Use of CAM among cancer patients : Results of a regional survey in Sweden

Feelings of guilt among cancer patients and the usage of complementary or alternative medicine - A cross-sectional survey

OBJECTIVES

This study aimed to investigate the influence of feelings of guilt among cancer patients on their health behavior, with a specific focus on the use of complementary and alternative medicine (CAM).

METHODS

A multicentric cross-sectional study was conducted, involving 162 oncological patients, assessing sociodemographic variables, feelings of guilt, patient activation, self-efficacy, and CAM usage. The Shame-Guilt-Scale was employed to measure guilt, with subscales including punitive guilt, self-criticism (actions), moral perfectionism, and empathy-reparation. To assess patient activation and self-efficacy, we used the German Version of the Patient Activation Measure 13 and the Short Scale for Measuring General Safe-efficacy Beliefs, respectively. To evaluate CAM-usage, we used a standardized instrument from the working group Prevention and Integrative Oncology of the German Cancer Society. Statistical analyses, including regression models, were employed to examine potential associations.

RESULTS

Female gender was associated with more frequent CAM usage. Regarding holistic and mind-body-methods, younger patients more often used these methods. No significant association was found between feelings of guilt and CAM usage. Patients experienced guilt most strongly related to empathy and reparation for their own actions.

SIGNIFICANCE OF RESULTS

Our results do not support the hypothesis of a direct link between guilt and CAM usage. Guilt may be an important aspect in psychological support for cancer patients, yet, with respect to counselling on CAM, it does not play an important part to understand patients' motivations.

Over 40% of cancer patients use complementary and alternative medications while receiving anticancer treatment

BACKGROUND

The use of complementary and alternative medications (CAM) is popular among cancer patients. CAM includes vitamins, minerals, phytotherapy, homeopathy, nutritional supplements and probiotics. CAM use may lead to unwanted risks by interacting with anticancer drugs; therefore, it is important for healthcare providers to be aware of CAM use by their patients. This article describes the prevalence and potential risk of CAM use in an adult Dutch cancer population. This is the first study in which CAM use was investigated using medication reconciliation.

METHODS

A descriptive, observational study was conducted at Amsterdam UMC between August 2021 and July 2022. Data regarding the use of CAM was obtained by medication reconciliation reviews with inpatients and outpatients with cancer who received systemic anticancer treatment. Acquired data were evaluated by the research team, and the risks of interactions were classified into relevant, potential, unknown or no interaction. Ultimately, patient-specific recommendations on the use of CAM were provided.

RESULTS

Of the 100 included patients, 73% used CAM during the past year and 41% used CAM actively while receiving anticancer treatment. The most common CAM were vitamins and multivitamins (both 28%). Some 10% of CAM were classified as having a relevant interaction with one or more concurrently used anticancer drugs. No association between age or gender and CAM use was found, while outpatients used significantly more CAM than inpatients (72.7% vs 32.1%; p=0.001). Patients received personalised advice from the hospital pharmacy about their CAM use.

CONCLUSIONS

More than 40% of oncology patients investigated in this study used CAM while receiving anticancer treatment, leading to unwanted risks. This prevalence is higher than reported in other studies, possibly due to the use of medication reconciliation interviews. To guarantee safety and efficacy of anticancer treatment, communication between healthcare professionals and patients about CAM is essential.

CAMONCO 2: Results From a Randomized Controlled Trial Comparing Open Dialogue About Complementary Alternative Medicine and Standard Care on Patients' Quality of Life

PURPOSE

This randomized controlled trial aimed to investigate the impact of OD-CAM on patients' quality of life (QoL), emotional well-being, decision regret, and survival. Patients undergoing antineoplastic treatment were randomly allocated to receive standard care (SC) plus OD-CAM or SC alone. The primary end point was patient-reported QoL 8 weeks after enrollment. Secondary end points included patient-reported QoL, anxiety, depression, and decision regret at 12 and 24 weeks after enrollment and overall survival at 52 weeks after enrollment.

MATERIALS AND METHODS

Patient-reported outcomes were evaluated using the European Organisation for Research and Treatment of Cancer Computer Adaptive Test Core questionnaire, the Hospital Anxiety and Depression questionnaire, and the Decision Regret Scale.

RESULTS

A total of 210 patients were equally randomly assigned, leaving 105 patients in each group. No significant differences were observed in QoL, well-being, decision regret, or survival between the groups.

CONCLUSION

OD-CAM did not demonstrate superiority over SC in enhancing the QoL and well-being of patients undergoing antineoplastic treatment. Increased levels of anxiety and fatigue might result from OD-CAM, underscoring the importance of the person-oriented approach inherent in OD-CAM. OD-CAM may hold clinical significance, especially for those already inclined toward CAM; however, further investigation into the essential components of OD-CAM and the characteristics of patients who are most likely to experience significant improvements of OD-CAM is recommended.

Growth of Renal Cancer Cell Lines Is Strongly Inhibited by Synergistic Activity of Low-Dosed Amygdalin and Sulforaphane

Background: Plant derived isolated compounds or extracts enjoy great popularity among cancer patients, although knowledge about their mode of action is unclear. The present study investigated whether the combination of two herbal drugs, the cyanogenic diglucoside amygdalin and the isothiocyanate sulforaphane (SFN), influences growth and proliferation of renal cell carcinoma (RCC) cell lines. Methods: A498, Caki-1, and KTCTL-26 cells were exposed to low-dosed amygdalin (1 or 5 mg/mL), or SFN (5 µM) or to combined SFN-amygdalin. Tumor growth and proliferation were analyzed by MTT, BrdU incorporation, and clone formation assays. Cell cycle phases and cell cycle-regulating proteins were analyzed by flow cytometry and Western blotting, respectively. The effectiveness of the amygdalin-SFN combination was determined using the Bliss independence model. Results: 1 mg/mL amygdalin or 5 µM SFN, given separately, did not suppress RCC cell growth, and 5 mg/mL amygdalin only slightly diminished A498 (but not Caki-1 and KTCTL-26) cell growth. However, already 1 mg/mL amygdalin potently inhibited growth of all tumor cell lines when combined with SFN. Accordingly, 1 mg/mL amygdalin suppressed BrdU incorporation only when given together with SFN. Clonogenic growth was also drastically reduced by the drug combination, whereas only minor effects were seen under single drug treatment. Superior efficacy of co-treatment, compared to monodrug exposure, was also seen for cell cycling, with an enhanced G0/G1 and diminished G2/M phase in A498 cells. Cell cycle regulating proteins were altered differently, depending on the applied drug schedule (single versus dual application) and the RCC cell line, excepting phosphorylated Akt which was considerably diminished in all three cell lines with maximum effects induced by the drug combination. The Bliss independence analysis verified synergistic interactions between amygdalin and SFN. Conclusions: These results point to synergistic effects of amygdalin and SFN on RCC cell growth and clone formation and Akt might be a relevant target protein. The combined use of low-dosed amygdalin and SFN could, therefore, be beneficial as a complementary option to treat RCC. To evaluate clinical feasibility, the in vitro protocol must be applied to an in vivo model.

Correlates and patterns of using complementary health approaches among individuals with recent and longer-term cancer diagnoses: a US national cross-sectional study

PURPOSE

To (1) describe and compare the prevalence of using of complementary health approaches, focusing on mind and body practices, and reasons for use among cancer survivors, and (2) examine characteristics associated with use among those with a recent and non-recent diagnosis of cancer compared to those without a previous cancer diagnosis.

METHODS

Using data from the 2022 US National Health Interview Survey, prevalence estimates were derived for using any complementary health approach, by category (manipulative body-based [chiropractor, acupuncture, massage], creative [music therapy, art therapy], and mind-body [meditation, guided imagery, yoga]), and reasons for use. Regression models identified correlates of use among all participants and within cancer diagnosis subgroups.

RESULTS

Among 26,523 adult participants, overall prevalence of using any complementary approach was similar amongst individuals with recent cancer (40.17%), non-recent cancer (37.75%), and no cancer diagnosis (37.93%). However, odds of use were higher amongst recent (OR = 1.37) and relatively long term (OR = 1.14) cancer survivors compared to those without a history of cancer in adjusted models (both p < 0.05). In cancer survivors, mind-body approaches were mostly used for general health purposes, whereas manipulative approaches were used for general health and pain management. Female sex, younger age, higher education and income were among the prominent variables associated with using complementary approaches.

CONCLUSION

We present an important snapshot of the landscape of using complementary approaches, specifically mind and body practices, in adult cancer survivors in the US. Inequalities in access to these therapies may exist, as use remains highest amongst those with higher socioeconomic conditions.

IMPLICATIONS FOR CANCER SURVIVORS

Given the prevalence and potential benefits of complementary approaches among cancer survivors, there is a need to better understand their effectiveness, optimal use, and integration into cancer care. Further research is needed to understand and address access barriers that might exist amongst some cancer survivors.

Regional Perspectives on Complementary and Alternative Medicine: Results of a Regional Survey

BACKGROUND

Complementary and alternative medicine (CAM) is widely used by patients with cancer. Research indicates that the use of CAM is more prevalent in rural areas compared to urban areas. There is currently a lack of information regarding the scope and specifics of CAM use among patients in Sweden, particularly in rural areas. The aim of this study was to estimate the extent and characteristics of CAM use among cancer patients in the rural areas of Region Gävleborg.

METHODS

A total of 631 questionnaires were sent out, and 376 of those were returned, corresponding to a response rate of 59.6%. Oncology patients received questionnaires at their initial appointment for curative care at Gävle Hospital's Department of Oncology. When enrolling in palliative outpatient care in their homes, palliative patients were sought out. Standard descriptive statistics were used to present the characteristics of the respondents. To determine odds ratios and potential factors (age, gender, diagnosis, and education) affecting CAM use after cancer diagnosis, a multivariable logistic model was constructed.

RESULTS

Based on clinical observations, the authors' hypothesis that CAM use is particularly common in small towns in the Hälsingland region was verified in this study. This was particularly pronounced among younger people and residents of small towns in the province of Halsingland. The higher level of CAM use appears to apply to both men and women.

CONCLUSIONS

CAM appears to be used more frequently by patients residing in rural areas. It is crucial that care providers enquire about all of the patient's health-seeking activities. Further research is needed on the usage of CAM in rural areas and the potential cultural influences contributing to CAM use. From a sociological standpoint, it is crucial to draw attention to the fact that CAM use may be more prevalent in certain rural areas, particularly in centralized societies where it is more difficult to access healthcare in remote regions.

Survey of Physicians and Healers Using Amygdalin to Treat Cancer Patients

Amygdalin is purported to exhibit anti-cancer properties when hydrolyzed to hydrogen cyanide (HCN). However, knowledge about amygdalin efficacy is limited. A questionnaire evaluating the efficacy, treatment, and dosing protocols, reasons for use, HCN levels, and toxicity was distributed to physicians and healers in Germany, providing amygdalin as an anti-cancer drug. Physicians (20) and healers (18) provided amygdalin over 8 (average) years to nearly 80 annually treated patients/providers. Information about amygdalin was predominantly obtained from colleagues (55%). Amygdalin was administered both intravenously (100%) and orally (32%). Intravenous application was considered to maximally delay disease progression (90%) and relieve symptoms (55%). Dosing was based on recommendations from colleagues (71%) or personal experience (47%). If limited success became apparent after an initial 3g/infusion, infusions were increased to 27g/infusion. Treatment response was primarily monitored with established (26%) and non-established tumor markers (19%). 90% did not monitor HCN levels. Negative effects were restricted to a few dizzy spells and nausea. Only 58% were willing to participate in clinical trials or contribute data for analysis (34%). Amygdalin infusions are commonly administered by healers and physicians with few side effects. The absence of standardized treatment calls for guidelines. Since intravenous application bypasses metabolization, re-evaluation of its mode of action is required.

Exploring Integrative Approaches: Insights Into Complementary Medicine Practices Among Breast Cancer Survivors in Saudi Arabia

OBJECTIVES

Complementary and integrative medicine (CAM) is a prevalent approach often used with conventional medical practices The study aims to understand the factors influencing breast cancer (BC) survivors' decisions regarding CAM therapy and the drivers behind their use.

SETTING

This research was conducted at an academic hospital in Saudi Arabia. The study used cross-sectional research with a questionnaire. Participants were enrolled in the study through BC survivors' groups on WhatsApp. Individuals who were actively following up at the clinic were also interviewed. Informed consent was obtained.

RESULTS

The study surveyed 211 BC survivors, aged 34-49 (50.2%), who had undergone surgery (93.4%), hormonal therapy (66.4%), and chemotherapy (87.7%). Less than half (44.5%) had chronic conditions such as diabetes and hypertension. CAM users were 43.6%. The most used CAM modalities were Zamzam water, honey, and water read-upon Quran. A significant motivator for CAM use was to boost the immune system. More than half of patients used less than 100 SAR per month on CAM modalities. Exactly 80.4% of CAM users perceived benefits from CAM use. Predictors of CAM use included higher family monthly income, radiation therapy, and being diagnosed from 1 to 5 years. BC survivors without medical conditions after diagnosis were less likely to use CAM.

CONCLUSION

The study highlights the prevalence, predictive factors, motivations, and perceived benefits of CAM use among BC survivors in Saudi Arabia, emphasizing the need for understanding and integration into cancer care plans and the need for further research on CAM safety and efficacy.

Interdisciplinary Integrative Oncology Group-Based Program: Evaluation of Long-Term Effects on Resilience and Use of Complementary and Alternative Medicine in Patients With Cancer

BACKGROUND

Cancer often causes reduced resilience, quality of life (QoL) and poorer overall well-being. To mitigate these problems, complementary and alternative medicine (CAM) is widely used among patients with cancer. This study aimed to evaluate the long-term effects of an interdisciplinary integrative oncology group-based program (IO-GP) on the resilience and use of CAM in patients with cancer.

METHODS

This was a prospective, observational, single-center study. Resilience (RS-13), CAM usage (I-CAM-G), QoL (SF-12) and health-related lifestyle factor (nutrition, smoking, alcohol consumption and physical exercise) data were collected for 70 patients who participated in a 10-week IO-GP between January 2019 and June 2022 due to cancer. The IO-GP is offered at the setting of a university hospital and is open to adult patients with cancer. It contains elements from mind-body medicine and positive psychology, as well as recommendations on healthy diet, exercise and CAM approaches. Patients who completed the IO-GP at least 12 months prior (1-4.5 years ago) were included in this study. Statistical analysis included descriptive analysis and parametric and nonparametric tests to identify significant differences (P < .05).

RESULTS

Resilience increased significantly ≥12 months after participation in the IO-GP (n = 44, P = .006, F = 8.274) and had a medium effect size (r = .410). The time since the IO-GP was completed ("12-24 months," "24-36 months," and ">36 months") showed no statistically significant interaction with changes in resilience (P = .226, F = 1.544). The most frequently used CAM modalities within the past 12 months were vitamins/minerals (85.7%), relaxation techniques (54.3%), herbs and plant medicine (41.1%), yoga (41.4%) and meditation (41.4%). The IO-GP was the most common source informing study participants about relaxation techniques (n = 24, 64.9%), meditation (n = 21, 72.4%) and taking vitamin D (n = 16, 40.0%). Significantly greater levels of resilience were found in those practicing meditation (P = .010, d = -.642) or visualization (P = .003, d = -.805) compared to non-practitioners.

CONCLUSION

IO-GPs have the potential to empower patients with cancer to continue using CAM practices-especially from mind-body medicine-even 1 to 4.5 years after completing the program. Additionally, resilience levels increased. These findings provide notable insight into the long-term effects of integrative oncology interventions on resilience and the use of CAM, especially in patients with breast cancer.