Use of alternative/complementary therapy in breast cancer patients--a psychological perspective

A Better Me? An Interpretative Phenomenological Analysis of the Experiences of Female Cancer Survivors' Heightened Preoccupation With 'Healthy Eating'

The end of treatment is known to be a particularly challenging time for many cancer survivors as they transition to coping with their condition independently. They may engage in health behaviours, such as implementing drastic dietary changes to manage the side effects of treatment they have undergone or as a way to assuage their anxiety. Understanding cancer survivors' heightened preoccupation with healthy eating is therefore fundamental to our understanding of the psychological phenomenology of cancer. This study explored how people who have developed a heightened preoccupation with healthy eating after a cancer diagnosis make sense of this change. Eight participants were recruited through social media. They each engaged in a semi-structured interview over Zoom concerning their changed relationship with food following cancer. Their accounts were then analysed using interpretative phenomenological analysis (IPA). The article focuses on four group experiential themes arising from the analysis: Open and Enlightened About Food, Becoming a Better Me?, Developing a New Passion for Nutrition, and Becoming Consumed by Food. The themes that arose from the analysis speak to the experience of becoming a 'better' person from having lived through cancer and developed a new relationship with food. Instead of seeing illness as a loss, several of the participants reported a positive shift linked to having developed an interest in healthy eating, something which became central to their identity. However, others experienced their new engagement with healthy eating as a preoccupation that engulfed them. These findings are discussed in light of existing theory and research, and their clinical implications are outlined. Areas for future research are also suggested.

Patient' and social aspects related to complementary mistletoe therapy in patients with breast cancer: A systematic review commissioned by the German agency for Health Technology Assessment

PURPOSE

To mitigate side effects of conventional cancer care and improve quality of life, many patients with breast cancer in German-speaking countries opt for mistletoe therapy in addition to standard treatment. To understand the value for users, we evaluated the domain "Patient and Social aspects" in a health technology assessment on complementary mistletoe therapy in patients with breast cancer.

METHODS

A systematic review was conducted according to PRISMA guidelines. Fifteen electronic databases and the internet were searched. Qualitative studies were analyzed using qualitative content analysis; quantitative studies were systematically summarized in evidence tables.

RESULTS

Seventeen studies out of 1203 screened publications with 4765 patients and 869 healthcare professionals were included in the review. The median proportion of patients using mistletoe therapy was 26.7% (range: 7.3-46.3%). Predictors for use were younger age and higher educational level. Main reasons for patients' use of mistletoe therapy were to leave nothing untried and to be actively involved in the treatment process. Reasons against use were related to a lack of knowledge or uncertainty regarding effectiveness and safety. Physicians mainly aimed to support the patient's physical condition as main reason for use and a lack of resources and knowledge as main reason against use.

CONCLUSION

Mistletoe therapy was commonly used in the treatment of breast cancer despite a lack of scientific knowledge among patients and physicians. Transparent communication on motivation for use and its potential effect enables realistic expectations. Relatively small samples of mistletoe therapy users limit the representativeness and validity of our results.

Additional treatment with mistletoe extracts for patients with breast cancer compared to conventional cancer therapy alone - efficacy and safety, costs and cost-effectiveness, patients and social aspects, and ethical assessment

Background

Chemotherapy is often used in the treatment of breast cancer in women. Side effects such as diarrhea, fatigue, hair loss, fever or disturbances in blood formation impair the women's quality of life. An essential treatment goal of the accompanying mistletoe therapy (MT) used in complementary medicine is to improve the health-related quality of life during cancer therapy.

Aim and methods

The HTA report on which this article is based examines the medical efficacy and safety, costs and cost-effectiveness, patient and social aspects, and ethical aspects of MT in women with breast cancer. Systematic reviews were conducted for this purpose. The search period of the literature search ranged from 2004 to October 2020.

Results

A total of 2 evidence-based medical guidelines, 3 randomized trials assessing efficacy and 1 additional non-randomized intervention trial, as well as 3 observational studies assessing safety, a cost analysis, 12 cross-sectional studies on patient aspects and 17 articles on ethical evaluation were included. Improvements in health-related quality of life compared to the control group were small to moderate. Due to the high risk of bias in the studies, it is possible that the difference is not caused by MT. One study with a small sample size showed no effect on progression-free survival after 5 years. Studies on the effect of MT on overall survival are lacking. In seven studies, local skin reactions of low and moderate severity were reported in a median of 25% (range 5 to 94%) of patients, and mild to moderate systemic reactions in a median of 2% (range 0 to 8%) of patients. A comparative cost analysis from Germany reported significantly lower medical costs within 5 years after surgery for patients with MT than for patients without MT, but the underlying observational study did not control for systematic bias. With regard to patient aspects, the frequency of use and the reasons for use from the patient's or practitioner's point of view were mainly investigated. A median of 25% (range 7 to 46%) of patients with breast cancer and 29% (range 29 to 79%) of treatment providers use MT. The main motivations of patients for use were to reduce side effects, strengthen the immune system and take an active role in the treatment process. Patients felt insufficiently advised. Studies on other aspects are lacking. The ethical evaluation was able to identify 6 overarching themes; the central challenge is the insufficient evidence on efficacy and safety.

Complementary and alternative medicine and musculoskeletal pain in the first year of adjuvant aromatase inhibitor treatment in early breast cancer patients

Background

Patients with breast cancer (BC) show strong interest in complementary and alternative medicine (CAM), particularly for adverse effects of adjuvant endocrine treatment — e.g., with letrozole. Letrozole often induces myalgia/limb pain and arthralgia, with potential noncompliance and treatment termination. This analysis investigated whether CAM before aromatase inhibitor (AI) therapy is associated with pain development and the intensity of AI-induced musculoskeletal syndrome (AIMSS) during the first year of treatment.

Patients and methods

The multicenter phase IV PreFace study evaluated letrozole therapy in postmenopausal, hormone receptor–positive patients with early BC. Patients were asked about CAM use before, 6 months after, and 12 months after treatment started. They recorded pain every month for 1 year in a diary including questions about pain and numeric pain rating scales. Data were analyzed for patients who provided pain information for all time points.

Results

Of 1396 patients included, 901 (64.5%) had used CAM before AI treatment. Throughout the observation period, patients with CAM before AI treatment had higher pain values, for both myalgia/limb pain and arthralgia, than non-users. Pain increased significantly in both groups over time, with the largest increase during the first 6 months. No significant difference of pain increase was noted regarding CAM use.

Conclusions

CAM use does not prevent or improve the development of AIMSS. Pain intensity was generally greater in the CAM group. Therefore, because of the risk of non-compliance and treatment discontinuation due to the development of higher pain levels, special attention must be paid to patient education and aftercare in these patients.

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Pain levels of myalgia/limb pain and arthralgia increase under letrozole intake.

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Within one year pain levels increase in both, CAM users as well as non-CAM users.

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In CAM users pain levels were higher at all time points than in non-CAM users.

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The greatest increase of pain levels was noted in the first six treatment months.

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CAM does not prevent or improve the development of myalgia/limb pain and arthralgia.

Exploring the Use of Complementary and Alternative Medicine in Cancer Patients

In Australia, it is estimated that around 17% to 87% of cancer patients have used one form of complementary therapy during their cancer treatment. There are numerous reasons and contributing factors for cancer patients to consider using complementary and alternative medicine (CAM). CAM information and products are readily available. However, the level of evidence to support the benefits of use in the cancer setting is limited, and the associated adverse effects and interactions with conventional medicine may not be fully studied. Besides, not all health professionals favor the concept of integrative health approaches, or have the confidence in dealing with CAM due to a lack of knowledge and standardization of practices. A thematic review of the literature was performed on the main contributing factors to cancer patients’ use of CAM, as well as the current issues that may be encountered by the patients and health professionals.

Exploring the Use of Complementary and Alternative Medicine in Cancer Patients

In Australia, it is estimated that around 17% to 87% of cancer patients have used one form of complementary therapy during their cancer treatment. There are numerous reasons and contributing factors for cancer patients to consider using complementary and alternative medicine (CAM). CAM information and products are readily available. However, the level of evidence to support the benefits of use in the cancer setting is limited, and the associated adverse effects and interactions with conventional medicine may not be fully studied. Besides, not all health professionals favor the concept of integrative health approaches, or have the confidence in dealing with CAM due to a lack of knowledge and standardization of practices. A thematic review of the literature was performed on the main contributing factors to cancer patients’ use of CAM, as well as the current issues that may be encountered by the patients and health professionals.

Powerful Pharma and Its Marginalized Alternatives?

Abstract. Only little is known about the underpinning psychological processes that determine medical choices. Across four studies, we establish that conspiracy mentality predicts a preference for alternative over biomedical therapies. Study 1a (N = 392) and 1b (N = 204) provide correlational support, Study 2 (N = 185) experimentally tested the role of power: People who endorsed a conspiracy mentality perceived a drug more positively if its approval was supported by a powerless (vs. powerful) agent. Study 3 (N = 239) again showed a moderating effect of power and conspiracy mentality on drug evaluation by comparing analytic versus holistic approaches. These findings point to the consequences of conspiracy mentality for health behavior and prevention programs.

Factors associated with insomnia and complementary medicine use in children: results of a national survey

OBJECTIVES

Sleep difficulties are a serious health problem in children, and interest in using complementary and alternative medicine (CAM) therapies to treat sleep is growing. In this study, we aimed to identify: the prevalence of sleep difficulties in children, and the prevalence and patterns of CAM use among children with trouble sleeping.

METHODS

We used the 2012 National Health Interview Survey (NHIS) dataset to estimate the prevalence of sleep difficulties and CAM use in children ages 6-17 years. Prevalence estimates were weighted to reflect the survey's sampling design. We used logistic regression to explore associations between sleep difficulties, psychosocial factors, comorbidities and CAM use.

RESULTS

6.4% of children in the 2012 NHIS dataset reported regular difficulty sleeping in the last year, corresponding to an estimated 1.5 million children in the US. Older age, poorer health status, more missed school days, and multiple comorbidities were all associated with sleep difficulties (p ≤ 0.001). Among children with sleep difficulties, 29% used at least one CAM therapy. Of the CAM therapies surveyed, non-vitamin, non-mineral supplements were the most commonly used (14.6%), followed by manipulation therapies (9.2%) and mind-body techniques (8.8%). Parental education and CAM use were most strongly associated with child CAM use (p ≤ 0.001).

CONCLUSIONS

CAM therapies, particularly non-vitamin, non-mineral supplements, are commonly used among children with sleeping problems. More research is needed to characterize the safety and efficacy of CAM therapies for sleep in this population.

The effect of relaxation techniques on edema, anxiety and depression in post-mastectomy lymphedema patients undergoing comprehensive decongestive therapy: A clinical trial

Objectives

Lymphedema is sometimes accompanied by high degrees of anxiety and depression. This study aimed to assess the effects of relaxation techniques on the level of edema, anxiety and depression in women undergoing Comprehensive Decongestive Therapy (CDT).

Design

This clinical trial compared two treatment methods in 31 women with post-mastectomy lymphedema, including 15 cases who received CDT and 16 who received RCDT (Relaxation plus CDT). The edema volume, anxiety and depression scores were compared at the first and last sessions of the first phase of the treatment and six weeks afterwards.

Results

The edema, anxiety and depression scores were 63.6%, 54.1% and 65.5% in the RCDT group and 60.7%, 31.4% and 35.2% in the CDT group. There were significant differences between the two groups in terms of the reduction in depression (p = 0.024) and anxiety (p = 0.011) scores throughout the study. This significant relationship was due to the differences in the depression score in the 3^rd and 9^th weeks of the study between the two groups. Similarly, anxiety levels differed significantly between the two groups at the 9^th week of the study (P = 0.013).

Conclusion

Relaxation techniques reduced the anxiety and depression scores and the volume of edema in the patients with lymphedema. The addition of this intervention to the therapeutic package for lymphedema patients requires further studies in terms of cost-effectiveness.

[Beweggründe von Krebspatienten für und gegen die Inanspruchnahme der Misteltherapie]

Einleitung: Die Misteltherapie ist im deutschsprachigen Raum ein häufig angewandtes komplementärmedizinisches Verfahren (KM) in der Onkologie. Diese Studie hatte das Ziel, die Beweggründe für oder gegen eine Inanspruchnahme der Misteltherapie zu untersuchen und Themenfeldern zuzuordnen. Patienten und Methoden: Es wurden qualitative leitfadengestützte Interviews mit Krebspatienten geführt. Der Interviewleitfaden fragte nach der Inanspruchnahme von KM, der Motivation zur Inanspruchnahme, Informationsverhalten und -bedürfnissen zu KM sowie nach der Krebserkrankung. Um die Beweggründe für die Inanspruchnahme oder Nichtinanspruchnahme der Misteltherapie zu verstehen, wurden die Interviews inhaltsanalytisch ausgewertet. Ergebnisse: Insgesamt wurden Interviews mit 88 Krebspatienten geführt, davon nutzen 18 (20,5%) die Misteltherapie. Die Beweggründe für oder gegen eine Inanspruchnahme der Misteltherapie ließen sich den 2 Themenfeldern «Wahrgenommene Indikation» und «Abwägungen bei der Entscheidungsfindung» zuordnen. Diskussion und Schlussfolgerungen: Mit der Misteltherapie wird sowohl ein Einfluss auf das Tumorwachstum als auch eine supportive Wirkung assoziiert. Anwender sehen die Misteltherapie als sicheres Verfahren; Nichtnutzer befürchten eher Neben- oder Wechselwirkungen. Die Empfehlung von Fachpersonal spielt eine wichtige Rolle bei der Inanspruchnahme. Zum Teil waren die Nichtnutzer interessiert an der Anwendung der Misteltherapie, befanden sich jedoch noch im Klärungsprozess.

Long-term Breast Cancer Survivors’ Use of Complementary Therapies: Perceived Impact on Recovery and Prevention of Recurrence

Objective:Many cancer survivors use some form of complementary therapy (CT); this is particularly true for women with breast cancer. The majority of reports on CT use in women with breast cancer have focused on CT use during cancer treatment or within a year or two of treatment completion. The purpose of this study was to evaluate longertermbreast cancer survivors’ (average, 8.7 years) frequency of CT use and their beliefs about the role of CT in cancer recovery and the prevention of cancer recurrence, as well as the relationship of CT use with current life satisfaction. Methods: A mail survey was completed by 608 breast cancer survivors a minimum of 2 years after their most recent cancer diagnosis. Participants were contacted through the American Cancer Society Reach to Recovery program in Florida. The self-report questionnaire inquired about the use of various CTs, beliefs about CT, current life satisfaction, demographic characteristics, and cancer treatment history. Results: Most of the respondents were older than 50, were Caucasian, were married, had attended or completed college, and were at least 5 years after breast cancer treatment. The most commonly used CTs included exercise, vitamins, prayer/spiritual practice, support groups, humor, self-help books, and relaxation. These survivors used CT therapies because they wanted to play a more active role in their cancer recovery, to manage stress, and to maintain hope. A majority of them reported that they used CT to reduce the risk of cancer recurrence. Use of CT was not correlated with life satisfaction. Conclusions: Most of the breast cancer survivors in this study had used some form of CT since the time of their most recent cancer diagnosis and believed that such therapies could be of significant benefit, despite a lack of correlation between CT use and current life satisfaction. Many believed that use of CT may prevent cancer recurrence. It is important, therefore, to investigate the efficacy of variousCTs among longer-termcancer survivors, especially with regard to their potential in preventing cancer recurrence.

Use of Complementary Therapies During Chemotherapy: Influence of Patients’ Satisfaction With Treatment Decision Making and the Treating Oncologist

The relationship between the use of complementary therapy (CT) and satisfaction with medical treatment decision making and with the treating oncologist was evaluated in a sample of 166 women who were undergoing an initial course of chemotherapy for early-stage breast cancer. At the beginning of chemotherapy, 39% indicated already trying CT and an additional 13% reported planning to try CT. These women mentioned a variety of vitamin, nutritional, herbal, physical, mental, and spiritual approaches. Four months later, when most patients had completed chemotherapy, more than half (53%) reported using CT, with another 8% planning to try it. Regression analysis controlling for psychosocial and medical variables revealed that women who were younger and less satisfied with their treatment decision-making experience were significantly more likely to use CT. When predicting use of CT at the conclusion of treatment, baseline utilization was the greatest predictor, but dissatisfaction with the oncologist was also a significant predictor. These findings suggest that patients who are dissatisfied with their medical care may be more likely to use CT during treatment. Further research is needed to elucidate the relationship between satisfaction with medical decision making and the patient-physician relationship to CT use among cancer patients. The findings also highlight the importance of good patient-physician communication about CT use throughout the cancer treatment experience.

Complementary and Alternative Medicine Use in Individuals Presenting for Care at a Comprehensive Cancer Center

Purpose: To define the use of complementary and alternative medicine (CAM) in individuals presenting for care at a comprehensive cancer center. Patients and Methods: A total of 17 639 individuals presenting to an NCI-designated Comprehensive Cancer Center (and consortium sites) completed a questionnaire regarding CAM use. Data were analyzed using the univariate χ² test to assess CAM use associated with a number of variables, including cancer status, age, gender, marital status, ethnicity, race, employment, and education level. Results: Eighty-seven percent of individuals who completed the CAM survey acknowledged CAM therapy use within the previous 12 months. Of the 5 broad categories of CAM, the most commonly used were biologically based approaches (14 759/17 639 [83.67%]), mind-body interventions (4624/17 485 [26.45%]), manipulative and body-based therapies (3957/17 537 [22.56%]), alternative medical systems (429/15 952 [2.69%]), and energy therapies (270/15 872 [1.7%]). CAM use was more prevalent among women, non-Hispanics, Caucasians, patients 60 to 69 years of age, and those who are married, have a higher level of education, and are employed (P < .005). Conclusions: This is the largest report of CAM use in individuals presenting for care at a comprehensive cancer center. Our analysis revealed that a very high percentage of patients utilize CAM. Because many of these CAM interventions are not studied in oncology patients, additional research on safety, efficacy, and mechanisms of action are essential. Furthermore, it is important that oncologists understand CAM modalities and counsel their patients about their use.

Complementary medicine for cancer patients in general practice: qualitative interviews with german general practitioners

BACKGROUND

The aim of this study was to investigate how general practitioners react when their cancer patients show interest in complementary medicine, and how their reaction is related to their knowledge in the field.

METHODS

We conducted semi-structured interviews with 10 German general practitioners. Interviewees came from 5 different federal states and varied in terms of urban/rural setting, single/joint practice, additional certifications, gender and length of professional experience. Interviews were electronically recorded, transcribed and then analysed using qualitative content analysis according to Mayring.

RESULTS

General practitioners feel largely responsible for providing information on complementary medicine to their cancer patients. However, uncertainty and a lack of knowledge concerning CAM lead mainly to reactive responses to patients' needs, and the general practitioners base their recommendations on personal experiences and attitudes. They wish to support their cancer patients and thus, in order to keep their patients' hopes up and maintain a trusting relationship, sometimes support complementary medicine, regardless of their own convictions.

CONCLUSION

Although general practitioners see themselves as an important source of information on complementary medicine for their cancer patients, they also speak of their uncertainties and lack of knowledge. General practitioners would profit from training in complementary medicine enabling them to discuss this topic with their cancer patients in a proactive, open and honest manner.

Complementary and Alternative Medicine Use among Norwegian Cancer Survivors: Gender-Specific Prevalence and Associations for Use

The associations for CAM use are only occasionally differentiated by gender in populations where both male and female cancer survivors occur. The aim of this study is to describe the prevalence of CAM use in individuals with a previous cancer diagnosis and to investigate gender differences regard to factors associated with use. A total of 12982 men and women filled in a questionnaire with questions about life style and health issues. Eight hundred of those had a previous cancer diagnosis of whom 630 answered three questions concerning CAM use in the last 12 months. A total of 33.8% of all cancer survivors reported CAM use, 39.4% of the women and 27.9% of the men (P < 0.01). The relationship between the demographic variables and being a CAM user differed significantly between men and women with regard to age (P = 0.03), education (P = 0.04), and income (P < 0.01). Female CAM users were more likely to have a university degree than the nonusers, while male CAM users were more likely to have a lower income than the nonusers. According to this study, prevalence and factors associated with CAM use differ significantly between male and female survivors of cancer.

Can treatment with Cocculine improve the control of chemotherapy-induced emesis in early breast cancer patients? A randomized, multi-centered, double-blind, placebo-controlled Phase III trial

Background

Chemotherapy induced nausea and vomiting (CINV) remains a major problem that seriously impairs the quality of life (QoL) in cancer patients receiving chemotherapy regimens. Complementary medicines, including homeopathy, are used by many patients with cancer, usually alongside with conventional treatment. A randomized, placebo-controlled Phase III study was conducted to evaluate the efficacy of a complex homeopathic medicine, Cocculine, in the control of CINV in non-metastatic breast cancer patients treated by standard chemotherapy regimens.

Methods

Chemotherapy-naïve patients with non-metastatic breast cancer scheduled to receive 6 cycles of chemotherapy including at least three initial cycles of FAC 50, FEC 100 or TAC were randomized to receive standard anti-emetic treatment plus either a complex homeopathic remedy (Cocculine, registered in France for treatment of nausea and travel sickness) or the matching placebo (NCT00409071 clinicaltrials.gov). The primary endpoint was nausea score measured after the 1^st chemotherapy course using the FLIE questionnaire (Functional Living Index for Emesis) with 5-day recall. Secondary endpoints were: vomiting measured by the FLIE score, nausea and vomiting measured by patient self-evaluation (EVA) and investigator recording (NCI-CTC AE V3.0) and treatment compliance.

Results

From September 2005 to January 2008, 431 patients were randomized: 214 to Cocculine (C) and 217 to placebo (P). Patient characteristics were well-balanced between the 2 arms. Overall, compliance to study treatments was excellent and similar between the 2 arms. A total of 205 patients (50.9%; 103 patients in the placebo and 102 in the homeopathy arms) had nausea FLIE scores > 6 indicative of no impact of nausea on quality of life during the 1^st chemotherapy course. There was no difference between the 2 arms when primary endpoint analysis was performed by chemotherapy stratum; or in the subgroup of patients with susceptibility to nausea and vomiting before inclusion. In addition, nausea, vomiting and global emesis FLIE scores were not statistically different at any time between the two study arms. The frequencies of severe (Grade ≥ 2) nausea and vomiting were low in our study (nausea: P: 17.6% vs C: 15.7%, p=0.62; vomiting: P: 10.8% vs C: 12.0%, p=0.72 during the first course).

Conclusion

This double-blinded, placebo-controlled, randomised Phase III study showed that adding a complex homeopathic medicine (Cocculine) to standard anti-emetic prophylaxis does not improve the control of CINV in early breast cancer patients.

Using a mixed methods research design to investigate complementary alternative medicine (CAM) use among women with breast cancer in Ireland

AIM

To investigate complementary and alternative medicine (CAM) use among women with breast cancer in Ireland using a mixed methods modified sequential explanatory design.

METHODS

Semi-structured interviews were conducted with oncology professionals (n = 20) and CAM practitioners (n = 20) and this was followed by a survey of 406 women with breast cancer using the 'Use of Complementary and Alternative Therapies Survey' questionnaire (UCATS) (Lengacher et al., 2003). Follow up interviews were subsequently undertaken with a subset of this survey sample (n = 31).

RESULTS

Over half of those surveyed (55.7%, n = 226) used some form of CAM since diagnosis. The most frequently used therapies were massage, herbal supplements (including herbs with oestrogenic properties), antioxidants, relaxation, counselling, health supplements, reflexology, reiki and support groups. Dietary interventions were used primarily to reduce symptoms and/or side effects while reduction of psychological stress was the primary reason for use of stress-reducing therapies. Most respondents reported that the CAM therapies they had used were helpful. The qualitative data elaborated on and provided clarification of the survey results.

CONCLUSIONS

Similar to international studies, CAM is popular among women with breast cancer in Ireland. As such, the challenge for Irish oncology professionals is to identify low risk CAM therapies that are likely to benefit patients while educating patients and themselves on therapies which may be of concern. This study clearly illustrates the benefits of using a mixed methods approach to enhance our understanding of a complex clinical issue and thus we recommend that this method should be the method of choice when planning health services research.

How many cancer patients use complementary and alternative medicine: a systematic review and metaanalysis

BACKGROUND

No comprehensive systematic review has been published since 1998 about the frequency with which cancer patients use complementary and alternative medicine (CAM).

METHODS

MEDLINE, AMED, and Embase databases were searched for surveys published until January 2009. Surveys conducted in Australia, Canada, Europe, New Zealand, and the United States with at least 100 adult cancer patients were included. Detailed information on methods and results was independently extracted by 2 reviewers. Methodological quality was assessed using a criteria list developed according to the STROBE guideline. Exploratory random effects metaanalysis and metaregression were applied.

RESULTS

Studies from 18 countries (152; >65 000 cancer patients) were included. Heterogeneity of CAM use was high and to some extent explained by differences in survey methods. The combined prevalence for "current use" of CAM across all studies was 40%. The highest was in the United States and the lowest in Italy and the Netherlands. Metaanalysis suggested an increase in CAM use from an estimated 25% in the 1970s and 1980s to more than 32% in the 1990s and to 49% after 2000.

CONCLUSIONS

The overall prevalence of CAM use found was lower than often claimed. However, there was some evidence that the use has increased considerably over the past years. Therefore, the health care systems ought to implement clear strategies of how to deal with this. To improve the validity and reporting of future surveys, the authors suggest criteria for methodological quality that should be fulfilled and reporting standards that should be required.

Predictors of yoga use among patients with breast cancer

OBJECTIVE

Emerging research suggests that yoga may be beneficial for reducing symptoms and improving quality of life among breast cancer patients. However, very little is known about the characteristics of breast cancer patients who use yoga; thus, this study seeks to identify the sociodemographic and clinical characteristics of yoga users among this population.

DESIGN

A cross-sectional survey study was conducted.

SETTING

The study was conducted at an outpatient breast oncology clinic at a large university hospital.

PARTICIPANTS

Three hundred postmenopausal breast cancer patients currently receiving aromatase inhibitors were included in this study.

MAIN OUTCOME MEASUREMENT

Self-reported use of yoga following the cancer diagnosis was collected along with sociodemographic and clinical data. Multivariate logistic regression was used to identify independent predictors of yoga use among breast cancer patients.

RESULTS

Of 300 participants, 53 (17.7%) reported having used yoga following cancer diagnosis. White patients were significantly more likely to use yoga than nonwhite patients (P = .02). Higher education level, lower BMI (body mass index), part-time employment status, previous chemotherapy, and radiation therapy were all associated with greater yoga use (all P < .05). Controlling for other factors, greater yoga use was independently associated with higher education level (adjusted odds ratio [AOR] 2.72, 95% confidence interval [CI], 1.15-6.46), and lower BMI (AOR 0.25, 95% CI, 0.09-0.66).

CONCLUSION

Yoga use following breast cancer diagnosis was substantially higher for white patients and those with lower BMI and higher education levels. Considering its potential benefits for symptom management in cancer, more research is needed to understand the attitudes and barriers to yoga use among individuals with nonwhite race, lower education, and higher BMI level. Such investigation will help design yoga programs that are aligned to the needs of these populations.

Thymic peptides for treatment of cancer patients

BACKGROUND

Purified thymus extracts (pTE) and synthetic thymic peptides (sTP) are thought to enhance the immune system of cancer patients in order to fight the growth of tumour cells and to resist infections due to immunosuppression induced by the disease and antineoplastic therapy.

OBJECTIVES

To evaluate the effectiveness of pTE and sTP for the management of cancer.

SEARCH STRATEGY

We searched CENTRAL (The Cochrane Library 2010, Issue 3), MEDLINE, EMBASE, AMED, BIOETHICSLINE, BIOSIS, CATLINE, CISCOM, HEALTHSTAR, HTA, SOMED and LILACS (to February 2010).

SELECTION CRITERIA

Randomised trials of pTE or sTP in addition to chemotherapy or radiotherapy, or both, compared to the same regimen with placebo or no additional treatment in adult cancer patients.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data from published trials. We derived odds ratios (OR) from overall survival (OS) and disease-free survival (DFS) rates, tumour response (TR) rates, and rates of adverse effects (AE) related to antineoplastic treatments. We used a random-effects model for meta-analysis.

MAIN RESULTS

We identified 26 trials (2736 patients). Twenty trials investigated pTE (thymostimulin or thymosin fraction 5) and six trials investigated sTP (thymopentin or thymosin α(1)). Twenty-one trials reported results for OS, six for DFS, 14 for TR, nine for AE and 10  for safety of pTE and sTP. Addition of pTE conferred no benefit on OS (RR 1.00, 95% CI 0.79 to 1.25); DFS (RR 0.97, 95% CI 0.82 to 1.16); or TR (RR 1.07, 95% CI 0.92 to 1.25). Heterogeneity was moderate to high for all these outcomes. For thymosin α(1) the pooled RR for OS was 1.21 (95% CI 0.94 to 1.56, P = 0.14), with low heterogeneity; and 3.37 (95% CI 0.66 to 17.30, P = 0.15) for DFS, with moderate heterogeneity. The pTE reduced the risk of severe infectious complications (RR 0.54, 95% CI 0.38 to 0.78, P = 0.0008; I² = 0%). The RR for severe neutropenia in patients treated with thymostimulin was 0.55 (95% CI 0.25 to 1.23,  P = 0.15). Tolerability of pTE and sTP was good. Most of the trials had at least a moderate risk of bias.

AUTHORS' CONCLUSIONS

Overall, we found neither evidence that the addition of pTE to antineoplastic treatment reduced the risk of death or disease progression nor that it improved the rate of tumour responses to antineoplastic treatment. For thymosin α(1), there was a trend for a reduced risk of dying and of improved DFS. There was preliminary evidence that pTE lowered the risk of severe infectious complications in patients undergoing chemotherapy or radiotherapy.

Discussing Complementary Therapy Use With Early-Stage Breast Cancer Patients: Exploring the Communication Gap

Objective. The current study aimed to (1) describe communication patterns between oncologists and breast cancer patients regarding the use of complementary and alternative medicine (CAM) and (2) assess the relationship between CAM discussions and anxiety levels. Methods. Interaction analysis of audiotaped initial consultations of 102 early-stage breast cancer patients with Australian and New Zealand oncologists was carried out. Preconsultation and postconsultation anxiety levels were assessed using the State-Trait Anxiety Inventory. Results. At least 1 instance of CAM discussion was found in 24 of the 102 consultations (24%). CAM discussions were mainly patient initiated (73%). The most common doctor’s response to a patient’s mention of CAM was encouragement (38%), although 23% of CAM references elicited a discouraging comment, and 20% were ignored. No patient demographics were significantly associated with CAM discussion. Patients who discussed CAM reported higher preconsultation and postconsultation anxiety levels than those who did not discuss CAM. Conclusions. CAM discussions during initial consultations between early-stage breast cancer patients and oncologists appear to be limited and linked with higher patient anxiety before and after the consultation. These findings indicate that doctors require further education about CAM therapies and supplements as well as guidance in how to raise and effectively discuss CAM issues with concern for their safety while balancing respect for the patients’ beliefs.

Art therapy improves experienced quality of life among women undergoing treatment for breast cancer: a randomized controlled study

Women with breast cancer are naturally exposed to strain related to diagnosis and treatment, and this influences their experienced quality of life (QoL). The present paper reports the effect, with regard to QoL aspects, of an art therapy intervention among 41 women undergoing radiotherapy treatment for breast cancer. The women were randomized to an intervention group with individual art therapy sessions for 1 h/week (n = 20), or to a control group (n = 21). The WHOQOL-BREF and EORTC Quality of Life Questionnaire-BR23, were used for QoL assessment, and administrated on three measurement occasions, before the start of radiotherapy and 2 and 6 months later. The results indicate an overall improvement in QoL aspects among women in the intervention group. A significant increase in total health, total QoL, physical health and psychological health was observed in the art therapy group. A significant positive difference within the art therapy group was also seen, concerning future perspectives, body image and systemic therapy side effects. The present study provides strong support for the use of art therapy to improve QoL for women undergoing radiotherapy treatment for breast cancer.

Lifestyle Interventions in the Prevention and Treatment of Cancer

Despite evidence that cancer death rates in the United States are declining, the absolute number of new cancers and cancer deaths continues to increase, and there is clear evidence that certain human behaviors are influencing these increases. The 4 major factors of lifestyle that continue to be causally related to certain cancers—tobacco use, an unhealthy diet, inadequate exercise, and excessive exposure to ultraviolet radiation—are each independently important in their effects on the genetic and molecular processes that result in the malignant transformation of human cells. There is both irrefutable and otherwise strong evidence that 4 common cancers that occur in the United States—lung cancer, colon/rectal cancer, breast cancer, and prostate cancer—and a less common cancer, malignant melanoma, have etiologic factors that are lifestyle based and therefore controllable through alterations in human behavior. These cancers and the evidence that lifestyle is important in the causation and/or prevention of the disease are the subjects of this review.

Immunological response to mistletoe (Viscum album L.) in cancer patients: a four-case series

European mistletoe (Viscum album) has been used in complementary cancer treatment, but little is known concerning its effects on immunological parameters, although there is evidence that Viscum may stimulate the immune system. In this study, a trial was conducted with cancer patients to determine whether Viscum album extracts could improve the results of immune tests. These were: white blood cell count (leukocytes, neutrophils, lymphocytes), CD4+ and CD8+ T-lymphocytes, intradermal tests of delayed hypersensitivity (candidin, trichophytin, purified protein derivative-PPD), complement C3 and C4, and immunoglobulin A, G and M. Four patients received seven doses of subcutaneous Viscum album 20 mg, twice weekly. Immunological tests were carried out before and after treatment, and an increase in several parameters of humoral and cellular immunity were shown. Apart from reactions around the injection sites, treatment was well tolerated and all patients benefited from it. These results suggest that Viscum album can enhance humoral and cellular immune responses in cancer patients, but further studies attesting to the possible clinical impact of these immunological effects are necessary.

Mistletoe Preparation Iscador: Are there Methodological Concerns with Respect to Controlled Clinical Trials?

In Europe many cancer patients use complementary therapies, particularly mistletoe. Only a few controlled clinical trials have been performed with the mistletoe preparation Iscador as a complementary treatment for cancer, many of them with medium to low quality due to methodological shortcomings. Reasons for some quality concerns, particularly discontinuation of treatment and/or participation and premature termination are analyzed. Analysis is based on controlled clinical trials dealing with Iscador. Data stem from the archive of published and ongoing research of the <> (Society for Cancer Research) in Arlesheim, Switzerland. Controlled clinical studies with cancer patients that were started after 01.01.1990 or were not completed by then have been evaluated. Fifty-six controlled studies are documented, 24 of them randomized and 32 non-randomized. Nine of the randomized studies were done by matched-pair design, the others by conventional parallel group design; six of the last were terminated prematurely primarily for slow recruitment due to patient preferences and compliance of physicians. Patient and physician preference seem to be important factors limiting recruitment for randomized trials and hence implementation. This adds to the overall unwillingness of participation by patients with serious diseases. A well-balanced mix of designs using different research methods and outcomes is suggested combined with analyses, in countries where mistletoe therapy in general or Iscador in particular is unknown or not available.

The use of complementary and alternative medicine among Chinese women with breast cancer

OBJECTIVES

Using data from the Shanghai Breast Cancer Survival Study (SBCSS), we estimated the prevalence and perceived benefits of complementary and alternative medicine (CAM) and Chinese herbal medicine (CHM), and relevant demographic and clinical factors.

DESIGN

This was a cross-sectional cohort study. SUBJECTS/SETTING/LOCATION: Subjects were 5046 women who participated in the SBCSS, conducted in urban Shanghai, China. INTERVENTIONS/OUTCOME MEASURES: Data on CAM use (at least once a week for at least 1 month), patient sociodemographics, and medical history were collected using a structured questionnaire.

RESULTS

The average diagnosis age of participants was 53.5 years. Interviews were completed about 6.5 months after diagnosis. Ninety-seven percent (97%) of participants used CAM therapy after diagnosis. Supplements were the most common type, followed by CHM, and physical activity. Walking was the most popular type of physical activity. Almost all CHM users used CHM as part of their cancer treatment; three quarters reported CHM use for boosting the immune system. About two thirds of women considered CHM effective. Supplement users were more likely to have higher income, higher educational attainment, be married, have undergone or completed radiotherapy, used tamoxifen, have estrogen receptor (ER)-negative/progesterone receptor (PR)-negative cancer, and have menopausal symptoms. CHM use was associated with younger age, higher income, menopausal symptoms, completion of chemotherapy, and past tamoxifen use. Patients with an earlier clinical stage or who had undergone radiotherapy used less CHM. Chemotherapy or radiotherapy and cancer metastasis were positively related to physical activity participation. Current tamoxifen use, ER-/PR- cancer, higher educational attainment, and reporting average or better quality of life were inversely related to exercise participation.

CONCLUSIONS

Given the high prevalence of CAM use in patients with breast cancer and the variety of types of CAM, more research is needed to determine the impact of CAM's effectiveness and safety and interaction with conventional cancer treatment on breast cancer survival.

Patient-Physician Communication Regarding Use of Complementary Therapies During Cancer Treatment

It is estimated that as many as 80% of adult cancer patients use at least one form of Complementary and Alternative Medicine (CAM) during or after conventional treatment. Studies of physician-patient communication about the use of CAM have concluded that patients frequently do not tell their oncologists about their use of CAM and physicians consistently underestimate the numbers of their patients using CAM. The purpose of this multi-site study was to assess newly diagnosed cancer patients' and oncologists' communication practices with regard to complementary therapies. Patients (106 breast and 82 prostate) indicated which of 45 complementary therapies they were using while physicians at their institutions indicated which they supported. It is noted that, although we use the popular acronym "CAM" all patients surveyed were receiving conventional medical treatment. Thus, the survey addressed complementary therapies only. A large majority (84%) indicated they were using at least one therapy with the most popular being exercise, vitamins, prayer, and nutritional supplements. Surprisingly, the oncologists surveyed were generally enthusiastic and supportive of patients' use of complementary therapies. In addition to those therapies popular with patients, at least half the physicians supported massage, journal writing, support groups, acupuncture, biofeedback, and art therapy. However, discussions of CAM are relatively rare and most likely to be initiated by patients. When the topic is discussed, both patients and doctors say it usually enhances their relationship. Implications for CAM program development and oncology professionals' roles in patient education regarding complementary therapies are presented.

Individual Patient Data Meta-analysis of Survival and Psychosomatic Self-regulation from Published Prospective Controlled Cohort Studies for Long-term Therapy of Breast Cancer Patients with a Mistletoe Preparation (Iscador)

Mistletoe preparations such as Iscador are in common use as complementary/anthroposophic medications for many cancer indications, particularly for solid cancers. The efficacy is still discussed controversially. This paper presents an individual patient data meta-analysis of all published prospective matched-pair studies with breast cancer patients concerned with long-term application of a complementary/anthroposophic therapy with the mistletoe preparation Iscador. Six sets of data were available for individual patient meta-analysis of breast cancer patients, matched according to prognostic factors into pairs with and without mistletoe (Iscador) therapy. The main outcome measures were overall survival and psychosomatic self-regulation. Overall survival was almost significant in favor of the Iscador group in the combined data set of the randomized studies: estimate of the hazard ratio with 95% confidence interval 0.59 (0.34, 1.02). Overall survival was highly significant in the combined data set of the non-randomized studies: 0.43 (0.34, 0.56). In the combined analysis of the randomized studies, improvement of psychosomatic self-regulation, as a measure of autonomous coping with the disease, was highly significant in favor of the Iscador group: estimate of the median difference 0.45 (0.15, 0.80), P = 0.0051. The analyzed studies show that therapy with Iscador might prolong overall survival and improve psychosomatic self-regulation of breast cancer patients.

Complementary and alternative medicine (CAM) and supportive care in cancer: a synopsis of research perspectives and contributions by an interdisciplinary team

GOALS OF WORK

The purpose of this short review is to provide a commonly accepted definition of complementary and alternative medicine (CAM), to illustrate the widespread use of CAM by people affected by cancer around the world, and to highlight the research contributions of the Cancer Complementary and Alternative Medicine (CCAM) research team and its colleagues.

METHODS

Based on research conducted by CCAM and several European colleagues, a collection of articles was compiled, reviewed, and edited.

MAIN RESULTS

CAM modalities play a role in supportive care and cancer. Because of the high CAM utilization, it is critical to help cancer patients make safe, informed, evidence-based decisions for their care. In addition, advances in research methodology, outcomes, and measurement in CAM studies are suggested to better account for individual and collective experiences.

CONCLUSION

This special issue provides clinicians with a summary of information about CAM and perspectives for better responding to cancer patient's needs.

Complementary and alternative medicine and coping in neuroimmunological diseases

The utilisation of complementary and alternative medicine (CAM) is widespread in neuroimmunological diseases like multiple sclerosis (MS) but has been disregarded in research until lately. After describing the problems of definition in CAM, different categories will be described. Various confounding factors on CAM utilisation exist, though hardly investigated. Besides sociodemographic variables like education, income, gender and age, illness-related factors like severity of disease are discussed. Furthermore, the important role of coping and CAM utilisation has not been investigated in neuroimmunological diseases, yet. Results derived from our investigations on CAM utilisation in MS indicate that users of CAM apply coping strategies, such as "rumination", "search for information" and "search for meaning in religion", more frequently than non-users and that current CAM utilisation is related to depression. Further research is needed in this field, as well as in other neuroimmunological diseases.

Trends in complementary/alternative medicine use by breast cancer survivors: comparing survey data from 1998 and 2005

BACKGROUND

Use of complementary and alternative medicine (CAM) by women with breast cancer is often said to be increasing, yet few data exist to confirm this commonly held belief. The purpose of this paper is to compare overall patterns of CAM use, as well as use of specific products and therapies at two different points in time (1998 vs 2005) by women diagnosed with breast cancer.

METHODS

Surveys were mailed to women randomly selected from the Ontario Cancer Registry (Canada) in the spring of 1998 (n = 557) and again in the spring of 2005(n = 877).

RESULTS

The response rates were 76.3% in 1998 and 63% in 2005. In 1998, 66.7% of women reported using either a CAM product/therapy or seeing a CAM therapist at some time in their lives as compared with 81.9% in 2005 (p = 0.0002). Increases were seen in both use of CAM products/therapies (62% in 1998 vs. 70.6% in 2005) and visits to CAM practitioners (39.4% of respondents in 1998 vs 57.4% of respondents in 2005). Women in 2005 reported that 41% used CAM for treating their breast cancer. The most commonly used products and practitioners for treating breast cancer as reported in 2005 were green tea, vitamin E, flaxseed, vitamin C, massage therapists and dietitians/nutritionists.

CONCLUSION

CAM use (both self-medication with products and visits to CAM practitioners) increased significantly from 1998 to 2005. Now that more than 80% of all women with breast cancer report using CAM (41% in a specific attempt to management their breast cancer), CAM use can no longer be regarded as an "alternative" or unusual approach to managing breast cancer.

Demographic, medical, and psychosocial correlates to CAM use among survivors of colorectal cancer

GOALS OF WORK

Complementary and alternative medicines (CAM) use among cancer patients is becoming more prevalent; however, our understanding of factors contributing to patients' decisions to participate in CAM is limited. This study examined correlates of CAM use among colorectal cancer (CRC) survivors, an understudied population that experiences many physical and psychological difficulties.

MATERIALS AND METHODS

The sample was 191, predominantly white, CRC survivors (mean age = 59.9 +/- 12.6) who were members of a colon disease registry at a NYC metropolitan hospital. Participants completed assessments of sociodemographic characteristics, psychosocial factors [e.g., psychological functioning, cancer specific distress, social support (SS), quality of life (QOL)], and past CAM use (e.g., chiropractic care, acupuncture, relaxation, hypnosis, and homeopathy).

MAIN RESULTS

Seventy-five percent of participants reported using at least one type of CAM; most frequently reported was home remedies (37%). Younger (p < 0.01) or female patients (p < 0.01) were more likely to participate in CAM than their older male counterparts. Among psychosocial factors, poorer perceived SS (p = 0.00), more intrusive thoughts (p < 0.05), and poorer overall perceived QOL (p < 0.05) were associated to CAM use. In a linear regression model (including age, gender, SS, intrusive thoughts, and perceived QOL), only age remained a significant predictor of CAM use.

CONCLUSION

These findings demonstrate that CAM use is prevalent among CRC survivors and should be assessed routinely by providers. CAMs may serve as a relevant adjunct to treatment among CRC patients as well as an indication of need for additional SS, especially among younger patients.

Relief of Symptoms, Side Effects, and Psychological Distress Through Use of Complementary and Alternative Medicine in Women With Breast Cancer

PURPOSE/OBJECTIVES

To identify use of complementary and alternative medicine (CAM) for relief of symptoms and side effects among women diagnosed with breast cancer and to identify demographic and clinical factors associated with the use of CAM in these patients.

DESIGN

A descriptive, cross-sectional survey.

SETTING

Clinics and community groups in the Tampa Bay area and community groups in a rural midwestern area.

SAMPLE

A convenience sample of 105 predominantly Caucasian women (mean age = 59 years) with a diagnosis of breast cancer was recruited from the Tampa Bay area and a rural midwestern area.

METHODS

The instrument used to gather the data was the Use of Complementary Therapies Survey. The reasons for choosing 33 individual CAM treatments were tabulated. The frequency of use was calculated according to four reasons: (a) to reduce physical symptoms or side effects, (b) to reduce psychological distress, (c) to gain a feeling of control over treatment, or (d) because of dissatisfaction with traditional medical care. Least-squares regression models were fit to identify independent demographic and clinical predictors of CAM therapy use.

MAIN RESEARCH VARIABLES

Use of CAM for relief of physical and psychological distress.

FINDINGS

Patients used all categories of CAM therapies to reduce physical symptoms and side effects. The most frequently cited reason for use of CAM was to reduce the symptom of psychological distress, whereas the lowest frequency of CAM use was because of dissatisfaction with traditional medical care. Traditional and ethnic medicines frequently were used to reduce physical symptoms and side effects, followed by diet and nutritional supplements. The most frequently used CAM therapy category cited for gaining a feeling of control over treatment was use of diet and nutritional supplements. Previous chemotherapy and having more than a high school education were associated with more frequent use of diet and nutritional supplements and stress-reducing techniques.

CONCLUSIONS

Frequency of specific use according to type of CAM was higher and more specific than reported in other studies. Patients who had undergone chemotherapy were most likely to use CAM.

IMPLICATIONS FOR NURSING

Oncology nurses are in a key position to identify which symptoms or side effects patients are experiencing and which CAM therapies may be helpful to relieve patients' symptoms related to treatment and psychological distress related to their cancer.

Trial of Essiac to Ascertain Its Effect in Women with Breast Cancer (TEA-BC)

BACKGROUND

Breast cancer is a major cause of morbidity, mortality, and medical expenditures among women in Canada. Essiac (Resperin Canada Limited, Waterloo, Ontario, Canada), a blend of at least four herbs (burdock root [Arctium lappa], Indian rhubarb [Rheum palmatum], sheep sorrel [Rumex acetosella], and the inner bark of slippery elm [Ulmus fulva or U. rubra]), has become one of the more popular herbal remedies for breast-cancer treatment, secondary prevention, improving quality of life, and controlling negative side-effects of conventional breast-cancer treatment.

OBJECTIVES

Our primary objective was to determine the difference in health-related quality of life (HR-QOL), as assessed by the Functional Assessment of Cancer Therapy Breast Cancer Version, between women who are new Essiac users (since breast cancer diagnosis) and those who have never used Essiac. Secondary endpoints included differences in depression, anxiety, fatigue, rate of adverse events, and prevalence of complications or benefits associated with Essiac during standard breast-cancer treatment. Additionally, we described the pattern of use of Essiac in this cohort of women.

METHODS

We performed a retrospective cohort study in 510 women, randomly chosen from the Ontario Cancer Tumour Registry, with a diagnosis of primary breast cancer in 2003.

RESULTS

With the exception changes in a Physical well-being subscale and a relationship with doctor subscale, Essiac did not have a significant effect on HR-QOL or mood states. Even for Physical well-being and relationship with doctor, Essiac seemed to have a negative effect, with Essiac users doing worse than the non-Essiac users. This might be attributed to the fact that the group of users comprised younger women with more advanced stages of breast cancer, and both of these subgroups of patients have been shown to be at a significantly increased risk for negative mood states and/or a decreased sense of well-being. The women were taking low doses (total daily dose 43.6 +/- 30.8 mL) of Essiac that corresponded to the label directions found on most Essiac products. Friends were the most common source of information, and most women were taking Essiac to boost their immune systems or increase their chances of survival. Only 2 women reported minor adverse events, whereas numerous women reported beneficial effects of Essiac.

CONCLUSIONS

Essiac does not appear to improve HR-QOL or mood states. Future studies are needed to determine whether other clinical outcomes, such as cancer reoccurrence, are affected by Essiac.

Prospective controlled cohort studies on long-term therapy of breast cancer patients with a mistletoe preparation (Iscador)

BACKGROUND

Mistletoe preparations such as Iscador (Weleda, Schwäbisch Gmünd, Germany) are commonly used in complementary and alternative / anthroposophic medicine for many cancer indications, particularly for solid cancers. Efficacy of this complementary therapy is still controversial.

OBJECTIVE

Does long-term therapy with Iscador show any effect on survival, tumor progression and psychosomatic self-regulation of patients with breast cancer?

PATIENTS AND METHODS

Prospective recruitment and long-term follow-up of two controlled cohort studies: (1) Randomized matched-pair study (38 pairs): breast cancer patients without any recurrences or metastases and no mistletoe therapy were matched for prognostic factors. By pairwise random allocation, one of the patients was suggested mistletoe therapy to be applied by the attending physician. (2) Non-randomized matched-pair study (84 pairs): breast cancer patients without recurrences or metastases that already received mistletoe therapy were matched to control patients without Iscador therapy.

RESULTS

For overall survival, the nonrandomized study shows significant effects in favor of Iscador therapy: hazard ratio HR estimate and 95% confidence interval CI: 0.43 (0.27-0.68). The effect of long-term Iscador therapy on tumor progression as measured by the time to local recurrences, lymphatic or distant metastases in breast cancer patients without any such events at first diagnosis, is in most cases significant in favor of the Iscador group, in the randomized as well as in the non-randomized study. Psychosomatic self-regulation in the Iscador group improves significantly within 12 months compared with the control group in the randomized as well as in the non-randomized study: estimate of the median difference and 95% CI: 0.35 (0.05-0.60), respectively 0.20 (0-0.35).

CONCLUSION

Iscador shows a clinically relevant effect on breast tumor progression as measured by overall survival as well as by the time to recurrences, lymphatic or distant metastases. In the short term, psychosomatic self-regulation increases more markedly under complementary Iscador therapy than under conventional therapy alone.

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.

Frequency of current utilisation of complementary and alternative medicine by patients with multiple sclerosis

OBJECTIVE

The purpose of the study was to examine the frequency and characteristics of complementary and alternative medicine (CAM) use among patients with multiple sclerosis (MS).

METHOD

In order to collect sociodemographic and disease related variables as well as aspects of CAM utilisation 254 MS patients were examined with an interview. The investigation was completed by data of the neurological examination.

RESULTS

At the time of investigation 67.3% of the MS patients reported that they were currently using one or more CAMs. Overall, most of the overall utilized therapies (90.6%) were chosen as a complement and 9.4% as an alternative therapy. Users of complementary medicine were more severely affected by the MS than non-users and had a longer duration of illness. No sociodemographic differences were found between users and non-users. When evaluating the efficacy of CAM, patients reported improvement in 67.1%, no influence in 32.3% and worsening in 0.6% of the cases. 3.7% of the CAM therapies were accompanied by minor side effects.

CONCLUSIONS

Since MS patients are frequently using CAM despite the absence of clinically proven efficacy and appraise it positively, further research on the motivation for utilisation and on objective effects of CAM are needed.

Patterns of use of complementary therapies among cancer patients and their family caregivers

Complementary therapies (CTs) are gaining popularity in the general population, including cancer patients, yet little is known about characteristics differentiating the use of one versus more CTs, about the patterns and persistence of CT use over time, or about the characteristics of cancer patients and their family caregivers who elect to participate in a study involving the use of CTs. The focus of this quasi-experimental study was to offer an 8-week, 5-contact, nurse-delivered intervention involving guided imagery, reflexology, and reminiscence therapy to cancer patients undergoing chemotherapy and their family caregivers. Participants were allowed to elect to use none or any combination of CTs. Twenty-seven percent of eligible patients signed consent forms and agreed to participate. The typical participant was Caucasian, married, and had at least a high school education. Higher levels of education predicted use of more than 1 CT among cancer patients; there were no significant predictors for caregivers. Female patients were more likely to complete the CT protocol than their male counterparts, but there were no associations between CT protocol completion and caregiver demographics. Patients and family caregivers who elected to use more than 1 CT did not consistently implement their CTs. Participants who elected to use only 1 CT were more consistently performing their CT over time, suggesting that this lower level of CT use may be easier to integrate into their lives during cancer treatment.

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.