Congress Abstracts 2004

80

ADVERSE REACTIONS IN CAM CANCER CARE: SUPPORT FOR WIDESPREAD EVIDENCE-BASED PRACTICE (EBP) INTERVENTIONS. Colleen Lee, RN, MS, AOCN^®, National Cancer Institute Office of Cancer Complementary and Alternative Medicine, Rockville, MD.

Adverse reactions are unexpected events occurring after drug administration. The events may be an exaggeration of a predicted action or a reaction ensuing from toxic effects. Most adverse drug reactions are preventable and caused mostly by failure to disseminate knowledge about the drugs to individuals giving or receiving them. Prior consideration of the mechanisms of action, expected reactions, and modifying factors help to prevent reactions. Registered nurses (RNs) play a key role in drug administration and monitoring.

CAM is increasingly popular among patients with cancer for improved symptom management and complementary disease treatment. Quality control of many CAM modalities simply does not exist. Regulations that govern the pharmaceutical industry, such as controlled drug acquisition and preparation, elimination of contaminants, in vitro and in vivo testing, and post-market surveillance do not govern the CAM industry. Anticancer therapies undergo strict pre-clinical toxicology testing, which is absent in the CAM arena. The purpose program is to highlight research findings regarding adverse reactions to educate RNs and support the development of widespread evidence-based practice interventions in CAM cancer care.

Acupuncture, herbal medicine, and dietary supplements are several extremely popular CAM modalities. The seven top selling herbal medicine products in the United States are ginkgo biloba, St. John’s Wort, ginseng, garlic, echinacea, saw palmetto, and kava. Resent research has identified adverse reactions for each of these areas. Select examples are (1) acupuncture may cause infection, tissue trauma, bleeding, and pain; (2) herbal medicine may cause dermatitis, anaphylactic shock, and renal failure; (3) dietary supplements such as ginseng, ephedra, St. John’s Wart, and kava may interact with prescription medications; (4) herbal tea concoctions cause adverse reactions either through constituent herbs or via interaction with prescription medications (kombucha, chaparral, and green teas); and (5) vitamin therapy, although generally well tolerated, may interact with prescription drug regimens. Patients with cancer use many of these modalities and are not aware of their safety and effectiveness profiles.

Anticipated outcomes of widespread evidence-based practice in CAM cancer care would involve oversight of regulation of CAM modalities and the interpretation of RCT data. RNs are key in disseminating accurate information to assist patients in selecting safe and effective modalities.

Recommendations include RN involvement in designing preclinical studies, reporting mechanisms for adverse reactions, post-market surveillance, development and monitoring of extensive CAM databases for patients, and a comprehensive CAM cancer RCT database.