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Complementary and Alternative
Medicine Use
in Gynecologic Cancer Patients
Amornrat Supoken, MD
Thitima Chaisrisawadsuk, MD
Bandit Chumworathayi, MD
Department of Obstetrics and Gynecology
Faculty of Medicine, Khon Kaen University
Introduction
 In Thailand
Cancer is the third highest
cause of death.1
Gynecologic cancer is the
most common cancer in
women.2
1.Ministry of Public Health, 1996; Hangsubcharoen, 1996
2.National Cancer Institute of Thailand, 1994
Introduction
 Gynecologic cancer is
associated with
 a high morbidity & mortality rate
 a significant decrease in quality of
life
Ronald. New Jersey:Parthenose Publishing Group; 1990
Introduction
 Complementary and alternative
medicine (CAM)
a group of diverse medical and
health care systems, practices,
and products that are not
generally considered part of
conventional medicine.
The National Center for Complementary and Alternative Medicine , 2009.
Introduction
The use of CAM is widespread all
over the world.
Adams M, Jewell AP. Int Semin Surg Oncol; 2007
Introduction
 There is emerging evidence
to support that quality of life
and general well-being is
improved in gynecologic
cancer patients who use
CAM.
Adams M, Jewell AP. Int Semin Surg Oncol; 2007
Introduction
Authors
Proportion of CAM use
Richardson, 2000
99.3%
Dy, 2004
88.2%
Swisher, 2002
49.6%
Navo, 2004
48.0%
Vasuratna, 2008
40.3%
Molassiotis, 2005
39.5%
Introduction
Authors
Proportion of CAM use
Richardson, 2000
99.3%
Dy, 2004
88.2%
Swisher, 2002
49.6%
Navo, 2004
48.0%
Vasuratna, 2008
40.3%
Molassiotis, 2005
39.5%
Introduction
 In the Northeast of Thailand where many
features of population are different from
other parts .
Introduction
 There is no study regarding CAM use
in Northeastern part of Thailand.
Design and Objective
 Design
 Descriptive analytical study
 Objective
 To determine the proportion,
types and associated factors of
CAM use in gynecologic cancer
patients who attend
Srinagarind Hospital.
Subjects and Methods
 Inclusion criteria
Gynecologic cancer patients
> 20 year-old
Able to give their informed
consent
>1-month of diagnosis
 Exclusion criteria
Use CAM for other reasons
Subjects and Methods
After IRB approval in September, 2008
Cross-sectional survey between
October to December, 2008
Inclusion criteria
gynecologic cancer patients
> 1-month of diagnosis
>20 year-old
able to give their informed consent
Exclusion criteria
Use CAM for other reasons
50 admitted and 50 walk-in gynecologic cancer
Collect data by one-by-one interview
Demographic data, Type of CAM
Subjects and Methods
 Operational definition
Acupuncture
Aromatherapy
Biofeedback
Homeopathy
Hypnotherapy
Yoga
Massage
Naturopathy
Nutritional
supplements
Relaxation therapy
Spiritual healing
Subjects and Methods
 Sample size calculation
Pilot study : Proportion 50%; P = 0.5
Zα= 1.96
95%CI; e = 0.1
N = Zα2P(1-P)/e2
N = (1.96)2x0.5x0.5/(0.1)2
N = 96.04
Statistical analysis
 Descriptive data
 Mean + SD
 Percentage
 Comparative statistics
 t-test for continuous data
 Fisher’s exact test for
categorical data
Z-test for difference for
proportions
Results
Characteristics of the included participants
Mean age (year old)
50.7
Occupation
Farmer
Marital status
Married
Education
Primary school
Diagnosis
Cervical cancer
Stages
I
Results
Characteristics of the included participants
Mean age (year old)
50.7
Occupation
Farmer
Marital status
Married
Education
Primary school
Diagnosis
Cervical cancer
Stages
I
Results
 The proportion of CAM use was 67%
(57.8-76.2%)
 The types of CAM were (N=67)
Buddhist praying
92.5%
Herbal medicines
40.3%
Exercises
37.3%
Diet modifications
23.9%
Others
34.4%
Results
The associated factors
Characteristics
P-values*
Age
0.38
Occupation
0.44
Marital status
0.55
Education
0.81
Income
0.63
Diagnosis
0.20
Stages*
0.01*
Chemotherapy*
<0.01*
Results
The associated factors
Characteristics
P-values*
Age
0.38
Occupation
0.44
Marital status
0.55
Education
0.81
Income
0.63
Diagnosis
0.20
Stages*
0.01*
Chemotherapy*
<0.01*
Discussion
 CAM use in our study is
very common up to 67%.
 The most common type of
CAM use is Buddhist praying.
 The associated factors were
stages and chemotherapy.
Discussion
Authors
Proportion of CAM use
Richardson, 2000
99.3%
Dy, 2004
88.2%
Swisher, 2002
49.6%
Navo, 2004
48.0%
Vasuratna, 2008
40.3%
Molassiotis, 2005
39.5%
Discussion
Authors
Richardson, 2000
Swisher, 2002
Dy, 2004
Navo, 2004
Type of CAM
- Spiritual practices
- Vitamins
- Herbs
- Movement -physical therapies
- Acupuncture
- Reflexology
- Electromagnetic therapy
- Vitamin-mineral
- Herbal products-megavitamins
Discussion
Vasuratna et al., 2008
 The most popular CAMs used
were foods and dietary
supplements (45.1%) followed
by herbs (37.8%).
Vasuratna et al. Poster presented in IGCS; 2008
Discussion
 The associated factors from
other studies
 Western country1
•
•
•
•
Lower age
Higher education level
Regular exercise
Social class
 Asian country2
• Age
• Advanced stage
• Higher education level
Lee MM, et al. American Journal of Public Health; 2006.1
Kay S, et al. The Journal of Alternative and Complementary Medicine; 2008. 2
Discussion
Vasuratna et al., 2008
The statistically significant factors
associated with CAM
•
•
•
•
•
Education (p=0.014)
Financial status (p=0.027)
Occupation (p=0.003)
* Stage of diseases (p<0.001)
* Chemotherapy treatment (p<0.001)
The last two factors were also found in our
study.
Vasuratna et al. Poster presented in IGCS; 2008
Discussion
 The possible explanation
is the difference in race,
religion and cultural
context.
Discussion
 This is the first study
regarding proportion and
type of CAM use in
gynecologic cancer patients
in Northeastern, Thailand.
Discussion
 The primary objective was to
determine the proportion of CAM use.
 The sample size calculation was
based on the primary objective.
 This may result in inadequate sample
size to give accurate assessment of
the associated factors.
Discussion
 Our results show a high
proportion of CAM use.
 The effect of CAM use is
needed for further research with
regard to the benefits and risks.
Acknowledgement
 Thitima Chaisrisawadsuk, MD
 Assoc.Prof. Bandit Chumworathayi, MD
 Assoc.Prof. Woraluk Somboonporn, MD
Thank you for
your attention