Communication Breakdown

Joan Pouch of suburban Philadelphia recalls that during her radiation treatments for breast cancer at Penn Medicine’s Abramson Cancer Center two years ago, “I sat in the waiting room with patients who said, ‘I am doing something on the side, and I’m not telling them.’”

Those patients might be more the norm than the exception. One review of studies published in 2012 in The Oncologist found wide variation in the percentage of patients who told their doctors about complementary care they were using, with some as low as 20 percent, but others as high as 77 percent. Lorenzo Cohen, of MD Anderson Cancer Center in Houston, says one study of breast and ovarian cancer patients at his center found that about half of those who were taking some kind of herb, vitamin or other product on the side had not told their physicians.

Why? “Nobody had asked them,” he says. “Another thing was they didn’t think it was important to tell anyone.” And some, he says, are reluctant to speak up because they are afraid their doctors will tell them to stop.

Doctors stress that they should be informed of anything patients are trying. Many methods, such as acupuncture or meditation, are generally considered safe, but some dietary supplements can interact with cancer treatments or exacerbate side effects like blood thinning. A review in 2008 in the Journal of the National Cancer Institute concluded that high doses of antioxidants during chemotherapy and radiation “should be discouraged because of the possibility of tumor protection and reduced survival.”

There is also a more basic reason for patients to talk to doctors and caregivers: They are there to help, says Heather Greenlee, president of the Society of Integrative Oncology. “Sometimes patients are trying to selfmedicate,” she says, “and there could be a therapy that is effective that they don’t know about.”