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LAURA BOEHNKE MICHAUD, PHARM.D., BCOP, is Clinical Pharmacy Specialist—Breast Oncology, Division of Pharmacy, The University of Texas M. D. Anderson Cancer Center, Houston. JULIE PHILLIPS KARPINSKI, PHARM.D., BCPS, is Assistant Director, Drug Information and Wellness Center, Department of Pharmacy Practice, School of Pharmacy, Southern Illinois University Edwardsville, Edwardsville. KELLIE L. JONES, PHARM.D., BCOP, is Clinical Pharmacy Specialist—Gynecologic Oncology; and JANET ESPIRITO, PHARM.D., is Clinical Pharmacy Specialist—Breast Oncology, Division of Pharmacy, The University of Texas M. D. Anderson Cancer Center.

Address correspondence to Dr. Michaud at the Division of Pharmacy, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1354, Houston, TX 77030 (lboehnke{at}mdanderson.org).

Purpose. The risks and key concepts regarding the use of dietary supplements in patients with cancer are described. Summary. There are six common characteristics of dietary supplements that must be addressed when used by patients with cancer. Clinicians must establish if the supplement is an antioxidant, is an anticoagulant or procoagulant, has immunosuppressive or immunomodulating properties, has hormonal properties, has known safety issues, and has known or theoretical drug interactions. These six characteristics of the dietary supplements commonly used by patients with cancer are reviewed to aid in the analysis of the scientific data and communication of the results with the patient or family members. A framework upon which clinicians can adequately help patients make informed decisions regarding the use of complimentary and alternative medicine and dietary supplements is also described. When evaluating the appropriateness of a supplement for use by a patient with cancer, clinicians must conduct a safety review (evaluate the six characteristics). If the supplement is considered safe, an efficacy review must be conducted, after which the clinicians can recommend the supplement’s use, accept the patient’s decision to use the supplement if no or inconclusive evidence exists, or discourage use if there is conclusive evidence supporting inefficacy. Available resources for locating information regarding dietary supplements are also discussed. Conclusion. Counseling patients with cancer about dietary supplements requires a systematic thought process that considers the available theories and data, as well as the patients’ views about the agents. Index terms: Anticoagulants; Antioxidants; Coagulants; Decision-making; Dietary supplements; Drug interactions; Drug use; Hormones; Immunomodulating agents; Immunosuppressive agents; Mechanism of action; Neoplasms; Patient information; Rational therapy; Toxicity