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Cancer Care Issues - Advice From Dr. Cary Presant

Herbs How Should We Advise our Patients?

Cary Presant, MD, Oncology, Hematology/Oncology, 04:41PM Nov 30, 2013

Here in Los Angeles, I am constantly asked about addition of herbs and vitamins to anti-cancer treatment regimens.  We are expected to answer these questions just as well as inquiries about diet and exercise. 

Fortunately, there is a new tool that can help us answer these questions.  Dr. Barrie Cassileth of Memorial Sloan Kettering Cancer Center has developed an app for iphones, ipads, and ipods (About Herbs can be downloaded from the App store).

I have used this app to help to identify proper doses of herbals, be aware of adverse effects, and review reported beneficial effects from peer-reviewed published studies.  This helps me in recommending evidence-based medical interventions to my patients. 

For example, we have heard that ginger has been useful in helping to control fatigue or nausea in some of our patients treated with chemotherapy.  I recommend that you download the About Herbs app, review the use of ginger 1200 mg to 2000 mg daily in patients, and come to your own conclusions about who might benefit from use of ginger or other herbal therapies.

Also, making sure your patients report all over the counter drugs they are taking is very important in evaluating prescription drug choices. Your staff can help by advising each patient to report all OTC intake.

Getting this history and making such recommendations represents a higher level of care, and one that our patients often expect.  Discussing such recommendations should be considered when coding your visit level.





Poll: Do you review herbal supplements with your patients? 1. Yes, my office always gets that history and I review it personally.|2. Yes, but only if my patients ask me.|3. No, I have not had a good resource for evaluating the interactions.|4. No, that is the role of the primary care physician.|
About This Blog

Dr. Cary Presant describes research results, observations on oncology issues, and discussions on current cancer care topics that can help improve your quality oncology care and your oncology practice.

Disclosure: Cary A. Presant, MD, has disclosed the following relevant financial relationships:
Served as a director, officer, partner, employee, advisor, consultant or trustee for: Diatech Oncology; Digital Medical Network
Received research grant from: Diatech Oncology
Have a 5% or greater equity interest in: Diatech Oncology; Digital Medical Network
Received income in an amount equal to or greater than $250 from: Diatech Oncology
Served on the Board of Directors for: Medical Oncology Association of South California; Cancer Schmancer

  • Cary Presant

    Cary A. Presant, MD, FACP, a hematologist and medical oncologist, is a staff physician at Wilshire Oncology Medical Group. He has been director of cancer programs at Washington University School of Medicine, the Jewish Hospital of St. Louis, and the City of Hope National Medical Center in Los Angeles, California. He is currently Professor of Clinical Medicine at the University of Southern California School of Medicine. Dr. Presant's current research includes pharmacologic improvement of chemotherapy effectiveness by magnetic resonance spectroscopy, as well as the development of a new chemotherapy sensitivity test, based on apoptosis, for all types of cancer. He is the author of over 400 scientific articles in cancer treatment, cancer detection, chemotherapy, experimental tumor biology and pharmacology, liposomes for cancer diagnosis and therapy, magnetic resonance spectroscopy, measurement of quality of life in cancer patients, and quality care in oncology. As an author, Dr. Presant has written Navigating American Medicine, soon to be published, and is the physician columnist for the national patient Website Dr. Presant is past president of the California Division of the American Cancer Society, Chairman of the Board of Directors of the Medical Oncology Association of Southern California (MOASC), past Director of the American Society of Clinical Oncology (ASCO), and past president of the Association of Community Cancer Centers (ACCC).

The content of this blog does not necessarily reflect the viewpoints of Medscape.
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