title: Potential risks associated with traditional herbal medicine use in cancer care: A study of Middle Eastern oncology health care professionals.
abstract: BACKGROUND
  The authors assessed the use of herbal medicine by Middle Eastern patients with cancer, as reported by their oncology health care professionals (HCPs). Herbal products identified by the study HCPs were evaluated for potential negative effects.
  
  
  METHODS
  Oncology HCPs from 16 Middle Eastern countries received a 17-item questionnaire asking them to list 5 herbal products in use by their patients with cancer. A literature search (PubMed, Micromedex, AltMedDex, and the Natural Medicine Comprehensive Database) was conducted to identify safety-related concerns associated with the products listed.
  
  
  RESULTS
  A total of 339 HCPs completed the study questionnaire (response rate of 80.3%), identifying 44 herbal and 3 nonherbal nutritional supplements. Safety-related concerns were associated with 29 products, including herb-drug interactions with altered pharmacodynamics (15 herbs), direct toxic effects (18 herbs), and increased in vitro response of cancer cells to chemotherapy (7 herbs).
  
  
  CONCLUSIONS
  Herbal medicine use, which is prevalent in Middle Eastern countries, has several potentially negative effects that include direct toxic effects, negative interactions with anticancer drugs, and increased chemosensitivity of cancer cells, requiring a reduction in dose-density. Oncology HCPs working in countries in which herbal medicine use is prevalent need to better understand the implications of this practice. The presence of integrative physicians with training in complementary and traditional medicine can help patients and their HCPs reach an informed decision regarding the safety and effective use of these products.
authors.affiliation: Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel.|Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Ben-Arye
authors.affiliation: Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel.|Tal Center for Integrative Oncology, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Noah
authors.initials: N
authors.lastname: Samuels
authors.affiliation: Clinical Pharmacology Unit, Haemek Medical Center, Afula, Israel.
authors.forename: Lee Hilary
authors.initials: LH
authors.lastname: Goldstein
authors.affiliation: Center for Palliative Care Research and Education, Dokuz Eylul University, Inciralti Izmir, Turkey.
authors.forename: Kamer
authors.initials: K
authors.lastname: Mutafoglu
authors.affiliation: Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Suha
authors.initials: S
authors.lastname: Omran
authors.affiliation: Department of Internal Medicine and Integrative Medicine Service, Bnai-Zion Hospital, Haifa, Israel.|Department for Complementary Medicine, Law and Ethics, The International Center for Health, Law and Ethics, Haifa University, Israel.
authors.forename: Elad
authors.initials: E
authors.lastname: Schiff
authors.affiliation: Bank of Cyprus Oncology Center, Nicosia, Cyprus.
authors.forename: Haris
authors.initials: H
authors.lastname: Charalambous
authors.affiliation: Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
authors.forename: Tahani
authors.initials: T
authors.lastname: Dweikat
authors.affiliation: Makassed Charitable Hospital, East Jerusalem, Israel.
authors.forename: Ibtisam
authors.initials: I
authors.lastname: Ghrayeb
authors.affiliation: Division of Oncology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Gil
authors.initials: G
authors.lastname: Bar-Sela
authors.affiliation: Dr. A.Y Ankara Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Turker
authors.affiliation: National Center for Cancer Care and Research, Doha, Qatar.
authors.forename: Azza
authors.initials: A
authors.lastname: Hassan
authors.affiliation: Botany Department, National Research Centre, Dokki, Giza, Egypt.
authors.forename: Esmat
authors.initials: E
authors.lastname: Hassan
authors.affiliation: Qasemi Research Center, Al-Qasemi Academy, Baqa El-Gharbia, Israel.|Faculty of Arts and Sciences, Arab American University, Jenin, Palestinian Authority.
authors.forename: Bashar
authors.initials: B
authors.lastname: Saad
authors.affiliation: Department of Cancer Prevention, Ministry of Health, Amman, Jordan.
authors.forename: Omar
authors.initials: O
authors.lastname: Nimri
authors.affiliation: Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Rejin
authors.initials: R
authors.lastname: Kebudi
authors.affiliation: Middle East Cancer Consortium, Haifa, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Silbermann
mesh_terms: D000328:Adult; D000488:Allied Health Personnel; D000818:Animals; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D031058:Arum; D002162:Camelus; D030024:Curcuma; D018552:Daucus carota; D005260:Female; D005737:Garlic; D041743:Herb-Drug Interactions; D029001:Herbal Medicine / Q000706:statistics & numerical data; D006722:Honey; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D008877:Middle East; D008892:Milk; D009369:Neoplasms / Q000188:drug therapy*; D031881:Nigella sativa; D010820:Physicians; D008517:Phytotherapy / Q000706:statistics & numerical data*; D028321:Plant Preparations / Q000009:adverse effects* / Q000627:therapeutic use; D012108:Research Personnel; D011795:Surveys and Questionnaires; D026982:Urtica dioica
chemical_list: D000970:Antineoplastic Agents; D028321:Plant Preparations
keywords: complementary traditional medicine; drug-herb interaction; integrative medicine; physician-patient communication; quality of life