Alternative therapies used by women with breast cancer in four ethnic populations

Age, ethnicity, and use of complementary and alternative medicine in health self-management

Drawing on models of health self-management, we develop hypotheses that age and ethnicity will modify associations among indicators ofpoor health and use of complementary and alternative medicine. These hypotheses are evaluated using the 2002 National Health Interview Survey with the Alternative Health Supplement. Results produced partial support for hypotheses that the effects of ailments on use of complementary and alternative medicine differ by age. Results suggest that ailments such as bodily pain, chronic conditions, and functional impairment are associated with use of complementary and alternative medicine among midlife and younger adults, but these associations are generally attenuated among older adults. Hypothesized ethnic differences received weak support. These findings suggest that different interpretations of ailments and appropriate responses may explain why complementary and alternative medicine is used by fewer older adults. The results also highlight the significance of social and cultural factors in understanding patterns of complementary and alternative medicine use in the adult population.

Modifiable Risk Factors for Breast Cancer Recurrence: What Can We Tell Survivors?

The potential for recurrence causes considerable distress for breast cancer survivors. Major information sources for survivors and providers offer few clear recommendations for postdiagnosis lifestyle change related to recurrence. To design interventions to improve long-term survivors' care and quality of life, we must know what survivors are doing to prevent recurrence in the absence of solid evidence, whether survivors' perceptions and behaviors correspond to hypothesized modifiable risk factors for recurrence, and whether survivors are adopting behaviors that could otherwise be harmful to their health. Our review first addresses the general lack of consensus on the impact of specific lifestyle factors on breast cancer recurrence and the resulting equivocal lifestyle recommendations for survivors. Second, we describe inadequacies of the studies of survivors' lifestyle changes related to recurrence. Because much of the existing knowledge about modifiable risk factors for recurrence comes from studies of survivors whose participation and behavior change were potentially influenced by their concern about recurrence, we need large, population-based observational studies of randomly selected breast cancer survivors, adequately representing the target population. Critical are data on lifestyle change from prediagnosis to postdiagnosis and changes over time after diagnosis, extensive data on conventional and nonconventional treatments, and the temporal relationship between behaviors and treatments, and inclusion of the full complement of potential lifestyle risk factors for recurrence. Understanding in detail the current status of survivors' perceptions and behaviors related to modifiable risk factors for recurrence can provide considerable practical information to inform future interventions and communication strategies for breast cancer survivors.

Dietary supplements in patients with cancer: Risks and key concepts, part 2

PURPOSE

The risks and key concepts regarding the use of dietary supplements in patients with cancer are described.

SUMMARY

There are six common characteristics of dietary supplements that must be addressed when used by patients with cancer. Clinicians must establish if the supplement is an antioxidant, is an anticoagulant or procoagulant, has immunosuppressive or immunomodulating properties, has hormonal properties, has known safety issues, and has known or theoretical drug interactions. These six characteristics of the dietary supplements commonly used by patients with cancer are reviewed to aid in the analysis of the scientific data and communication of the results with the patient or family members. A framework upon which clinicians can adequately help patients make informed decisions regarding the use of complimentary and alternative medicine and dietary supplements is also described. When evaluating the appropriateness of a supplement for use by a patient with cancer, clinicians must conduct a safety review (evaluate the six characteristics). If the supplement is considered safe, an efficacy review must be conducted, after which the clinicians can recommend the supplement's use, accept the patient's decision to use the supplement if no or inconclusive evidence exists, or discourage use if there is conclusive evidence supporting inefficacy. Available resources for locating information regarding dietary supplements are also discussed.

CONCLUSION

Counseling patients with cancer about dietary supplements requires a systematic thought process that considers the available theories and data, as well as the patients' views about the agents.

Surgical treatment preferences in Chinese-American women with early-stage breast cancer

Breast-conserving treatment (BCT) is considered preferable to radical or modified radical mastectomy (MRM) for most women diagnosed with early-stage breast cancer. Studies have found that Chinese-American women are more likely to be treated with MRM, regardless of age or stage of disease. The central question posed in this study is: what are the cultural factors that influence the selection of treatments by Chinese-American patients and the presentation of treatment options by providers? Focused group discussions, semi-structured interviews, and ethnographic observations were conducted with 69 Chinese-American women and 14 health professionals. Results indicated that (1) many Chinese-American women, regardless of age, migration status, education, and income level, expressed a preference for MRM because it was seen as safer; (2) this was primarily a communal belief that even women who had BCT felt pressure to conform to; (3) some women felt pressured into the BCT decision by their physician and/or were unhappy with their choice; (4) patient and physician bias and difficulties with translation issues and supplemental materials all led to cross-cultural miscommunication; and (5) this miscommunication was cited as a reason for (a) not completing treatment regimes or (b) drastic changes in the treatment selected.

Predictors of Use of Complementary and Alternative Therapies Among Patients With Cancer

PURPOSE/OBJECTIVES

To determine predictors of use of complementary and alternative medicine (CAM) therapies among patients with cancer.

DESIGN

Secondary analysis of two federally funded panel studies.

SETTING

Urban and rural communities in the midwestern United States.

SAMPLE

Patients with lung, breast, colon, or prostate cancer (N = 968) were interviewed at two points in time. 97% received conventional cancer treatment, and 30% used CAM. The sample was divided evenly between men and women, who ranged in age from 28-98; the majority was older than 60.

METHODS

Data from a patient self-administered questionnaire were used to determine CAM users. Responses indicated use of herbs and vitamins, spiritual healing, relaxation, massage, acupuncture, energy healing, hypnosis, therapeutic spas, lifestyle diets, audio or videotapes, medication wraps, and osteopathic, homeopathic, and chiropractic treatment.

MAIN RESEARCH VARIABLES

Dependent variable for analysis was use or nonuse of any of the identified CAM therapies at time of interviews. Independent variables fell into the following categories: (a) predisposing (e.g., gender, age, race, education, marital status), (b) enabling (e.g., income, health insurance status, caregiver presence, geographic location), and (c) need (e.g., cancer stage, site, symptoms, treatment, perceived health need).

FINDINGS

Significant predictors of CAM use were gender, marital status, cancer stage, cancer treatment, and number of severe symptoms experienced.

CONCLUSIONS

Patients with cancer are using CAM while undergoing conventional cancer treatment.

IMPLICATIONS FOR NURSING

Nurses need to assess for CAM use, advocate for protocols and guidelines for routine assessment, increase knowledge of CAM, and examine coordination of services between conventional medicine and CAM to maximize positive patient outcomes.

Asian/Pacific Islander American Women: Age and Death Rates During Hospitalization for Breast Cancer

PURPOSE/OBJECTIVES

To investigate whether differences in age and death rates exist between hospitalized Asian/Pacific Islander American (APIA) women and women of other racial groups.

DESIGN

Secondary data analysis of a national data set.

SETTING

The Healthcare Cost and Utilization Project Nationwide Inpatient Sample, Release 6, was used to obtain hospitalization data on women with breast cancer based on racial status. A total of 20,507 hospitalization records met the study criteria.

SAMPLE

All women who were hospitalized with a primary diagnosis of breast cancer, were older than 18, and did not die during hospitalization, plus all women who met the criteria stated above but died during hospitalization.

METHODS

Secondary data analysis. Post hoc analysis was used to identify significant differences among racial groups.

FINDINGS

Significant differences were found between APIA and Caucasian and Latino women. Significant differences based on race were found between subjects who had died during hospitalization. On average, APIA women were the youngest to die.

CONCLUSIONS

APIA women with breast cancer were among the youngest women being hospitalized and the youngest to die during hospitalization.

IMPLICATIONS FOR NURSING

Cultural awareness by nurses is critical when discussing methods for prevention and early detection of breast cancer with minority women. Targeting new immigrants is a priority for those who screen and educate women about detection and treatment of breast cancer.

What non-prescription treatments do UK women with breast cancer use?

Understanding the self-prescribing behaviours of patients as well as their attitudes towards prescribed medication regimens is essential if healthcare professionals are to support treatment adherence and avoid unwanted pharmacological interactions and compromises in treatment efficacy. Evidence shows that women with breast cancer are particularly likely to use complementary and alternative therapies. This paper describes the reported treatment profile of a sample of 208 women with breast cancer in the UK. The information was gathered as part of a study exploring the preferences for injection or tablets in the administration of breast cancer treatment. Almost two-thirds of the sample were currently taking prescribed breast cancer treatment, mostly a single hormone therapy. Prescribed medications for co-morbid diseases were also common, and 53% of the women were self-medicating mainly with supplements, principally vitamins, various oils and minerals. In line with other studies, higher levels of education, socio-economic status and internal locus of control were associated with non-prescription use as well as a body mass index <30.

Complementary and Alternative Medicine: Oncology Nurses' Experiences, Educational Interests, and Resources

PURPOSE/OBJECTIVES

To describe oncology nurses' experiences with patients communicating interest in or use of complementary and alternative medicine (CAM) therapies along with oncology nurses' CAM resources and educational interests.

DESIGN

National mailed survey.

SETTING

A national medical center and research institute.

SAMPLE

A random sample of 850 Oncology Nursing Society (ONS) members who are RNs involved in direct patient care.

METHODS

Respondents completed a demographic questionnaire and the Nurse Complementary and Alternative Medicine Knowledge and Attitude Survey. Initial analysis compared the demographics of the sample to the ONS membership. Descriptive analysis was used to further describe nurses' experiences with patients communicating interest in or use of CAM, nurses' interest in CAM education, and nurses' use of CAM resources.

MAIN RESEARCH VARIABLES

Experiences, resources, interests, and CAM therapies.

FINDINGS

Oncology nurses reported their experiences with patients who communicated interest in or use of CAM therapies. Respondents demonstrated considerable interest in learning more about specific CAM therapies and used a variety of resources to find information on CAM therapies.

CONCLUSIONS

Assessing oncology nurses' experiences, resources used, and interest in learning about CAM therapies is the first step in determining the learning needs of oncology nurses in the direct patient care environment. The next step is to obtain baseline information on oncology nurses' CAM knowledge and attitudes for developing and providing appropriate education. CAM education will provide nurses with knowledge to support and advocate for their patients.

IMPLICATIONS FOR NURSING

Oncology nurses are the bridge to help patients safely integrate evidence-based CAM therapies into conventional treatment.

Misclassification of race/ethnicity in a population-based cancer registry (United States)

Cancer registry data on race/ethnicity are vital for understanding cancer patterns in population subgroups, as they inform public health policies for allocating resources and form the bases of etiologic hypotheses. However, accuracy of cancer registry data on race/ethnicity has not been systematically evaluated. By comparing race/ethnicity in the Greater Bay Area Cancer Registry to self-reported race/ethnicity for patients from 14 racial/ethnic groups, we determined the accuracy of this variable and the patient and hospital characteristics associated with disagreement. The extent of misclassification (measured by sensitivity and predictive value positive (PV+)) varied across racial/ethnic groups (total n=11,676). Sensitivities and PV+'s were high (exceeding 90%) for non-Hispanic Whites and Blacks, moderate for Hispanics and some Asian subgroups (70-90%), and very low for American Indians (<20%). Overall, registry and interview race/ethnicity disagreed for 11% of the sample. In a multivariate model, disagreement was associated with non-White race/ethnicity, younger age, being married, being foreign-born but preferring to speak English, and diagnosis in a large hospital. Improving data quality for race/ethnicity will be most effectively attempted at the reporting source. We advocate a concerted effort to systematize collection of these patient data across all facilities, which may be more feasible given electronic medical admissions forms.

Soy and red clover for mid-life and aging

INTRODUCTION

Menopause is associated with mid-life, a time when many women begin to experience the signs and symptoms of aging, such as increases in blood pressure, changes in lipid profiles, loss of bone mass density, and diminished memory and cognition. Given the result of the Women's Health Initiative, many women no longer consider hormone therapy the first option for promoting healthy aging. Instead, they are turning to botanical and dietary supplement (BDS) products in place of hormone therapy. This paper reviews the evidence available for use of isoflavones from soy and red clover for the treatment or prevention of these health issues.

METHODS

The MEDLINE and EMBASE databases were searched for articles relating to soy or red clover supplement use for prevention and/or treatment of heart disease, hyperlipidemia, osteoporosis, mood disorders and cognitive abilities. Studies were included if they were randomized, controlled trials and included peri- or postmenopausal women.

RESULTS

Isoflavone products appear to be the most useful for improving lipid profiles; however, the evidence suggests that isoflavone extracts from soy are less effective than products containing soy protein or red clover isoflavones. Soy protein appears to reduce levels of total cholesterol and low density lipoprotein cholesterol, while red clover reduces levels of triglycerides and increases high density lipoprotein cholesterol. The data were somewhat less convincing, although promising, for increasing bone mass density and improving cognitive abilities.

CONCLUSIONS

Research suggests that isoflavones found in soy foods and red clover appear to have a small but positive health effect on plasma lipid concentrations, bone mass density, and cognitive abilities. Given the lack of serious safety concerns in the short term, it would appear that including soy and red clover in the diet of postmenopausal women, not withstanding a soy allergy, might be beneficial.

Complementary and alternative medicine in pediatric oncology

Children with cancer and their families use complementary and alternative medicine (CAM) to reduce symptoms, cope with life-threatening illness, and improve overall well-being. Despite numerous published surveys on the use of CAM in pediatric oncology, few studies have tested CAM therapies for safety and efficacy. A growing body of literature in adult oncology provides evidence for the role of CAM to help manage symptoms and reduce distress. Translating this research to children requires studies with new models that address family roles and include measurement of outcomes relevant to children's developmental stages and unique responses. One of the limitations in pediatrics is the small samples available to single institutions. Conducting clinical trials through the cooperative group mechanism is one way of obtaining sufficient sample sizes to determine effectiveness and safety of CAM therapies. This article summarizes research to date and describes a beginning approach to measuring outcomes of supportive CAM therapies in children with cancer.

Outcomes of breast cancer in patients who use alternative therapies as primary treatment

BACKGROUND

Some breast cancer patients opt for alternative treatments in place of conventional treatments. The lack of published data on the outcome of this strategy may contribute to this trend.

METHODS

A chart review was performed of breast cancer patients who refused or delayed standard surgery, chemotherapy, and/or radiation therapy. Prognosis was calculated for recommended and actual therapy.

RESULTS

Thirty-three patients were included in the analysis. Of 11 patients who initially refused surgery, 10 developed disease progression. Of 3 patients who refused adequate nodal sampling, 1 developed nodal recurrence. Of 10 patients who refused local control procedures, 2 developed local recurrences and 2 died of metastatic disease. By refusing chemotherapy, 9 patients increased their estimated 10-year mortality rate from 17% to 25%.

CONCLUSIONS

Alternative therapies used as primary treatment for breast cancer are associated with increased recurrence and death. Homeopathy instead of surgery resulted in disease progression in most patients. These data may aid patients who are considering alternative therapies.

Health psychology: psychological adjustment to chronic disease

Chronic diseases carry important psychological and social consequences that demand significant psychological adjustment. The literature is providing increasingly nuanced conceptualizations of adjustment, demonstrating that the experience of chronic disease necessitates adaptation in multiple life domains. Heterogeneity in adjustment is apparent between individuals and across the course of the disease trajectory. Focusing on cancer, cardiovascular disease, and rheumatic diseases, we review longitudinal investigations of distal (socioeconomic variables, culture/ethnicity, and gender-related processes) and proximal (interpersonal relationships, personality attributes, cognitive appraisals, and coping processes) risk and protective factors for adjustment across time. We observe that the past decade has seen a surge in research that is longitudinal in design, involves adequately characterized samples of sufficient size, and includes statistical control for initial values on dependent variables. A progressively convincing characterization of risk and protective factors for favorable adjustment to chronic illness has emerged. We identify critical issues for future research.

Complementary and alternative medicine (CAM) in Mexican patients with cancer

BACKGROUND

Cancer is the second cause of death in Mexico, most cases are detected at advanced stages and the use of chemotherapy is frequent. At present, more than 300 types of complementary and/or alternative medicine (CAM) treatments are known that offer different therapeutic objectives. Many patients use this type of treatments.

OBJECTIVE

To determine the characteristics of the patients that use CAM, to identify the aim of these treatments, the source of information and the potential benefits obtained by the patient.

PATIENTS AND METHODS

A questionnaire was applied from February 20 to March 5, 2004 to non-selected patients with cancer in private consultation to determine age, sex, education level, work, use of CAM, type and number of used therapies, potential benefits and monthly cost. Two groups were formed, A for users and B for non-users of CAM. Results between groups were compared and the mentioned variables were correlated with the use of alternative medicine.

RESULTS

Group A included 37 patients and group B included 38, with no difference regarding age, education level, work and oncological diagnosis, p > 0.05; a significant trend was found as regards the feminine sex, p = 0.07, neoplasm different from breast cancer, p = 0.08 and evident association with neoplasm advanced stages, p = 0.02. Most patients used between 1 and 3 types of therapies, 97.2%. The most common types of therapies were nutritional and spiritual, 54% and 48.6%, respectively. The source was the patient's family in 56.4% and the physician in 24.3%. Complementary and alternative therapy was considered a success in 57.1%; most of the users mentioned benefits (78.6%) deemed as tranquility (46.4%) or improvement of the physical condition (46.4%). The average monthly cost was $ 345.5 dollars, with a range of $ 13.6 to $ 2,545.5 dollars.

CONCLUSIONS

The use of complementary and/or alternative therapy is frequent among young women with advanced cancer and high level of education. The family participates in the decision of using these methods; most users noticed a benefit in their general condition and reported tranquility; these patients may be prone to higher incidence of depression and anxiety. The effectiveness and safety of this type of treatments remain to be determined, as well as the possible interactions with conventional therapy.

Contemporary alternatives to plant estrogens for menopause

OBJECTIVES

Every year, millions of women begin the peri-menopause and may experience a number of symptoms related to this transition. Many women are reluctant to use exogenous hormone therapy for treatment of menopausal symptoms and are turning to botanical and dietary supplements (BDS) for relief. This paper reviews the literature on alternatives to plant estrogens for relief of menopausal symptoms.

METHODS

The MEDLINE database was searched for clinical trials of non-estrogenic plant extracts for menopausal symptoms. To be included, studies had to include peri- or postmenopausal women as subjects. All clinical trials (randomized-controlled trials, open trials, and comparison group studies) were included for this review.

RESULTS

Black cohosh appears to be one of the most effective botanicals for relief of vasomotor symptoms, while St. John's wort can improve mood disorders related to the menopausal transition. Many other botanicals have limited evidence to demonstrate safety and efficacy for relief of symptoms related to menopause.

CONCLUSIONS

A growing body of evidence suggests that some botanicals and dietary supplements could result in improved clinical outcomes. Health care providers should discuss these issues with their patients so they can assist them in managing these alternative therapies through an evidence-based approach.

Differential response to phytoestrogens in endocrine sensitive and resistant breast cancer cellsin vitro

Women approaching menopause increasingly investigate alternatives to hormone replacement therapy. Plant phytoestrogens are being promoted as "natural" alternatives but there is a lack of substantive data to advocate their safe use in breast cancer patients receiving tamoxifen (TAM), or in those who have relapsed. The aim of our study was to investigate the proliferative effects and mode of action of the phytoestrogens genistein, daidzein and coumestrol on TAM-sensitive (-s) and resistant (-r) breast cancer cells under in vitro conditions designed to mimic the hormonal environment of the pre- and post-menopausal breast. At physiological concentrations (<10 microM) and under reduced estrogen (E2) conditions, genistein was mitogenic to TAM-s cells with TAM-r cells generally refractory. Daidzein and coumestrol were growth stimulatory irrespective of TAM sensitivity. Transcriptional activity was ERE-mediated. Combining phytoestrogens with E2 (simulating the pre-menopausal breast environment) had no effect on growth of TAM-s or TAM-r cells. Addition of 4-HT mimicked the hormonal environment in post-menopausal breast cancer patients receiving TAM. The growth inhibitory effects of 4-HT were abrogated in TAM-s cells when combined with genistein and coumestrol, and to a lesser extent, daidzein, where significant growth stimulatory effects were observed. In TAM-r cells, proliferation did not exceed control values. At phytoestrogen concentrations above 10 microM, growth inhibitory effects were seen, irrespective of estrogenic environment or cell sensitivity to TAM. Our in vitro data suggests that phytoestrogens could have potentially adverse mitogenic effects on tumour cells and should probably be avoided by patients who remain sensitive to TAM or in those with pre-existing and possibly undiagnosed breast tumours.

Correlates of use of different types of complementary and alternative medicine by breast cancer survivors in the nurses’ health study

PURPOSE

Among breast cancer survivors, we identified the prevalence and correlates of use of different types of complementary and alternative medicine (CAM).

PATIENTS AND METHODS

We included 2,022 women diagnosed with breast cancer 1998-2003 who responded to a survey about CAM use. We performed logistic regression to determine demographic and disease factors associated with use of different CAM therapies (including relaxation/imagery, spiritual healing, yoga, energy healing, acupuncture, massage, chiropractic, high-dose vitamins, herbs, and homeopathy). We also measured quality of life (QoL) using the SF36 and optimism using LOT-R and fit linear regression models to compare mean scores among CAM users and nonusers.

RESULTS

Sixty-two percent of respondents used CAM. Younger age was the most consistent correlate of CAM use, but factors associated with CAM use varied by type of CAM. Chemotherapy was associated with use of relaxation/imagery (OR 1.3 95%CI 1.1-1.7). Radiotherapy was associated with use of high-dose vitamins (OR 1.5 95% CI 1.2-2.0). Tamoxifen or anastrozole treatment was associated with use of homeopathy (OR 0.5 95%CI 0.3-0.9). Users of most types of CAM had worse QoL scores than nonusers, but better QoL was found among users of yoga. The lowest QoL scores were associated with the use of energy healing. Optimism was higher among users of relaxation/imagery.

CONCLUSIONS

Factors associated with CAM use varied according to type of CAM. Our finding of worse QoL among women using energy healing and better QoL among women using yoga suggests the need for longitudinal studies to determine the temporal relationships between these therapies and QoL.

Race/ethnicity and women's use of complementary and alternative medicine in the United States: results of a national survey

OBJECTIVES

We studied the use of complementary and alternative medicine (CAM) among women in 4 racial/ethnic groups: non-Hispanic Whites, African Americans, Mexican Americans, and Chinese Americans.

METHODS

We obtained a nationally representative sample of women aged 18 years and older living in the United States in 2001. Oversampling obtained 800 interviews in each group, resulting in a sample of 3068 women.

RESULTS

Between one third and one half of the members of all groups reported using at least 1 CAM modality in the year preceding the survey. In bivariate analyses, overall CAM use among Whites surpassed that of other groups; however, when CAM use was adjusted for socioeconomic factors, use by Whites and Mexican Americans were equivalent. Despite the socioeconomic disadvantage of African American women, socioeconomic factors did not account for differences in CAM use between Whites and African Americans.

CONCLUSIONS

CAM use among racial/ethnic groups is complex and nuanced. Patterns of CAM use domains differ among groups, and multivariate models of CAM use indicate that ethnicity plays an independent role in the use of CAM modalities, the use of CAM practitioners, and the health problems for which CAM is used.

Reasons for and characteristics associated with complementary and alternative medicine use among adult cancer patients: a systematic review

PURPOSE

To conduct a systematic review of reasons for and sociodemographic and disease characteristics associated with complementary and alternative medicine (CAM) use in cancer patients.

METHODS

Eligible studies were identified by searching the following databases: Alt Health Watch, AMED, CINAHL, CancerLit, PremMEDLINE, MEDLINE, Pub-Med, Ingenta, EMBASE, and Health Star, as well as reference lists in review articles. Only English-language articles published between 1994 and 2004 were included. Search terms included CAM and oncology/cancer, decision making and CAM and oncology/cancer, treatment decision making and CAM and oncology/cancer, and health care choices and CAM and oncology/cancer.

RESULTS

Fifty-two eligible studies were identified and summarized. These studies were conducted in 14 different countries, with the largest number of studies being completed in the United States (34.6%). A therapeutic response, wanting control, a strong belief in CAM, CAM as a last resort, and finding hope were the most commonly cited reasons for using CAM. Age, socioeconomic status, and gender were the dominant characteristics associated with CAM use.

CONCLUSION

Reasons for and characteristics associated with CAM use among cancer patients have been studied extensively. Future CAM research among cancer patients should focus on identifying decision-making processes and building theoretical decision-making models. These can be used in the development of decisional aids for patients when confronted with the choice to use CAM as part of their cancer treatment.

Use of complementary therapies among breast and prostate cancer patients during treatment: a multisite study

PURPOSE

The purpose of this study was to compare the use of complementary therapies (CT) among breast and prostate cancer patients during active cancer treatment. The authors compared use and beliefs about the role of CT in cancer recovery.

METHODS

A self-report survey was completed by 126 breast cancer patients and 82 prostate cancer patients as part of a multisite research project. The self-report questionnaire inquired about the use of various CTs, sources of information about CT, reasons for using CT, beliefs about the benefits and risks of CT, demographic characteristics, and cancer treatment history.

RESULTS

Most of the respondents were older than 50 years, Caucasian, married, had attended or completed college, and were less than 1 year post-diagnosis. Prostate cancer patients were significantly older than the breast cancer patients (P < .001). Several differences emerged between the groups. Compared to the prostate cancer patients, significantly more of the breast cancer patients reported using CT because they wanted to reduce the risk of recurrence (P < .01), play a more active role in recovery (P < .01), help manage stress (P < .01), take a more holistic approach (P < .01), or boost the immune system (P < .01). More of the prostate cancer patients reported using CT to have more control of their recovery (P < .05). The 2 groups also differed significantly (P < .01) on several beliefs about the potential benefits and risks of using CT.

CONCLUSIONS

Most of the patients in this study had used some form of CT since the time of their diagnosis. Differences among breast and prostate cancer patients with regard to their use of CT during cancer treatment should be considered by oncology professionals who are discussing this topic with their patients.

Dietary factors and vasomotor symptoms in breast cancer survivors

OBJECTIVE

Vasomotor symptoms (VMS)(hot flashes, night sweats) are associated with natural or surgically or chemotherapy-induced menopause, the latter occurring frequently in women treated for breast cancer. To manage VMS, some women seek alternatives to menopausal hormone therapy, such as supplements or modified food choices. The objective of the present analyses was to assess associations of VMS occurrence and change in severity of VMS over 12 months with dietary intakes of fiber, fat, and selected soy-containing foods, and use of phytoestrogen or vitamin E supplements in women with recent early stage breast cancer, adjusting for covariates.

DESIGN

Using multivariate logistic regression, data were analyzed from 2,198 women with early-stage breast cancer who enrolled 2 to 48 months after diagnosis in the Women's Healthy Eating and Living randomized, controlled trial of a high-vegetable, high-fiber, reduced-fat diet.

RESULTS

Being peri- or postmenopausal, using tamoxifen, having low social support or depressive symptoms, and using vitamin E or phytoestrogen supplements were significantly associated cross-sectionally with reporting moderate/severe VMS at enrollment. Increased symptom severity after 12 months was significantly associated with higher body mass index, tamoxifen use, and smoking. Decreased symptom severity at 12 months was significantly associated with high dietary fiber intake; no decrease was observed in women who were peri- or postmenopausal, using tamoxifen, or had low fat intake or low social support.

CONCLUSIONS

High dietary fiber intakes, premenopausal, and high social support were related to decreased severity of VMS 1 year after study enrollment in women recently treated for breast cancer.

Complementary and alternative medicine in breast cancer patients

OBJECTIVE

Complementary and Alternative Medicine (CAM) is becoming increasingly popular among cancer patients, in particular those with breast cancer. It represents one of the fastest growing treatment modalities in the United States. Therefore, knowledge of CAM therapies is becoming necessary for physicians and other health care providers. CAM encompasses a wide range of modalities including special diet and nutrition, mind-body approaches, and traditional Chinese medicine.

METHODS

We reviewed the biomedical literature on CAM use in breast cancer patients, using Medline search from 1975 until 2002. In addition, consensus reports and books on CAM and breast cancer were included in the review. We evaluated the prevalence of CAM use in breast cancer patients, the reasons cited for its use, the different available modalities, and the reported outcomes.

RESULTS

Use of CAM in breast cancer patients ranges between 48% and 70% in the United States. The most commonly used CAM modalities include dietary supplements, mind-body approaches, and acupuncture. The reasons cited for using CAM were to boost the immune system, improve the quality of life, prevent recurrence of cancer, provide control over life, and treat breast cancer and the side effects of treatment. Several studies reported favorable results including improved survival, better pain control, reduced anxiety, improvement in coping strategies and significant efficacy in treating nausea and vomiting. Other less well-organized trials have reported either no benefit or negative effect of CAM and potential toxicity of some commercial products.

SIGNIFICANCE OF RESULTS

CAM is a growing field in health care and particularly among breast cancer patients. Knowledge of CAM by physicians, especially oncologists, is necessary. Oncologists should be willing to discuss the role of CAM with their patients and encourage patients to participate in well-organized research about CAM.

Biologically based complementary and alternative medicine use among breast cancer survivors: relationship to dietary fat consumption and exercise

Previous literature has shown that more than half of all female cancer survivors use some form of complementary and alternative medicine (CAM). Although the prevalence of CAM use in this population is becoming apparent, few researchers have examined the relationship between CAM use and lifestyle factors that could influence patients' well-being. The present study examined whether breast cancer survivors who use biologically based CAM are more likely than CAM nonusers to follow a low-fat diet and maintain moderate or vigorous exercise. Sixty-five female breast cancer survivors who were within 3 months of completing primary treatment were recruited. CAM use was measured by self-reported use of one or more of a list of 15 supplements. Dietary fat was measured by a 23-item self-report measure estimating fat consumption in the past month. Dietary fat stage of change and moderate and vigorous exercise stage of change were assessed using measures based on the Transtheoretical Model of Behavior Change. Results showed that biologically based CAM users maintained a lower percentage of calories from fat in their diet (t=2.12, p<0.05), and there was a trend for CAM users to be more likely than CAM nonusers to be in the action or maintenance stage for dietary fat consumption (p<0.09). However, this study did not find that CAM users were more likely to be in the action or maintenance stage of change for moderate or vigorous exercise. These findings suggest that biologically based CAM use among breast cancer survivors is associated with some, but not all, healthy lifestyle behaviors.

Complementary and alternative medicine use in patients with head and neck cancers in Europe

The aim of the present study was to examine the patterns of complementary and alternative medicine (CAM) use in a sample of head and neck cancer patients, forming part of a larger study. A cross-sectional survey design was used collecting data through a descriptive 27-item questionnaire in nine countries in Europe. The participants were 75 patients with head and neck cancers. The prevalence rate of CAM use was 22.7%. The most common therapies used were herbal medicine (47%), medicinal teas (23.5%), use of vitamins/minerals (11.8%) and visualization (11.8%). Use of CAM dramatically increased after the diagnosis with cancer (i.e. eightfold increase in the use of herbs). A profile of CAM users was not evident in this sample. Patients used CAM for a variety of reasons together, with counteracting the ill effects from cancer and its treatment being the most common one. Information about CAM was obtained mostly from friends and family. As one in five head and neck cancer patients use CAM it is important that clinicians explore practices with their patients, improve communication about CAM with them and assist those who want to use CAM in using appropriate and safe therapies.

Evaluation of haptotherapy for patients with cancer treated with chemotherapy at a day clinic

OBJECTIVE

The purpose of this study was to evaluate a haptotherapeutic treatment and its effects on the perceived well-being of patients with cancer treated with chemotherapy in day care.

METHODS

The study had a pre-test-post-test semi-experimental design, with 31 patients in the intervention group and 26 in the control group. Patients in the control group were matched with patients in the experimental condition with respect to age, gender, type of cancer, type of chemotherapy, prognosis and the period between pre- and post-test. Standardized questionnaires were used measuring perceived well-being and satisfaction with care (haptotherapy). Indicators of well-being measured were quality of life, mood, meaning in life, general functioning, physical and psychological symptoms, sleep quality and body awareness. The intervention consisted of five haptotherapy sessions of 45 minutes each. Patients in the control condition received standard medical care.

RESULTS

Patients were highly satisfied with the haptotherapy treatment, and especially valued the personal attention and the relaxation they experienced. The haptotherapy treatment improved both the perceived general quality of life and the perceived cognitive and social functioning of patients. No improvement was found for mood, meaning in life, general functioning, physical symptoms, sleep quality and body awareness.

CONCLUSION

It may be concluded that haptotherapy positively contributes to several indicators of perceived well-being of patients with cancer during the period they receive chemotherapy. More rigorous experimental studies are necessary in this field, especially concerning randomization, number of participants and homogeneity of the sample.

PRACTICE IMPLICATIONS

Haptotherapy as a type of complementary medicine is a potentially valuable and effective intervention to raise the well-being of patients with cancer undergoing invasive treatments like chemotherapy.

Complementary and alternative medicine use in breast cancer patients in Europe

Complementary and alternative medicine (CAM) has gained popularity among cancer patients in the past years. For this study, CAM includes any group of health care systems, practices or products that are not considered to be part of conventional medicine at present (National Center for Complementary and Alternative Medicine). The present study assessed patterns of CAM use in breast cancer patients in Europe. The study used a descriptive cross-sectional design, and data were collected through a 27-item questionnaire. The sample, which was part of a larger study, consisted of 282 breast cancer patients from 11 countries in Europe. Among participants, 44.7% used CAM since their diagnosis of cancer. The most common therapies used included herbal medicine (46.4%) and medicinal teas, relaxation techniques, spiritual therapies, homeopathy and vitamins/minerals. Younger patients with higher education and who had received combination treatments for their cancer in the past were more likely to use CAM. High levels of satisfaction were reported, with only 6.5% of the women reporting no benefits from the CAM used. Main sources of information about CAM were mostly friends/family and the media. Findings suggested that a high proportion of breast cancer patients used CAM, which may have implications for the clinical management of these patients.

The use of complementary and alternative medicines among patients with locally advanced breast cancer--a descriptive study

Background

Complementary and alternative medicine (CAM) use is common among cancer patients. This paper reviews the use of CAM in a series of patients with locally advanced breast cancer (LABC).

Methods

Women with LABC attending a specialist clinic at a single Canadian cancer centre were identified and approached. Participants completed a self-administered survey regarding CAM usage, beliefs associated with CAM usage, views of their risks of developing recurrent cancer and of dying of breast cancer. Responses were scored and compared between CAM users and non-users.

Results

Thirty-six patients were approached, 32 completed the questionnaire (response rate 89%). Forty-seven percent of LABC patients were identified as CAM users. CAM users were more likely to be younger, married, in a higher socioeconomic class and of Asian ethnicity than non-users. CAM users were likely to use multiple modalities simultaneously (median 4) with vitamins being the most popular (60%). Motivation for CAM therapy was described as, "assisting their body to heal" (75%), to 'boost the immune system' (56%) and to "give a feeling of control with respect to their treatment" (56%). CAM therapy was used concurrently with conventional treatment in 88% of cases, however, 12% of patients felt that CAM could replace their conventional therapy. Psychological evaluation suggests CAM users perceived their risk of dying of breast cancer was similar to that of the non-Cam group (33% vs. 35%), however the CAM group had less severe anxiety and depression.

Conclusion

The motivation, objectives and benefits of CAM therapy in a selected population of women with LABC are similar to those reported for women diagnosed with early stage breast cancer. CAM users display less anxiety and depression and are less likely to believe they will die of their breast cancer. However the actual benefit to overall and disease free survival has yet to be demonstrated, as well as the possible interactions with conventional therapy. Consequently more research is needed in this ever-growing field.

Lack of stimulatory activity of a phytoestrogen-containing soy extract on the growth of breast cancer tumors in mice

The present study was designed to investigate the effects of a phytoestrogens-containing soy extract (SOYSELECT, SSE) on the growth of estrogen-dependent (MCF-7) and estrogen-unresponsive (MDA-MB-231) human breast cancer xenografts in athymic mice. Results obtained provided evidence that MCF-7 tumors did not grow over the treatment period (5 weeks) in ovariectomized females receiving 50 or 100 mg/kg/day SSE (oral route); administration of SSE also did not affect the estradiol-sustained growth of MCF-7 tumors in mice. Similarly, no effects on tumor growth were observed in SSE-treated mice bearing MDA-MB-231 xenografts. Data from pS2, progesterone receptor and cyclin D1 mRNA expression in tumors showed that, although SSE was able to induce a moderate estrogenic effect in MCF-7 cells, it did not increase cellular proliferation and tumor growth, in our experimental conditions. Besides, when used in association with 17beta-estradiol, it displayed antiestrogenic activity. The expression of other genes involved in tumor progression and angiogenesis, such as Thrombospondin 1, Transforming Growth Factor beta2 and Kallikrein 6 was also evaluated in tumor samples, results showing a decrease in mRNA expression upon SSE treatment. The effect of SSE on angiogenesis in vivo was also evaluated in the Matrigel plug assay; results obtained showed a striking anti-angiogenic activity in mice receiving 100 mg/kg/day SSE, thereby confirming that this extract may interfere with angiogenesis. Collectively, these experimental data suggest that SSE could be not harmful for women with a history of or at high risk for breast cancer, at least for short treatment periods; however, further studies are needed to thoroughly characterize the activity profile of the extract in this specific setting of patients.

Complementary medicine use by Australian women with gynaecological cancer

AIMS AND OBJECTIVES

Social and cultural factors are identified that impact on complementary therapy use among Australia-born and immigrant women diagnosed with gynaecological cancer.

METHODS

A qualitative study design including in-depth interviews with women diagnosed with gynaecological cancer (N=53) and participant observation was conducted.

RESULTS

Approximately one-third of women utilized complementary and alternative medicine, with this being determined by current health concerns and health beliefs related to the efficacy of different modalities. Four types of complementary therapy users emerged: consequential, therapeutic, informed and exploratory.

CONCLUSION

There was a relatively low uptake of complementary treatments. Choice was influenced by women's socio-demographic background, clinical and personal history, lack of personal experiences of gynaecological cancer among study participants' kin and friends, and lack of popular alternative literature on such cancer.

Complementary and alternative medical therapy use among Chinese and Vietnamese Americans: prevalence, associated factors, and effects of patient-clinician communication

OBJECTIVE

We examined the use of complementary and alternative medical (CAM) therapies among Chinese and Vietnamese Americans who had limited proficiency with the English language and explore the association between patient-clinician discussions about CAM therapy use and patient assessments of quality of care.

METHODS

We surveyed Chinese and Vietnamese Americans who visited 11 community health centers in 8 major cities throughout the United States.

RESULTS

Of the 4410 patients surveyed, 3258 (74%) returned completed questionnaires. Two thirds of respondents reported they had "ever used" some form of CAM therapy; however, only 7.6% of these patients had discussed their use of CAM therapies with clinicians. Among patients who had used CAM therapies during the week before their most recent visits, clinician-patient discussions about CAM therapy use were associated with better overall patient ratings of quality of care.

CONCLUSION

Use of CAM therapies was common among Chinese and Vietnamese Americans who had limited proficiency with the English language. Although discussions about CAM therapy use with clinicians were uncommon, these discussions were associated with better ratings of quality of care.

Assessment of a dietary questionnaire in cancer patients receiving cytotoxic chemotherapy

PURPOSE

Few studies have examined the influence of diet on survival and chemotherapy-associated toxicities in patients with cancer. Although several comprehensive dietary questionnaires have been validated and calibrated in healthy populations, similar studies have not been performed among cancer patients.

METHODS

Two hundred patients with colorectal, breast, or neuroendocrine cancer undergoing treatment with cytotoxic chemotherapy completed a self-administered, 131-item, semiquantitative food frequency questionnaire. Using the questionnaire, we calculated dietary intakes of carotenoids, tocopherols, and fatty acids, and correlated these values with relevant biomarkers measured in simultaneously collected plasma specimens.

RESULTS

The Pearson correlation coefficients for various carotenoids as measured by the questionnaire, with the corresponding measurements in plasma specimens, ranged from 0.33 to 0.44 (all P < .001), adjusted for total energy intake, body mass index, age, sex, smoking status, and total plasma cholesterol. Similarly, the adjusted correlation between self-reported total vitamin E intake and plasma alpha-tocopherol was 0.34 (P < .001). Correlations between questionnaire and plasma measurements of trans-fat, eicosapentaenoic acid, and docosahexaenoic acid were 0.55, 0.29, and 0.42 (all P < .001), respectively. These levels of correlation are consistent with those reported in similar studies of self-reported diet in otherwise healthy populations.

CONCLUSION

Among patients with cancer receiving cytotoxic chemotherapy, questionnaire-based measurements of various micronutrients and dietary factors appeared to predict meaningful differences in the corresponding measurements in plasma specimens. This dietary questionnaire could offer an informative and practical means for assessing the influence of diet in cancer patients receiving chemotherapy.

Complementary and alternative medicine use in lung cancer patients in eight European countries

This paper presents findings from a cross-sectional survey about the use of complementary and alternative medicine (CAM) in patients with lung cancer, forming part of a larger study. Data from 111 lung cancer patients in 8 countries in Europe were collected through a descriptive 27-item questionnaire. The data suggest that 23.6% of the lung cancer patients used CAM after the diagnosis with cancer. The most popular CAM modalities were herbal medicine (48.1%), medicinal teas (11.5%), homeopathy (11.5%), use of animal extracts (11.5%) and spiritual therapies (11.5%). Herbal use increased by three times after the diagnosis of cancer. Patients seemed quite satisfied with the CAM used. They were also spending on average about 142 Euros monthly on CAM therapies or remedies. The most common motivation to use CAM was to increase the body's ability to fight the cancer. Main sources of information about CAM were friends and family. As CAM is increasingly used by patients with lung cancer, it is important to be able to assist patients make an appropriate decision by discussing the issue of CAM openly, providing reassurance and communicating safe and appropriate information to patients.

Herb and supplement use in the US adult population

BACKGROUND

Research on the scope of use and factors associated with herbal medicine use is limited.

OBJECTIVES

The aims of this work were to assess national usage patterns, reasons for use, and the perceived efficacy of herbal products and dietary supplements.

METHODS

This was a secondary analysis of the complementary and alternative medicine (CAM) supplement to the 2002 National Health Interview Survey (NHIS), conducted by the National Center for Health Statistics (NCHS). Participants were asked whether they had used natural herbs for their own health and treatment. Those who responded yes were compared with those who responded no. Supplement users were asked whether they had used any of 36 specific herbs or nonherbal dietary supplements (eg, glucosamine, fish oil, bee pollen), how important the use of CAM treatment was to them, whether they had seen a CAM provider, and whether they had informed a conventional medical provider about their use. NCHS weights, derived from Decennial Census data, were used to calculate national prevalence estimates. Group comparisons of herbal use were conducted with the Wald x(2) test.

RESULTS

A total of 31,044 adults participated in the 2002 NHIS CAM survey; 632 were omitted from analyses due to incomplete information. In all, 5787 adults said they had used herbs or supplements during the previous 12 months, of whom 57.3% said they used these products to treat specific conditions. Based on these responses, an estimated approximately 38.2 million adults in the United States used herbs and supplements in 2002. More than half of all users said that herbs and natural products were important to their health and well-being. Use rates were higher for women than men (21.0% vs 16.7%; P < 0.001); adults aged 45 to 64 years (P < 0.001 vs other age groups); those of multiple races (32.2%), Asians (24.6%), or American Indians or Alaskan natives (21.9%) rather than whites (19.1%) or blacks (14.3%) (effect of race, P < 0.001); residents of the western United States (effect of region, P < 0.001), and college graduates (25.3% vs 10.4% among those who did not graduate high school; effect of education, P < 0.001). Only 33.4% told a conventional health care provider about their herb or supplement use use.

CONCLUSION

Herb and natural supplement use was widespread in the US adult population in 2002, according to data from the NHIS CAM survey, despite the fact that few participants informed their conventional health care providers about such use.

Differential control of growth, cell cycle progression, and expression of NF-κB in human breast cancer cells MCF-7, MCF-10A, and MDA-MB-231 by ponicidin and oridonin, diterpenoids from the chinese herb Rabdosia rubescens

Ponicidin and oridonin are novel diterpenoids isolated from Rabdosia rubescens. We tested their effects in MCF-7 and MDA-MB-231 cells, as representing low and high invasive breast carcinoma, with normal MCF-10A cells. Clonogenicity and proliferation in MCF-7 cells were inhibited more significantly by ponicidin than oridonin, while the reverse was observed in MCF-10A cells. Ponicidin and oridonin induced S/G2M arrest and G1/S block in MCF-7 cells. In MCF-10A cells treated with either diterpenoid, induction of apoptosis was observed. Moreover, oridonin almost completely blocked MCF-10A progression from S to G2/M phase; in contrast, ponicidin-treated MCF-10A cells showed no discernable changes in cell cycle phase distribution. Neither diterpenoid affected growth of MDA-MB-231 cells, at the dose range effective for MCF-7 or MCF-10A cells. Ponicidin-treated MCF-7 cells expressed reduced levels of cyclin B1, cdc2, transcription factor E2F, and Rb including phosphorylation at S780. Less pronounced effects were found in cells treated with oridonin. Neither compound altered cyclin D1 and cdk4 in MCF-7 cells. In MCF-10A cells, oridonin was more active than ponicidin in inhibiting the expression of cyclin B1, cdc2, S780-phosphorylated Rb, and E2F. To further investigate induction of apoptosis in MCF-10A cells, we measured changes in NF-kappaB. Decreases in p65 or p50 forms of NF-kappaB and its upstream regulator I-kappaB were found in oridonin-treated MCF-10A and not MCF-7 cells. Taken together, these results provide a mechanistic framework for the cellular effects of ponicidin and oridonin in different stage breast cancer cells.

Complementary and alternative therapeutic approaches in patients with early breast cancer: a systematic review

Complementary and alternative medicine (CAM) is becoming increasingly popular, particularly among patients with breast cancer. We have done a systematic review of studies published between 1995 and February 2005, identified through a comprehensive search. CAM encompasses a wide range of treatment modalities, including dietary and vitamin supplements, mind-body approaches, acupuncture, and herbal medicines. The objectives of CAM treatments are diverse: reduction of therapy-associated toxicity, improvement of cancer-related symptoms, fostering of the immune system and even direct anticancer effects. Clinical trials have generated few or no data on the efficacy of CAM, whether regarding disease recurrence, survival, overall quality of life or safety. Some CAM methods may even have adverse effects or reduce the efficacy of conventional treatment. The primary justification for CAM is based on empirical evidence, case studies, and hypothetical physiological effects. We conclude that available data on CAM modalities in the treatment of early-stage breast cancer does not support their application.

Acupuncture for side effects of chemoradiation therapy in cancer patients

OBJECTIVE

To review strategies and recommendations to improve utilization of acupuncture treatment for side effects of chemoradiation therapy in cancer centers.

DATA SOURCES

Research studies and articles, government reports, and author experience.

CONCLUSION

Recent evidence in clinical research indicates that acupuncture is beneficial for chemotherapy-induced nausea, vomiting, and cancer pain. Other preliminary data also suggests acupuncture might be effective for chemotherapy-induced leukopenia, postchemotherapy fatigue, radiation therapy-induced xerostomia, insomnia, and anxiety. However, the utilization rate of acupuncture remains low despite the wide use of other complementary and alternative medical therapies among cancer patients. This low usage of acupuncture in cancer patients indicates a health care quality issue.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses need to increase their awareness of the available evidence in the use of acupuncture in the supportive care of cancer patients.

Botanical and dietary supplements for menopausal symptoms: what works, what does not

BACKGROUND

Approximately two thirds of women who reach menopause develop menopausal symptoms, primarily hot flashes. Hormone therapy long was considered the first-line treatment for vasomotor symptoms. However, given the results of the Women's Health Initiative (WHI), many women are reluctant to use exogenous hormones for symptomatic treatment and are turning to botanicals and dietary supplement (BDS) products for relief. Despite the fact that there is limited scientific evidence describing efficacy and long-term safety of such products, many women find these natural treatments appealing. Perimenopausal and postmenopausal women are among the highest users of these products, but 70% of women do not tell their healthcare providers about their use. Compounding this issue is the fact that few clinicians ask their patients about use of BDS, largely because they have not been exposed to alternative medical practices in their training and are unfamiliar with these products.

METHODS

This paper reviews the botanicals and dietary supplements commonly used in menopause (such as black cohosh, red clover, and soy products) as well as the available data on efficacy and safety. We searched the MEDLINE database from 1966 to December 2004 using terms related to BDS and menopausal symptoms for perimenopausal or postmenopausal women. Abstracts from relevant meetings as well as reference books and websites on herbal supplements were also searched. Randomized, controlled trials (RCTs) were used if available; open trials and comparison group studies were used when RCTs were not available.

RESULTS AND CONCLUSIONS

The evidence to date suggests that black cohosh is safe and effective for reducing menopausal symptoms, primarily hot flashes and possibly mood disorders. Phytoestrogen extracts, including soy foods and red clover, appear to have at best only minimal effect on menopausal symptoms but have positive health effects on plasma lipid concentrations and may reduce heart disease. St. John's wort has been shown to improve mild to moderate depression in the general population and appears to show efficacy for mood disorders related to the menopausal transition. Other commonly used botanicals have limited evidence to demonstrate safety and efficacy for relief of symptoms related to menopause.

Complementary medicine practices in a community-based sample of lesbian and heterosexual women

While researchers have examined the established the foundation for understanding the correlates of complementary and alternative medicine (CAM) use among some medical populations, less is known about the correlates of CAM use in nonclinical samples of women, and particularly according to sexual orientation. Information on CAM modalities was collected as part of a survey of lesbian and heterosexual women's health. Eighty-two percent of the sample reported CAM use. Predictors of CAM use included a lesbian sexual orientation, less health-related worry, and perceived discrimination in health care settings. Additional research is warranted to better understand how sexual orientation relates to use of CAM. Future studies should also examine the relationships between and experiences with discrimination in traditional medical settings and increased use of complementary and alternative medicine.

Quality of cancer registry birthplace data for Hispanics living in the United States

Patient birthplace from the SEER population-based cancer registries is potentially useful for identifying disparities in cancer occurrence and for studying cancer etiology. However, for Hispanics, completeness and accuracy of registry birthplace is unknown. By comparing registry birthplace to self-reported birthplace from 13 interview studies, we determined the completeness and accuracy of this variable and the associations of these measures with patient and hospital characteristics in the Greater Bay Area. Registry birthplace was unrecorded for 46% of 1277 Hispanic cancer cases, and unrecorded birthplace (i.e., incompleteness) was associated with younger age, higher education, English language preference, US birthplace, and admission at certain hospitals. For 691 Hispanics with available registry birthplace, sensitivity and positive predictive value compared to self-report (i.e., accuracy) were 96.3 and 97.3 among foreign-born, and 96.8 and 95.6 among US-born. US-born Hispanics misclassified in the registry as foreign-born were more likely to have unavailable education information, be deceased, prefer a language besides English, and be diagnosed at a smaller hospital or before 1996. Among self-reported foreign-born Hispanics, those misclassified as US-born were less likely to have been diagnosed at an HMO. Although the completeness and accuracy of birthplace information may vary across registries, this variable appears to be limited for analyses involving Hispanics.

Spiritual Complementary Therapies in Cancer Care

OBJECTIVES

To review literature documenting the frequency of use and efficacy of spiritual complementary therapies. Implications for clinical practice and research that reflect this literature are offered.

DATA SOURCES

Data based research on complementary therapy usage and clinical articles about selected mind/body therapies.

CONCLUSION

Spiritual complementary therapies are among the most frequently used. Prayer, spiritual healing, and meditation are the most frequently used spiritual therapies. Equivocal evidence supports their efficacy.

IMPLICATIONS FOR NURSING PRACTICE

Although spiritual practices may not be considered a "therapy," clinicians should assess and support these practices. Clinicians should only pray with patients when observing ethical guidelines.

Knowledge, attitudes, and behaviors of healthcare providers for botanical and dietary supplement use for postmenopausal health

OBJECTIVE

To identify the knowledge, attitudes, and behaviors of health care providers (physicians and nurses) regarding the use of botanical dietary supplements (BDS) for peri- and postmenopausal women.

DESIGN

Health care providers (physicians and nurse practitioners/nurse midwives) completed a questionnaire to assess knowledge, attitudes, and behaviors regarding botanical dietary supplement use for peri- and postmenopausal women. A total of 62 providers were included in the final analysis.

RESULTS

Two thirds of providers reported that they had limited or no knowledge about botanical dietary supplements. By far, the majority of providers had no formal training nor had they studied these supplements on their own. Although knowledge was limited, a majority of providers wanted additional training predominantly because of growing patient awareness and use and were open to using these therapies for their patients either in combination with conventional Western medicine or as the only support for relief of peri- and postmenopausal symptoms. However, only 25% of providers regularly asked their peri- and postmenopausal patients about use of botanical dietary supplements. Providers who had practiced longer (> or =11 y) were more likely to be knowledgeable about dietary supplements and to have studied on their own (P < 0.01), to believe that botanicals are part of evidence-based medicine (P < 0.05), and to have talked to their patients (P < 0.05) about use of these therapies. Increased knowledge also appeared to predict a more positive attitude on the part of providers toward their patients who use BDS (P < 0.001) as well as more proactive behavior related to referring and recommending these therapies as treatment (P < 0.01).

CONCLUSIONS

Our findings suggest that knowledge about botanical therapies among health care providers caring for peri- and postmenopausal women is quite low, but they are open to learning more about these modalities and using them for treatment, if appropriate. Our results suggest that increased years in practice is related to increased knowledge, more positive attitudes, and more proactive behaviors related to botanical dietary supplements.

Discrepant views of oncologists and cancer patients on complementary/alternative medicine

GOALS

Complementary/ alternative medicine (CAM) is widely used by patients but rarely discussed with oncologists. To understand reasons for the communication gap, this study compares physicians and patients on perceived reasons for CAM use and nondisclosure of use, reactions of physicians to disclosure, and expectations for CAM.

PATIENTS AND METHODS

Cross-sectional studies assessed 82 physicians (response 68.3%) and 244 of 374 outpatients (response 65.2%) identified as CAM users at the MD Anderson Cancer Center. Data were summarized by frequency and compared using chi-square tests.

MAIN RESULTS

Physicians were more likely (p<0.001) than patients to attribute CAM use to hope (chi2=17.7), control (chi2=17.5), incurable disease (chi2=42.8), or a nontoxic approach (chi2=50.9). Both physicians and patients agreed CAM could relieve symptoms/side effects, but physicians were less likely (p<0.001) than patients to expect that CAM improved immunity (chi2=72.2) or quality of life (chi2=17.1), cured disease (chi2=42.5), or prolonged life (chi2=58.4). Physicians and patients responded differently (p<0.005) on reasons for nondisclosure. Physicians believed patients felt CAM discussions were unimportant (chi2=7.9) and physicians would not understand (chi2 =48.1), discontinue treatment (chi2=26.4), discourage or disapprove of the use (chi2=131.7); patients attributed nondisclosure to their uncertainty of its benefit (chi2=10.4) and never being asked about CAM (chi2=9.9) by physicians. Physicians were more likely (chi2=9.5, p<0.002) to warn of risks and less likely (chi2=23.5, p<0.001) to encourage use than patients perceived.

CONCLUSION

Oncologists and cancer patients hold discrepant views on CAM that may contribute to a communication gap. Nevertheless, physicians should ask patients about CAM use, discuss possible benefits, and advise of potential risks.

Dietary supplement use is prevalent among children with a chronic illness

OBJECTIVE

To determine the nature and prevalence of dietary supplement use among chronically ill children.

DESIGN

This descriptive study used a self-report questionnaire.

SUBJECTS

A convenience sample of parents of 505 chronically ill children and adolescents seen in subspecialty medical clinics in Salt Lake City, UT. The medical conditions studied included asthma, cystic fibrosis, diabetes, cancer, liver and renal transplantations, seizures, and rheumatological and neurobehavioral disorders. Statistics Sample characteristics were described using frequencies, percentages, means, and standard deviations. chi 2 tests were used to compare sex, ethnicity, parental education level, and dietary supplement use variations among the various diagnostic categories. Analysis of variance with Bonferroni correction for multiple comparisons was used to determine differences among diagnosis groups for continuous variables, and the Kruskal-Wallis test was used to test categorical variables.

RESULTS

The population sampled was predominately white (88.5%), with a mean age of 9.9+/-5.3 years. Sixty-two percent of the population used dietary supplements, and 30% used nonprescribed supplements. Significant differences were noted among diagnosis groups, with the highest nonprescribed use reported in children with cancer (solid tumors=46%; leukemia=44%), cystic fibrosis (35%), neurobehavioral disorders (35%), and rheumatological disorders (34%). Only 20% of those using nonprescribed dietary supplements had discussed this use with the health care provider.

CONCLUSIONS

Dietary supplement use is prevalent among chronically ill children, especially among those with a poor prognosis or for whom there are limited medical treatments. Few pediatric health care providers are aware of their patients' use of nonprescribed supplements. This is a concern because of the unknown effects of many supplements on growth and development and the potential for adverse drug interactions.

Prevalence of complementary and alternative medicine use in cancer patients during treatment

GOALS OF WORK

To assess complementary and alternative medicine (CAM) therapies being utilized by cancer patients during treatment and communication about CAM usage between the patient and physician.

PATIENTS AND METHODS

Newly diagnosed cancer patients receiving chemotherapy or radiation therapy were recruited to complete a CAM survey within 2 weeks after the termination of treatment. Patients were queried on which CAM modalities they utilized and whether or not they were discussed with either their oncologist or primary care physician.

MAIN RESULTS

Of the patients surveyed, 91% reported using at least one form of CAM. The most widely used forms of CAM were prayer, relaxation and exercise. CAM users tended to be women chemotherapy patients with at least a high school education. Of the patients using CAM, 57% discussed the use of at least one of these therapies with their oncologist or primary care physician. The most frequent CAM modalities discussed with at least one physician were diets, massage, and herbal medicine.

CONCLUSIONS

An overwhelming proportion of cancer patients are using CAM, particularly prayer, relaxation, and exercise. However, patients may not discuss the use of CAMs at all or fully with their physician; if they do, it is most likely to be their oncologist, but not about the most frequently used CAMs. Future research needs to assess effective ways for oncologists to gather information about CAM usage by patients during allopathic treatment and discern ways these therapies may enhance or interfere with traditional cancer treatments.

Good communication with patients receiving bad news about cancer in Japan

PURPOSE

Despite a recent increase in the attention given to improving communication when disclosing bad news to cancer patients, understanding of good patient-physician communication is still lacking in Japan. The aim of the present study is to describe attributes of good communication with patients receiving bad news about cancer in Japan.

METHODS

Forty-nine participants, including 42 cancer patients and seven oncologists, were requested to undergo an in-depth interview, and the data obtained were qualitatively analyzed.

RESULTS

Seventy-one attributes of good communication with patients receiving bad news about cancer were obtained from 619 opinions, and classified into four domains. (1)

SETTING

a private room and sufficient time. (2) Information given: impact on daily activities and alternative therapy. (3) Method of disclosure: facilitation of patient understanding. (4) Emotional support: encouragement and allowing expression of emotions.

CONCLUSIONS

The four domains of good patient-physician communication in Japan are apparently similar to those in Western countries. The domain involving information given and method of disclosure in previous Western studies was further divided into two domains in the present study. Japanese physicians should perhaps pay careful attention to these issues when disclosing bad news about cancer. There are some cultural differences related to the details of communication attributes (e.g. using euphemisms and showing consideration for the patient's family).

Breast cancer knowledge assessment in female Chinese immigrants in New York

The purpose of this study was to examine the relationships between acculturation level and perceptions of health access, Chinese health beliefs, Chinese health practices, and knowledge of breast cancer risk. This descriptive, correlational cross-sectional study used a survey approach. The sample included 135 Chinese women from the New York City metropolitan area. Data were analyzed using correlational techniques and polytomous regression. There were no significant relationships between acculturation and health access, Chinese health beliefs, Chinese health practices, and breast cancer risk knowledge. Only "years of education," "marital status," and "household income" significantly predicted breast cancer risk knowledge level. The data indicate that women with a better knowledge of breast cancer risk are twice as likely to have higher income and have more education. The most knowledgeable women are less likely to be married and less likely to have partners compared to least knowledgeable group. Providers need to promote health knowledge and provide information about as well as access to preventive health practices to the immigrant population, given that acculturation to the new dominant society is inevitable.

Intake of selected nutritional supplements by African-American men

OBJECTIVES

To measure the self-reported intake of vitamins, selenium, vitamin E, and saw palmetto supplements in African-American men.

METHODS

A correlational study was conducted of 198 African-American men, aged 40 to 70 years old, who attended a community-based free prostate cancer educational and screening program. The rates of supplement use were compared among demographic groups.

RESULTS

Just more than one half of the men (51%) took one or more of the supplements. Almost one half (46%) took multivitamin supplements. About 34% took vitamin E supplements, 6% took selenium supplements, and 7% took saw palmetto. Higher income men were more likely to take nutritional supplements. No statistically significant associations were found between supplement use and age, education, or marital status. Almost all use of selenium, vitamin E, and saw palmetto was among men who were already taking a multivitamin supplement.

CONCLUSIONS

The implications from the results of this study include the need to conduct an assessment of supplement intake as part of the health history.

Use of Alternative Therapy in Postmenopausal Breast Cancer Patients Treated with Tamoxifen after Surgery

The goal of this study was to determine the frequency of alternative therapy use in postmenopausal women with early stage breast cancer who were enrolled in a randomized clinical trial designed to determine the value of breast irradiation after treatment with breast-conserving surgery and tamoxifen. A questionnaire was given to 300 patients, ages 52 to 90 years, after completion of radiation therapy (if any). Of the 290 respondents, 78 (27%) had used some form of alternative therapy. Of these, 60.3% started after the diagnosis of breast cancer. Users of alternative therapies were significantly younger than nonusers (67.0 +/- 8.4 years versus 70.0 +/- 8.7 years, p = 0.009) and they used a median of one type of therapy per person (range 1-13). Users of alternative therapies were more likely to have experienced symptoms (stiffness, pain, numbness, or swelling) in the ipsilateral shoulder or arm after treatment of their breast cancers compared to nonusers (odds ratio [OR] = 2.0, p = 0.02). This relationship between alternative therapy use and symptoms was strongest in the group who started alternative therapies after breast cancer diagnosis (OR = 2.1, p = 0.05). On multivariate analysis, younger age and radiotherapy treatment were related to alternative therapy use. In conclusion, 27% of patients with early stage breast cancer used alternative therapy. Users were more likely to be younger and to experience shoulder or arm symptoms after breast-conserving surgery with radiation.

The inhibitory effect of a herbal formula comprising ginseng and carthamus tinctorius on breast cancer

A compound (Zhu-xiang) from herbal extracts containing ginseng and carthamus tinctorius was used to treat the MDA-MB-231 breast cancer cell and normal human mammary gland cell lines. The inhibition of cell proliferation by Zhu-xiang, epirubicin, 5-fluorouracil and cyclophosphamide was determined by WST-1 assays. The apoptotic effect was studied by flow cytometry analysis of DNA strand breaks and ApopTag Peroxidase In Situ Apoptosis kit by the TUNEL assay. The proliferation index as well as cell cycle progression were also evaluated by flow cytometry using Ki-67 and propidium iodide respectively as markers. The Zhu-xiang showed significantly inhibition in cell proliferation and the inhibition was dose dependent. The inhibitory effect of Zhu-xiang was significantly greater than commonly used cytotoxic drugs. The inhibitory effect is a result of the induction of apoptosis, which is concentration- and time-dependent. DNA histograms indicate that the compound causes accumulation of cells mainly in the S phase. The viability of cells in breast solid tumours was measured by ATP bioluminescence assay to determine the drug-induced cytotoxicity of Zhu-xiang. The three different concentrations of Zhu-xiang all exhibited the ability to inhibit proliferation in solid tumour. Zhu-xiang could be a useful anti-cancer compound against breast cancer.