Utilization of complementary/alternative services by women with breast cancer

The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided

Background

Previous research has investigated utilization rates, who sees chiropractors, for what reasons, and the type of care that chiropractors provide. However, these studies have not been comprehensively synthesized. We aimed to give a global overview by summarizing the current literature on the utilization of chiropractic services, reasons for seeking care, patient profiles, and assessment and treatment provided.

Methods

Systematic searches were conducted in MEDLINE, CINAHL, and Index to Chiropractic Literature using keywords and subject headings (MeSH or ChiroSH terms) from database inception to January 2016. Eligible studies: 1) were published in English or French; 2) were case series, descriptive, cross-sectional, or cohort studies; 3) described patients receiving chiropractic services; and 4) reported on the following theme(s): utilization rates of chiropractic services; reasons for attending chiropractic care; profiles of chiropractic patients; or, types of chiropractic services provided. Paired reviewers independently screened all citations and data were extracted from eligible studies. We provided descriptive numerical analysis, e.g. identifying the median rate and interquartile range (e.g., chiropractic utilization rate) stratified by study population or condition.

Results

The literature search retrieved 14,149 articles; 328 studies (reported in 337 articles) were relevant and reported on chiropractic utilization (245 studies), reason for attending chiropractic care (85 studies), patient demographics (130 studies), and assessment and treatment provided (34 studies). Globally, the median 12-month utilization of chiropractic services was 9.1% (interquartile range (IQR): 6.7%-13.1%) and remained stable between 1980 and 2015. Most patients consulting chiropractors were female (57.0%, IQR: 53.2%-60.0%) with a median age of 43.4 years (IQR: 39.6-48.0), and were employed (median: 77.3%, IQR: 70.3%-85.0%). The most common reported reasons for people attending chiropractic care were (median) low back pain (49.7%, IQR: 43.0%-60.2%), neck pain (22.5%, IQR: 16.3%-24.5%), and extremity problems (10.0%, IQR: 4.3%-22.0%). The most common treatment provided by chiropractors included (median) spinal manipulation (79.3%, IQR: 55.4%-91.3%), soft-tissue therapy (35.1%, IQR: 16.5%-52.0%), and formal patient education (31.3%, IQR: 22.6%-65.0%).

Conclusions

This comprehensive overview on the world-wide state of the chiropractic profession documented trends in the literature over the last four decades. The findings support the diverse nature of chiropractic practice, although common trends emerged.

Can we demonstrate that breast cancer "integrative oncology" is effective? A methodology to evaluate the effectiveness of integrative oncology offered in community clinics

BACKGROUND

Many women diagnosed with breast cancer receive both standard cancer treatment and care from providers trained in the emerging field of medicine called integrative oncology (IO) in which science-based complementary and alternative medical therapies are prescribed by physicians. The effectiveness of IO services has not been fully studied, so is yet unknown.

PURPOSE

Determine if a matched, case-controlled prospective outcomes study evaluating the efficacy and safety of breast cancer IO care is feasible.

METHODS

Methodological proof of principle requires demonstration that (1) it is possible to find matched control breast cancer patients using the Surveillance, Epidemiology and End

RESULTS

Results. A pilot study was conducted in 2008 (n = 14) to determine if matched controlled women could be identified in the western Washington SEER database. All 14 women who were approached agreed to participate. The cases were matched to the CSS along 5 variables: age and stage at diagnosis, race, and marital and Estrogen Receptors/Progesterone Receptors (ER/PR) status. Multiple matches were found for 12 of the 14 participants.

CONCLUSION

A prospective cohort study with a matched comparison group is a feasible and potentially rigorous

STUDY DESIGN

It may provide valuable data for the evaluation of the effectiveness of IO care on patient health, relapse rate, and health-related quality of life (HRQOL). A federally funded matched case controlled outcomes study is currently under way at Bastyr University and the Fred Hutchinson Cancer Research Center.

How many cancer patients use complementary and alternative medicine: a systematic review and metaanalysis

BACKGROUND

No comprehensive systematic review has been published since 1998 about the frequency with which cancer patients use complementary and alternative medicine (CAM).

METHODS

MEDLINE, AMED, and Embase databases were searched for surveys published until January 2009. Surveys conducted in Australia, Canada, Europe, New Zealand, and the United States with at least 100 adult cancer patients were included. Detailed information on methods and results was independently extracted by 2 reviewers. Methodological quality was assessed using a criteria list developed according to the STROBE guideline. Exploratory random effects metaanalysis and metaregression were applied.

RESULTS

Studies from 18 countries (152; >65 000 cancer patients) were included. Heterogeneity of CAM use was high and to some extent explained by differences in survey methods. The combined prevalence for "current use" of CAM across all studies was 40%. The highest was in the United States and the lowest in Italy and the Netherlands. Metaanalysis suggested an increase in CAM use from an estimated 25% in the 1970s and 1980s to more than 32% in the 1990s and to 49% after 2000.

CONCLUSIONS

The overall prevalence of CAM use found was lower than often claimed. However, there was some evidence that the use has increased considerably over the past years. Therefore, the health care systems ought to implement clear strategies of how to deal with this. To improve the validity and reporting of future surveys, the authors suggest criteria for methodological quality that should be fulfilled and reporting standards that should be required.

Use of Chinese medicine by cancer patients: a review of surveys

Chinese medicine has been used to treat a variety of cancer-related conditions. This study aims to examine the prevalence and patterns of Chinese medicine usage by cancer patients. We reviewed articles written in English and found only the Chinese medicine usage from the studies on complementary and alternative medicine (CAM). Seventy four (74) out of 81 articles reported rates of CAM usage ranging from 2.6 to 100%. Acupuncture was reported in 71 out of 81 studies. Other less commonly reported modalities included Qigong (n = 17), Chinese herbal medicine (n = 11), Taichi (n = 10), acupressure (n = 6), moxibustion (n = 2), Chinese dietary therapy (n = 1), Chinese massage (n = 1), cupping (n = 1) and other Chinese medicine modalities (n = 19). This review also found important limitations of the English language articles on CAM usage in cancer patients. Our results show that Chinese medicine, in particular Chinese herbal medicine, is commonly used by cancer patients. Further research is warranted to include studies not written in English.

Determination of parameters affecting the use of complementary and alternative medicine in cancer patients and detection of prevalence of use

This study was conducted to find out the frequency of complementary and alternative medicine (CAM) use that could lead to troubles in patient health and in applied standard therapy protocols when used improperly, which method is used, the reasons for use and from which resources the information about this topic were obtained. A questionnaire consisting of 28 questions was applied to 195 patients with cancer diagnosis by a face-to-face interview. The obtained data were assessed with SPSS 11.5 program. Out of 195 cancer patients, 100 (51.3%) were using CAM and 48.7% (n=95) were not. The most commonly used agent was nettle (72%). This was followed by herbal teas (21%), grape molasses (20%) and black seed (20%). The frequency of CAM use was found higher in those under age 50, in literate people, in those working during the diagnosis stage and having disease at the later stage. While CAM was commonly recommended by friends and relatives of the patients (73%), this ratio was only 5% for health professionals. While 51.3% of all patients were gathering information about CAM, 75% of those actually using CAM gathered information about it. Whilst information was gathered mostly from the relatives of patients and tamperers (47%), it can be gathered from physicians only with a ratio of 10%. Cancer patients use CAM and they gather information mainly from unreliable sources rather than physicians. Although the primary information source should be physicians, the ratio for this was very low (10%). We suggest that physicians should spend more time in gathering correct information and sharing them with their patients for a better guidance.

Complementary Therapy Used by Hispanic Women During Treatment for Breast Cancer

The purposes of this study are to assess Hispanic women’s use of complementary interventions during breast cancer treatment and delineate the association between the most burdensome side effects and the most frequently used complementary and alternative medicine (CAM). The researchers examined both descriptive statistics and correlational relationships between side effects and CAM. Data were collected from a convenience sample ( N = 125). The mean age was 54, the educational average was less than 10 years, and the median income level was less than $20,000 per year. CAM was positively correlated with family income. Prayer was used by 93% of the women, humor was used by 83%, and 65% used exercise. The most frequent side effect of hair loss (70%) was the most bothersome side effect. The most burdensome and unmanageable side effects were bowel problems and nausea. Nurses play a key role in offering affordable, culturally appropriate symptom management interventions.

[Use of complementary and alternative medicine by cancer patients: systematic review]

Interest in complementary and alternative medicine has increased, especially among oncology patients. A systematic literature review of the profile of patients who choose to use this type of medicine, as well as their motivations, was carried out on the PubMed database. For this search, the key words used were ?cancer and complementary alternative medicine? and ?oncology and complementary alternative medicine?, covering the period between 1995 and 2005. The selection criteria were the following: key words were present in the article title; article was written in either English, Portuguese, or Spanish; and study was performed with an adult population. From the 43 articles analyzed, it could be concluded that the use of complementary and alternative medicine is part of these patients? social scope. Moreover, its use plays an important role in the identity construction of cancer patients, helping them to make decisions related to conventional treatment.

A test of the self-help model and use of complementary and alternative medicine among Hispanic women during treatment for breast cancer

PURPOSE/OBJECTIVES

To describe the relationships in Braden's Self-Help Model of side-effect burden to uncertainty, complementary and alternative medicine (CAM), self-care, and quality of life (QOL) in Hispanic women during breast cancer treatment.

DESIGN

Descriptive, correlational; convenience sample; cross-sectional design.

SETTING

An outpatient oncology clinic in a public setting of a metropolitan community in southern Texas.

SAMPLE

137 Hispanic women receiving or completing treatment for breast cancer.

METHODS

Participants completed a comprehensive set of instruments. Analyses included a correlation of variables and multiple regressions to examine variables for potential theoretical relationships.

MAIN RESEARCH VARIABLES

CAM use, uncertainty, and enabling skills.

FINDINGS

CAM use as a resource to reduce uncertainty for Hispanic women during breast cancer treatment was not supported. As a type of self-care, CAM was minimally effective in improving QOL. The greater the side-effect burden that Hispanic women experienced, the more uncertainty and depression and lower QOL scores were found. In contrast, women who were involved in CAM self-care had higher QOL scores.

CONCLUSIONS

The study results provide valuable information about understanding CAM's role during breast cancer therapy among Hispanic women. The model-testing findings indicated strong support for a predicted pattern in Braden's Self-Help Model with a slight trend for CAM as a special type of self-care.

IMPLICATIONS FOR NURSING

The findings further inform the concept development of CAM and model building. Additional research with a longitudinal design is needed to understand how CAM is used throughout the breast cancer treatment trajectory and will contribute to knowledge guiding nurses in facilitating self-care interventions for Hispanic women.

Use of complementary and alternative medicine therapies to control symptoms in women living with lung cancer

Complementary and alternative medicine (CAM) use by cancer patients, especially women, is increasing. However, CAM use among patients with lung cancer, who have been reported to have the highest symptom burden, is poorly documented. This study describes types and frequencies of specific CAM therapies used by women with lung cancer to manage symptoms, and examines differences in demographic and clinical characteristics between CAM users and non-CAM users. Participants included 189 women with non-small cell lung cancer and > or =1 of 8 symptoms. Six CAM therapies, used to control symptoms, were assessed, including herbs, tea, acupuncture, massage, meditation, and prayer. Forty-four percent (84 women) used CAM therapies, including prayer (34.9%), meditation (11.6%), tea (11.6%), herbs (9.0%), massage (6.9%), and acupuncture (2.6%). Complementary and alternative medicine use was greatest for difficulty breathing and pain (54.8% each), with prayer the most commonly used CAM for all symptoms. Significant differences (P < .05) were found for age (t = 2.24), symptom frequency (t = -3.02), and geographic location (chi = 7.51). Women who were younger, experienced more symptoms, and lived on the West Coast or South (vs Northeast) were more likely to use CAM. We found that CAM use is variable by symptom and may be an indicator of symptom burden. Our results provide important initial data regarding CAM use for managing symptoms by women with lung cancer.

Correlates of use of different types of complementary and alternative medicine by breast cancer survivors in the nurses’ health study

PURPOSE

Among breast cancer survivors, we identified the prevalence and correlates of use of different types of complementary and alternative medicine (CAM).

PATIENTS AND METHODS

We included 2,022 women diagnosed with breast cancer 1998-2003 who responded to a survey about CAM use. We performed logistic regression to determine demographic and disease factors associated with use of different CAM therapies (including relaxation/imagery, spiritual healing, yoga, energy healing, acupuncture, massage, chiropractic, high-dose vitamins, herbs, and homeopathy). We also measured quality of life (QoL) using the SF36 and optimism using LOT-R and fit linear regression models to compare mean scores among CAM users and nonusers.

RESULTS

Sixty-two percent of respondents used CAM. Younger age was the most consistent correlate of CAM use, but factors associated with CAM use varied by type of CAM. Chemotherapy was associated with use of relaxation/imagery (OR 1.3 95%CI 1.1-1.7). Radiotherapy was associated with use of high-dose vitamins (OR 1.5 95% CI 1.2-2.0). Tamoxifen or anastrozole treatment was associated with use of homeopathy (OR 0.5 95%CI 0.3-0.9). Users of most types of CAM had worse QoL scores than nonusers, but better QoL was found among users of yoga. The lowest QoL scores were associated with the use of energy healing. Optimism was higher among users of relaxation/imagery.

CONCLUSIONS

Factors associated with CAM use varied according to type of CAM. Our finding of worse QoL among women using energy healing and better QoL among women using yoga suggests the need for longitudinal studies to determine the temporal relationships between these therapies and QoL.

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.

Complementary and alternative medicine use in patients with head and neck cancers in Europe

The aim of the present study was to examine the patterns of complementary and alternative medicine (CAM) use in a sample of head and neck cancer patients, forming part of a larger study. A cross-sectional survey design was used collecting data through a descriptive 27-item questionnaire in nine countries in Europe. The participants were 75 patients with head and neck cancers. The prevalence rate of CAM use was 22.7%. The most common therapies used were herbal medicine (47%), medicinal teas (23.5%), use of vitamins/minerals (11.8%) and visualization (11.8%). Use of CAM dramatically increased after the diagnosis with cancer (i.e. eightfold increase in the use of herbs). A profile of CAM users was not evident in this sample. Patients used CAM for a variety of reasons together, with counteracting the ill effects from cancer and its treatment being the most common one. Information about CAM was obtained mostly from friends and family. As one in five head and neck cancer patients use CAM it is important that clinicians explore practices with their patients, improve communication about CAM with them and assist those who want to use CAM in using appropriate and safe therapies.

Complementary and alternative medicine use in breast cancer patients in Europe

Complementary and alternative medicine (CAM) has gained popularity among cancer patients in the past years. For this study, CAM includes any group of health care systems, practices or products that are not considered to be part of conventional medicine at present (National Center for Complementary and Alternative Medicine). The present study assessed patterns of CAM use in breast cancer patients in Europe. The study used a descriptive cross-sectional design, and data were collected through a 27-item questionnaire. The sample, which was part of a larger study, consisted of 282 breast cancer patients from 11 countries in Europe. Among participants, 44.7% used CAM since their diagnosis of cancer. The most common therapies used included herbal medicine (46.4%) and medicinal teas, relaxation techniques, spiritual therapies, homeopathy and vitamins/minerals. Younger patients with higher education and who had received combination treatments for their cancer in the past were more likely to use CAM. High levels of satisfaction were reported, with only 6.5% of the women reporting no benefits from the CAM used. Main sources of information about CAM were mostly friends/family and the media. Findings suggested that a high proportion of breast cancer patients used CAM, which may have implications for the clinical management of these patients.

Complementary and alternative medicine use in colorectal cancer patients in seven European countries

PURPOSE

The aim of the present study was to examine the use of complementary and alternative medicine (CAM) in a sample of colorectal cancer patients in Europe.

METHODS

The study was a descriptive cross-sectional survey and data were collected through a 27-item self-reported questionnaire from seven European countries.

RESULTS

As part of a larger study, 126 colorectal cancer patients participated in this survey. Among the participants, 32% used CAM after the diagnosis of cancer. Almost half the CAM therapies used were new therapies, never tried before the diagnosis. The most common CAM therapies used included herbal medicine (48.7%), homeopathy (20.5%), use of vitamins/minerals (17.9%), spiritual therapies (15.4%), medicinal teas (15.4%) and relaxation techniques (12.8%). A dramatic increase was observed in the use of CAM from usage levels before the cancer diagnosis. High levels of satisfaction with CAM were also reported. Patients used CAM more often to increase the body's ability to fight the cancer or to improve physical well-being. However, expectations did not always match with the benefits reported.

CONCLUSIONS

As one-third of colorectal cancer patients use CAM, health professionals should be more aware of this approach to the patient's management. They should discuss the role of CAM therapies with their patients in a non-judgemental and open manner, and endeavour to provide accurate information in order to allow patients to make their own decision about CAM.