Standardizing Supplement Recommendations in a Neuro-Oncology Clinic: A Pharmacist-Led Quality Improvement Initiative

BACKGROUND

Patients with primary brain tumors frequently use supplements and repurposed drugs alongside standard treatments. However, inconsistent counseling practices, variable provider knowledge, and limited evidence-based guidance contribute to fragmented recommendations, potential drug-supplement interactions, and adverse events.

OBJECTIVES

This quality improvement initiative aimed to (1) assess existing supplement and repurposed drug usage within a neuro-oncology clinic, (2) identify high-risk supplements and repurposed drugs relevant to neuro-oncologic treatment, and (3) implement a pharmacist-designed, evidence-based standard to guide supplement and repurposed drug recommendations and patient education.

METHODS

Retrospective chart review of patient-reported supplement and repurposed drug use; literature review of peer-reviewed data regarding preclinical data, adverse effects, and drug interactions; and incorporation of these findings into a standardized clinical decision aid.

RESULTS

Baseline review of 960 patients with glioblastoma revealed reported supplement or repurposed drug usage in 37% of patients. The supplements and repurposed drugs identified as most relevant to neuro-oncology care included boswellia, high-dose vitamin C, ginseng, turmeric, ginger, beetroot, mushrooms, milk thistle, ivermectin, and mebendazole.

CONCLUSION

A pharmacist-led, evidence-based quality improvement initiative successfully standardized supplement and repurposed drug recommendations within a neuro-oncology clinic. Formalizing recommendations enhanced supplement and repurposed drug use documentation and streamlined provider recommendations. Integration of this standardized model into neuro-oncology workflows may serve as a scalable approach for other oncology specialties facing similar challenges with complementary supplement use.