Complementary Medicine Use Common in Cancer Survivors

Roxanne Nelson

August 13, 2008

August 13, 2008 — A substantial number of cancer survivors are using complementary methods (CM) of healthcare, along with conventional treatment protocols, according to new data published online August 4 in Cancer. Survivors who were most likely to use CM tended to be white, female, younger than 55 years of age, and to have a higher income. Breast and ovarian cancer survivors were the most likely to use CMs, whereas melanoma and kidney cancer survivors were the least likely to use them.

"CMs are much more popular among breast and ovarian cancer survivors than among people with other cancers, and this is not simply because ovarian cancer is limited to women and breast cancer is extremely rare among men," said lead author Ted Gansler, MD, MBA, from the American Cancer Society. "For example, all types of CMs were used more often by breast and ovarian cancer survivors than by uterine cancer survivors, who are also female. And, when multivariable models were used to consider the effects of gender, stage of disease, age, and several other factors, the type of cancer still remained a significant predictor of CM use."

The use of complementary medicine is widespread in the United States and is increasing among people with a variety of health conditions. Data analyzed from the 2002 National Health Interview Survey (NHIS) showed that 36% of the 31,044 respondents reported using at least 1 type of CM during the previous year. When prayer for health reasons was included in the definition of CM, that number rose to 62%.

Of the 1904 cancer survivors who responded to the NHIS survey, 40% reported using some type of CM within the previous year, and 62% reported using prayer for healing. When controlled for confounders, CM use was higher among cancer survivors than among the general population, but similar to other groups with chronic symptomatic illnesses.

Dr. Gansler explained that 1 goal of the current research was to better understand how an individual's personality, demographic characteristics, and medical situation influence health decisions, such as CM use. "Variations by cancer type are likely to be influenced by disease prognosis and by severity of symptoms and side effects, as well as by the ways in which various cancers influence feelings about one's body and the influence of in-person and online cancer survivor communities," he told Medscape Oncology. "Gender differences in CM use among cancer survivors are certainly influenced by use prior to diagnosis."

As an example, he pointed out that yoga is more popular among female cancer survivors than among male survivors, but that seems to also be a trend in the general population. "You're likely to find far more women than men in a typical yoga class," he said. "Gender differences in acknowledging and sharing feelings are likely to influence the use of some complementary methods, as are differences in attitudes about methods, such as massage, that involve touching."

In the current study, the researchers analyzed the prevalence and the medical and demographic associations of CM use among 4931 cancer survivors who were surveyed 10 to 24 months after their initial diagnosis. The participants were selected from stratified random samples provided by 11 statewide cancer registries, and were diagnosed between January 2000 and September 2003 with breast, prostate, bladder, uterine, lung, colorectal, or ovarian cancers, or with skin melanoma or non-Hodgkin's lymphoma. The participants were surveyed by mail and telephone and asked about their use of 19 CMs.

Slightly more than half of the participants were women (57.6%), the majority were non-Hispanic white (87.5%), and about a third (31.7%) were 65 years or younger. Almost two thirds of the cohort (60.5%) reported a family income of at least $40,000, and more than one third were college educated (36.3%).

Among the 19 CMs studied, prayer and spiritual practice were the most prevalent, reported by 61.4% of survivors. This was followed by relaxation (44.3%), faith and spiritual healing (42.4%), nutritional supplements and vitamins (40.1%), meditation (15%), religious counseling (11.3%), massage (11.2%), and support groups (9.7%). Hypnosis was least likely to be used (0.4%), and biofeedback therapy (1.0%) and acupuncture/acupressure (1.2%) were used only slightly more often.

Women were more likely to use CMs than men in all categories. The gap between the sexes was smallest for biologic therapies (odds ratio [OR], 0.719) and nonspiritual mind-body therapies (OR, 0.772), but largest for manipulative and body-based practices (OR, 0.336) and energy medicine practices (OR, 0.344).

The use of CMs was higher among non-Hispanic whites than among other ethnic and racial groups, and higher-income respondents were more likely to report CM use. The prevalence of use increased with education levels as well.

Further research should investigate the connection between CM use and specific long-term and late effects of treatment. In addition, the perceived benefits might be a valuable area for investigation, the authors write.

"I think most oncologists recognize that it is very important to discuss biologically based complementary treatments, like dietary supplements and special diets, that can interact with conventional treatment," said Dr. Gansler. "In addition, someone needs to advise patients on which other complementary therapies are likely to be beneficial to them and which local providers are reputable."

"The main take-home recommendation," he added, "is to become familiar with complementary methods that are used most often — those with the strongest evidence of benefit, and those with clearest evidence of harm."

Cancer. 2008;113:1048-1057. Abstract

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