Complementary and Alternative Medicine and Holistic Care: Perspectives Of Cancer Patients Dinesh Kumar* N K Goel* Avdhesh K. Pandey** Kislaya Dimri** Department of Community Medicine, Govt. Medical College, Chandigarh Department of Radiation Oncology, Govt. Medical College, Chandigarh Abstract: Objectives: 1) To explore knowledge, attitude, perceptions and beliefs of patients concerning holistic approach of cancer cure. 2) To investigate the current status of knowledge, attitude and practice of cancer patients relating to complementary and alternative medicine (CAM). 3) To explore views of patients regarding the disease and role of spirituality in curing cancer. Study design: A cross-sectional study design was adopted among cancer patients attending Out Patient Department (OPD) of oncology unit of a tertiary care health facility. Methods: Surveyed patients were interviewed in depth for collecting Information regarding CAM use and some of their qualitative and quantitative characteristics including their opinions about cancer and CAM use, perceptions and beliefs regarding CAM, reasons of CAM use and perceived benefits etc. Normal test of proportions and Chi square test were used for data analysis. Results: Survey of 140 cancer patients including 69 male and 71 females (32.9% from rural and 67.1 % from urban background) indicated lot of misconceptions regarding the disease. Overall Awareness of CAM was reported among 111 (79.3%). Closure/proximity of CAM towards nature (61.4%), easy availability (57.9%) was among main reported reasons in favour of CAM use. Regarding holistic approach for curing the disease, patients were of the opinion that it is something related with God, body and soul. About 69.2% strongly believed existence of spiritual health dimension also and 46.1% were of opinion that spirituality can be helpful in coping with illness in a better way. Faith in God was reportedly increased among 6.9% patients after their sufferings from the disease. Conclusions: CAM use among cancer patients is prevalent irrespective of their socio- demographic and some other characteristics. Varied opinions regarding holistic approach among and CAM use were prevalent among cancer patients and CAM providers indicating need for better understanding and evaluation of holistic approach for care of cancer patients in Indian set-up. Key Words: Complementary and Alternative Medicine (CAM); Holistic Approach; Traditional Indian Medicine (TIM). Introduction: Holistic medicine, a system of health care may lead to optimal attainment of the physical, mental emotional, social and spiritual aspects of health. In this system emphasis is laid upon all components including physical, nutritional, environmental, emotional, social, spiritual, and lifestyle values. This term holistic is used by doctors to reflect a focus on a person’s overall health, a focus that includes prevention, rehabilitation, and other approaches, rather than illness alone. The approach suggests that a person should treat not only the illness but the whole self to reach a higher level of wellness. Holistic healing is really a lifestyle approach, far beyond the mind-body connection of finding and maintaining wellness and is therefore preferable. It refers to interventions when used in conjunction with mainstream techniques under the umbrella term complementary and alternative medicine (CAM). Holistic medicine can involve the use of conventional and alternative therapies but focuses mostly on lifestyle changes. Physical, mental, emotional, and spiritual elements of the body are interconnected to maintain wellness with Holistic approach. Charak Samhita and Sushruta provide evidence of a rich tradition of herbal medicine in India. Historical and anthropological studies have repeatedly demonstrated the importance of yoga’s ‘upanishadic’ roots and philosophical basis. In India, there is a high degree of reliance and cultural acceptability of Ayurveda Medicine in favour of traditional systems of medicine. The growing incidence of chronic and incurable diseases, such as diabetes, cancer, HIV/AIDS etc, has led to the increased use of CAM in recent years. There has been increased global interest in traditional medicine. Historical and anthropological studies have repeatedly demonstrated the importance of yoga’s ‘upanishadic’ roots and philosophical basis. Ayurveda and traditional Chinese medicine remain the most ancient yet living traditions. Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. CAM is defined as "diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine"1. In recent years, CAM has become popular among the general population. Complementary therapy may be used alongside traditional treatment, while alternative therapy is generally used in place of traditional methods/ standard medical treatments. Government of India established a separate department for Indian Systems of Medicine and Homeopathy (ISM&H) now known as AYUSH (Ayurveda, Yoga, Unani, Siddha, Homoeopathy) in March 1995 to promote indigenous systems. A review article2 discussed key determinants of success of different systems in global markets. The use of CAM is not restricted to developing countries .The number of patients seeking alternate and herbal therapy is growing exponentially3. According to the World Health Organization, the use of herbal remedies throughout the world exceeds that of conventional drugs by two to three-fold4 .Herbal medicine is still the mainstay of about 75–80% of the world population, mainly in developing countries, for primary health care5 . A detailed account of the current and future scenario of herbal medicine can be found in a recent study6 . A 2002 survey7 of US adults 18 years and older conducted by the National Center for Health Statistics and the National Center for Complementary and Alternative Medicine indicated that 74.6% had used some form of CAM and 62.1% had done so within the preceding twelve months. Prevalence of CAM use has been reported to be 67.7% among individuals with diabetes in an Indian community8. The exact reasons for the popularity of CAM are complex, varying with time, space and also from therapy to therapy. No single determinant of the present popularity of complementary and alternative medicine exists. There is a broad range of interacting positive and negative motivations found in the literature9. Natural medicines are considered to be in great demand because of their efficacy, safety and lesser side effects. Increased side effects of drugs, lack of curative treatment for several chronic diseases, high cost of new drugs, microbial resistance and emerging diseases are some reasons for renewed public interest in complementary and alternative medicines10. A systematic review11 of studies assessing its prevalence in 13 countries concluded that about 31% of cancer patients use some form of complementary and alternative medicine. Blind use of CAM by patients may confuse their treating doctors, which may affect diagnostic and treatment decisions resulting in misleading or unknown treatment outcomes due to interaction of drugs with CAM in various forms of plants or plant extracts, minerals and other natural products. A natural product is not necessarily a safe product. Also, beneficial effects associated with CAM, if any, should also not be ignored without scientific evaluation. Clinical decisions should be adjusted accordingly. However, a little research has been carried out on usage patterns of CAM for cancer patients in India. Therefore, present study was conducted in an Indian population with the following specific objectives. Objectives 1. To explore knowledge, attitude, perceptions and beliefs of patients concerning holistic approach of cancer cure 2. To investigate the current status of knowledge, attitude and practice of cancer patients relating to complementary and alternative medicine (CAM) 3. To explore views of patients regarding the disease and role of spirituality in curing cancer. Methods: Present hospital-based cross-sectional study was conducted during September 2011 to March 2012 among cancer patients attending outpatient Radiotherapy OPD of a tertiary health care facility in Chandigarh, North India. Qualitative Survey among 140 new confirmed cancer patients attending Radiotherapy OPD of GMCH Chandigarh, undergoing treatment was conducted. A pilot sample of only 140 patients as a part of a detailed survey under ICMR sponsored project are presented in this qualitative survey exploring their views in depth. Recent available Ethical Guidelines of ICMR (2006) on human participants were followed. Approval from Institutional Ethics Committee was taken for conducting the study. Consents of respondents for participation in the study were taken and confidentiality of responses was ensured. In case the patient is below 18 years of age, unable to give consent due to his/her condition or due to any other reason, consent was taken from accompanying close relative of the patients and he/she served as respondent to provide the relevant information concerning the patient. All ethical issues were explained in detail and most patients agreed to participate in the study. Patients not giving consent were excluded from the study and were replaced by new participants. A mixed method