Hormone-modulating Complementary and Alternative Medical Therapies: Implications for the Management of Ovarian Cancer

Introduction: Between 44% and 53% of women with ovarian cancer use some form of complementary and alternative medicine (CAM) during the course of diagnosis and treatment, some of which may be hormonally active (HCAM). Studies have shown that ovarian cancer cells can express hormone receptors for estrogen, progesterone and Her-2/neu and that steroid hormone receptor status possesses prognostic significance. Current studies do not allow us to exclude the possibility that estrogens alone could stimulate ovarian cancer growth in a small fraction of patients. Indiscriminant use of these therapies may lead to under treatment of disease have a negative impact on long-term clinical outcomes including increased morbidity and mortality. Goal: The goal of this study was to develop a detailed understanding of HCAM and HRT use by women with ovarian cancer throughout the course of their treatment, including use prior to diagnosis, in the post-treatment period and at the time of the survey (current use). Methods: The study consisted of a cross-sectional survey regarding the use of contraindicated CAM substances (including HCAM) and was provided to all women with ovarian cancer associated with two Seattlearea participating gynecologic oncology practices. Results: The groups of women surveyed for this analysis were largely similar in terms of demographics, lifestyle and health behaviors. A higher percentage of the women using both HCAM and HRT experienced recurrent disease sooner and had the fewest number of participants 5 years or more from diagnosis than their HCAM or HRT counterparts. HCAM and HRT combined users also scored lower on the SF-36 physical and mental health subscales than those in the HCAM or HRT groups. Both HCAM and HRT were used prior to diagnosis and throughout conventional treatment, including chemotherapy. Conclusion: Patients using a combination of HCAM and HRT may experience earlier recurrence that those using HCAM or HRT alone and women with recurrent disease may be more willing to utilize a broader range of treatment options, including CAM therapies, for their cancer. There is a clear need for additional research regarding the extent to which hormone levels and exogenous hormone supplementation affect morbidity and mortality in ovarian cancer