Evaluating the impact of cancer on complementary and alternative medicine use, distress and health related QoL among Australian women: a prospective longitudinal investigation

Use of Complementary and Alternative Medicine and Its Relationship with Health-Related Quality of Life (HRQOL) in Patients with Type 2 Diabetes Mellitus

The present study investigated the use of complementary and alternative medicine (CAM) and its relationship with health-related quality of life (HRQOL) in patients with type 2 diabetes mellitus. A total of 421 patients with type 2 diabetes mellitus who completely met the inclusion criteria, aged 67.3 ± 12.8 years, among 622 outpatients were recruited in this cross-sectional study. We examined the use of CAM, such as supplements, Kampo, acupuncture, and yoga. HRQOL was assessed by EuroQOL. A total of 161 patients (38.2%) with type 2 diabetes mellitus used some type of CAM. The use of supplements and/or health foods was the highest among CAM users (112 subjects, 26.6%). HRQOL was significantly lower in patients who used some CAM (0.829 ± 0.221) than in those without any CAM use (0.881 ± 0.189), even after adjustments for confounding factors [F(1, 414) = 2.530, p = 0.014]. Proper information on CAM is needed for patients with type 2 diabetes mellitus.

Use of Complementary and Alternative Medicine (CAM) in Patients With Colorectal Cancer

This study was conducted to analyze the relationship between cancer-related stress and the types of complementary and alternative medicine (CAM) used by subjects diagnosed with colorectal cancer. The number of study subjects was 142, and for data analysis, descriptive statistics, t-test, χ2 test, logistic regression procedures were performed. Of the subjects, 114 were CAM users, who accounted for 79.6%. When it came to using CAM, 82 (72.6%) said they did "to prevent cancer recurrence." The most popular reason for not using CAM was "to focus on treatment as instructed by the doctor," with 22 (75.8%) respondents selecting the answer. Of those who used CAM, 79 (55.6%) said they took "dietary supplements," followed by 65 (45.8%) who picked "vitamins and minerals." Regarding CAM usage, ginger, aloe, swimming, and walking had the highest satisfaction (4.25 ± 0.71). The cancer-related stress of subjects who use CAM (18.21 ± 15.37) was higher than that of subjects who did not use CAM (10.11 ± 12.08). Logistic regression analysis determined that cancer-related stress were factors significantly associated with CAM use. Patients using CAM had higher cancer-related stress, suggesting that stress on cancer increased CAM interest. Safe and reliable CAM information and standardized recommendations should be provided to cancer survivors. We propose the development of training programs for CAM to improve communication between medical staff and patients and to protect patients.

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.

Use of complementary and alternative medicine and quality of life of cancer patients who received chemotherapy in Turkey

OBJECTIVES

This study aims to evaluate the frequency of use of CAM therapies among cancer patients, the types of CAM therapies they used, the demographic and clinical factors affecting their tendency to use CAM therapies, and the difference between quality of life of CAM user and non-user patients.

DESIGN

This cross-sectional study was carried out between March and June 2016 in an education and research hospital located in Mugla, Turkey. A CAM use questionnaire, the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire (EORTC QLQ-C30 version 3.0) and the Nightingale Symptom Assessment Scale (N-SAS) were administered to 211 patients.

RESULTS

Among all the participating patients, 46.4% were CAM users. The most commonly used CAM therapy was herbal products. The rate of CAM use was higher among the patients with a low education level (P = 0.004). No statistically significant difference was found between the quality-of-life scores of the CAM user and non-user patients.

CONCLUSION

Almost half of the cancer patients used CAM therapy, with the most commonly used CAM therapy being herbal products. Doctors/nurses should assess patients in terms of the CAM therapies they use to determine their possible side effects and drug interactions. Further research should be performed to determine the relationship between CAM therapy and quality of life.

Cancer and Complementary Therapies: Current Trends in Survivors' Interest and Use

Background. Cancer survivors use complementary therapies (CTs) for a variety of reasons; however, with interest and use reportedly on the rise and a widening range of products and practices available, there is a need to establish trends in and drivers of interest. We aimed to determine (1) frequencies of use, level of interest, and barriers for 30 specific CTs and (2) whether physical symptoms, perceived stress (PS), or spiritual well-being were related to interest levels. Method. A total of 212 cancer outpatients were surveyed at the Tom Baker Cancer Centre in Calgary, Canada. Results. Overall, up to 75% of survivors already used some form of CTs since their diagnosis. The most highly used were the following: vitamins B12 and D, multivitamins, calcium, and breathing and relaxation exercises. Those who had not used CTs indicated highest interest in massage, vitamin B12, breathing and relaxation, mindfulness-based stress reduction, and antioxidants. The most frequently reported barriers for all CTs were not knowing enough about what a therapy was and not having enough evidence on whether it worked. High PS predicted higher interest for all CTs, but spirituality was not significantly related to any. Physical symptoms, anxiety, and depression were significant predictors of interest for some CTs. Conclusion. These findings provide a blueprint for future clinical efficacy trials and highlight the need for clinical practice guidelines.

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.

Stress increases the risk of type 2 diabetes onset in women: A 12-year longitudinal study using causal modelling

Background

Type 2 diabetes is associated with significant morbidity and mortality. Modifiable risk factors have been found to contribute up to 60% of type 2 diabetes risk. However, type 2 diabetes continues to rise despite implementation of interventions based on traditional risk factors. There is a clear need to identify additional risk factors for chronic disease prevention. The aim of this study was to examine the relationship between perceived stress and type 2 diabetes onset, and partition the estimates into direct and indirect effects.

Methods and findings

Women born in 1946–1951 (n = 12,844) completed surveys for the Australian Longitudinal Study on Women’s Health in 1998, 2001, 2004, 2007 and 2010. The total causal effect was estimated using logistic regression and marginal structural modelling. Controlled direct effects were estimated through conditioning in the regression model. A graded association was found between perceived stress and all mediators in the multivariate time lag analyses. A significant association was found between hypertension, as well as physical activity and body mass index, and diabetes, but not smoking or diet quality. Moderate/high stress levels were associated with a 2.3-fold increase in the odds of diabetes three years later, for the total estimated effect. Results were only slightly attenuated when the direct and indirect effects of perceived stress on diabetes were partitioned, with the mediators only explaining 10–20% of the excess variation in diabetes.

Conclusions

Perceived stress is a strong risk factor for type 2 diabetes. The majority of the effect estimate of stress on diabetes risk is not mediated by the traditional risk factors of hypertension, physical activity, smoking, diet quality, and body mass index. This gives a new pathway for diabetes prevention trials and clinical practice.

Understanding the Attitudes of Patients with Cancer Toward Complementary and Alternative Therapies

BACKGROUND

The high prevalence of complementary and alternative medicine (CAM) use among patients with cancer can be explained by reasons such as growing scientific evidence and improved regulation. However, subjective considerations are also relevant for practicing CAM and perceiving its effectiveness. The current study aimed at qualitatively estimating patients' prior beliefs and expectations, as well as their level of satisfaction after the treatment.

PATIENTS AND METHODS

Patients with cancer who received six weekly sessions of CAM during their oncologic treatments participated in the study. They detailed their prior expectations and their level of posttreatment satisfaction. The open-ended answers were analyzed using interpretative phenomenological analysis. In addition, the contents before and after the intervention were compared.

RESULTS

Over a 2-year period, 163 patients entered the study, 135 of whom completed all six CAM sessions. The content analysis of the pretreatment expectations revealed four main categories: emotional, physical, external, and aspects related to the practice of CAM. After the intervention, patients referred to the therapeutic encounter as a significant aspect, in addition to the emotional and physical ones.

CONCLUSION

CAM sessions encouraged emotional and relational aspects in patients' perspectives, which may be highly relevant for their coping process. Encouraging personal motives may increase treatment efficacy and ensure optimal use of health care resources.

A longitudinal analysis of self-prescribed complementary and alternative medicine use by a nationally representative sample of 19,783 Australian women, 2006-2010

BACKGROUND

Complementary and alternative medicine (CAM) use is increasingly popular amongst general populations around the world with women constituting substantial CAM users. However, self-prescribed CAM use does raise potential safety concerns and so it is important to identify those risk factors associated with self-prescribed CAM use.

METHODS

Data was obtained from the Australian Longitudinal Study on Women's Health (ALSWH). Longitudinal data analyses were conducted on questionnaire data from the 1973-78 cohort (n=9,145) and the 1946-51 cohort (n=10,638), collected over the period 2006-2010.

RESULTS

In the 1973-78 cohort, use of self-prescribed CAM was 73.2% in 2006 and 75.3% in 2009. For the 1946-51 cohort, use of self-prescribed CAM was 73.9% in 2007 and 74.7% in 2010. There were similar levels of use of individual self-prescribed CAM, with the exception that the use of herbal medicine was much higher among the 1946-51 cohort (20% vs. 27%). There was a substantial increase over three years in the use of vitamins/minerals in both cohorts (21% and 19%, respectively). In contrast, there was a considerable decline over three years in use of aromatherapy oils in both cohorts (34% and 28%, respectively).

CONCLUSION

Self-prescribed CAM use is popular amongst women in Australia and it is important that conventional practitioners providing women's health care be cognizant of such use amongst their patients. In order to ensure effective practice, there is a need for further research to explore women's decision-making and experiences around self-prescribed CAM use.

Complementary and Alternative Medicine Use in Cancer Patients in Rural Australia

Aim. Numerous studies have demonstrated the high prevalence of complementary and alternative medicine (CAM) use in metropolitan cancer cohorts but few have been conducted in regional and remote populations. This study aimed to investigate the trends and regional variations in CAM use by cancer patients at a regional cancer care center in Toowoomba, South East Queensland, Australia. Methods. All English-speaking adult cancer patients attending the regional cancer care center were invited to participate. Eligible patients were provided a self-administered questionnaire that was developed based on published surveys. Ethics approval was obtained. Results. Overall 142 patients completed the questionnaire and 68% were currently or had previously used at least one form of CAM. CAM users and nonusers did not differ significantly by region, age, gender, time since diagnosis, income, town size, treatment intent, or metastases. CAM users were more likely to have a higher level of education. Concurrent CAM use with conventional treatment was reported by approximately half of respondents. The most common reason for CAM use was “to improve general physical well-being.” The most common sources of CAM information were family (31%) and friends (29%). Disclosure of CAM use to either the general practitioner or specialist was reported by 46% and 33% of patients, respectively. The most common reason for nondisclosure was “doctor never asked.” Conclusion. This study supports previous research that CAM use is as common in regional and remote areas as metropolitan areas. Nondisclosure of CAM use to health professionals was common. Future research needs to focus on strategies to improve communication between patients and health professionals about the use of CAM.

Effectiveness of an additional individualized multi-component complementary medicine treatment on health-related quality of life in breast cancer patients: a pragmatic randomized trial

The aim of this study was to evaluate the effectiveness of an additional, individualized, multi-component complementary medicine treatment offered to breast cancer patients at the Merano Hospital (South Tyrol) on health-related quality of life compared to patients receiving usual care only. A randomized pragmatic trial with two parallel arms was performed. Women with confirmed diagnoses of breast cancer were randomized (stratified by usual care treatment) to receive individualized complementary medicine (CM group) or usual care alone (usual care group). Both groups were allowed to use conventional treatment for breast cancer. Primary endpoint was the breast cancer-related quality of life FACT-B score at 6 months. For statistical analysis, we used analysis of covariance (with factors treatment, stratum, and baseline FACT-B score) and imputed missing FACT-B scores at 6 months with regression-based multiple imputation. A total of 275 patients were randomized between April 2011 and March 2012 to the CM group (n = 136, 56.3 ± 10.9 years of age) or the usual care group (n = 139, 56.0 ± 11.0). After 6 months from randomization, adjusted means for health-related quality of life were higher in the CM group (FACT-B score 107.9; 95 % CI 104.1-111.7) compared to the usual care group (102.2; 98.5-105.9) with an adjusted FACT-B score difference between groups of 5.7 (2.6-8.7, p < 0.001). Thus, an additional individualized and complex complementary medicine intervention improved quality of life of breast cancer patients compared to usual care alone. Further studies evaluating specific effects of treatment components should follow to optimize the treatment of breast cancer patients.

Changes in complementary and alternative medicine use across cancer treatment and relationship to stress, mood, and quality of life

OBJECTIVES

Complementary and alternative medicine (CAM) use is prevalent, but specific use of CAM across cancer treatment is underinvestigated. The objectives of this study were to assess changes in CAM use across cancer treatment; specific reasons for and satisfaction with specific types of CAM used; and associations of CAM use with stress, mood, and quality of life (QOL) in women with newly diagnosed breast cancer.

DESIGN AND SETTING

Seventy-seven women with early-stage breast cancer who underwent active cancer treatment participated in the study. Data were collected three times: shortly after cancer diagnosis and 2 months and 6 months after the start of adjuvant cancer therapy.

OUTCOME MEASURES

CAM Questionnaire, Impact of Event Scale (stress), Profile of Mood State (mood), and Functional Assessment of Cancer Therapy-Breast Cancer (QOL).

RESULTS

Mean age was 52.4 years, and 94%-97% of women used on average five to six CAMs across three time points. Women largely started CAM use before cancer diagnosis and continued across cancer treatment. The five most common CAMs were prayer (88.3%), multivitamin use, massage, and vitamins E and C, followed by music, meditation, green tea, chiropractic care, and vitamin A, with little changes in types of CAM use across cancer treatment. Satisfaction was high, and satisfaction with prayer was the highest. Prayer, meditation, and music were used specifically for a feeling of control, whereas vitamins were used to improve the immune system, showing clear patterns. Stress, mood disturbance, and QOL declined significantly over time, p<0.001-0.04, but the number of CAMs used was unrelated to these variables.

CONCLUSIONS

CAM use was highly prevalent with multiple CAMs and continued throughout cancer treatment. Prayer was the most common CAM; it had the highest satisfaction rating and the perception of being most helpful. The effect of long-term CAM use requires further investigation on psychological and biobehavioral outcomes with consideration of demographic and clinical characteristics.

Australian men with cancer practice complementary therapies (CTs) as a coping strategy

OBJECTIVE

The aim of this study was to explore how and why Australian men with cancer practice complementary therapies (CTs) and how their significant others (SOs) contribute to the regular uptake of CTs.

METHODS

This qualitative study employed semi-structured interviews with 26 male cancer patients and 24 SOs. Participants were purposefully sampled from a preceding Australian survey investigating the use of CTs in men with cancer (94% response rate and 86% consent rate for follow-up interview). Interviews were conducted in a metropolitan location, and the 43 interview transcripts were analyzed thematically.

RESULTS

Three core themes were identified: men used CTs as (a) problem-focused coping (e.g., diet modification), (b) emotion-focused coping (e.g., meditation), and (c) meaning-based coping (e.g., prayer). Practicing CTs helped men to cope with physical, emotional, and spiritual concerns, although some men spoke of difficulties with practicing meditation to regulate their emotions. SOs were supportive of men's coping strategies but were only rarely involved in men's emotion-focused coping.

CONCLUSIONS

Complementary therapies have the potential to facilitate coping with cancer, independent of any measurable physiological benefit. Our findings suggest that when clinicians engage in conversations about CTs use, they should consider the type of coping strategy employed by their patient. Such information may enhance the efficacy of some interventions (e.g., meditation) and also provide for an opportunity to discuss patients' expectations concerning CTs.

The influence of perceived stress on the onset of arthritis in women: findings from the Australian Longitudinal Study on women's health

BACKGROUND

Psychosocial factors are considered as risk factors for some chronic diseases. A paucity of research exists surrounding the role of perceived stress in arthritis onset.

PURPOSE

Perceived stress as a risk factor for arthritis development was explored in an ageing cohort of Australian women.

METHODS

This study focused on 12,202 women from the 1946-1951 cohort who completed the Australian Longitudinal Study on Women's Health surveys in 2001, 2004 and 2007. Longitudinal associations were modelled, with and without a time lag.

RESULTS

Findings from the multivariate time lag modelling, excluding women with persistent joint pain, revealed that perceived stress predicted the onset of arthritis, with women experiencing minimal and moderate/high stress levels having a 1.7 and 2.4 times greater odds of developing arthritis 3 years later, respectively (p's < 0.001).

CONCLUSION

Chronically perceiving life as stressful is detrimental to future health. The findings provide support for perceived stress to be considered alongside other modifiable risk factors.