Patient Agreement & Acknowledgement For Off-label Medicine Use

Condition to be Treated:  METABOLIC SUPPORT IN CANCER

1. Purpose of This Document
This document confirms the discussion between you,

(Patient), and Dr. Nyjon Eccles, regarding the proposed treatment with the medicine named above. This medicine is being prescribed in a way that is "off-label."

2. What "Off-Label" Means

• Every licensed medicine has an official "marketing authorisation" (or "license") which states the approved uses, based on evidence reviewed by regulators (like the MHRA in the UK or EMA in the EU).
• "Off-label" means using a medicine:
  • For a condition or purpose not listed in its official approval.
  • At a different dose.
  • For a different age group.
  • Or via a different method of administration.

3. Why Off-Label Use is Being Recommended
Your doctor has recommended this off-label use because, in their professional judgement, it is in your best medical interest. The reasons include:

• There is no suitable licensed alternative treatment for your condition and in this scenario we mean to address metabolic dysfunction that can be seen in cancer patients
• Licensed alternatives have been tried and were not effective or caused side effects.
• There is credible scientific evidence and/or respected clinical guidelines supporting this use for your condition.

4. Discussion & Key Points We Have Covered
Your doctor has explained the following, and you have had the opportunity to ask questions:

• The Approved ("On-Label") Use: The standard licensed use of this medicine is for: PARASITIC INFECTIONS
• Benefits: The potential benefits of using it for your condition are: IMPROVED SENSITIVITY OF CANCER CELLS TO CONVENTIONAL TREATMENTS BY SPECIFIC ACTIONS THAT SUPPORT DYSFUNCTIONAL METABOLISM.
• Risks & Unknowns: Potential risks, side effects, and uncertainties specific to this off-label use include: POTENTIAL FOR DISTURBED LIVER FUNCTION.
• Evidence Base: The recommendation is based on: Published medical studies Established clinical practice and Expert guidelines.
• Alternatives: Other treatment options we have discussed include: METABOLIC SUPPORT WITH SUPPLEMENTS ONLY (NON-PHARMACEUTICAL).

Important Notice/Summary:
The metabolism support supplements and repurposed/off-label medicines provided are not intended diagnose, treat, cure, or prevent cancer or any other disease. These interventions are offered solely to support metabolic health, as emerging research suggests that cancer may involve metabolic imbalances and that supporting this can have positive impact on outcomes associated with conventional treatments.

These supplements and off label medicines are not a substitute for conventional cancer treatments such as chemotherapy, radiation, immunotherapy, or surgery. Patients should consult with their oncologist or primary healthcare provider before starting any new supplement or repurposed medication, especially while undergoing active cancer treatment.

While metabolic support and certain repurposed medicines may play a role in overall well-being they should be used as a complementary approach and not as a replacement for evidence-base medical treatments. Individual responses may vary, and there is no guarantee of specific health outcomes. It is also important to note that when on these off-label medicines that regular blood tests are recommended to monitor liver and kidney function since there are reports that suggest that these medicines can affect liver function. By using these supplements and repurposed/off label medicines, I acknowledge that I understand the intended purpose and agree to seek professional medical advice for any concerns regarding cancer treatment and overall health. I also agree that I will comply with regular blood test monitoring as outlined above.

5. Your Consent & Responsibilities

• I understand that the use of this medicine for my condition is off-label.
• I have been informed of the potential benefits, risks, and uncertainties, including those that may be less well-known than for its licensed use.
• I have had the opportunity to ask questions, and my questions have been answered to my satisfaction.
• I understand that I may stop this treatment at any time, but I should discuss this with my doctor first.
• I agree to report any new or unexpected symptoms to my doctor or pharmacist promptly.
• I agree to regular blood tests as advised to monitor my liver and kidney function.
• I understand that my doctor is prescribing this medicine based on their professional judgement and the available evidence, and that this decision is made in my best interest.

6. Declaration

Patient Declaration:
I have read and understood the information above. I consent to receiving medications such as Ivermectin, Fenbendazole, or Mebendazole for the metabolic support of my cancer.

Clinician Declaration:
I have explained the nature, purpose, benefits, risks, and alternatives of the proposed off-label treatment to the patient.

Clinician Signature: 

Print Name & GMC/Medical Council Number: 3586952

7. For Clinic Notes (To be filed in patient record)
A copy of this signed form must be placed in the patient's medical records. The consultation notes should also summarise the discussion, the evidence cited, and the reasons for choosing an off-label treatment.