes cancer associated anemia, thrombocytopenia, and a deep vein
thrombosis for which he is receiving Coumadin. Would you have any concerns with his
decision to use ginseng?
3.2
Readings
3.2.1 Annotated Readings
Boon H, Wong J. Botanical medicine and cancer: a review of the safety and efficacy. Expert Opinion in
Pharmacotherapy 2004; 5(12); 2485-2501.
This well structured review examines the efficacy (prevention and/or treatment) and safety of a
number of botanicals used by cancer patients. The botanicals reviewed include: Essiac, Evening
Primrose Oil, Garlic, Ginger, Ginseng, Green Tea, Mistle Toe, Reishi, Shiitake Mushroom, Soy
Products, Tomato, and Turmeric. Studies of these various botanicals are summarized in chart
form. Expert opinion on the preventative and treatment effects of these botanicals is provided at
the end of the article. Articles for this review were identified by searching Medline (1966-July
2004) and Embase (1980-2004 week 20) so more recent literature (i.e., post 2004) would not
have been included.
Oneschuk D, Younus J, Boon H. Herbal medicine. In: Enhancing Cancer Care, Complementary Therapy
and Support, Barraclough J (ed). Oxford University Press, Oxford, 2007.
Reviews the followings topics: Safety issues, drug interactions, and interactions with
chemotherapy and radiation, counseling patients with cancer on herbal use, and the evidence
base for the following herbs: Asian ginseng, Essiac, Ginger, Green Tea, and Mistletoe
3.2.2 CAMpod Reference List
1. Boon H, Stewart M, Kennard M, et al. Use of complementary/alternative medicine by breast cancer
survivors in Ontario: prevalence and perceptions. J of Clinical Oncology 2000; 18: 2515-2521.
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2. Correa-Velez I, Clavarino A, Barnett A, Eastwood H. Use of complementary and alternative medicine
and quality of life: changes at the end of life. Palliative Medicine 2003; 17: 695-703.
3. Patterson R, Neuhouser M, Hedderson M, et al. Types of alternative medicine used by patients with
breast, colon, or prostate cancer: predictors, motives, and costs. J of Alternative and Complementary
Medicine 2002; 8; 477-485.
4. Richardson M, Sanders T, Palmer J, Greisinger A, Singletary S. Complementary/alternative medicine
use in a comprehensive cancer center and the implications for oncology. J of Clinical Oncology 2000;
18: 2505-2514.
5. Gupta D, Lis C, Birdsall T, Grutsch J. The use of dietary supplements in a community hospital
comprehensive cancer center: implications for conventional cancer care. Support Care Cancer 2005;
13: 912-919.
6. Lopaczynski W, Zeisel SH. Antioxidants, programmed cell death, and cancer. Nutr Res 2001; 21:
295-307
7. Seifried HG, McDonald SS, Anderson DE, Greenwald P, Milner JA. The Antioxidant Conundrum in
Cancer. Cancer research 2003; 63: 4295- 4298
8. Drisko JA, Chapman J, Hunter VJ. The use of antioxidants during chemotherapy. Gynecologic
Oncology 2003;88: 434-439
9. Conklin KA. Dietary Antioxidants During Cancer Chemotherapy: Impact on Chemotherapeutic
Effectiveness and Development of Side Effects. Nutrition and Cancer 2000; 37: 1-18
10. Conklin KA.Chemotherapy-Associated Oxidative Stress: Impact on Chemotherapeutic Effectiveness.
Integr Cancer Ther 2004; 3: 294-300
11. Conklin KA. Cancer Chemotherapy and Antioxidants. J Nutrition 2004; 134: 3201S-3204S
12. Lamson DW, Brignall MS. Antioxidants in cancer therapy: their actions and interactions with oncologic
therapies. Altern Med Rev 1999; 4: 304-329
13. Lamson DW, Brignall MS. Antioxidants and cancer therapy II: quick reference guide. Altern Med Rev
2000;5: 152-163
14. Block KI. Antioxidants and Cancer Therapy: Furthering the Debate. Integr Cancer Ther 2004; 3: 342348
15. Ladas EJ, Jacobson JS, Kennedy DD, Teel K, Fleischauer A, Kelly KM. Antioxidants and Cancer
Therapy: A Systematic Review. J Clin Oncol 2004; 22: 517-528.
16. Pal D, Mitra AK. MDR and CYP3A4-mediated drug-herbal interactions. Life Sciences 2006;78: 21312145.
17. Kumar N, Allen K, Bell H. Perioperative Herbal Supplement Use in Cancer Patients: Potential
Implications and Recommendations for Presurgical Screening. Cancer Control 2005; 12: 149-157.
18. Weiger W, Smith M, Boon H, Richardson M, Kaptchuk T, Eisenberg D. Advising Patients who Seek
Complementary and Alternative Medical Therapies for Cancer. Annals of Internal Medicine 2002; 137:
889-903.
3.2.3
Additional Readings
Sagar SM. Alternative Therapies as Primary Treatments for Cancer. In: Abrams D, Weil A, editors.
Integrative Oncology. Oxford University Press, in print.
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Websites

Natural Medicines Comprehensive Database (NMCD) is an up to date electronic database with
individual monographs prepared by physicians and pharmacists. Each monograph includes clinically
relevant information (i.e. efficacy, toxicity, mechanisms of action, potential interactions) and a section
for patients in layman’s terms. http://www.NaturalDatabase.com

Natural Standard Web site provides evidence based information based on systematic reviews or
prepared monographs of various NHPs. It is peer reviewed and contains the following topics: Related
Terms, Background, Scientific Evidence (graded), Tradition/Theory, Dosing, Safety, and Interactions.
http://www.naturalstandard.com

CAMline is a Canadian Web site from the Faculty of Pharmacy, University of Toronto. Recently revised
and updated. An evidence based website for healthcare professionals and the public. Provides
information on the efficacy and safety of NHPs. http://www.camline.ca
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