Page 49 Complete Your CE Test Online - Click Here people over age 50, a time when many have a reduced ability to absorb naturally occurring vitamin B12 from foods [281]. While many herbal supplements are carefully grown, tracked, harvested, and prepared under clean controlled conditions, there are others that are not. Many supplements sold today have fillers and contaminants that are not on the label. Supplements have had to be recalled by the FDA because of proven or potential harmful effects. Reasons for these recalls include [281]: ● ● Microbiological, pesticide, and heavy metal contamination. ● ● Absence of a dietary ingredient claimed to be in the product. ● ● The presence of more or less than the amount of the dietary ingredient claimed on the label. Although some may find it disappointing, there is nothing inherently safe about “natural” plants and animal parts unless they are well understood, carefully prepared, and properly used. Some of the most toxic substances and potent allergens in the world occur naturally [22]. Hemlock and poison mushrooms are natural but are quite dangerous if taken internally. There have been some concerns about the content of many herbal preparations sold in the U.S. When herbal supplements have been purchased and tested by researchers, many of them have been found to contain contaminants or fillers. Some supplements did not contain any of the substances listed on their labels, which in 2015 led to legal action by the state Attorney General of New York [225,226]. One major supplement retailer signed an agreement to authenticate supplements and adopt new standards as a result [224]. Unfortunately, a few manufacturers produce so-called “natural” supplements that are covertly adulterated with actual drugs that are known to have harmful side effects. For example, many weight loss products and “men’s supplements” contain prescription drugs (for example, sibutramine, anabolic steroids, tadalafil), some of which have been banned by the FDA because they were harmful to human health [76]. In fact, according to the IARC, androgenic (anabolic) steroids are probable carcinogens [32]. It is also important for patients to know that dietary supplements do not have to prove effectiveness or safety before being marketed; they are considered safe until proven otherwise. The U.S. FDA regulates food supplements like food because it expects them to have no more effect than food does. The FDA also regulates claims that can be made by supplement sellers as well as the types of materials that are allowed in the supplements, but laws are sometimes broken [22]. Based on the evidence about nutrition and dietary supplements, the American Cancer Society advises that it is better to eat healthy foods to obtain antioxidants and vitamins rather than take them as supplements. No dried supplement is equivalent to eating whole foods, fruits, and vegetables. Food is the best source of vitamins and minerals [115]. Most vitamins and other supplements do not cause problems in normal doses, but high doses of supplemental vitamin E (taken alone), in one study, were linked to a slightly higher rate of prostate cancer in men who had lower levels of selenium in the body [186]. Commonly available herbs cannot cure or prevent cancer Although some studies suggest that alternative or complementary therapies, including some herbs, might help patients cope with the side effects of cancer treatment, no herbal products have been shown to be effective for treating cancer. It is helpful to ask cancer patients open-ended questions about vitamins and herbal supplements and any other complementary therapies they may be using when reviewing their current medications [158]. Health concerns for nurses treating cancer patients As nurses and caregivers, those who prepare and administer hazardous drugs need special training and procedures to avoid skin contact, splashes, and aerosols. Mechanical protection such as compounding biologic safety cabinets are used along with careful splash-minimizing procedures during drug preparation. Those administering dangerous and cytotoxic drugs should use personal protective equipment (PPE, such as disposable chemotherapy gloves, gowns, and goggles) for reducing the risks of splashes, aerosols, and other exposures. Used PPE must be disposed of appropriately, along with bags, syringes, tubing, and other administrative equipment. Reusable goggles should be carefully cleaned following procedures that minimize possible contamination of the health care worker or the work environment. NIOSH has a list of hazardous drugs in healthcare settings along with how those drugs were chosen, and what those hazards are online at [216]. Eye-wash stations and drenching hoses are also strongly recommended by OSHA in areas near areas where cytotoxic drugs are prepared and administered and near possible bloodborne pathogen exposures. These are intended to manage potentially hazardous splashes after the fact, but they are not a substitute for preventive measures [278]. Summary This continuing education course covered cancer prevention, cancer nursing, early detection, myths about cancer and cancer prevention, drug interactions, dangers to the nurse and the patient from cancer treatment, financial issues, and standards of care. Cancer prevention and cancer nursing are broad topics with many interesting facets and complex challenges, from the molecules of drugs to patient interactions. As each patient’s story unfolds, it is easy to see the impact that a cancer diagnosis can have. There is so much to know that cannot be covered in education modules like this, which can only examine small bits of the big picture in the hope that some of it will be useful to the nurse caring for these patients and families. But given the scope of the information for which there is not space, following are some resources that might be of help in inpatient and outpatient settings, for the nurse and to share with patients and the people who (almost) never get a day off, caregivers. Resources for nurses Cancer screening, prevention, and treatment information ● ● The National Cancer Institute has cancer information including PDQs for professionals at hp with evidence to support many aspects of cancer including treatment, palliative care, prevention, genetics, and complementary and alternative treatments. Much more can be found at http://www. or by calling 1-800-4-CANCER. ● ● The American Cancer Society has cancer screening guidelines, complementary and alternative medicine information, carcinogen lists, and information on cancer types and stages, survival and treatment at or 1-800-ACS-2345. ● ● The National Comprehensive Cancer Network (NCCN) has guidelines for care both for various cancer types and stages as well as supportive care for symptoms like nausea, fatigue, pain, palliative care, survivorship and more. Free of charge to health professionals (requires registration) at ● ● The U.S. Preventive Services Task Force health recommendations, including cancer screening information and evidence, at http://www. ● ● The Joint Commission for inpatient and outpatient practice standards, at Practice standards and safety information ● ● National Institute for Occupational Safety and Health for safety information, technical assistance for safety issues at work; antineoplastic and hazardous drug information: niosh/topics/antineoplastic/effects.html ● ● The Occupational Safety and Health Administration has regulatory standards for health care workers and others, such as Material System Data Sheet (MSDS) requirements at ● ● The Centers for Disease Control Basic Infection Control and Prevention Plan for Outpatient Oncology Settings: Minimum Expectations for Safe Care at guidelines/Ambulatory-Care+Checklist_508_11_2015.pdf; also