title: Perioperative herbal supplement use in cancer patients: potential implications and recommendations for presurgical screening.
abstract: BACKGROUND
  Products made from botanicals that are used to maintain or improve health are known as herbal supplements, botanicals, or phytomedicines. Many herbs have a long history of use and claimed health benefits. However, many herbal supplements and botanicals have potent pharmacologic activity that can contribute to adverse effects and drug interactions. The use of herbal supplements by cancer patients in the perioperative period is common and consistent with the substantial increase in the use of alternative medical therapies.
  
  
  METHODS
  We reviewed the literature to examine the constituents, safety, pharmacokinetics, and pharmacodynamics of those herbal supplements that are predominantly used by cancer patients.
  
  
  RESULTS
  Different supplements possess antiplatelet activity, adversely interact with corticosteroids and central nervous system depressant drugs, have gastrointestinal manifestations, produce hepatotoxicity and nephrotoxicity, and produce additive effects when used with opioid analgesics.
  
  
  CONCLUSIONS
  With the increasing use of herbal supplements by cancer patients, surgical staff need to screen patients pre-surgically for use of these supplements. Clinical practice guidelines are needed for screening and prevention of herbal supplement usage to prevent potential adverse events that may arise from herbal medications taken alone or combined with conventional therapies during the perioperative period.
authors.affiliation: Department of Nutrition, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida College of Medicine, Tampa, Florida 33612, USA. kumar@moffitt.usf.edu
authors.forename: Nagi B
authors.initials: NB
authors.lastname: Kumar
authors.forename: Kathy
authors.initials: K
authors.lastname: Allen
authors.forename: Heather
authors.initials: H
authors.lastname: Bell
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D019587:Dietary Supplements / Q000009:adverse effects*; D041743:Herb-Drug Interactions; D029001:Herbal Medicine; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy* / Q000601:surgery; D017410:Practice Guidelines as Topic; D011300:Preoperative Care
chemical_list: D000305:Adrenal Cortex Hormones; D000701:Analgesics, Opioid