LWBK1006-48 LWW-Govindan-Review December 12, 2011 20:53
CHAPTER 48 COMPLEMENTARY,
ALTERNATIVE, AND
INTEGRATIVE THERAPIES IN
CANCER CARE
VAMSIDHAR VELCHETI•DANIEL MORGENSZTERNDIRECTIONS Each of the numbered items below is followed by lettered answers. Select the
ONE lettered answer that is BEST in each case unless instructed otherwise.QUESTIONS
Question 48.1. A 55-year-old African American woman was recently diagnosed with
metastatic carcinoma of the colon. She started first-line chemotherapy
with FOLFIRI (Irinotecan (CPT-11) and 5-fluorouracil and leucovorin).
She was advised by her aunt to take a herbal potion containing St. John’s
Wort (Hypericum perforatum) for anxiety relief. Which one of these
responses is appropriate regarding the use of this herbal supplement dur-
ing chemotherapy with irinotecan?
A. There is no scientific evidence supporting its anxiolytic effects.
B. St. John’s Wort increases the side effects from treatment with irinote-
can.
C. St. John’s Wort results in more than 50% reduction in serum levels
of the active metabolite of irinotecan.
D. There is an increased risk of bleeding when used concomitantly with
irinotecan.Question 48.2. A 43-year-old premenopausal woman is on adjuvant tamoxifen therapy
for hormone-receptor positive breast cancer. She also uses herbal supple-
ments including St. John’s Wort for depression, and drinks three cups of
green tea daily. What would you recommend at this time?
A. Discontinue St. John’s Wort
B. Discontinue green tea
C. Increase the dose of tamoxifen
D. Discontinue tamoxifen and start an aromatase inhibitorCorresponding Chapter inCancer: Principles & Practice of Oncology,Ninth Edition: 181 (Complementary, Alter-
native, and Integrative Therapies in Cancer Care).589