LiteratureWatch

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.

Complementary and alternative medicine use and breast cancer prognosis: a pooled analysis of four population-based studies of breast cancer survivors

BACKGROUND

Complementary and alternative medicine (CAM) use is common among breast cancer survivors, but little is known about its impact on survival.

METHODS

We pooled data from four studies conducted in Hawaii in 1994-2003 and linked to the Hawaii Tumor Registry to obtain long-term follow-up information. The effect of CAM use on the risk of breast cancer-specific death was evaluated using Cox regression.

RESULTS

The analysis included 1443 women with a median follow-up of 11.8 years who had a primary diagnosis of in situ and invasive breast cancer. The majority were Japanese American (36.4%), followed by white (26.9%), Native Hawaiian (15.9%), other (10.6%), and Filipino (10.3%). CAM use was highest in Native Hawaiians (60.7%) and lowest in Japanese American (47.8%) women. Overall, any use of CAM was not associated with the risk of breast cancer-specific death (hazard ratio [HR] 1.47, confidence interval [CI] 0.91-2.36) or all-cause death (HR 0.82, 95% CI 0.63-1.06). However, energy medicine was associated with an increased risk of breast cancer-specific death (HR 3.19, 95% CI 1.06-8.52). When evaluating CAM use within ethnic subgroups, Filipino women who used CAM were at increased risk of breast cancer death (HR 6.84, 95% CI 1.23-38.19).

CONCLUSIONS

Our findings suggest that, overall, CAM is not associated with breast cancer-specific death but that the effects of specific CAM modalities and possible differences by ethnicity should be considered in future studies.

Experience of proximate spiritual healing in women with breast cancer, who are receiving long-term hormonal therapy

BACKGROUND

This paper presents the research protocol for a pragmatic study of the experience of spiritual healing. This unique qualitative study seeks to identify any qualitative benefits of hands-on or proximate spiritual healing for women experiencing adverse reactions to hormonal treatments. Healing will be administered as adjuvant therapy for the long-term management of breast cancer.

DESIGN

A purposive sample of up to 20 women who have completed their initial treatments at least 6 months previously will be recruited through the Oncology Department at Southampton General Hospital. The study will take place at the Wellcome Trust Clinical Research Facility within Southampton General Hospital, where spiritual healing will be provided by healers who are National Federation of Spiritual Healers registered. Patients will be offered up to 10 weekly healing sessions.

OUTCOME

Patients will be asked to keep a daily log noting any changes they have noticed during or after the healing sessions and their attributions of these. Audio recorded in-depth interviews will be carried out after completion of the final healing. Participants will also be invited to attend focus group meetings to discuss any effects of healing. Data will be analyzed initially using an ethnographic approach allowing further analysis using other appropriate qualitative methodologies. Depending on the findings, this study will also form the preliminary stage of a further study to develop and evaluate a healing-specific questionnaire.

Complementary and Alternative Medicine Use Among Breast Cancer Survivors

OBJECTIVES

The use complementary and alternative medicine (CAM) by patients with breast cancer and survivors has been widely studied. However, scant research has focused on the degree to which CAM activity is related to the cancer experience, as opposed to use for other reasons. The study objective was to examine the use of CAM in a sample of patients with breast cancer. Additional objectives were to measure associations between psychosocial and medical factors and CAM use both related and unrelated to a breast cancer diagnosis.

DESIGN

Breast cancer survivors (N=115) at least 1 year beyond active medical treatment were recruited during routine clinic visits. Survey data collected via structured telephone interview focused on CAM use, motivations for use, perceived risk of cancer recurrence, and breast cancer-specific and general measures of anxiety.

RESULTS

Sixty-nine percent (69%) of participants reported use of CAM. Of CAM users, 73% reported initiating or changing CAM activity specifically because of their cancer diagnosis. Patients engaging in CAM for cancer-related reasons were younger (p<0.001) and had been diagnosed with cancer at a younger age (p<0.01). Although overall anxiety scores in this sample were not significantly elevated, higher trait anxiety was associated with CAM use related to one's cancer diagnosis.

CONCLUSIONS

Rate of CAM use was high, with the majority of CAM users associating that activity with their breast cancer. Anxiety levels varied between nonusers, CAM users for cancer, and CAM users for other reasons, with highest trait anxiety among those who associate their CAM use with cancer. Assessing motivations for CAM use may be important in future examinations of the relationship between CAM use and quality of life among breast cancer survivors.

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

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

Acupuncture use in the United States: findings from the National Health Interview Survey

OBJECTIVE

Acupuncture has become an important provider-based complementary and alternative medicine (CAM) treatment. To improve understanding of its role in personal health care, an analysis of national data was conducted to examine user sociodemographics, conditions treated, and the relationship of use with conventional Western medical care.

DESIGN

A nationally representative cross-sectional survey.

SETTING

The 2002 National Health Interview Survey (NHIS), conducted in all 50 states and the District of Columbia.

PARTICIPANTS

Thirty-one-thousand and forty-four (31,044) adults who completed the NHIS Sample Adult Core.

OUTCOME MEASURES

The primary outcome measure was recent use of acupuncture, defined as use within the previous 12 months.

RESULTS

In the 2002 NHIS sample, 4.1% of the respondents reported lifetime use, and 1.1% (representing 2.13 million Americans) reported recent use of acupuncture. Recent use (n = 327) was positively associated with being an Asian female, living in the West or Northeast, having poorer self-reported health status, a higher level of education, and being an ex-smoker. Among recent users, the most typical treatment regimen was two to four treatments (34.5%), with musculoskeletal complaints being the most frequently reported conditions, led by back pain (34.0%). Reports of perceived benefit were generally high. Respondents indicated that acupuncture was used both as an alternative and as a complementary therapy. A reasonable number also reported being referred to acupuncture by a conventional medical professional (25.3%). The cross-sectional nature of the data precluded analysis of transitions in health care use (between conventional and CAM treatments) over time.

CONCLUSIONS

Utilization of acupuncture was somewhat lower than expected given its significant national and international recognition and its visibility in the media. This may in part be a function of provider availability and cultural factors.

Levels of Commitment: Exploring Complementary Therapy Use by Women with Breast Cancer

OBJECTIVES

Previous research on complementary therapy use in populations of patients with breast cancer has failed to differentiate among the different types of therapies and utilization patterns, resulting in wide discrepancies in prevalence rates. The purpose of this study was to develop more refined and rigorous estimates of the prevalence of complementary therapy use in women with breast cancer and their level of commitment to complementary therapy. DESIGN AND SAMPLE/SETTING: Using a cross-sectional, retrospective survey design, a random sample of 334 women with breast cancer was drawn from a Canadian provincial cancer registry. Using an intensive therapy inventory, women were asked to indicate the therapies and practices they had used since cancer diagnosis, frequency of use, amount of effort associated with using each therapy, and financial cost of therapy use.

RESULTS

A substantial proportion of women with breast cancer were found to be using complementary therapies, with between 19.5% (most conservative estimate) and 79.9% (liberal estimate) of the women reporting the use of at least one complementary therapy following diagnosis. While the majority of therapies were used on a daily basis, a minimal amount of effort and finances was expended on complementary therapy use. Using two-way cluster analysis, two homogenous groups of complementary therapy users were identified based on level of commitment to complementary therapy use. Women with a low commitment to complementary therapy use comprised 73.9% of the sample and were more likely to be older and report less education than women with a moderate-to-high commitment to complementary therapy use.

CONCLUSIONS

The use of complementary therapies by women with breast cancer warrants more precise measurement to accurately capture the types of complementary therapies used and the level of commitment to complementary therapy use. The findings of this study point to the value of the concept of commitment in identifying individuals willing to commit substantial time, energy and financial resources to complementary therapy use.

Coping in women with breast cancer in complementary and conventional care over 5 years measured by the mental adjustment to cancer scale

OBJECTIVE

Many patients with cancer, women more often than men, use complementary and alternative medicine (CAM) and care. Our aim was to examine coping over 5 years (November 1995 to January 1999) in two samples of women with breast cancer who were treated with anthroposophic care or conventional medical treatment. The present study is part of a larger study of the outcome of anthroposophic care for women with breast cancer.

DESIGN

A nonrandomized controlled trial design was used with individual matching and repeated measurements on six occasions (at admission, 1 month, 3 months, 6 months, 1 year, and 5 years). The matching was based on the following variables: stage of disease at entry, age, treatment during the 3 months before entering the study, and prognosis.

SETTING

An anthroposophic hospital and conventional hospitals in Sweden.

SUBJECTS

Sixty (60) women treated with anthroposophic medicine and 60 women from an oncology outpatient department participated. Forty-nine (49) women in anthroposophic care and 51 in the outpatient group survived 1 year; 26 women in anthroposophic care and 31 in the outpatient group survived 5 years.

INTERVENTION

An anthroposophic care program.

OUTCOME MEASURE

Coping was measured using the Mental Adjustment to Cancer scale. Repeat measures of analysis of variance (ANOVA) were used for within-group comparisons, and effect size (ES) was used for between-group comparisons.

RESULTS

The women in anthroposophic care showed more passive and anxious coping on admission, but this decreased over time. In the women in anthroposophic care, there were small ES improvements in fighting spirit and passive, anxious coping at 4 of the measured timepoints compared to admission.

CONCLUSION

The choice of anthroposophic care could be seen as a possible way to cope with emotional distress in this group of women with breast cancer.