Download N=52

“A Cross-sectional study on the Use of Complementary and
Alternative Medicine (CAM) by Cancer Patients in a Tertiary Care
Hospital”
Harsha Kumar H N 1, Sumedha P S, Aditi B, Megha J, Sharanya S N,
Ritika S
Presenting Author
1Dr. Harsha Kumar H N
Associate Professor,
Department of Community Medicine,
Kasturba Medical College, Manipal Univeristy
Mangalore
India
Background
• Use of Complimentary & Alternative system of Medicine [CAM]
by cancer patients has increased over last 15 years. [1,2]
• Use of CAM by cancer patients in Europe is about 35.9% [Range
of 14.8% - 73.1% across countries]. [1]
• Increasing use of CAM for cancer from Turkey [54% - 61%],
Thailand [60%] & China [93.4%]. [3-5]
•
Beliefs / reasons for use of CAM are: 1. Directly fights against
cancer (31.1%) 2. Adjuvant to conventional treatment (25.2%),
3. Reduces suffering from allopathic treatment (33.1%). [6]
Objectives
• To know the proportion of cancer patients using
complementary and alternative medicine [CAM] in tertiary
care hospital
• To know the patterns of usage of CAM among Cancer patients.
• To know the reasons and perceptions for preferring CAM.
Materials & Methods
• Study design: This is a interview based Cross sectional study.
• Study Setting: Tertiary care cancer hospital of Kasturba Medical
College [Manipal University].
• Study Population: Cancer patients admitted for treatment. Those who
were 1. moribund, 2. could not respond to questionnaire were
excluded.
• Sample Size: Using the formula for finite population [N = Z2PQ / d2 ],
assuming that at least 40% have used CAM, for 95% Confidence
Interval, a power of 80% & 10% non-response, the sample size was
144.
• Sampling: Non-random sampling.
Materials & Methods
• Study Instrument: An interview schedule was prepared in the local
language to know: 1. Socio demographic characteristics of study
participants, 2. Patterns of CAM usage, 3. Reasons for preference and
perception about CAM
• Pre-testing: This was pretested and modified to suit our study.
Interview was conducted by trained medical students well versed with
local language.
• The research protocol was approved by the Institutional Ethics
Committee.
• Data Collection: Interviews were conducted in the hospitals after
obtaining informed consent.
Data Analysis: Was done using SPSS Version 10. The results are
presented in Tables. Chi-square test was used. ‘p’ < 0.05 was
considered significant.
Results
• Totally 154 cancer patients participated in the study
• Half [n=78; 50.6%] were between 41-60 years of age. Females were
than males [n=91; 59.1%].
• Majority [n=123; 83.7%] of them were married.
• Most [n=109; 70.78%] of them were educated up to secondary school.
• Skilled & semiskilled occupation [n=62; 40.2%] constituted majority.
About a third [n=55; 35.7%] were women who were not employed.
Table 1: Type of cancer among the patients (N=154)
Type of Cancer
n (%)
1.Breast Cancer
2.Leukemia
3.Eosophageal
4.Gastric cancer
5.Lymphoma
6.Brain cancer
7.Lung cancer
8.Ovarian
9.Colorectal
cancer
10. Oral cancer
Others*
37 (24)
17 (11.03)
10 (6.5)
9 (5.8)
9 (5.8)
7 (4.5)
7 (4.5)
7 (4.5)
5 (3.2)
5 (3.2)
41(26.6)
*Bone cancer (4), Uterine cancer (4), Cervical cancer (3), Renal cell carcinoma (3), prostate cancer
(2), Skin cancer (2), Liver cancer (2), Soft tissue sarcoma (2) and 18 others(all in single digits).
Table 2: Details of daignosis & treatment receved by Cancer patients (N=154)
Variables
Time since diagnosis
<1 month
1-3 months
4-6 months
7-12 months
1-2 years
2-5 years
>5 years
Treatments received*
Chemotherapy
Radiation
Surgery
Biological or targeted therapy
Satisfied with Allopathy
Yes
No
n(%)
12 (7.8)
27 (17.5)
24 (14.9)
35 (22.7)
24 (15.6)
25 (16.2)
8 (5.2)
130 (84.4)
47 (30.5)
81 (52.6)
4 (2.6)
145 (94.2)
9 (5.8)
Most of the patients were
diagnosed & treated in last one
year.
*Cancer patients received a
combination of treatments
Figure 1: Proportion of CAM users (N=154)
Percentage of CAM users
33.80%
Yes
(n=52)
No
(n=102)
66.20%
Table 3: Types of CAM
used*(N=52)
Type of CAM used
1.Ayurveda
2.Herbal Medicine
3.Yoga
4.Dietary adjuvant/ High
dose vitamin c
5.Meditation
6.Massage
7. Homeopathy
8.Vegetarian diet
9.Spiritual therapies
10.Siddha
Table 4: Patterns CAM usage (N=52)
n(%)
26 (50)
9 (17.3)
7 (13.5)
5 (9.6)
4 (7.7)
4 (7.7)
3 (5.8)
3 (5.8)
2 (3.8)
1 (1.9)
*Cancer patients used / tried more than
one CAM
Variables
Time since starting
<6 months
7-12 months
1-2 years
2-5 years
>5 years
n(%)
25 (48.2)
10 (19.2)
10 (19.2)
6 (11.5)
1(1.9)
Treatment Used first
CAM first
13 (25)
Conventional first
39 (75)
Frequency of usage
Daily
Weekly
Occasionally
Only once
42 (80.8)
2 (3.8)
7 (13.5)
1 (1.9)
Table 5: Patterns of usage of CAM(N=52)
Patterns of Usage
Discontinued CAM
Yes
No
Discontinued Allopathy after
starting CAM
Yes
No
Supervision/Guidance for CAM
Yes
No
Satisfied with CAM
Yes
No
Recommend CAM to another
Yes
No
n (%)
18 (37.5)
34 (62.5)
1 (1.9)
51 (98.1)
24 (46.2)
28 (53.8)
35 (67.3)
17 (32.7)
31 (59.6)
21 (40.4)
Most (65.4%) of the
patients did not
spend any money
on CAM. It was
free.
Table 6: Predominant Purpose(N=52)
Purpose
n(%)
Primary modality for treatment of cancer
Primary modality for treatment of side effects of cancer
Both of the above
Adjuvant to conventional treatment
17 (32.7)
7 (13.5)
2 (3.8)
26 (50)
Table 8: Reasons and Perceptions(N=52)
Reasons and Perceptions
Yes
No
Satisfied with Allopathy treatment
Side effects of Allopathy treatment bearable
Allopathy treatment tolerable
Allopathy treatment too expensive
Allopathy treatment not accessible
Allopathy treatment not available
CAM matches my beliefs & your inner self
CAM helps me to control treatment & faith.
Allopathy is technological & lacks human
touch
Trying everything that can help
Allopathy makes me more dependent
50 (96.2)
35 (67.3)
37 (71.2)
31 (59.6)
17 (32.7)
13 (25)
13 (25)
7 (13.5)
11 (21.2)
2 (3.8)
17 (32.7)
14 (26.9)
21 (40.4)
35 (67.3)
37 (71.2)
27 (51.9)
30 (57.7)
39 (75)
Uncertain
1(1.9)
2 (3.8)
12 (23.1)
15 (28.8)
2 (3.8)
44 (84.6) 7 (13.5) 1 (1.9)
12 (23.1) 33 (63.5) 7 (13.5)
Table 9: Perceived Benefits (N=52)*
Benefits
Directly treats/cures your cancer
Boosts your body’s ability to fight the cancer
To do everything possible to fight the cancer
Relieves the symptoms of the cancer
Improves your physical well being
Relieves the adverse effects of conventional treatment
Improves psychological/emotional wellbeing
Cleans up your wounds /reduces the mass of tumor
Allows you to relax/sleep
Others
*Cancer patients have perceived multiple benefits
N (%)
22 (42.3)
20 (38.5)
20 (38.5)
16 (30.7)
14 (26.9)
13 (25)
8 (15.4)
7 (13.5)
4 (7.7)
6 (11.5)
Table 10: Awareness & Opinion of Non-CAM users
Awareness & Opinion
Heard about CAM (N=102)
Yes
No
Opinion (N=69)
Conventional treatment is more effective & trustable
CAM might not be effective
No opinion
CAM is outdated
Others
N (%)
69 (67.6)
33 (32.4)
35 (51.5)
22 (32.4)
10 (14.7)
7 (10.3)
8 (11.6)
Table 11: Comparison of CAM users and Non-users [N = 154].
Study Variables
CAM users Non CAM
Chi square
(n=52)
users (n=102) (p)
Satisfied with allopathy
Yes
50 (96.23)
No
2(3.8)
Time since diagnosis
<1 year
>1 year
27 (51.93)
25 (48.07)
96 (94.1)
6 (5.9)
70 (68.63)
32 (31.37)
0.320
(0.852)
3.28
(0.07)
Comparison of socio demographic variables between users and non-users
did not show any significant differences.
Discussion
1. Proportion
• Proportion of CAM users was 33.8%. This is with in the range reported
from studies conducted in other countries [14.8% to 93.4%]. [1-5]
• Studies conducted among patients suffering from a specific type of cancer
reported a higher percentage of CAM use.
2. Types of CAM
• We found that Ayurveda & herbal medicine was the most common CAM
used. Other studies reported use of supplements (herbs or vitamins). [1-5]
• CAM usage associated with cultural beliefs. So the preference for Ayurveda
in India.
Beliefs and Perceptions for CAM use
• Most patients were simply trying everything that could help
(84.6%). Similar findings reported from other studies. [1-5]
Conclusions
• About 33.8% used CAM. Majority (96.2%) of CAM users were
satisfied with allopathy. Half of them used CAM as an adjuvant to
Allopathy.
• Limitations: 1. Repsonse bias 2. Study limited to one tertiary care
center.
Acknowledgement
• We thank the study participants for their
cooperation. We also thank Institutional Ethics
Committee which approved the research
References
1.
Molassiotis A, Fernadez-Ortega P, Pud D, Ozden G, Scott JA, Panteli V et al. Use of
complementary and alternative medicine in cancer patients: a European survey. Annals
of oncology 2005. 16. 655-63.
2.
Ernst E, Cassileth BR. The prevalence of complementary/alternative medicine in cancer.
A systematic review. Cancer 1998 Aug 15.83(4):777-82.
3.
Akyol AD, Oz B. The use of complementary and alternative medicine by patients with
cancer in Turkey. Complementary Therapies in Clinical Practice 2011:17(4):230–4.
4.
Shaharudin SH, Sulaiman S, Emran NA, Shahril MR, Hussain SN. The use of
complementary and alternative medicine among Malay breast cancer survivors. Altern
Ther Health Med 2011 Jan-Feb:17(1):50-6.
5.
Teng L, Jin K, He KHK, Bian C, Chen W, Fu K, et al. Use of complementary and
alternative medicine by cancer patients at Zhejiang university teaching hospital Zhuji
hospital, China. African Journal of Traditional, Complementary and Alternative
Medicines 2010:7(4):322–30.
6.
Puataweepong P, Sutheechet N, Ratanamongkol P. A survey of complementary and
alternative medicine use in cancer patients treated with radiotherapy in Thailand. Evid
Based Complement Alternat Med 2012; 23(6): 704-08.
Thank You