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Alternative medicine has been defined as the use of various treatment modalities that are not usually used in traditional medicine, taught in medical schools, or covered by insurance companies. Terminology, however, is changing and these treatments are being incorporated more and more into traditional therapies and hence the term complimentary medicine is now used more frequently (Complimentary-Alternative Medicine [CAM]). In 1991, the National Institutes of Health (NIH) established the office for Alternative Medicine to address the growing use of these treatments. It has been estimated that two-thirds of the American population has used some form of CAM (59). Of importance, 70% ofthose patients using CAM did not disclose this use to their physician (60). In 1998 the Alternative Medicine office changed its name to the National Center for Complimentary and Alternative Medicine (NCCAM). Alternative therapies include things such as imagery, biofeedback, acupuncture, reiki, dietary supplements, herbal products, and traditional Chinese medicine. The NCCAM web site is: http://www.nccam.nih.gov and can be used for more detailed information beyond the scope of this review.

The Glioma Outcome project or "GO" was a physician directed project with the goal of improving the care of brain tumor patients. A total of 788 HGG patients were enrolled. The project collected data on the use of alternative therapies by glioma patients. An abstract of this data was presented at the Society for Neurooncology meeting in 2000 (61), which evaluated data from the first 520 patients. Patients were asked about alternative therapy use within 3 wk of glioma surgery and at 3-mo intervals after that. Forty-nine percent of patients used at least one alternative therapy during their treatment. The most frequently used treatments included meditation and prayer (28%), high-dose vitamins (23%), and herbs (18%). Interestingly, alternative therapy use at some point (49%) was greater than the use of chemotherapy (25%), or those who enrolled in clinical trials (21%). An earlier study by Verhoef et al. (62) out of Canada also found that alternative therapy in glioma patients is common (24%). In that trial, conducted in Southern Alberta, 167 patients were evaluated using a prospectively administered questionnaire. Verhoef et al. felt alternative medicine use resulted from the patients' need to perceive that they have some autonomy in the management and treatment for their tumor. Clearly, these are evolving fields that require closer evaluation. Because it is obvious that patients are looking to other sources of treatment, we as a community need to evaluate these "therapies" in clinical trials. It is also imperative that when asking patients and caregivers about medications that it includes over-the-counter and herbal medications. As an example, grapefruit juice has been shown to be a CYP-450 inhibitor and St. John's Wort a CYP-450 inducer. This information can be found at http://medicine.iupui.edu/flockhart/.

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