doi 10.1515/jcim-2013-0048
J Complement Integr Med. 2014; 11(2): 139–145
Jenny M. Wilkinson* and Mark J. Stevens
Use of complementary and alternative medical therapies (CAM) by patients attending a regional comprehensive cancer care centre Abstract Background: This study determined the prevalence, types, and attitudes towards complementary and alternative medicines (CAMs) and therapies in cancer patients actively undergoing conventional cancer treatment at a regional cancer centre. Methods: Data were collected using a self-administered questionnaire provided to adult cancer patients attending a comprehensive cancer care centre in regional Australia over a 3-month period. Results: A participation rate of 89% was recorded over the 3-month period with 285 of 320 cancer patients providing completed data. Mean age was 64 years and slightly more females responded (56%). CAM types used by patients were classified according to US National Centre for Complementary and Alternative Medicine (NCCAM) domains. Overall prevalence of CAM use was 49% (140/285). The NCCAM domains of biologicallybased treatments (mainly herbal and vitamin/mineral supplements) and manipulative/body-based methods (chiropractic and massage) were the most popular. Most patients (61%) who used CAM prior to cancer diagnosis continued complementary practices afterwards, and 33% of participants became first-time CAM users only after diagnosis. CAM use appeared to be associated with high patient acceptance and satisfaction which was not related to either cancer diagnosis or prognosis. Patients who used CAM were mainly willing to disclose (77%) this practice to their conventional health care providers. Conclusions: CAM use is prevalent in regional Australia. Collaborative integration of some CAM practices into conventional cancer care pathways (a process known as integrative oncology) is likely to have substantial patient support.
Keywords: cancer, complementary medicine, integrative oncology, rural
*Corresponding author: Jenny M. Wilkinson, School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia, E-mail: [email protected] Mark J. Stevens, Riverina Cancer Care Centre, Wagga Wagga, NSW, Australia
Introduction Repeated surveys of Australian communities have shown a high use of complementary and alternative medicine (CAM) by both the general public and health professionals [1–6]. In common with worldwide data, older, female, and better educated people as well as those with chronic disease-states, such as cancer, have the highest use [7–9]. Many cancer patients consider CAM within a personal repertoire of self-care primarily to alleviate unpleasant symptoms of their disease or oncological treatment [10, 11]. Although CAM and conventional cancer care are usually considered to exist within separate therapeutic paradigms, there is pressure for integration. This is being driven by both strong consumer demand and a growing acceptance by oncologists of the efficacy and safety of specific CAM strategies [12]. This beneficial and supervised interaction between CAM and conventional cancer care has been termed “integrative oncology”. Practice guidelines for the incorporation of CAM within cancer treatment plans are growing [11, 13, 14], and integrative oncology is a major theme of the current New South Wales (NSW, Australia) Cancer Plan [15]. Five CAM domains are recognised by US National Centre for Complementary and Alternative Medicine (NCCAM) [16]. Within this framework, selected CAM therapies (e.g. acupuncture, mind–body interventions such as meditation, and some biologically-based treatments including herbal remedies and special diets) have found niches in the management of various cancer-associated symptoms such as pain, fatigue, nausea and vomiting, depression, and hot flushes [12]. While
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140
Wilkinson and Stevens: Complementary medicine use by cancer patients
evidence for efficacy of some CAMs is however variable and CAMs will not “cure” cancer, there is clear and growing evidence for use of CAM for supportive and palliative cancer care. The present study sought to examine the prevalence and range of CAM products and practices (NCCAM domains) used by out-patients attending a comprehensive cancer treatment facility in regional NSW, Australia. Complementary health beliefs, attitudes, and level of cancer patient satisfaction with CAM were also assessed with the aim of developing a “therapeutic footprint” for a future integrative programme at the Riverina Cancer Care Centre (RCCC), NSW.
Materials and methods The RCCC, Wagga Wagga is only in-land cancer treatment facility in NSW and services the inhabitants of the eastern half of Greater Southern and southern portion of the Greater Western Area Health Service regions. This geographical area has an estimated population of 0.5 million. Study participants with a broad range of adult cancers were recruited from all out-patients attending the RCCC during a 3-month period. The RCCC offers comprehensive cancer care including complex chemotherapy and radiation therapy. Most disciplines of cancer surgery (except cranial neurosurgery and thoracic surgery) and all diagnostic services except positron emission tomography are available locally. Potential respondents were approached by a member of the RCCC nursing staff when they attended the centre for an appointment. The purpose of the research was explained, and those interested in being involved were provided with a copy of the questionnaire. Completed questionnaires could be either returned to a sealed box at the RCCC reception desk or posted back to the research team using a provided reply paid envelope. The research was approved by both the RCCC Ethics Committee and the Charles Sturt University Ethics in Human Research Committee. A CAM questionnaire based on that used previously by Wilkinson and Simpson [1] and Begbie et al. [17] was designed to gather information on the following areas: (A) demographic and cancer diagnosis, (B) use, attitudes, and perceived benefits of CAM, and (C) complementary health beliefs questionnaire (CHBQ) [18]. With the exception of a question asking respondents to name specific CAM products they were currently using, responses were of a tick-box or Likert-scale type.
Data from the questionnaire were coded and entered into SPSS version 14 (SPSS Inc., Chicago, IL, USA) software for analysis. Both descriptive and inferential statistics were calculated with differences between groups determined using Fisher’s exact test. Differences were deemed statistically significant if p
J Complement Integr Med. 2014; 11(2): 139–145
Jenny M. Wilkinson* and Mark J. Stevens
Use of complementary and alternative medical therapies (CAM) by patients attending a regional comprehensive cancer care centre Abstract Background: This study determined the prevalence, types, and attitudes towards complementary and alternative medicines (CAMs) and therapies in cancer patients actively undergoing conventional cancer treatment at a regional cancer centre. Methods: Data were collected using a self-administered questionnaire provided to adult cancer patients attending a comprehensive cancer care centre in regional Australia over a 3-month period. Results: A participation rate of 89% was recorded over the 3-month period with 285 of 320 cancer patients providing completed data. Mean age was 64 years and slightly more females responded (56%). CAM types used by patients were classified according to US National Centre for Complementary and Alternative Medicine (NCCAM) domains. Overall prevalence of CAM use was 49% (140/285). The NCCAM domains of biologicallybased treatments (mainly herbal and vitamin/mineral supplements) and manipulative/body-based methods (chiropractic and massage) were the most popular. Most patients (61%) who used CAM prior to cancer diagnosis continued complementary practices afterwards, and 33% of participants became first-time CAM users only after diagnosis. CAM use appeared to be associated with high patient acceptance and satisfaction which was not related to either cancer diagnosis or prognosis. Patients who used CAM were mainly willing to disclose (77%) this practice to their conventional health care providers. Conclusions: CAM use is prevalent in regional Australia. Collaborative integration of some CAM practices into conventional cancer care pathways (a process known as integrative oncology) is likely to have substantial patient support.
Keywords: cancer, complementary medicine, integrative oncology, rural
*Corresponding author: Jenny M. Wilkinson, School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia, E-mail: [email protected] Mark J. Stevens, Riverina Cancer Care Centre, Wagga Wagga, NSW, Australia
Introduction Repeated surveys of Australian communities have shown a high use of complementary and alternative medicine (CAM) by both the general public and health professionals [1–6]. In common with worldwide data, older, female, and better educated people as well as those with chronic disease-states, such as cancer, have the highest use [7–9]. Many cancer patients consider CAM within a personal repertoire of self-care primarily to alleviate unpleasant symptoms of their disease or oncological treatment [10, 11]. Although CAM and conventional cancer care are usually considered to exist within separate therapeutic paradigms, there is pressure for integration. This is being driven by both strong consumer demand and a growing acceptance by oncologists of the efficacy and safety of specific CAM strategies [12]. This beneficial and supervised interaction between CAM and conventional cancer care has been termed “integrative oncology”. Practice guidelines for the incorporation of CAM within cancer treatment plans are growing [11, 13, 14], and integrative oncology is a major theme of the current New South Wales (NSW, Australia) Cancer Plan [15]. Five CAM domains are recognised by US National Centre for Complementary and Alternative Medicine (NCCAM) [16]. Within this framework, selected CAM therapies (e.g. acupuncture, mind–body interventions such as meditation, and some biologically-based treatments including herbal remedies and special diets) have found niches in the management of various cancer-associated symptoms such as pain, fatigue, nausea and vomiting, depression, and hot flushes [12]. While
Brought to you by | New York University Bobst Library Technical Services Authenticated Download Date | 5/19/15 4:11 AM
140
Wilkinson and Stevens: Complementary medicine use by cancer patients
evidence for efficacy of some CAMs is however variable and CAMs will not “cure” cancer, there is clear and growing evidence for use of CAM for supportive and palliative cancer care. The present study sought to examine the prevalence and range of CAM products and practices (NCCAM domains) used by out-patients attending a comprehensive cancer treatment facility in regional NSW, Australia. Complementary health beliefs, attitudes, and level of cancer patient satisfaction with CAM were also assessed with the aim of developing a “therapeutic footprint” for a future integrative programme at the Riverina Cancer Care Centre (RCCC), NSW.
Materials and methods The RCCC, Wagga Wagga is only in-land cancer treatment facility in NSW and services the inhabitants of the eastern half of Greater Southern and southern portion of the Greater Western Area Health Service regions. This geographical area has an estimated population of 0.5 million. Study participants with a broad range of adult cancers were recruited from all out-patients attending the RCCC during a 3-month period. The RCCC offers comprehensive cancer care including complex chemotherapy and radiation therapy. Most disciplines of cancer surgery (except cranial neurosurgery and thoracic surgery) and all diagnostic services except positron emission tomography are available locally. Potential respondents were approached by a member of the RCCC nursing staff when they attended the centre for an appointment. The purpose of the research was explained, and those interested in being involved were provided with a copy of the questionnaire. Completed questionnaires could be either returned to a sealed box at the RCCC reception desk or posted back to the research team using a provided reply paid envelope. The research was approved by both the RCCC Ethics Committee and the Charles Sturt University Ethics in Human Research Committee. A CAM questionnaire based on that used previously by Wilkinson and Simpson [1] and Begbie et al. [17] was designed to gather information on the following areas: (A) demographic and cancer diagnosis, (B) use, attitudes, and perceived benefits of CAM, and (C) complementary health beliefs questionnaire (CHBQ) [18]. With the exception of a question asking respondents to name specific CAM products they were currently using, responses were of a tick-box or Likert-scale type.
Data from the questionnaire were coded and entered into SPSS version 14 (SPSS Inc., Chicago, IL, USA) software for analysis. Both descriptive and inferential statistics were calculated with differences between groups determined using Fisher’s exact test. Differences were deemed statistically significant if p
