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Patterns of Complementary and Alternative Medicine Use Among Patients Undergoing Cancer Treatment

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Patterns of Complementary and Alternative Medicine Use Among Patients Undergoing Cancer Treatment Original article Patterns of complementary and alternative medicine use among patients undergoing cancer treatment J. CORNER, bsc, phd, rn, School of Nursing and Midwifery, University of Southampton, Highfield, Southampton, J. YARDLEY, srn, hvcert, ma (ed), School of Nursing and Midwifery, University of Southampton, Highfield, Southampton, E.J. MAHER, frcp, frcr, Supportive Oncology Research Team, Lynda Jackson Macmillan Centre, Mount Vernon Cancer Centre, Northwood, Middx, L. ROFFE, bsc (hons), School of Nursing and Midwifery, University of Southampton, Highfield, Southampton, T. YOUNG, bsc, Supportive Oncology Research Team, Lynda Jackson Macmillan Centre, Mount Vernon Cancer Centre, Northwood, Middx, S. MASLIN-PROTHERO, rn, rm, dipn, msc, phd, School of Nursing and Midwifery, Keele University, Stoke-on-Trent, Staffordshire, C. GWILLIAM, ba (hons), Supportive Oncology Research Team, Lynda Jackson Macmillan Centre, Mount Vernon Cancer Centre, Northwood, Middx, J. HAVILAND, msc, ICR-CTSU, Institute of Cancer Research, Sutton, Surrey, & G. LEWITH, md, frcp, Complementary Medicine Research Unit, Primary Medical Care, School of Medicine, University of Southampton, Aldermoor Health Centre, Southampton, UK CORNER J., YARDLEY J., MAHER E.J., ROFFE L., YOUNG T., MASLIN-PROTHERO S., GWILLIAM C., HAVILAND J. & LEWITH G. (2009) European Journal of Cancer Care 18, 271–279 Patterns of complementary and alternative medicine use among patients undergoing cancer treatment This study aimed to assess the prevalence of complementary and alternative medicine (CAM) use in a representative cancer population prior to and within 6 months of diagnosis. A total of 304 newly diagnosed cancer patients from two UK cancer centres completed a postal survey. Of them, 100 patients (32.9%) used CAM before their cancer diagnosis, 59 of these CAM users continued post diagnosis. Twenty-nine individuals who had not used CAM before began to use it after their cancer diagnosis, creating a total of 88 (28.9%) CAM users in this sample. Reasons for not using CAM included lack of interest, lack of information or endorsement from professionals and satisfaction with conventional care. For those using CAM before diagnosis but not afterwards, the most common reason was a lack of expert guidance on what was safe to use. The use of CAM medicines bought from health food and other retail outlets was high. Complementary and alternative medicine use in cancer patients is common and demonstrates a complex pattern, but CAM use is not significantly greater than in the general population. Some patients purchase CAM medicines without seeking medical advice, thus risking drug interactions. Research to generate information on safety and efficacy of CAM is required. Keywords: complementary medicine, alternative medicine, cancer, cancer treatment. INTRODUCTION use is increasing. Surveys conducted in the UK, the US and in Australia indicate that between 10% and 25% of Complementary and alternative medicines (CAM) are the population use CAM each year, and 50% of the popu- widely used among the general population, indeed their lation use CAM at some point in their lifetime (Eisenberg et al. 1993; Fisher & Ward 1994; MacLennan et al. 1996). Correspondence address: JL Corner, Professor of Cancer and Palliative Care, School of Nursing and Midwifery, University of Southampton, High- A recent population-based survey in England (Thomas field, Southampton, SO17 1BJ, UK (e-mail: [email protected]). et al. 2001) found that 14% of adults had visited one of Accepted 21 November 2007 eight specified complementary therapists, and 28% of DOI: 10.1111/j.1365-2354.2007.00911.x adults surveyed had used a therapy or over the counter European Journal of Cancer Care, 2009, 18, 271–279 remedy in the previous 12 months. Only 10% of contacts © 2009 The Authors Journal compilation © 2009 Blackwell Publishing Ltd CORNER et al. with CAM therapists were through the UK National research team had been allowed to approach patients after Health Service (NHS), the remainder being paid for questionnaire distribution and to follow-up non-response. through out-of-pocket expenditure (Thomas et al. 2001). All patients provided written informed consent. The prevalence of CAM use has led to questions as to the Those recruited completed a postal questionnaire efficacy and safety of this largely unregulated form of including closed and open-ended questions about their use health care, as well as whether such therapies should be of CAM both before and since receiving a cancer diagno- integral to formal systems of health care such as the NHS. sis. The questionnaire was developed and piloted follow- Studies of patients with cancer have suggested a higher ing a review of published questionnaires including use of CAM than the normal population (Cassileth et al. estimating CAM use, and was based on both the House 1984; Downer et al. 1994; Rees et al. 2000; Sollner et al. of Lords Science and Technology Select Committee 2000; Paltiel et al. 2001; Malassiotis 2005). A systematic (2000) definition of CAM and Thomas et al.’s (2001) review of 26 studies from 13 countries revealed that questionnaire-based survey. between 7% and 63% of patients with cancer use CAM Patient characteristics and frequencies of CAM use with a median of 31% for the patients sampled (Ernst & before and after diagnosis were tabulated. The Townsend Cassileth 1998). However, these studies involve selective Material Deprivation Index (Townsend et al. 1988) (based patient samples and differing definitions of CAM, distort- on patients’ postcode) was used as a measure of socio- ing true estimates of prevalence of CAM use among economic status, and categorized by quintiles within the people with cancer. This study set out to explore the ways study population. As distribution of time from diagnosis in which CAM is used by a nationally representative to screening was skewed, data were presented using group of newly diagnosed cancer patients undergoing medians and interquartile ranges (IQR). In order to deter- active conventional treatment. mine which patient characteristics predicted CAM use before and after diagnosis, factors were first investigated in univariate analyses and tested using the c2 test (or c2 METHODS test for trend where appropriate), the t-test for age and the This was a questionnaire-based cross-sectional epidemio- non-parametric Mann–Whitney test for time from diagno- logical study. Patients were sampled on a quota basis, to sis. Forward stepwise logistic regression analysis was then ensure that the distribution of cancer sites mirrored carried out, including all of the patient characteristics to figures from National Cancer Statistics 2001 (Cancer UK determine which factors remained significant indepen- 2001). Data were collected from a sample of recently diag- dent predictors for CAM use before and after diagnosis. nosed (within 6 months) patients attending two cancer Analysis of open-ended questions relating to the reasons treatment centres in the South of England. Local research why patients used or did not use CAM used a content- ethics approval was given at both study centres analysis approach. Statements recorded on questionnaires (Southampton and South-west Hampshire (052/03/w) and were collated and grouped into like categories, where they West Hertfordshire Hospitals NHS Trust (EC2003-34)). were summarized and then described thematically. Initially, study centre 1 was refused permission for the Counts of the number of patients with similar responses researchers to approach patients directly and discuss the were made to identify the most commonly occurring study, so questionnaires were distributed in sealed enve- themes. lopes by reception staff as patients arrived for treatment. After 3 months of low recruitment, a case was made to the RESULTS local research ethics committee (LREC) that relying on reception staff to distribute the sealed envelopes led to the A total of 304 patients returned their questionnaire by situation where the research team were unable to know post. Over the study period, and across both centres, this whether or not patients had been approached and, there- represents 51% of all patients approached for the study. fore, it was unclear whether the low recruitment was due However, the initial response rate at study centre 1 was to patients declining to take part or that they had been very low due to LREC restrictions, but once these were overlooked by busy clinic staff. As a result, the restriction removed, the response rate approached that of study was removed by the LREC. Both committees specified centre 2 at 65%. As with other such surveys, patients were that no contact was allowed with patients after distribu- less likely to return questionnaires if they were male, had tion of the questionnaire and no reminders could be sent. advanced disease and did not have breast cancer. Demo- The stringency applied by both LRECs meant that recruit- graphic data about the patient sample are contained in ment was lower than would have been the case if the Table 1 and were similar in both centres, but with a lower 272 © 2009 The Authors Journal compilation © 2009 Blackwell Publishing Ltd Patterns of complementary and alternative medicine Table 1. Demographic and clinical characteristics cancer sites (e.g. bladder, non-Hodgkins lymphoma, head Demographic/clinical characteristic Total (%) n = 304 and neck), but some of the most frequent sites were over- Age (years) represented (breast, prostate), while others were under- < 50 64 (21.1) represented (lung), particularly in centre 1. 50–59 71 (23.4) 60–69 82 (27.0) Ն70 85 (28.0) Unknown 2 (0.7) PATTERNS OF CAM USE Mean (SD) 60.0 (13.5) Gender Four patterns of CAM use were identified: patients who Female 169 (55.6) used CAM before diagnosis and continued to do during Male 134 (44.1) Unknown 1 (0.3) cancer treatment, patients who used CAM before diagno- Marital status sis but stopped using CAM during treatment; patients Married/re-married/living with partner 221 (72.7) who used CAM for the first time following diagnosis; and Single/widowed/separated/divorced 80 (26.3) Unknown 3 (1.0) finally patients who did not use CAM at any time.
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