title: Bridging cross-cultural gaps: monitoring herbal use during chemotherapy in patients referred to integrative medicine consultation in Israel.
abstract: BACKGROUND
  The high prevalence of the use of traditional herbs among patients with cancer is a cause for concern with regard to potentially adverse interactions with conventional oncology treatments. In this study, we explore herbal use among patients with cancer in northern Israel who are referred by their health care providers to complementary and traditional medicine (CTM) consultations provided to them within the conventional oncology department. The study's objectives were to identify which herbs patients use and to examine the scope of current research on the efficacy and safety regarding the identified herbs.
  
  
  METHODS
  Herbal use by patients receiving oncology care was assessed prospectively from July 2009 to July 2012 by integrative physicians (IPs) trained in herbal medicine. Historical, ethnobotanical, basic research, and clinical data regarding the identified herbs were explored by using a keyword search in PubMed and Middle Eastern ethnohistorical literature.
  
  
  RESULTS
  Disclosure of herbal use was reported by 154 of the 305 patients (50.5 %) interviewed by IPs. The use of 85 single herbs and 30 different herbal formulas was documented during the initial or follow-up IP assessments. Patients reported 14 quality of life-associated indications for herbal use. The ten most prevalent herbs displaying in vitro/in vivo anticancer activity and nine other herbs were preliminarily assessed concerning potential risks, safety, and interaction with chemotherapy.
  
  
  CONCLUSIONS
  Herbal use by patients with cancer in northern Israel is widespread and calls for further study in order to address issues of safety and effectiveness. We recommend constructing a multinational and multidisciplinary team of researchers with ethnopharmacological and clinical expertise that will explore the use of herbs among patients with cancer in a cross-cultural perspective attuned with patients' affinity to traditional herbal medicine.
authors.affiliation: Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, 35 Rothschild St., Haifa and Western Galilee District, Haifa, Israel.
authors.forename: Limor
authors.initials: L
authors.lastname: Almog
authors.forename: Efraim
authors.initials: E
authors.lastname: Lev
authors.forename: Elad
authors.initials: E
authors.lastname: Schiff
authors.forename: Shai
authors.initials: S
authors.lastname: Linn
authors.forename: Eran
authors.initials: E
authors.lastname: Ben-Arye
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D004347:Drug Interactions / Q000208:ethnology*; D005260:Female; D006801:Humans; D055048:Integrative Medicine / Q000592:standards*; D007557:Israel / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000208:ethnology; D008517:Phytotherapy / Q000592:standards*
chemical_list: D000970:Antineoplastic Agents