Usage of alternative or complementary therapies

Overview

Complementary and alternative medicine (CAM) use is common among haematological malignancy patients - open, non-judgemental discussion is important given the potential for interaction with conventional treatment and to maintain trust and treatment engagement
A substantial proportion of cancer patients use some form of complementary therapy alongside conventional treatment, often without volunteering this information to their treating team unless specifically asked

Some complementary substances (particularly herbal preparations) have genuine pharmacological activity and can interact with chemotherapy or other haematology drugs - either reducing efficacy (e.g. St John's Wort inducing CYP enzymes, reducing levels of several chemotherapy and immunosuppressive drugs) or increasing toxicity/bleeding risk (e.g. some herbal supplements with antiplatelet/anticoagulant activity)

Routine, explicit, non-judgemental enquiry about CAM use (rather than relying on the patient to volunteer it) is essential, since patients often do not mention CAM use unprompted, sometimes from concern about a negative clinical reaction

Discuss specific interaction risks where relevant, and support informed patient choice rather than dismissing CAM use outright - many complementary approaches (e.g. mind-body techniques, some forms of exercise/nutrition support) can be genuinely complementary to (not competing with) conventional treatment, and a collaborative, non-judgemental approach maintains trust and keeps the conversation open for ongoing disclosure

St John's Wort and CYP enzyme induction, herbal supplements with antiplatelet/anticoagulant activity, complementary therapies with genuine supportive evidence (e.g. some mind-body techniques for symptom/distress management)

A judgemental or dismissive response to disclosed CAM use risks the patient simply not disclosing future use, losing the opportunity to identify and manage a genuine interaction risk - a non-judgemental, collaborative approach that keeps the conversation open is more protective than an outright prohibition stance

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