Use of complementary and alternative medicine in cancer patients: a European survey
TL;DR: It is imperative that health professionals explore the use of CAM with their cancer patients, educate them about potentially beneficial therapies in light of the limited available evidence of effectiveness, and work towards an integrated model of health-care provision.
About: This article is published in Annals of Oncology.The article was published on 2005-04-01 and is currently open access. It has received 1020 citations till now.
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TL;DR: 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 and the health care systems ought to implement clear strategies of how to deal with this.
Abstract: 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.
593 citations
TL;DR: To update previous systematic reviews of 12‐month prevalence of complementary and alternative medicine (CAM) use by general populations and explore trends in CAM use by national populations, a brief tool for assessing methodological quality of published CAM‐use prevalence surveys is developed.
Abstract: SUMMARY Objectives: To update previous systematic reviews of 12-month prevalence of complementary and alternative medicine (CAM) use by general populations; to explore trends in CAM use by national populations; to develop and apply a brief tool for assessing methodological quality of published CAM-use prevalence surveys. Design: Nine databases were searched for published studies from 1998 onwards. Studies prior to 1998 were identified from two previous systematic reviews. A sixitem literature-based tool was devised to assess robustness and interpretability of CAM-use estimates. Results: Fifty-one reports from 49 surveys conducted in 15 countries met the inclusion criteria. We extracted 32 estimates of 12-month prevalence of use of any CAM (range 9.8‐76%) and 33 estimates of 12-month prevalence of visits to CAM practitioners (range 1.8‐48.7%). Quality of methodological reporting was variable; 30 ⁄51 survey reports (59%) met four or more of six quality criteria. Estimates of 12-month prevalence of any CAM use (excluding prayer) from surveys using consistent measurement methods showed remarkable stability in Australia (49%, 52%, 52%; 1993, 2000, 2004) and USA (36%, 38%; 2002, 2007). Conclusions: There was evidence of substantial CAM use in the 15 countries surveyed. Where national trends were discernable because of consistent measurement, there was no evidence to suggest a change in 12-month prevalence of CAM use since the previous systematic reviews were published in 2000. Periodic surveys are important to monitor population-level CAM use. Use of governmentsponsored health surveys may enhance robustness of population-based prevalence estimates. Comparisons across countries could be improved by standardising approaches to data collection.
477 citations
TL;DR: Yoga appeared to be a feasible intervention and beneficial effects on several physical and psychosocial symptoms were reported, and in patients with breast cancer, effect size on functional well-being was small, and they were moderate to large for Psychosocial outcomes.
Abstract: Background: This study aimed to systematically review the evidence from randomized controlled trials (RCTs) and to conduct a meta-analysis of the effects of yoga on physical and psychosocial outcomes in cancer patients and survivors. Methods: A systematic literature search in ten databases was conducted in November 2011. Studies were included if they had an RCT design, focused on cancer patients or survivors, included physical postures in the yoga program, compared yoga with a non-exercise or waitlist control group, and evaluated physical and/or psychosocial outcomes. Two researchers independently rated the quality of the included RCTs, and high quality was defined as >50% of the total possible score. Effect sizes (Cohen’s d) were calculated for outcomes studied in more than three studies among patients with breast cancer using means and standard deviations of post-test scores of the intervention and control groups. Results: Sixteen publications of 13 RCTs met the inclusion criteria, of which one included patients with lymphomas and the others focused on patients with breast cancer. The median quality score was 67% (range: 22–89%). The included studies evaluated 23 physical and 20 psychosocial outcomes. Of the outcomes studied in more than three studies among patients with breast cancer, we found large reductions in distress, anxiety, and depression (d = −0.69 to −0.75), moderate reductions in fatigue (d = −0.51), moderate increases in general quality of life, emotional function and social function (d = 0.33 to 0.49), and a small increase in functional well-being (d = 0.31). Effects on physical function and sleep were small and not significant. Conclusion: Yoga appeared to be a feasible intervention and beneficial effects on several physical and psychosocial symptoms were reported. In patients with breast cancer, effect size on functional well-being was small, and they were moderate to large for psychosocial outcomes.
273 citations
Cites background from "Use of complementary and alternativ..."
...Because of these barriers, approximately one out of three adult cancer patients turns to complementary and alternative medicine techniques, mindfulness, or yoga, to help manage their symptoms [24-26]....
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TL;DR: Although the use of CAM by patients with cancer is high, patients frequently fail to disclose its use to their health professionals for reasons emanating from both sides of the dyadic patient-doctor relationship.
Abstract: Objective. To explore the nondisclosure of complementary and alternative medicine (CAM) use among cancer patients, including reasons for and outcomes from nondisclosure of CAM use, within the context of patient-doctor communication. Method. A systematic review was conducted exploring investigations surrounding the communication of CAM use for patients with cancer published until August 2011. Results.Atotalof21studieswerelocated,whichreporteda prevalence of CAM use among patients with cancer ranging between11%and95%;ofthesepatients,20%to77%didnot disclose their CAM use. The main reasons for nondisclosure werethedoctor’slackofinquiry;patient’santicipationofthe doctor’s disapproval, disinterest, or inability to help; and patient’s perception that disclosure of CAM use is irrelevant to their conventional care. There is some evidence to suggest that patient-doctor communication about the use of CAM was associated with an enhanced patient-doctor relationship and higher patient satisfaction. Conclusions. Although the use of CAM by patients with
252 citations
Cites background from "Use of complementary and alternativ..."
...The main reasons include to help alleviate the side effects caused by medical treatment [11]; to satisfy unmet needs from conventional medicine and doctors, including for emotional support and humanistic care [9]; and to improve quality of life and overall care [12]....
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Memorial Sloan Kettering Cancer Center1, University of Texas MD Anderson Cancer Center2, University of California, San Francisco3, Columbia University4, University of Alberta5, Centennial College6, Berklee College of Music7, University of South Florida8, University of Texas Health Science Center at Houston9, McMaster University10
TL;DR: The Society for Integrative Oncology is an international organization dedicated to encouraging scientifi c evaluation, dissemination of evidence-based information, and appropriate clinical integration of complementary therapies.
Abstract: In recent years, the term integrative medicine has gained acceptance in medical academia. The Consortium of Academic Health Centers for Integrative Medicine defi nes this term as “the practice of medicine that reaffi rms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals, and disciplines to achieve optimal health and healing.” 1 Integrative oncology has been specifi cally described as both a science and a philosophy that focuses on the complex health of people with cancer and proposes an array of approaches to accompany the conventional therapies of surgery, chemotherapy, molecular therapeutics, and radiotherapy to facilitate health. 2 The SIO and its Medline -indexed journal ( Journal of the Society of Integrative Oncology ), founded by leading oncologists and oncology professionals from major cancer centers and organizations, promote quality research and appropriate application of useful, adjunctive complementary modalities T he Society for Integrative Oncology (SIO) is an international organization dedicated to encouraging scientifi c evaluation, dissemination of evidence-based information, and appropriate clinical integration of complementary therapies. Practice guidelines have been developed by the authors and endorsed by the Executive Committee of the SIO. Guidelines are a work in progress; they will be updated as needed and are available on the SIO Web site ().
245 citations
References
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TL;DR: Alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient.
Abstract: Context.—A prior national survey documented the high prevalence and costs of
alternative medicine use in the United States in 1990.Objective.—To document trends in alternative medicine use in the United States
between 1990 and 1997.Design.—Nationally representative random household telephone surveys using comparable
key questions were conducted in 1991 and 1997 measuring utilization in 1990
and 1997, respectively.Participants.—A total of 1539 adults in 1991 and 2055 in 1997.Main Outcomes Measures.—Prevalence, estimated costs, and disclosure of alternative therapies
to physicians.Results.—Use of at least 1 of 16 alternative therapies during the previous year
increased from 33.8% in 1990 to 42.1% in 1997 (P≤.001).
The therapies increasing the most included herbal medicine, massage, megavitamins,
self-help groups, folk remedies, energy healing, and homeopathy. The probability
of users visiting an alternative medicine practitioner increased from 36.3%
to 46.3% (P=.002). In both surveys alternative therapies
were used most frequently for chronic conditions, including back problems,
anxiety, depression, and headaches. There was no significant change in disclosure
rates between the 2 survey years; 39.8% of alternative therapies were disclosed
to physicians in 1990 vs 38.5% in 1997. The percentage of users paying entirely
out-of-pocket for services provided by alternative medicine practitioners
did not change significantly between 1990 (64.0%) and 1997 (58.3%) (P=.36). Extrapolations to the US population suggest a 47.3%
increase in total visits to alternative medicine practitioners, from 427 million
in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary
care physicians. An estimated 15 million adults in 1997 took prescription
medications concurrently with herbal remedies and/or high-dose vitamins (18.4%
of all prescription users). Estimated expenditures for alternative medicine
professional services increased 45.2% between 1990 and 1997 and were conservatively
estimated at $21.2 billion in 1997, with at least $12.2 billion paid out-of-pocket.
This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations.
Total 1997 out-of-pocket expenditures relating to alternative therapies were
conservatively estimated at $27.0 billion, which is comparable with the projected
1997 out-of-pocket expenditures for all US physician services.Conclusions.—Alternative medicine use and expenditures increased substantially between
1990 and 1997, attributable primarily to an increase in the proportion of
the population seeking alternative therapies, rather than increased visits
per patient.
6,814 citations
"Use of complementary and alternativ..." refers background in this paper
...In the USA, where such data are available, the use of CAM is conservatively estimated to cost patients US$27 billion (for the year 1997) [30]....
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TL;DR: In most categories, CAM use was common among outpatients and given the number of patients combining vitamins and herbs with conventional treatments, the oncology community must improve patient-provider communication, offer reliable information to patients, and initiate research to determine possible drug-herb-vitamin interactions.
Abstract: PURPOSE: Oncologists are aware that their patients use complementary/alternative medicine (CAM). As cancer incidence rates and survival time increase, use of CAM will likely increase. This study assessed the prevalence and predictors of CAM use in a comprehensive cancer center. SUBJECTS AND METHODS: Subjects were English-speaking cancer patients at least 18 years of age, attending one of eight outpatient clinics at The University of Texas M.D. Anderson Cancer Center, Houston, TX, between December 1997 and June 1998. After giving written informed consent, participants completed a self-administered questionnaire. Differences between CAM users and nonusers were assessed by χ2 and univariate logistic regression analysis. A multivariate logistic regression model identified the simultaneous impact of demographic, clinical, and treatment variables on CAM use; P values were two-sided. RESULTS: Of the 453 participants (response rate, 51.4%), 99.3% had heard of CAM. Of those, 83.3% had used at least one CAM approac...
1,001 citations
"Use of complementary and alternativ..." refers background in this paper
...Spiritual therapies, prayer as a therapy, massage, shark cartilage, green tea, support groups and non-traditional diets are also commonly reported in the literature [6, 9, 11, 14, 15]....
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...US studies demonstrate a much higher use of CAM, which is often well above 40% [6, 8, 9, 15]....
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...3% in an outpatient sample of 453 patients [6]....
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TL;DR: The aim of this review was to summarize the existing data on complementary/alternative cancer treatments and to conclude that reliable prevalence rates do not exist.
Abstract: BACKGROUND
Complementary/alternative cancer treatments are believed to be prevalent. However, reliable prevalence rates do not exist. The aim of this review was to summarize the existing data on this topic.
METHODS
A series of computerized literature searches was performed to locate all published studies documenting the prevalence of complementary and/or alternative therapy (CAM) use among patients with cancer.
RESULTS
A total of 26 surveys from 13 countries, including 4 studies of pediatric patients, was retrieved. The use of CAM therapies in adult populations ranged from 7-64%. The average prevalence across all adult studies was 31.4%.
CONCLUSIONS
This large degree of variability most likely is due to different understandings of "complementary/alternative medicine" on the part of both investigators and patients. It is likely that the results of the current study reflect the primarily adjunctive use of CAM treatments. Future studies should use a standardized protocol to determine the true prevalence of these therapies more closely. Cancer 1998;83:777-782. © 1998 American Cancer Society.
930 citations
"Use of complementary and alternativ..." refers background or result in this paper
...The use of CAM has increased steadily over the past 15 years or so, and undoubtedly it has gained medical, economic and sociological importance [3]....
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...This is an increase of the average mean CAM use from that reported in a review of 29 studies covering 20 years [3]....
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...Similar to the study by Ernst and Cassileth [3], there was great variability in the use of CAM, and this may partly be the result of the patient’s understanding of what CAM is....
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TL;DR: Harmonisation of training and regulation of practitioners is the challenge for the future of complementary medicine in Europe.
Abstract: Complementary or unconventional treatments are used by many doctors and other therapists throughout Europe. The major forms are acupuncture, homoeopathy, manual therapy or manipulation, and phytotherapy or herbal medicine. The relative popularity of therapies differs between countries, but public demand is strong and growing. Regulation of practitioners varies widely: in most countries only registered health professionals may practice, but in the United Kingdom practice is virtually unregulated. Germany and some Scandinavian countries have intermediate systems. Legal reforms are in progress in the Netherlands and the United Kingdom. European institutions are starting to influence the development of complementary medicine. Harmonisation of training and regulation of practitioners is the challenge for the future.
To speak of “alternative” medicine is, as Pietroni has pointed out, like talking about foreigners—both terms are vaguely pejorative and refer to large, heterogeneous categories defined by what they are not rather than by what they are.1 The analogy is apt: the current worldwide trend away from suspicion and hostility between “orthodox” and “alternative” medicine towards investigation, understanding, and consumer protection can be compared with the process by which Europeans have learnt to view each other as partners rather than foreigners. This shift in attitude is evident in the BMA's recent publication, Complementary Medicine: New Approaches to Good Practice,2 and in the use of the term “complementary” rather than “alternative.” We welcome this new spirit and believe it will benefit patients.
Even the term complementary medicine is not entirely satisfactory, lumping together as it does a wide range of methods with little in common except that they are outside the mainstream of medicine. The most accurate term is perhaps “unconventional therapeutic methods.”
Consumer surveys consistently show positive public attitudes to complementary medicine, with about 60% of the public in the Netherlands3 and Belgium4 declaring themselves …
758 citations
TL;DR: In the absence of prospective data, which do not exist, the results represent, to the knowledge, the most accurate information currently available on U.S. trends in CAM therapy use over the past half-century.
Abstract: Background Although recent research has shown that many people in the United States use complementary and alternative medical (CAM) therapies, little is known about time trends in use. Objective To present data on time trends in CAM therapy use in the United States over the past half-century. Design Nationally representative telephone survey of 2055 respondents that obtained information on current use, lifetime use, and age at first use for 20 CAM therapies. Setting The 48 contiguous U.S. states. Participants Household residents 18 years of age and older. Measurement Retrospective self-reports of age at first use for each of 20 CAM therapies. Results Previously reported analyses of these data showed that more than one third of the U.S. population was currently using CAM therapy in the year of the interview (1997). Subsequent analyses of lifetime use and age at onset showed that 67.6% of respondents had used at least one CAM therapy in their lifetime. Lifetime use steadily increased with age across three age cohorts: Approximately 3 of every 10 respondents in the pre-baby boom cohort, 5 of 10 in the baby boom cohort, and 7 of 10 in the post-baby boom cohort reported using some type of CAM therapy by age 33 years. Of respondents who ever used a CAM therapy, nearly half continued to use many years later. A wide range of individual CAM therapies increased in use over time, and the growth was similar across all major sociodemographic sectors of the study sample. Conclusions Use of CAM therapies by a large proportion of the study sample is the result of a secular trend that began at least a half century ago. This trend suggests a continuing demand for CAM therapies that will affect health care delivery for the foreseeable future.
735 citations
"Use of complementary and alternativ..." refers background in this paper
...[18] also suggest that the trend in the use of CAM in the USA may be a result of a secular trend that began about half a century ago, which nevertheless highlights the increasing patient demand for such therapies....
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