Association between complementary and alternative medicine use and prolonged time to conventional treatment among Thai cancer patients in a tertiary-care hospital

Traditional and Complementary Medicine Use among Cancer Patients in Asian Countries: A Systematic Review and Meta-Analysis

Globally, cancer patients frequently use T&CM during their treatment for various reasons. The primary concerns regarding the use of T&CM among cancer patients are the potential risks associated with interactions between pharmaceuticals and T&CM, as well as the risk of noncompliance with conventional cancer treatments. Despite the higher prevalence of T&CM use in Asia, driven by cultural, historical, and resource-related factors, no prior review has tried to estimate the prevalence and influencing factors of T&CM use and disclosure among cancer patients in this region. This study aims to examine the prevalence and disclosure rates of T&CM use among cancer patients in Asia to assess various factors influencing its use across different cancer treatment settings in Asia. Systematic research on T&CM use was conducted using four databases (PubMed, EMBASE, Web of Science, and CINAHAL) from inception to January 2023. Quality was assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS). A random effects model was used to estimate the pooled prevalence of T&CM use, and data analysis was performed using Stata Version 16.0. Among the 4849 records retrieved, 41 eligible studies conducted in 14 Asian countries were included, involving a total of 14,976 participants. The pooled prevalence of T&CM use was 49.3%, ranging from 24.0% to 94.8%, and the disclosure rate of T&CM use was 38.2% (11.9% to 82.5%). The most commonly used T&CM modalities were herbal medicines and traditional medicine. Females were 22.0% more likely to use T&CM than males. A subgroup analysis revealed the highest prevalence of T&CM use was found in studies conducted in East Asia (62.4%) and those covered by both national and private insurance (55.8%). The disclosure rate of T&CM use to physicians remains low. Moreover, the factors influencing this disclosure are still insufficiently explored. Since the disclosure of T&CM use is a crucial indicator of patient safety and the quality of cancer treatment prognosis, future research should focus on identifying the determinants of non-disclosure.

Predicaments and coping strategies in implementing cancer truth-telling: a qualitative content analysis

PURPOSE

The patient-centered communication principles in Western countries are widely esteemed. In Eastern countries, a family-centered approach to medical decision-making is preferred. However, the predicaments faced by attending physicians and their coping strategies in the process of truth-telling about cancer are unknown. Therefore, this study aimed to understand attending physicians' predicaments and coping strategies in implementing truth-telling for cancer in Taiwan.

METHODS

This study used a qualitative description approach to conduct in-depth interviews with attending physicians. Data were collected from two medical centers in Taiwan. Purposive sampling was also conducted. A total of 17 attending physicians participated in individual semi-structured interviews. All interviews were audio recorded and transcribed verbatim. Inductive content analysis was used to analyze and develop the subcategories, generic categories, and main categories.

RESULTS

Four main categories emerged: (1) Causing harm to the patient: Family members' cooperation is needed. (2) Family members' request to conceal the truth: Physicians should judge based on the patient's disease condition. (3) Delayed treatment: Physicians should prioritize establishing confidence. (4) Delivering bad news about relapse: Physicians have different coping strategies.

CONCLUSION

Physicians in Taiwan face challenges but prioritize family-centered care despite having coping strategies to protect patients. When faced with a scenario in which family members request concealment of truth, most physicians cooperate with them to determine the level and method of disclosing unfavorable news to patients. Physicians should prioritize patients' psychological needs when they experience relapse or metastasis or face strong negative emotions.

Herbal medicine use in Thai patients with type 2 diabetes mellitus and its association with glycemic control: A cross-sectional evaluation

Introduction

Herbal medicine has been integrated into Thai culture for many centuries. However, studies on using herbal medicine in combination with antidiabetic agents for glycemic control in managing diabetes are limited. Herein, we aimed to assess the use of herbal medicines with different dosages of antidiabetic agents and their association with glycemic control in Thai patients with type 2 diabetes mellitus (T2DM).

Methods

This hospital-based study included 739 patients with T2DM who consecutively visited four district hospitals in Thailand. An interviewer-administered questionnaire was used to collect patient-specific information, including hemoglobin A1c (HbA1c) levels. Chi-square and logistic regression analyses were used to assess associations and predictors, respectively.

Results

The prevalence of herbal medicine use was 37.5% (n = 264); 70.5% of the patients received information about herbal medicine usage for glycemic control from their relatives and friends, and 21 herbal plants were consumed in combination with their prescribed antidiabetic drugs. The use of herbal medicine was associated with the patients’ educational level (p = 0.001), income (p < 0.001), and duration of diabetes (p < 0.001). Good glycemic control (HbA1c < 7.0%) was associated with the use of bitter gourd in combination with 500 mg/day of the antidiabetic drug metformin (adjusted odds ratio = 8.33, 95% confidence interval = 1.04–66.49, p = 0.046). These patients were 2.92 times more likely to have good glycemic control than those who relied solely on 500 mg/day of metformin (adjusted OR = 2.921, 95% CI = 1.227–6.952, p = 0.015).

Conclusions

The prevalence of herbal plant use was associated with different variables, including age, BMI, T2DM duration, and metformin dosage. Among the 21 herbal plants, the consumption of bitter gourd with 500 mg/day of metformin was associated with good glycemic control.

The Use of Complementary and Alternative Medicine in Thai Gynecologic Oncology Patients: Influencing Factors

Background

To determine the factors influencing the use of complementary and alternative medicine (CAM) in gynecologic cancer patients and the prevalence and pattern of CAM use.

Methods

This was a cross-sectional study of 370 gynecologic cancer patients conducted at the outpatient clinic, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. After obtaining informed consent, participants were asked to complete a standardized questionnaire including sociodemographic and clinical characteristics, detail of CAM use, attitude of CAM use, and quality of life using EORTC-QLQ-C30.

Results

The prevalence of CAM use was 25.13%. The most common type was herbal medicine (55.90%). The participants who resided or had a birthplace in rural areas presented with a higher proportion of CAM use than those in urban areas (P=0.470 and P=0.004, respectively). Participants who received multiple modalities of cancer treatment reported a significantly higher proportion of CAM use (P=0.024). Most CAM users agreed that the CAM could be used in combination with standard treatment, and some rather disagreed that CAM could interrupt the treatment effect of the conventional treatment. CAM users had significantly higher role functioning in quality-of-life scores.

Conclusion

Factors influencing CAM use in gynecologic cancer patients were rural area birthplace or residency, receiving multiple modalities of cancer treatment, having positive attitude toward CAM use. CAM users had better performance in role functioning in the quality-of-life score. Therefore, gynecologic oncologists should pay attention to these factors in order to communicate with gynecologic cancer patients about CAM use.

Clinical outcomes of head and neck cancer patients who refuse curative therapy in pursuit of alternative medicine

BACKGROUND

We investigated the alarming trend of curable head and neck cancer (HNC) patients forgoing conventional treatment to pursue alternative medicine (AM).

METHODS

A prospectively maintained database identified HNC patients with ≥12 weeks from diagnosis to treatment initiation between 2012 and 2017. Reasons for delay were categorized and clinical stages and outcomes of AM patients were assessed through chart review by December 2019.

RESULTS

Among 1462 patients with primary HNC, 68 patients (4.7%) were confirmed to delay initiation of potentially curative treatment, and 19 of these patients (28%) delayed treatment to pursue AM. Eleven of 19 AM patients transitioned from curative intent to palliation while exploring AM. Continued treatment rejection was common and outcomes corresponded to patients' degree of treatment adherence.

CONCLUSIONS

AM caused treatment delay and poor outcomes in potentially curable HNC. Improved knowledge among physicians regarding AM and complementary approaches is urgently needed to improve patient counseling.

LEVEL OF EVIDENCE

Level 2c outcomes research.

The trends of complementary alternative medicine use among cancer patients

BACKGROUND

The use of complementary and alternative medicine (CAM) is common among cancer patients and it may reflect the individual and societal beliefs on cancer therapy. Our study aimed to evaluate the trends of CAM use among patients with cancer between 2006 and 2018.

METHODS

We included 2 Cohorts of patients with cancer who were recruited for Cohort 1 between 2006 and 2008 and for Cohort 2 between 2016 and 2018. The study is a cross-sectional study obtaining demographic and clinical information and inquiring about the types of CAM used, the reasons to use them and the perceived benefits. We compared the changes in the patterns of CAM use and other variables between the two cohorts.

RESULTS

A total of 1416 patients were included in the study, with 464 patients in Cohort 1 and 952 patients in Cohort 2. Patients in Cohort 2 used less CAM (78.9%) than Cohort 1 (96.8%). Cohort 1 was more likely to use CAM to treat cancer compared to Cohort 2 (84.4% vs. 73%, respectively, p < 0.0001,); while Cohort 2 used CAM for symptom management such as pain control and improving appetite among others. Disclosure of CAM use did not change significantly over time and remains low (31.6% in Cohort 1 and 35.7% for Cohort 2). However, physicians were more likely to express an opposing opinion against CAM use in Cohort 2 compared to Cohort 1 (48.7% vs. 19.1%, p < 0.001, respectively).

CONCLUSION

There is a significant change in CAM use among cancer patients over the decade, which reflects major societal and cultural changes in this population. Further studies and interventions are needed to improve the disclosure to physicians and to improve other aspects of care to these patients.

Discovering the Use of Complementary and Alternative Medicine in Oncology Patients: A Systematic Literature Review

Background

Patients with cancer pursue all possible opportunities of effective remedies. In Saudi Arabia, most patients have tried complementary medicine during their cancer treatment plan; however, some complementary medicines might pose a danger to health. In Arab countries, studies regarding the use of complementary medicines and the intentions behind using complementary medicines among cancer patients are inadequate and all but nonexistent. The aim of this review was to focus on demographic, prevalence, and reasons for complementary and alternative medicine use among patients with cancer.

Methods

A rigorous literature search was conducted for articles published in the English language, using the search terms "complementary and alternative medicine," "oncology," "malignancy" AND "cancer patients" in five scientific databases, namely, Medical Literature On-Line (MEDLINE), PubMed, Web of Science, Psychology Information (PsycINFO), and Google Scholar, from 2010 to 2020.

Results

Of the 13,160 studies returned from the search, only 12 were eligible and included in this review. The combined prevalence for using complementary and alternative medicines across all studies totaled 25%-80% of cancer patients for the treatment of their cancers. Natural products, including vitamins and minerals, herbal products, and relaxation, were the most common type of complementary and alternative medicines used. The reason for using complementary and alternative medicines was reported to be their helpfulness in recovering, healing, and improving health. Most of the studies mentioned that participants obtained their complementary and alternative medicines from multiple sources, including the media, family and friends, and physicians.

Conclusion

The use of complementary and alternative medicines in cancer patients can be inferred as an attempt to investigate all possibilities, a manifestation of a coping style, or an illustration of unmet desires in the cancer management continuum. Anyhow, there should be adequate communication between healthcare providers and patients, which is crucial for establishing a trusting healthcare provider-patient relationship. Relevance to clinical practice. It is crucial that healthcare providers explore the use of complementary and alternative medicines with their cancer patients, as well as educating them about the possible usefulness of therapies based on the available evidence.