Top

Supportive Care in Cancer

Published in:

01-11-2004 | Original Article

Discrepant views of oncologists and cancer patients on complementary/alternative medicine

Authors: Mary Ann Richardson, Louise C. Mâsse, Kelly Nanny, Christina Sanders

Published in: Supportive Care in Cancer | Issue 11/2004

Abstract

Goals

Complementary/alternative medicine (CAM) is widely used by patients but rarely discussed with oncologists. To understand reasons for the communication gap, this study compares physicians and patients on perceived reasons for CAM use and nondisclosure of use, reactions of physicians to disclosure, and expectations for CAM.

Patients and methods

Cross-sectional studies assessed 82 physicians (response 68.3%) and 244 of 374 outpatients (response 65.2%) identified as CAM users at the MD Anderson Cancer Center. Data were summarized by frequency and compared using chi-square tests.

Main results

Physicians were more likely (p<0.001) than patients to attribute CAM use to hope (χ²=17.7), control (χ²=17.5), incurable disease (χ²=42.8), or a nontoxic approach (χ²=50.9). Both physicians and patients agreed CAM could relieve symptoms/side effects, but physicians were less likely (p<0.001) than patients to expect that CAM improved immunity (χ²=72.2) or quality of life (χ²=17.1), cured disease (χ²=42.5), or prolonged life (χ²=58.4). Physicians and patients responded differently (p<0.005) on reasons for nondisclosure. Physicians believed patients felt CAM discussions were unimportant (χ²=7.9) and physicians would not understand (χ²=48.1), discontinue treatment (χ²=26.4), discourage or disapprove of the use (χ²=131.7); patients attributed nondisclosure to their uncertainty of its benefit (χ²=10.4) and never being asked about CAM (χ²=9.9) by physicians. Physicians were more likely (χ²=9.5, p<0.002) to warn of risks and less likely (χ²=23.5, p<0.001) to encourage use than patients perceived.

Conclusion

Oncologists and cancer patients hold discrepant views on CAM that may contribute to a communication gap. Nevertheless, physicians should ask patients about CAM use, discuss possible benefits, and advise of potential risks.

Adler SR, Fosket JR (1999) Disclosing complementary and alternative medicine use in the medical encounter: A qualitative study in women with breast cancer. J Fam Pract 48(6):453–458PubMed

Ashikaga T, Bosompra K, O’Brien P, Nelson L (2002) Use of complementary and alternative medicine by breast cancer patients: prevalence, patterns and communication with physicians. Support Care Cancer 10(7):542–548CrossRefPubMed

Boon H, Stewart M, Kennard M, Gray R, Sawka C, Brown J, McWilliam C, Gavin A, Baron R, Aaron D, et al (2000) Use of complementary/alternative medicine by breast cancer survivors in Ontario: prevalence and perceptions . J Clin Oncol 18:2515–2521

Bruera E, Willey J, Palmer J, Rosales M (2002) Treatment decisions for breast carcinoma: patient preferences and physician perceptions. Cancer 94:2976–3080CrossRef

Burstein HJ, Gelber S, Guadagnoli E, Weeks JC (1999) Use of alternative medicine by women with early-stage breast cancer. JAMA 340(22):1733–1739CrossRef

Charles C, Whelan T, Gafni A, Willan A, Farrell S (2003) Shared treatment decision making: waht does it mean to physicians? J Clin Oncol 21(5):932–936

Conklin K (2000) Dietary antioxidants during cancer chemotherapy: impact on chemotherapeutic effectiveness and development of side effects. Nutr Cancer 37(1):1–18CrossRefPubMed

Corbin Winslow L, Shapiro H (2002) Physicians want education about complementary and alternative medicine to enhance communication with their patients. Arch Intern Med 162(10):1176–1181CrossRefPubMed

Eisenberg DM (1997) Advising patients who seek alternative medical therapies. Ann Inter Med 127(1):61–69

10.

Gotay C, Hara W, Issell B, Maskarinec G (1999) Use of complemetnary and alternative medicine in Hawaii cancer patients. Hawaii Med J 58(4):94–95PubMed

11.

Hyodo I, Eguchi K, Nishina T, Endo H, Tanimizu M, Mikami I, Takashima S, Imanishi J (2003) Perceptions and attitudes of clinical oncologists on complementary and alternative medicine: a nationwide survey in Japan. Cancer 97(11):2861–2868CrossRefPubMed

12.

Kappauf H, Leykauf-Ammon D, Bruntsch U, Horneber M, Kaiser G, Buschel G, Gallmeir W (2000) Use of and attitudes held towards unconventional medicine by patients in a department of internal medicine/oncology and heaemetology. Support Care Cancer 8(4):314–322CrossRefPubMed

13.

Keating N, Guadagnoli E, Landrum M, Borbas C, Weeks J (2002) Treatment decision making in early-stage breast cancer: should surgeons match patients’ desired level of involvement? J Clin Oncol 20(6):1473–1479

14.

Kelly K, Jacobson J, Kennedy D, Braudt S, Mallick M, Weiner M (2000) Use of unconventional therapies by children with cancer at an urban medical center. J Pediatr Hematol Oncol 22(5):412–426CrossRefPubMed

15.

Lamson D, Brignall M (1999) Antioxidants in cancer therapy; their actions and interactions with oncologic therapies. Altern Med Rev 4(5):304–329PubMed

16.

Lee MM, Lin SS, Wrensch MR, Adler SR, Eisenberg D (2000) Alternative therapies used by women with breast cancer in four ethnic populations. J Natl Cancer Inst 92(1):42–47CrossRefPubMed

17.

Lerner IJ, Kennedy BJ (1992) The prevalence of questionable methods of cancer treatment in the United States. CA Cancer J Clin 42(3):181–191PubMed

18.

Mathijssen R, Verweij J, de Bruijn P, Loos W, Sparreboom A (2002) Effects of St. John’s wort on irinotecan metabolism. J Natl Cancer Inst 94(16):1247–1249CrossRefPubMed

19.

McCurdy E, Spangler J, Wofford M, Chauvenet A, McLean T (2001) Complementary and alternative therapy use in pediatric oncology patients. J Ped Hem Onc A27

20.

Morris K, Johnson N, Horner L, Walts D (2000) A comparison of complementary therapy use between breast cancer patients and patients with other primary tumor sites. Am J Surg 179:407–411CrossRefPubMed

21.

Moschen R, Kemmler G, Schweigkofler H, Holzner B, Dunser M, Richter R, Fleischhacker, Sperner-Uterweger B (2001) Use of alternative/complementary therapy in breast cancer patients- a psychological perspective. Support Care Cancer 9:267–274CrossRefPubMed

22.

Moyad M (2001) The prevalence and effectiveness of complementary and alternative medicine: what has been learned and what it may be telling us about our patients, ourselves, and conventional medical treatment. Semin Urol Oncol 19(4):257–269PubMed

23.

National Center for Complementary and Alternative Medicine. Expanding horizons of healthcare: The five-year NCCAM strategic plan 2001–2005. http://nccam.nih.gov/about/plans/fiveyear/index.htm. Cited 20 July 2004

24.

Powell C, Dibble S, Dall’era J, Cohen I (2002) Use of herbs in women diagnosed with ovarian cancer. Int J Gynecol Cancer 12:214–217CrossRefPubMed

25.

Rees R, Feigel I, Vickers A, Zollman C, McGurk R, Smith C (2000) Prevalence of complementary therapy use by women with breast cancer: a population-based survey. Eur J Cancer 36:1359–1364CrossRefPubMed

26.

Richardson M, Straus S (2002) Complementary and alternative medicine: Opportunities and challenges for cancer management and research. Semin Oncol 29 (6):531–535CrossRefPubMed

27.

Richardson MA, Ramirez T, Palmer JL, Greisinger A, Singletary SE (2000) Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology. J Clin Oncol 18:2505–2514

28.

Sandler R, Halabi S, Kaplan E, Baron J, Paskett E, Petrelli N (2001) Use of vitamins, minerals, and nutritional supplements by participants in a chemoprevention trial. Cancer 91:1040–1045CrossRefPubMed

29.

Sollner W, Maislinger S, DeVries A, Steixner E, Rumpold G, Lukas P (2000) Use of complementary and alternative medicine by cancer patients is not associated with perceived distress or poor compliance with standard treatment but with active coping behavior. Cancer 89(4):873–880CrossRefPubMed

30.

Sparber A (2001) Clinical center sets new policy on use of herbal and other alternative supplements by CC patients. NIH Catalyst 9(6):8–9

31.

Sparber A, Bauer L, Curt G, Eisenerg D, Levin T, Parks S, Steinberg S, Wooton J (2002) Use of complementary medicine by adult patients participating in cancer clinical trials. Oncol Nurs Forum 27(4):623–630

32.

Tasaki K, Maskarinec G, Shumay D, Tatsumura Y, Kakai H (2002) Communication between physicians and cancer patients about complementary and alternative medicine: exploring patients’ perspectives. Psychooncol 11( ):212–220CrossRef

33.

Verhoef MJ, Hagen N, Pelletier G, Forsyth P (1999) Alternative therapy use in neurologic diseases. Neurology 52:617–622PubMed

34.

Von Gruenigen V, White L, Kirven M, Showalter A, Hopkins M (2000) A comparison of complementary and alternative medicine use by gynecology and gynecologic oncology patients. Int J Gynecol Cancer 11:205–209

35.

Weiger W, Smith M, Boon H, Richardson M, Kaptchuk T, Eisenberg D (2002) Adivising patients who seek complementary and alternative medical therapies for cancer. Ann Intern Med 137:889–903PubMed

36.

Weijl NI, Cleton FJ, Osanto S (1997) Free radicals and antioxidants in chemotherapy-induced toxicity. Cancer Treatment Reviews 23:209–240CrossRefPubMed

37.

Zeisel S, Salganik R (1999) Special commentary: antioxidants and nutrition support. Curr Opin Clin Nutr Metab Care 2(1):1–3CrossRefPubMed

Title: Discrepant views of oncologists and cancer patients on complementary/alternative medicine
Authors: Mary Ann Richardson
Louise C. Mâsse
Kelly Nanny
Christina Sanders
Publication date: 01-11-2004
Publisher: Springer-Verlag
Published in: Supportive Care in Cancer / Issue 11/2004
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-004-0677-3

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The STEP trials

Springer Medicine

Abstract

Goals

Patients and methods

Main results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2004

Society News 12/11

Peripherally inserted central venous catheter in pediatric hematological patients

Gaps and junctions between clinical experience and theoretical framework in the use of opioids

Pulse oximetry in supportive and palliative care

Effect of aerobic exercise and relaxation training on fatigue and physical performance of cancer patients after surgery. A randomised controlled trial

A hidden cause of hypokalemic paralysis in a patient with prostate cancer

Keynote webinar | Spotlight on antibody–drug conjugates in cancer