By Robin Eisner

N E W Y O R K, June 29 "?It’s a new twist on the “don’t ask, don’t tell"?policy.
　　 According to a new study in the current Journal of Clinical Oncology more patients may be taking alternative medicines while undergoing traditional treatments than previously thought. But they are not telling their doctors about it, nor are doctors asking. Either way, the patients may be getting hurt.
　　 A survey of 453 cancer patients going to outpatient facilities affiliated with the University of Texas M.D. Anderson Cancer Center, a world-renowned cancer center in Houston, revealed that 69 percent were using alternative treatments such as vitamins and herbs, homeopathic remedies, essiac tea and mistletoe. The majority of those interviewed also were undergoing chemotherapy and radiation.
　　 Earlier and smaller studies of cancer patients have indicated that perhaps around 50 percent were employing alternative methods. Approximately 42 percent of Americans in the general population use alternative treatments, spending $34 billion in 1997 for them.
　　High Expectations
　　Performed between December 1997 and June 1998, this survey of patients "?who had breast, thoracic/head and neck, gastrointestinal, prostate and lymphomic cancers "?also revealed that 60 percent of the patients did not tell their physicians they were taking these medications. Seventy-four percent of the total, however, wanted more information about the substances and, of these, 50 percent of wanted the information from their doctors.
　　 While patients did not abandon conventional care, they had high expectations of the alternative therapies. Seventy-seven percent thought they would improve the quality of their life; 71 percent believed they would boost their immune system; 62 percent thought they would prolong their lives; and 37 percent had high expectations they would cure their disease.
　　 The research also dispels the myth that alternative medicine users are terminally ill, desperate and uneducated: most were well-educated.

Alternatives Can Cause Problems
　　While many patients believe that the herbs, supplements and vitamins are innocuous, some may have a detrimental effect.
　　 “What is most important about the study is that patients might not be aware that some of the alternative methods they are taking might be interfering with their chemotherapy and radiation, says study lead author Dr. Mary Ann Richardson, a program officer in the National Institutes of Health Center for Complementary Medicine. Richardson had led the study while at the University’s School of Public Health.
　　 Gingko biloba or high vitamin E doses can cause bleeding problems, which can cause a problem for someone undergoing surgery, she says. Essiac tea, (one of the most common herbal mixtures used by cancer patients) soy, ginseng and tonic with red clover have estrogen-stimulating effects that might hurt women who have breast cancers that grow in response to the hormone.
　　 “Many of these alternative substances have gastrointestinal side effects and without knowing a patient was taking it, a doctor might mistakenly take a patient off a chemotherapeutic agent thinking it was causing the problem,"?explains Dr. Gary Kao, a radiation oncologist at the University of Pennsylvania Hospital, in Philadelphia, commenting on the study.
　　 The drugs also might be affecting clinical trials of cancer treatments, skewing results without doctors being aware of it.
　　 Richardson says the study points to the need for further studies analyzing the safety and efficacy of these alternative herbs and drugs for cancer patients. Many of these are ongoing, she says, with the results not yet known.
　　 Preliminary studies, Richardson says, do show certain substances such as melatonin, acting perhaps as an antioxidant, might decrease the side effects of chemotherapy. Mistletoe, presumed to be a non-specific immune stimulant, has been used in cancer treatment since the 1920s. The National Cancer Institute is doing a large clinical trial examining if a type of shark cartilage can prevent blood vessel growth in tumors and thus cut off their nutrient supply.

Doctors Should Ask
　　 But until data from clinical studies becomes available and doctors can better communicate with patients about them, Richardson says, doctors should be asking patients whether they are taking these drugs, a practice that is not as common as it should be.
　　 Indeed, at M.D. Anderson it is not routine practice to ask patients about their alternative medicine use, which co-author and chief of breast surgery Dr. S. Eva Singletary hopes will change at her facility and elsewhere as a result of the study. “We hope this research encourages both the public and physicians to keep and open mind and abandon this ‘don’t ask, don’t tell"?policy,"?Singletary says.
　　 “It is probably not a routine practice for most doctors in the United States to ask their patients about their use of alternative medications,"?Pennsylvania’s Kao agrees. “But it is a vicious cycle. The patients don’t tell, the doctors don’t ask because they don’t feel comfortable without having objective studies of the compounds."?br /> 　　 With research, doctors should be able to distinguish which therapies could harm or hurt, says Dr. Wendy Weiger, a post-doctoral fellow at the Beth Israel-Deaconess Center for Alternative Medicine, in Boston, also commenting on the research.
　　 “Until then, an open line of communication should exist between a patient and a doctor,"?Weiger says. “Patients should not feel they will be rejected if they reveal they are taking these alternative medications. Doctors also need to educate themselves about these things and should feel comfortable telling patients that there is a limited amount of information that’s available about these substances.
　　
　　(From ABCNEWS)