Prevalence of complementary/alternative medicines (CAMs) in a cancer population in northern Italy receiving antineoplastic treatments and relationship with quality of life and psychometric features

Supplement use and its impact on daily life of cancer patients: a cross-sectional study

PURPOSE

This cross-sectional study aimed to investigate the prevalence and characteristics of supplement usage among cancer patients and explore its potential associations with anxiety, excessive daytime sleepiness, and overall quality of life.

METHODS

Cancer patients receiving specific care at Hôtel Dieu de France University Hospital, Beirut, were enrolled between April and June 2023. In face-to-face interviews, participants were asked to complete a questionnaire consisting of sociodemographic information, supplement usage details, and cancer-related variables. Three validated surveys (Epworth Sleepiness Scale, GAD-7, and EORTC-QLQ-C15-PAL) were employed to assess excessive daytime sleepiness, anxiety, and overall quality of life. Statistical analyses, including chi-square tests, t-tests, and multiple regression models, were conducted to examine associations between supplement use and other variables.

RESULTS

A total of 202 participants were interviewed. Fifty-two percent reported regular use of supplements following their cancer diagnosis, with vitamin D being the most commonly used supplement. Using multivariate logistic regression, supplement use was associated with being female, having lower educational levels, having a longer duration since cancer diagnosis, and having a poor overall quality of life. The multivariate logistic regression showed no significant correlation between supplement use and excessive daytime sleepiness and anxiety.

CONCLUSION

This study highlights a high prevalence of supplement usage among cancer patients in Lebanon, indicating a rising interest in alternative therapies aimed at enhancing quality of life. Larger prospective studies are needed to assess the relation between supplement intake and excessive daytime sleepiness and anxiety and establish clear guidelines pertaining to supplement use in cancer patients.

Well-being treatments in cancer care: patient benefits

OBJECTIVES

Well-being care is widely offered and delivered in patients with cancer. However, very few studies have rigorously evaluated its benefits. The objective of this study was to evaluate the impact of four well-being treatments (foot reflexology, socio-aesthetics, sophrology and singing) provided in a healthcare facility.

METHODS

Three hundred and seventy-four patients with cancer were offered a well-being treatment and agreed to evaluate the type of treatment received, the benefits felt as a result, and numerical evaluation scales for pain and well-being before and after the session.

RESULTS

The distribution of well-being treatments provided was as follows: foot reflexology: 19.0%, socio-aesthetics: 63.9%, sophrology: 6.7%, singing: 10.4%. The average gain in pain relief was 1.01 on a scale of 0-10 (p<10-5) and on well-being 6.97 on a scale of -10 to +10 (p<10-5). One patient (0.3%) experienced pain induced by a foot reflexology session and one patient (0.3%) experienced a deterioration in well-being following a singing session.

CONCLUSION

The well-being treatments studied provided significant pain relief and increased well-being in patients with cancer after their completion.

Quality of life in terminally ill cancer patients: what is the role of using complementary and alternative medicines?

BACKGROUND AND PURPOSE

Cancer is the world's second greatest cause of mortality and a leading cause of death in both developed and developing countries. Patients employ a number of complementary and alternative medicine (CAM) methods to deal with the problems and difficulties of cancer, which can have an impact on their quality of life (QOL). The aim of the present study was to assess the correlation between QOL and the use of different CAM methods in terminally ill cancer patients.

METHODS

This was a cross-sectional study. In southern Iran, 238 individuals with advanced cancer were studied in oncology centers and doctors' offices. During the months of January to August 2021, patients were selected using convenience sampling. A demographic information questionnaire, the EORTC core quality of life questionnaire, and the CAM questionnaire were used to collect data.

RESULTS

The results showed that terminally ill cancer patients had a good quality of life. Last year, 85.7% of participants used at least one kind of CAM. Furthermore, 45.4% of participants used only one form of CAM, 30.3% used two types of CAM, 6.7% used three types of CAM, and 3.4% used four to five types of CAM. When all CAM users were compared to non-CAM users, CAM users had significantly higher social QOL and overall quality of life. Two subscales of QOL symptoms and function were correlated with cancer history, income, and use of CAMs, and the scores of QOL symptoms and function were greater in CAM users compared to non-CAM users. Among all the study variables, only the usage of CAM was correlated to overall QOL among terminally ill cancer patients.

CONCLUSION

The current study found that using CAM could affect different aspects of QOL in terminally ill cancer patients. As a result, it is feasible that using CAM could help these people enhance their health and QOL.

Psychosomatic Symptoms in Terminally Ill Cancer Patients and Its Relation With Using Complementary and Alternative Medicines: A Cross-Sectional Study in Southeast Iran

BACKGROUND

Cancer patients face various problems and complications, which they address through various complementary and alternative medicines (CAM). The aim of this study was to investigate the relationship between CAM and psychosomatic symptoms in terminally ill cancer patients.

METHODS

This cross-sectional study was performed on 221 terminally ill cancer patients (based on metastatic stage and according to the physicin diagnosis) in southeastern Iran. Convenience sampling was used to select terminally ill cancer patients. Using questionnaires like the demographic and clinical information questionnaire, Edmonton Symptom Assessment Scale (ESAS), Hospital Anxiety and Depression Scale (HADS), CAM questionnaire and satisfaction with the use of CAM, the researcher was able to compile a comprehensive picture of the population.

RESULTS

The mean age of the participants was 51.66 ± 13.34 years. The majority of the samples were female, married, educated, and unemployed. The mean score for the physical symptoms of the participants according to ESAS was 22.25 ± 17.57 which was less than the midpoint of the scale (the possible score of ESAS was 0-100). Only 2.7% (n = 6) and 0.9% (n = 2) of the participants had mild and moderate anxiety, respectively, and the other participants' anxiety levels were normal. Only 7.7% (n = 17) and 4.1% (n = 9) of the participants had mild and moderate depression, respectively, and the other participants' depression levels were normal. Last year, 87.3% of the participants used at least one type of CAM. Aside from prayer, 42.1% of the participants used at least one type of CAM in the last year. Prayer was used by 83.7% of the participants, medicinal plants by 35.8%, massage by 9.5%, dietary supplements by 3.6%, wet cupping by 3.2%, relaxation and meditation by 2.7%, dry cupping by 2.4%, and acupuncture by 0.5%. The common reason for using CAM was to reduce the stress and anxiety caused by cancer and to treat it. There were no significant differences in physical and psychological symptoms between the CAM-users and non-CAM users.

CONCLUSION

Patients with cancer have a relatively low level of psychosomatic symptoms, and the primary reason for using CAM was to relieve stress and anxiety associated with cancer and treat it. However, psychosomatic symptoms were the same for CAM and non-CAM users. Because so many people with cancer use CAM, future studies should look into why and how CAM is used.

The Association between the Use of Dietary Supplement and Psychological Status of Cancer Survivors in Korea: A Cross-Sectional Study

Background

Dietary supplements (DS) use is known to be common among cancer survivors. However, detailed information on the factors influencing DS use seems insufficient, including cancer-related and psychological factors.

Methods

Study subjects were 1,852 Korean adult cancer survivors recruited from cancer survivor clinic of two university-affiliated hospitals. Data were collected retrospectively through review of medical records and self-administered questionnaires. Psychological factors were assessed using Hospital Anxiety and Depression Scale (HADS) and Fear of Cancer Recurrence Inventory-Short Form. Factors associated the DS use were evaluated by multiple logistic regression analysis after adjusting for covariates.

Results

The prevalence of long-term DS use was 15.7% in overall (17.5% in female and 11.6% in male). Female survivors were 3.14 times (95% confidence interval [CI], 1.89–5.22) more likely to use DS than male. In male cancer survivors, ever-smoking and previous radiotherapy were positively associated with DS use. In females, breast cancer survivors were 0.32 times less likely to use DS compared with stomach cancer survivors, and survivors with family history of cancer were 1.39 times more likely to use DS than those without. After adjusting for sociodemographic, clinical, and lifestyle factors, survivors with anxiety (HADS ≥8) used DS 1.38 times (95% CI, 1.01–1.91) more frequently, compared with those without anxiety.

Conclusion

Diverse factors such as female sex, cancer treatment modality, smoking history, family history and anxiety status were associated with DS use in Korean cancer survivors. Targeted strategies with consideration of these factors are needed for counseling DS use for cancer survivors.

The use of complementary and alternative medicine among lymphoma and cancer patients with a solid tumor: Oncology clinics at Northern and Southern Turkey

PURPOSE

This study aimed to determine the prevalence and predictors of the use of Complementary and Alternative Medicine (CAM) and to examine the differences between patients who used CAM and those who did not among those who were being treated in oncology clinics in the northern and southern regions of Turkey. In order to collect the relevant data, 288 outpatients receiving chemotherapy were selected to participate in the study.

MATERIALS AND METHODS

The research was designed as a descriptive, relational and cross-sectional study. Data was collected by the researchers using a form which had already been developed in the literature.

RESULTS

As a result of our study, we found that 33.2% of the patients had stage 4 cancer and 22.9% of them had respiratory system cancer. The most commonly used form of CAM was herbal preparations, which were used by 48.4% and around 31 species of herbs were employed. 59.1% of the patients used CAM to support their conventional treatment. The prevalence of the CAM usage was determined as 32.3%.

CONCLUSION

Even though a wide range of different forms of CAM are currently used by oncology patients in the northern and southern regions of Turkey, further cooperation with health professionals is needed to obtain better information about both CAM usage and medical treatment. Better informing patients about how best to use CAM in conjunction with medical treatment is also crucial.

Complementary and alternative medicine use in cancer: A systematic review

BACKGROUND AND PURPOSE

Complementary and alternative medicine (CAM) use in cancer is increasing. The purpose of this study was to systematically review the literature to determine demographic profiles and prevalence and reasons for use in cancer patients.

METHODS

In this systematic review, the databases OVID, PubMed, and Scopus were searched for studies on CAM use in cancer between 2009 and June 2018.

RESULTS

The results showed that an average of 51% of cancer patients used CAM. Common independent demographic characteristics associated with CAM use were younger, female cancer patients, having higher education, earning a higher income and having previously used CAM. Frequent reasons for use, grouped into themes were shown to be to influence their cancer and general health and to treat complications of the cancer or therapy.

CONCLUSION

The review provides an insight and will serve to better inform health professionals on how this population is using CAM.

Relevance of the natural HDAC inhibitor sulforaphane as a chemopreventive agent in urologic tumors

Due to an increased understanding of molecular biology and the genomics of cancer, new and potent agents have been approved by the Food and Drug Administration (FDA) to fight this disease. However, all of these drugs cause severe side effects and resistance inevitably develops, re-activating tumor growth and dissemination. For this reason, patients turn to natural compounds as alternative or complementary treatment options, since it has been found that natural plant products may block, inhibit, or reverse cancer development. The present review focusses on the role of the natural compound sulforaphane (SFN) as an anti-tumor agent in urologic cancer. SFN is a natural compound found in cruciferous vegetables from the Brassicaceae family such as broccoli, cauliflower and cabbage. Several epidemiologic and clinical studies have documented chemopreventive properties of SFN, making it an interesting candidate for additive cancer treatment. SFN shows remarkable anti-tumor effects in vitro and in vivo without exerting toxicity. The review summarizes the current understanding of SFN and provides insights into its molecular mode of action with particular emphasis on epigenetic tumor control.

Exploring associations between psychiatric disorder, psychological distress, and health care utilization in cancer patients

OBJECTIVE

The mental burden of cancer might elicit additional health care utilization. However, it is unclear how psychiatric disorder and psychological distress relate to health care utilization. Therefore, this study explores associations between psychiatric disorder, psychological distress, and health care utilization. It was hypothesized that presence of psychiatric disorder and psychological distress was associated with increased health care utilization and costs.

METHODS

The current study consisted of secondary analyses of baseline data of a larger randomized controlled trial. Two hundred forty-five mixed-cancer patients with at least mild symptoms of psychological distress (Hospital Anxiety and Depression Scale-T ≥ 11) were mainly recruited via online media, participating centers and patient associations. Patients were assessed with Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) for depressive, anxiety, and/or adjustment disorder. Psychological distress was measured by the Hospital Anxiety and Depression Scale. Retrospective self-reported health care utilization in the past 3 months was collected. Associations between predictors and health care utilization in terms of incidence rate ratios (IRR) and costs per category (mental, primary, somatic, and complementary) were assessed by negative binomial, logistic, and gamma regression.

RESULTS

Eighty-nine (36.3%) patients suffered from psychiatric disorder, which was associated with mental health care utilization (IRR = 1.63) and costs (OR = 3.11). We observed a nonsignificant trend of somatic health care utilization in patients with psychiatric disorder. Psychological distress was associated with mental health care utilization (IRR = 1.09) and costs (OR = 1.09). Psychological distress was also associated with complementary health care utilization (IRR = 1.03).

CONCLUSION

Psychiatric disorder and psychological distress were associated with mental health care use and costs. Psychological distress was associated with complementary health care use. Adequate assessment and referral to mental health care might prevent unnecessary health care utilization.

Cancer Impact, Complementary/Alternative Medicine Beliefs, and Quality of Life in Cancer Patients

OBJECTIVES

The purpose of this study was to explore the relationships among cancer impact, belief in complementary and alternative medicine (CAM), CAM use, and quality of life (QOL).

DESIGN

The study used a cross-sectional, descriptive correlational design with convenience sampling. A total of 122 cancer patients participated. Data were collected at a medical center in Chunghua, Taiwan. The questionnaires included the Chinese version of the Cancer Problem in Living Scale (CPILS), Complementary and Alternative Medicine Belief Inventory (CAMBI), Complementary and Alternative Medicine scale, and Chinese versions of QOL scales, including the Functional Assessment of Cancer Therapy-General (FACT-G).

RESULTS

The mean age was 56.5 years, and most participants were male (n = 69, 56.6%), had completed high school or above (n = 56, 45.9%), and were married (n = 109, 89.3%). The most common type of cancer was oral (n = 17, 13.9%), followed by esophageal (n = 15, 12.3%) and colorectal (n = 13, 10.7%). Cancer patients, on average, use one or two types of CAM. The impact of cancer is significantly related to age (F = 7.12, p < 0.05), and income is related to QOL (F = 3.61, p < 0.05). Pearson correlations showed that the use of CAM was positively associated with belief in CAM (CAMBI) (r = 0.26, p = 0.01), and the impact of cancer was highly negatively associated with QOL (r = -0.71, p = 0.001). The predictors of QOL were the impact of cancer and use of CAM, and the impact of cancer accounted for 51% of the variance in QOL.

CONCLUSION

This study supports research on the impact of cancer, belief in CAM, and use of CAM as related to QOL in cancer patients. These results can be used to provide options to clinicians and cancer patients.

Complementary and Alternative Medicine: Italian Validation of a Questionnaire on Nurses' Personal and Professional Use, Knowledge, and Attitudes

BACKGROUND

Patients are showing an increasing interest in the use of complementary and alternative medicine (CAM). Most nurses are open to the adoption of CAM into clinical nursing practice, but they may experience a lack of knowledge about the safe and effective use of these therapies. Several studies concerning nurses' knowledge and attitudes toward CAM have been published, but only in one, the authors (Shorofi and Arbon) used a validated questionnaire. In Italy, there are no validated questionnaires to investigate this aspect of nursing practice.

PURPOSE

To test the psychometric properties of the Italian Shorofi and Arbon questionnaire for use with Italian nurses.

METHODS

A forward-backward translation method was used to translate the questionnaire from English to Italian. Content validity, face validity and reliability were established.

RESULTS AND CONCLUSIONS

This study examined the potential usefulness of the Shorofi and Arbon questionnaire for the evaluation of CAM knowledge of Italian speaking nurses, which showed good content validity and good reliability.

Complementary and Alternative Medicine Use and Its Association with Quality of Life among Cancer Patients Receiving Chemotherapy in Ethiopia: A Cross-Sectional Study

Background. Today, complementary and alternative medicine (CAM) use is being routinely practiced by cancer patients worldwide. This study aimed at examining the prevalence of CAM use in patients with cancer and comparing the quality of life (QoL) in CAM users and nonusers. Methods. A cross-sectional study was employed on 195 cancer patients receiving chemotherapy at Gondar University Referral Hospital (GURH) chemotherapy center. Interviewer-administered questionnaires were used and the collected data were analyzed by the Statistical Package for the Social Sciences (SPSS) software version 21.0 for Windows. Results. 154 (79%) patients were found to be users of CAM. Educational status, average monthly income, disease stage, and comorbidity were strong predictors of use of CAM. The most commonly utilized types of CAM were traditional herbal based medicine (72.1%) and only 20.8% of patients discuss with their doctors CAM use. No significant difference was found in QoL between CAM users and nonusers except in financial difficulties (p = 0.020). Conclusions. This study revealed a high rate of CAM use with very low disclosure rate to their health care providers. Health care providers should be open to discuss the use of CAM with their patients as it will lead to better health outcome.

Herbal medicine use in adults who experience anxiety: A qualitative exploration

Herbal medicine use is widespread and has been reported to be as high as 21% in people with anxiety disorders. Critical thematic analysis was used to explore beliefs and attitudes towards herbal medicines in adults experiencing anxiety. In-depth interviews were conducted with eight adults who experienced anxiety and used herbal medicines. Three major themes were found: Herbal medicines being different from pharmaceuticals, evidence and effectiveness, and barriers to herbal medicine use. Within these themes people held beliefs about the safety of natural treatments, valued anecdotes from friends and family as a form of evidence for self-prescribing, and described confusion about herbal medicines and their cost as barriers to using them as a treatment option. The findings will inform future research and provide guidance for health practitioners.

Quality of Life in CAM and Non-CAM Users among Breast Cancer Patients during Chemotherapy in Malaysia

Background

Complementary and alternative medicine (CAM) use has become increasingly popular among patients with cancer. The purposes of this study were to compare the QOL in CAM users and non-CAM users and to determine whether CAM use influences QOL among breast cancer patients during chemotherapy.

Methodology

A cross-sectional survey was conducted at two outpatient chemotherapy centers. A total of 546 patients completed the questionnaires on CAM use. QOL was evaluated based on the European Organization for Research and Treatment of Cancer (EORTC) core quality of life (QLQ-C30) and breast cancer-specific quality of life (QLQ-BR23) questionnaires.

Results

A total of 70.7% of patients were identified as CAM users. There was no significant difference in global health status scores and in all five subscales of the QLQ C30 functional scales between CAM users and non-CAM users. On the QLQ-C30 symptom scales, CAM users (44.96±3.89) had significantly (p = 0.01) higher mean scores for financial difficulties than non-CAM users (36.29±4.81). On the QLQ-BR23 functional scales, CAM users reported significantly higher mean scores for sexual enjoyment (6.01±12.84 vs. 4.64±12.76, p = 0.04) than non-CAM users. On the QLQ-BR23 symptom scales, CAM users reported higher systemic therapy side effects (41.34±2.01 vs. 37.22±2.48, p = 0.04) and breast symptoms (15.76±2.13 vs. 11.08±2.62, p = 0.02) than non-CAM users. Multivariate logistic regression analysis indicated that the use of CAM modality was not significantly associated with higher global health status scores (p = 0.71).

Conclusion

While the findings indicated that there was no significant difference between users and non-users of CAM in terms of QOL, CAM may be used by health professionals as a surrogate to monitor patients with higher systemic therapy side effects and breast symptoms. Furthermore, given that CAM users reported higher financial burdens (which may have contributed to increased distress), patients should be encouraged to discuss the potential benefits and/or disadvantages of using CAM with their healthcare providers.

Anti-lung cancer potential of pure esteric-glycoside condurangogenin A against nonsmall-cell lung cancer cells in vitro via p21/p53 mediated cell cycle modulation and DNA damage-induced apoptosis

BACKGROUND

Marsdenia condurango (condurango) is a tropical woody vine native to South America. Our earlier study was limited to evaluation of anti-cancer potentials of crude condurango extract and its glycoside-rich components in vitro on lung cancer.

OBJECTIVE

This study aims at evaluating the effect of the single isolated active ingredient condurangogenin A (ConA; C32H42O7) on A549, H522 and H460-nonsmall-cell lung cancer cells.

MATERIALS AND METHODS

ConA was isolated by column chromatography and analyzed by mass spectroscopy, Fourier transform infrared spectroscopy and proton-nuclear magnetic resonance. diphenyltetrazolium bromide assays were conducted on three cell-types using 6%-alcohol as control. Critical studies on cellular morphology, cell-cycle regulation, reactive oxygen species, mitochondrial membrane potential, and DNA-damage were made, and expressions of related signaling markers studied.

RESULTS

As IC50 doses of ConA proved to be too high and toxic to both A549 and H522 cells, all experimental studies were carried out on H460 cells with the IC50 dose (32 μg/ml - 24 h). Cellular morphology revealed typical apoptotic features after ConA treatment. At early treatment hours (2 h-12 h), maximum cells were arrested at G0/G1 phase that could be correlated with reduced level of cyclin D1-CDK with p21 up-regulation. At 18 h - 24 h, sub G0/G1 cell population was increased gradually, as revealed from cytochrome-c release and caspase-3 activation, further confirming the apoptosis-inducing ability of ConA at later phases. Gradual increase of TUNEL-positive cells with significant modulation of mitochondria-dependent apoptotic markers at longer time-points would establish apoptosis-induction property of ConA, indicating its potential as a strong candidate for anti-cancer drug formulation.

CONCLUSION

Further studies are warranted against other types of cancer cells and animal models before its possible human use.

Biologically based therapies are commonly self-prescribed by Brazilian women for the treatment of advanced breast cancer or its symptoms

PURPOSE

Breast cancer (BC) might be associated with loss of function in affected patients, with a direct impact on their quality of life (QOL). Many women with metastatic BC seek relief of symptoms, including the use of complementary and alternative medicine (CAM) to cure cancer. The present study aimed to identify the pattern of CAM used by patients with metastatic BC and to assess the correlation between CAM use and scores on anxiety, depression, and QOL scales.

METHODS

A total of 126 women with metastatic BC were interviewed using four instruments: (1) a questionnaire containing socioeconomic, clinical, and demographic data and CAM use; (2) European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ)-C30; (3) EORTC QLQ-BR23; and (4) the Hospital Anxiety and Depression Scale.

RESULTS

Fifty percent of the participants reported the use of at least one CAM modality. Biologically based practices were the most frequently used to treat BC and/or its symptoms, the most commonly discussed with the oncologists, and one of the CAM categories in which more patients reported a desire to learn more about. The overall use of CAM was not correlated with the scores on the anxiety, depression, and QOL scales. However, analysis of the association of the QOL scores with specific CAM modalities revealed some potential associations (especially for food supplements, art therapy, psychotherapy, and prayer).

CONCLUSIONS

Women with metastatic BC frequently make use of CAM to treat the cancer and/or its symptoms. Biologically based practices seem to be particularly important in Brazil. An association between specific CAM modalities and some QOL domains was suggested, but it needs further confirmation.

Characteristics associated with the use of complementary health approaches among long-term cancer survivors

PURPOSE

This study aims to identify the prevalence and characteristics of long-term adult cancer survivors who use complementary health approaches (CHA).

METHODS

Participants completed the Follow-up Care Use Among Survivors (FOCUS) Survey, a cross-sectional investigation of long-term cancer survivors. The use of CHA and reasons for use were assessed. A multivariable logistic regression model was applied to identify if predisposing, enabling, and need characteristics described in the Complementary and Alternative Medicine Healthcare Model were associated with CHA use in the past year.

RESULTS

Long-term cancer survivors in the study (N = 1,666) were predominately female (62%) and older (mean age = 69.5), with breast, prostate, colorectal, ovarian, and endometrial cancers. Thirty-three percent of survivors used CHA in the past year. Common reasons for CHA use were to relieve stress (28%), treat or prevent cancer (21%), relieve cancer-related symptoms (18%), and deal with another condition (18%). Predisposing (i.e., higher optimism) and need factors (i.e., experienced cancer-related symptoms, ever had depression/anxiety) were significantly associated with CHA (p-values < .05). Enabling factors (i.e., insurance coverage, financial resources) were not.

CONCLUSIONS

Cancer survivors continue to report a high prevalence of recent CHA use more than 5 years after initial diagnosis. Healthcare providers should be aware of increased use of CHA among subgroups of long-term cancer survivors in order to guide safe and optimal use.

Predictors of Use of Complementary and Alternative Medicine by Non-Hodgkin Lymphoma Survivors and Relationship to Quality of Life

Hypotheses. This study hypothesized that non-Hodgkin lymphoma (NHL) patients who used complementary and alternative medicine (CAM) would have higher health-related quality of life (HRQOL) and a greater perceived sense of control than nonusers. However, since CAM may predict HRQOL, and perceived control may be both associated with CAM use as well as being an independent predictor of HRQOL, the authors also sought to test whether perceived control mediated the relationship between CAM use and HRQOL. Study design. This was a cross-sectional study design. NHL survivors diagnosed between June 1, 1998 and August 31, 2001 were selected from the population-based SEER (Surveillance, Epidemiology, and End Results) cancer registry for Los Angeles County and were mailed a survey in 2003 that assessed CAM use and predictors of CAM use. The response rate was 54.8%; 319 provided complete data for analysis. Methods. Categories of CAM were defined according to the National Center for Complementary and Alternative Medicine guidelines. The authors measured survivors’ cancer-related control using the Perceived Personal Control scale, a 4-question scale that was adapted from previously validated scales. HRQOL was measured using the mental component summary and physical component summary scores from the SF-36 v2.0. Bivariate and multivariable logistic and linear regression models were used to assess factors associated with CAM use and the association of CAM use with psychosocial health outcomes, respectively. Results. Sixty-one percent of respondents reported using at least one CAM modality within the past 4 weeks, and 40% did so after excluding personal prayer and support groups. Younger age and higher education were significantly associated with greater CAM use as were higher perception of cancer-related control ( P = .004) and more positive mental functioning ( P = .016). Perception of control significantly mediated the association between CAM use and mental functioning ( P < .001). Conclusions. CAM use may be related to more positive mental health–related quality of life by increasing patients’ perception of perceived control over their health; however, cause and effect cannot be determined. Physicians should be aware that cancer survivors have a need to take an active role in improving their health.