Changing patterns of CAM use among prostate cancer patients two years after diagnosis: Reasons for maintenance or discontinuation

Patients' Experiences of Ending Massage Therapy Care: a Commentary

Patients are best positioned to provide information about their experiences of healthcare services; however, their perspectives are often underutilized. During informal discussions with massage therapists (MTs) and through the authors' own professional experiences, it was noted that there are times when patients decide independently, and without notice, to end the care they are receiving. To date, no research has been published exploring the experiences of patients who choose to discontinue massage therapy care and there is a gap in the quality assurance process of MTs. Lack of understanding of patients' experiences is a missed opportunity to strengthen the therapeutic relationship, ensure patient safety, improve treatment quality, and develop professionally. We recommend researchers explore mixed methods designs, involve patients in the research process, and solicit multiple perspectives when studying patients' experiences of ending massage therapy care.

Factors associated with the use of diet and the use of exercise for prostate cancer by long-term survivors

Objective

To assess the use of diet and the use of exercise for prostate cancer (and/or its treatments’ side effects) by long-term survivors and whether such use is associated with selected socio-demographic, clinical, health-related quality-of-life (HRQOL) and psychological factors.

Design, setting and participants

Population-based cohort study in New South Wales, Australia of prostate cancer survivors aged <70 years at diagnosis and who returned a 10-year follow-up questionnaire.

Methods

Validated instruments assessed patient’s HRQOL and psychological well-being. Poisson regression was used to estimate adjusted relative proportions (RRs) of prostate cancer survivor groups who were currently eating differently (‘using diet’) or exercise differently (‘using exercise’) to help with their prostate cancer.

Results

996 (61.0% of 1634) participants completed the 10-year questionnaire of whom 118 (11.8%; 95%CI[9.8–13.9]) were using diet and 78 (7.8%; 95%CI[6.2–9.5]) were using exercise to help with their prostate cancer. Men were more likely to use diet or use exercise for prostate cancer if they were younger (p-trend = 0.020 for diet, p-trend = 0.045 for exercise), more educated (p-trend<0.001, p-trend = 0.011), support group participants (p-nominal<0.001, p-nominal = 0.005), had higher Gleason score at diagnosis (p-trend<0.001, p-trend = 0.002) and had knowledge of cancer spread (p-nominal = 0.002, p-nominal = 0.001). Use of diet was also associated with receipt of androgen deprivation therapy (RR = 1.59; 95%CI[1.04–2.45]), a greater fear of cancer recurrence (p-trend = 0.010), cognitive avoidance (p-trend = 0.025) and greater perceived control of cancer course (p-trend = 0.014). Use of exercise was also associated with receipt of prostatectomy (RR = 2.02; 95%CI[1.12–3.63]), receipt of androgen deprivation therapy (RR = 2.20; 95%CI[1.34–3.61]) and less satisfaction with medical treatments (p-trend = 0.044).

Conclusions

Few long-term prostate cancer survivors use diet or exercise to help with their prostate cancer. Survivors may benefit from counselling on the scientific evidence supporting healthy eating and regular exercise for improving quality-of-life and cancer-related outcomes.

Use of Chinese Medicine Among Survivors of Nasopharyngeal Carcinoma in Taiwan

Hypotheses. The authors hypothesized that the use of alternative medicine, in the form of Chinese medicine (CM), among patients in the continuing care phase of nasopharyngeal carcinoma (NPC) in Taiwan is higher than the use in a matched control group of noncancer individuals. Study design. This was a case-control study. Methods. Using a population-based claim database, the authors identified 181 long-term survivors of NPC and 905 matched controls. They obtained information on CM use and associated cost as outcome measures. Descriptive analysis and regression models were applied to examine the association between NPC and the outcome measures. Results. The unadjusted CM initiation (34% vs 32%; P = .54), intensity of use (2.15 vs 1.73 visits; P = .37), and cost (US$79 vs US$58; P = .16) were higher for patients in the NPC group than for those in the control group. Regression analyses suggested that the NPC group had significantly more CM visits (1.01; 95% confidence interval = 0.07-1.96), and more than 50% of these visits were related to cancer. Conclusion. The authors confirmed their hypotheses that the use of CM in the continuing care phase by patients with NPC in Taiwan was higher than the use in their matched, noncancer counterparts. These findings suggest that current clinical surveillance strategies for NPC might not meet patients’ physical and emotional needs.

Why consumers maintain complementary and alternative medicine use: a qualitative study

OBJECTIVES

Although research evidence exists to suggest why consumers use complementary and alternative medicine (CAM), there remains a need to distinguish between factors and processes involved in the initial uptake of therapies and those involved in their subsequent maintenance. We therefore conducted a qualitative study to explore and describe consumers' reasons for maintaining or stopping CAM use.

METHODS

This was a qualitative study. We interviewed 46 CAM consumers and 9 CAM practitioners, in two high-street CAM clinics in the UK. The interviews were analyzed thematically using techniques from grounded theory.

RESULTS

Consumers described and evaluated their CAM experiences along four dimensions: interpersonal (e.g., interactions with practitioners), physical (e.g., sensations such as touch or pain during treatment), affective (e.g., empowerment), and cognitive (e.g., beliefs about treatment). They evaluated their experiences in relation to their individual needs and expectations; financial considerations could limit maintenance of CAM use. Practitioners emphasized the effectiveness of treatment and themselves as contributing to consumers maintaining treatment, and recognized the role of financial considerations in decisions to stop CAM use.

CONCLUSIONS

This study suggests that experiences of conventional medicine are of limited importance after the decision to initiate CAM. Experiences of CAM were foremost in our consumers' decisions to maintain or stop specific CAM therapies. Maintenance of CAM could occur even if consumers' experiences were not entirely positive. Our findings provide novel, systematic insights that will be of particular interest to practitioners who want to support consumers as they decide whether to maintain CAM use.

Pushed and Pulled

We used Self-Regulation Theory (SRT) to elaborate and describe cognitive and affective representations presumed to underlie CAM decisions in a sample of 55 men who were using CAM after having received conventional treatment for early-stage, localized prostate cancer. Positive representations of CAM were the strongest predictors of beliefs that CAM was necessary for one's health (a `pulling' effect toward CAM). Nonetheless, negative representations of conventional medicine made an important, though somewhat lesser contribution (a `pushing' effect away from conventional medicine and towards CAM). Our results also indicate preliminarily that affect may be more important than cognition in shaping CAM decisions.