Prevalence of complementary and alternative therapy use by cancer patients undergoing radiation therapy

Perspectives of Complementary and Alternative Medicine use by cancer patients in a regional hospital in North Queensland, Australia

OBJECTIVES

This study aimed to investigate CAMs used, and reasons for and disclosure of this use by cancer patients in a regional hospital in North Queensland, Australia.

METHODS

Patients attending the Day Oncology Unit of the Townsville University Hospital were invited to participate in a self-completed questionnaire or telephone interview regarding perspectives of their CAM use. Data were analysed using descriptive statistics and chi-squared and independent t-tests were performed to allow comparison between the responses by CAM users and non-users.

RESULTS

102 completed questionnaires were used in the analysis, where 40.2 % of respondents were found to be using some form of CAM. Cannabis, magnesium, and massage were the most prominent therapies used, with cannabis use in cancer, not commonly reported in prior literature. The main reasons given for using CAM were to treat symptoms of cancer, side-effects of treatment or to improve general health. Two-thirds of these respondents disclosed their CAM use to health professionals mostly to obtain a professional opinion or due to concerns of interactions with cancer treatment. CAM users were statistically more likely to have used CAM prior to their cancer diagnosis and have lower emotional wellbeing than non-users. Non-CAM users indicated that a lack of knowledge of CAM or concerns regarding interactions with cancer treatment were the most popular reasons for not adopting these therapies.

CONCLUSION

While lower than the averages of previously published CAM use, our study highlights that there is still a significant group of cancer patients in the North Queensland region using CAMs.

Olive Mill Wastewater Inhibits Growth and Proliferation of Cisplatin- and Gemcitabine-Resistant Bladder Cancer Cells In Vitro by Down-Regulating the Akt/mTOR-Signaling Pathway

Bladder cancer patients whose tumors develop resistance to cisplatin-based chemotherapy often turn to natural, plant-derived products. Beneficial effects have been particularly ascribed to polyphenols, although their therapeutic relevance when resistance has developed is not clear. The present study evaluated the anti-tumor potential of polyphenol-rich olive mill wastewater (OMWW) on chemo-sensitive and cisplatin- and gemcitabine-resistant T24, RT112, and TCCSUP bladder cancer cells in vitro. The cells were treated with different dilutions of OMWW, and tumor growth and clone formation were evaluated. Possible mechanisms of action were investigated by evaluating cell cycle phases and cell cycle-regulating proteins. OMWW profoundly inhibited the growth and proliferation of chemo-sensitive as well as gemcitabine- and cisplatin-resistant bladder cancer cells. Depending on the cell line and on gemcitabine- or cisplatin-resistance, OMWW induced cell cycle arrest at different phases. These differing phase arrests were accompanied by differing alterations in the CDK-cyclin axis. Considerable suppression of the Akt-mTOR pathway by OMWW was observed in all three cell lines. Since OMWW blocks the cell cycle through the manipulation of the cyclin-CDK axis and the deactivation of Akt-mTOR signaling, OMWW could become relevant in supporting bladder cancer therapy.

An education on pharmacologically active complementary and alternative medicine and its effects on cancer treatment: literature review

PURPOSE

This literature review examines the provision of an education on pharmacologically active complementary and alternative medicines (CAMs), to people with cancer, their carers and oncology health professionals.

METHODS

A search of the published literature between 2000 and 2020, in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, was conducted. The search retrieved 1121 studies, 1080 were excluded based on their title or abstract and 26 articles were excluded based on their text. One article was retrieved from the reference lists of the included articles and in total fifteen studies met the inclusion criteria. This review utilised Medical Education Research Quality Instrument (MERSQI) to evaluate the quality of the included studies. Four key outcomes were utilised for analysis and recommendations for future education and/or research were generated. The recommendations were graded according to the Strength of Recommendation Taxonomy (SORT).

RESULTS

This review consistently found that people with cancer, their carers and oncology health professionals derived benefit from a pharmacologically active CAM education and recommends that this population receives one. Conversely, the review found many education formats utilised and no consensus on the most successful methods.

CONCLUSION

Future research should examine who a CAM education should be delivered to, what type of delivery platform is most accessible and useful, and the features of the education that most increase CAM knowledge. The popularity of CAMs amongst people with cancer and the potential dangers associated with their use necessitates further research into how best to communicate CAMs to this population.

The Impact of an Evidence-Based Education on Complementary and Alternative Medicine Usage in People with Cancer: Pilot Study

Complementary and alternative medicine (CAM) usage amongst cancer patients is high globally and in Australia. CAM use in cancer care has the ability to increase chemotherapy toxicity or cause sub-therapy due to altered metabolism as well as increase a patient's bleeding risk. Furthering these risks, people with cancer are largely obtaining their CAM use information from non-evidence-based sources. This study aimed to determine whether the implementation of a CAM education influenced decision-making with regard to CAM usage amongst cancer patients. Twenty people with cancer were recruited for participation in this study. The aims of this study were achieved by surveying patients via questionnaire, both prior to and following receiving an evidence-based CAM education, in either or both written or audiovisual format. This exploratory study found, consistent with the literature, that the majority of participants were obtaining their CAM use information from non-evidenced-based sources. Additionally, it found that the participants wanted more CAM use information and that they demonstrated some altered decision-making after receiving evidenced-based information. On the post-educational questionnaire, the number of participants that stated that they would use CAMs decreased by almost 14%, and some participants made CAM use decisions in accordance with the information provided in the resources. Furthermore, a small increase in CAM knowledge was demonstrated, and it was reported that the resource had prompted them to look further into CAM information. Lastly, the participants in this study found the resource to be mostly useful and helpful and preferred the animated video to the written information.

Survival outcomes for breast cancer patients who decline recommended treatment: a propensity score-matched analysis

BACKGROUND

For patients with breast cancer who decline recommended treatments, available data examining survival outcomes are sparse. We compared overall survival and relapse-free survival outcomes between patients with breast cancer who declined recommended primary treatments and those who received recommended primary treatments.

METHODS

Using data from the BreastSurgANZ Quality Audit database, a retrospective cohort study was performed for patients diagnosed with breast carcinoma (stage 0-IV) between 2001 and 2014 who were treated in our integrated cancer centre. A propensity score-matched analysis was performed to compare overall survival and relapse-free survival between patients who either declined or received the standard recommended treatment.

RESULTS

A total of 56/912 (6.1%) patients declined one or more recommended therapies. Five-year overall survival for those who declined or received treatment as recommended was 81.8% versus 88.9% (P = 0.17), respectively. Ten-year survival was 61.3% versus 67.8% (P = 0.22), respectively. For patients who declined treatments, 5-year relapse-free survival was 72.4%, compared to 87.4% for those who received them (P = 0.005). Ten-year relapse-free survival was 61.0% versus 80.6% (P = 0.002), respectively. On adjusted Cox regression analysis, treatment refusal was associated with poorer relapse-free survival (adjusted hazard ratio 2.76 (95% confidence interval 1.52-5.00), P < 0.001).

CONCLUSION

In conclusion, patients who declined recommended treatment for breast cancer had poorer relapse-free survival compared to those who received them. These data may help clinicians assist patients with breast cancer in their decision-making.

Sulforaphane Reduces Prostate Cancer Cell Growth and Proliferation In Vitro by Modulating the Cdk-Cyclin Axis and Expression of the CD44 Variants 4, 5, and 7

Prostate cancer patients whose tumors develop resistance to conventional treatment often turn to natural, plant-derived products, one of which is sulforaphane (SFN). This study was designed to determine whether anti-tumor properties of SFN, identified in other tumor entities, are also evident in cultivated DU145 and PC3 prostate cancer cells. The cells were incubated with SFN (1–20 µM) and tumor cell growth and proliferative activity were evaluated. Having found a considerable anti-growth, anti-proliferative, and anti-clonogenic influence of SFN on both prostate cancer cell lines, further investigation into possible mechanisms of action were performed by evaluating the cell cycle phases and cell-cycle-regulating proteins. SFN induced a cell cycle arrest at the S- and G2/M-phase in both DU145 and PC3 cells. Elevation of histone H3 and H4 acetylation was also evident in both cell lines following SFN exposure. However, alterations occurring in the Cdk-cyclin axis, modification of the p19 and p27 proteins and changes in CD44v4, v5, and v7 expression because of SFN exposure differed in the two cell lines. SFN, therefore, does exert anti-tumor properties on these two prostate cancer cell lines by histone acetylation and altering the intracellular signaling cascade, but not through the same molecular mechanisms.

Complementary and alternative therapy use in a regional radiation oncology treatment centre: Can staff knowledge, views, confidence and documentation be improved?

INTRODUCTION

Complementary and alternative therapies (CATs) are widely used by cancer patients but are infrequently disclosed and documented. This study aimed to improve radiation therapy staff knowledge, confidence, views and documentation of radiation oncology patients' use of CATs.

METHOD

Participants completed a baseline questionnaire regarding their knowledge, confidence, views and documentation relating to patients' CAT use. An intervention was undertaken whereby participants attended an educational session and a CAT screening tool was implemented simultaneously. Participants immediately completed a post-intervention questionnaire and later a 6-month follow-up questionnaire. A patient record audit was conducted to measure the documentation of CAT use pre- and post-intervention.

RESULTS

From baseline to post-intervention, there was a statistically significant shift in staff knowledge and confidence (P = 0.001-0.01). The observed shift was sustained over a 6-month period, (P = 0.453-1.00). Participants' perceived views of CATs did not change as a result of the intervention (P = 0.261-1.000). The post-intervention audit compared to the baseline audit yielded a statistically significant increase in documentation. There was an increase in CAT use mentioned in patient records from 14% (15/108) to 40% (35/88) (P < 0.001).

CONCLUSIONS

The implementation of a screening tool and staff education increased radiation therapy staff knowledge of CATs and increased staff confidence when discussing CAT use with patients. Documentation of CATs in the patient record increased post-intervention. These changes positively affected radiation therapy staff understanding the use of CATs by cancer patients.

Reasons for complementary therapy use by cancer patients, information sources and communication with health professionals

BACKGROUND

Cancer patients are known to commonly use complementary therapies (CT). However, it is emphasized that patients do not share sufficient information with health professionals about this subject and that the subject is ignored in oncology practice. The aim of the study is to assess cancer patients' reasons for using complementary therapy, information resources and communication with health professionals.

METHODS

The study is a descriptive, cross-sectional study. In this study, a questionnaire was used by the researchers. A questionnaire form consisting of 3 parts was used. In the first part of this form, there were questions about the gender, age and educational status of the patients (8 questions). In the second part, there were questions about disease and treatment information (3 questions), and the third part had questions about the use of complementary therapies (9 questions). To determine the use of complementary therapy, patients were asked 'Do you currently use complementary treatment?' (Yes or No). 183 patients included in the study completed the questionnaire about complementary therapies.

RESULTS

In this study, it was determined that 37.7% of the patients were using complementary therapies. The most commonly used complementary therapy was natural products (46.4%). The most common reason for using complementary therapy was to provide support for treatment. Almost half of the cancer patients (48.5%) did not talk about this issue with their physicians, and 41.1% of them did not talk about CT with their nurses. The study found that the most important reason why the patients did not talk about CT was that they were not asked about it by health professionals.

CONCLUSION

This study determined that almost half of patients could not receive information about CT from health professionals. Patients expect physicians and nurses to initiate communication on this subject. Providing healthcare professionals with evidence-based counseling about CT is essential for improving patient safety and patient outcomes.

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.

Open to Exploration? Association of Personality Factors With Complementary Therapy Use After Breast Cancer Treatment

Purpose: Many cancer survivors seek complementary therapies (CTs) to improve their quality of life. While it is well-known that women who are younger, more highly educated, and have higher incomes are more likely to use CTs, individual differences such as personality factors have been largely unexplored as predictors of CT use. Methods: In a secondary analysis of a larger study, 270 women with stage I to III breast cancer completed self-report measures of demographic and illness-related information, personality variables, and use of several different types of CTs. A series of logistic regression models were used to explore whether demographic, illness-related, and personality variables predicted different types of CT use. Results: Prior relationships between education and CT use were replicated. There were no significant relationships between illness-related variables and different types of CT use. Of the 5 personality factors, only openness to experience was a significant predictor of multiple types of CT use. Conclusions: Openness to experience may represent an individual difference variable that predicts CT use among cancer survivors. CTs themselves may represent a form of intellectual curiosity and novelty seeking. Further studies are needed to replicate and examine the generalizability of the relationship between openness to experience and CT use in oncology populations.

Can a peri-rectal hydrogel spaceOAR programme for prostate cancer intensity-modulated radiotherapy be successfully implemented in a regional setting?

INTRODUCTION

The aim of this study was to investigate whether the implementation of a hydrogel spacer (SpaceOAR) programme for patients treated with 81 Gy prostate intensity-modulated radiotherapy (IMRT) in a regional setting can reduce rectal doses and toxicity.

METHODS

In this retrospective study, 125 patients with localised prostate cancer treated between April 2014 (programme commencement) and June 2015 were compared: 65 with SpaceOAR (inserted by five different urologists) and 60 patients treated over the same time period without SpaceOAR. Patients were treated with 81 Gy in 45Fx of IMRT over 9 weeks. Planning aims included restricting rectal doses to V40 Gy < 35%, V65 Gy < 17%, V75 Gy < 10%. Acute toxicity was assessed weekly during radiotherapy and at 12 weeks.

RESULTS

Rectal volume parameters were all significantly lower in the SpaceOAR group, with an associated reduction in acute diarrhoea (13.8% vs 31.7%). There were no significant differences in the very low rates of acute and late faecal incontinence or proctitis, however, there was a trend towards increased haemorrhoid rate in the SpaceOAR group (11.7% vs 3.1%, P = 0.09).

CONCLUSION

A SpaceOAR programme in a regional setting with urologists performing low volumes of insertions (<1 per month on average) is of clinical benefit, and was associated with significantly lower radiation doses to the rectum and lower rates of acute diarrhoea.

Use of non-conventional medicine two years after cancer diagnosis in France: evidence from the VICAN survey

PURPOSE

The purpose of this study was to assess the use of non-conventional medicine (NCM) in a representative sample of French patients 2 years after cancer diagnosis.

METHODS

The study was based on data obtained in the VICAN survey (2012) on a representative sample of 4349 patients 2 years after cancer diagnosis. Self-reported data were collected at telephone interviews with patients. The questionnaire addressed the various types of non-conventional treatments used at the time of the survey.

RESULTS

Among the participants, 16.4% reported that they used NCM, and 45.3% of this group had not used NCM before cancer diagnosis (new NCM users). Commonly, NCMs used were homeopathy (64.0%), acupuncture (22.1%), osteopathy (15.1%), herbal medicine (8.1%), diets (7.3%) and energy therapies (5.8%). NCM use was found to be significantly associated with younger age, female gender and a higher education level. Previous NCM use was significantly associated with having a managerial occupation and an expected 5-year survival rate ≥80% at diagnosis; recent NCM use was associated with cancer progression since diagnosis, impaired quality of life and higher pain reports.

CONCLUSION

This is the first study on NCM use 2 years after cancer diagnosis in France. In nearly half of the NCM users, cancer diagnosis was one of the main factors which incited patients to use NCM. Apart from the NCM users' socioeconomic profile, the present results show that impaired health was a decisive factor: opting for unconventional approaches was therefore a pragmatic response to needs which conventional medicine fails to meet during the course of the disease.

IMPLICATIONS FOR CANCER SURVIVORS

Better information of patients and caregivers is needed to allow access to these therapies to a larger population of survivors.

Complementary medicine use by the Australian population: a critical mixed studies systematic review of utilisation, perceptions and factors associated with use

BACKGROUND

There is increasing evidence that complementary medicine (CM) services are being used by a substantial proportion of the Australian population and this topic has attracted keen interest from primary health care providers and policy makers. This article outlines the first summative critical review of the predictors of CM use in Australia as well as the characteristics and perceptions of Australian CM users over the last 14 years.

METHODS

A literature search was conducted to ascertain original research from 2000 to 2014 in the AMED; CINAHL; and PubMed databases. Selected articles were subject to a critical appraisal analysis to identify the quality of the article. The search was confined to peer reviewed original articles published in English which identified the nature of CM services use in Australia.

RESULTS

The findings indicate a correlation between CM users and gender, with reports of a higher rate of use from females compared to males. Female CM users are more likely to be middle-aged with a higher education and higher annual income in comparison to female non-CM users. An association between resident location and use of CM disciplines was also identified with reports of rural residents utilising manual therapies more frequently compared to urban residents. CM users are more likely to seek CM services for a range of chronic conditions including diseases identified as National Health Priority Areas by the Australian Government.

CONCLUSIONS

This article provides the first comprehensive review examining the nature of CM use in Australia. The review findings offer important insights into the characteristics and features of CM use in Australia and provide insights for national and regional primary health care initiatives and of interest to medical doctors, allied health professionals, CM practitioners, researchers and policy makers.

From self-care for healthy people to self-management for cancer patients with cancer portals

Self-care to prevent cancer and self-management to cope with the disease are two discrete effective mechanisms for improving of control and management of neoplasia. Both them have certain strategies and practices. Often the two are used interchangeably despite their different approaches. Strategies of self-care usually refer to prevention at different levels include primary, secondary and tertiary. In contrast, strategies of self-management are related to management and alleviation of unpleasant cancer-related symptoms and treatment-related side effects for improving the quality of life of cancer survivors. Successful promoting of self-care and self-management strategies need people and survivor empowerment. Within this context, innovative approaches open a new window. In this paper after a brief review of related strategies and practices, we provide an explanation of how cancer portals may play an important role in the empowerment process and what are key potentials for implementing of self- care and self-management strategies for cancer.

From Disappointment to Holistic Ideals: A Qualitative Study on Motives and Experiences of Using Complementary and Alternative Medicine in Sweden

Background

Recent studies indicate increased use of complementary and alternative medicine (CAM) in western societies, to ameliorate health problems. Even if there is substantial research on general patterns of use, there is limited knowledge on individual motives. This study contributes to a qualitative understanding of experiences of choosing and using CAM.

Design and methods

This study consists of in-depth interviews with 10 CAM users in Sweden. The participants represent different backgrounds and experiences of using CAM. The interviews have been analysed in accordance with content analysis.

Results

In analysing experiences of choosing and using CAM four main themes were identified: frustration and critique, values and ideology, individual responsibility, and combining treatments. In general, the participants were highly reflexive on issues concerning their health. They highlighted their own role and responsibility, combined a variety of treatments, and continuously dealt with questions on risks, even if they had relatively different approaches to if and when to use CAM. The results also show that motives may change over time. Even if initial choices were closely related to frustration and critique of conventional treatments (for example, by perceiving conventional health care as limited, not receiving proper diagnoses, or being critical to conventional drugs) was long-term use motivated by ideological characteristics of CAM (such as holistic and individualized treatments, and extensive interaction with practitioners).

Conclusions

Four main themes, concerning experiences of choosing and using CAM were identified. This study also supports the idea that initial motives for choosing CAM may differ from those explaining long-term use.