A survey of adult cancer patients in western Washington has found that more than 70 per cent use alternative therapies and almost all report substantial improvements in well-being as a result of the treatments.
The Fred Hutchinson Cancer Research Center survey looked at predictors, motivators and costs of different types of alternative medicine use in adults with cancer. Findings appear in the recent issue of The Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice and Policy.
Dr Ruth Patterson, study leader, said: "This is the first study to specifically inquire about patients' attitudes regarding the effectiveness of alternative treatments." Patients were considered users of alternative medicine if they received care from an alternative provider within the past year or had used at least one alternative supplement or therapy.
Depending on the type of therapy, 83 per cent to 97 per cent of patients surveyed said they used alternative medicine for general health and nearly all reported that use of these therapies improved their well-being.
A smaller number of those surveyed, between 8 per cent and 56 per cent, turned to alternative interventions to treat their cancer. Patients who underwent multiple medical therapies (chemotherapy, radiation, surgery) were twice as likely to use alternative medicine for cancer treatment or symptom management than those who had surgery alone.
The most common form of alternative treatment among those surveyed was the use of dietary supplements, which were taken by 65 per cent of the patients, many of whom used several such products simultaneously. The investigators classified all types of individual supplements (vitamins, minerals, herbals and botanicals) as alternative, with the exception of one-a-day-type multivitamins because these generally are accepted by mainstream medicine.
Seventeen per cent of the patients received care from an alternative provider such as a naturopathic doctor, spiritual advisor or massage therapist, and 20 per cent used some form of mental or energy-based therapy such as biofeedback, hypnotism, guided imagery, or use of crystals, chelation therapy or magnets.
While the use of alternative medicine is well known among adult cancer patients, until now little has been known about which patients are most likely to use such therapies.
Cancer patients who were female and college-educated, for example, were five times more likely to seek an alternative health-care provider and twice as likely to take dietary supplements. Age also influenced use; patients aged 60 and younger were nearly twice as likely to opt for alternative treatment than those over the age of 70.
Income, in contrast, was not significantly associated with alternative-therapy use and did not seem to be a barrier to treatment.
Overall, the median cost of alternative therapy was about $70 per patient per year, although individual expenses ranged from $4 to $15,000. Dietary supplements averaged $50 per person annually.
Cancer type also appeared to influence alternative-therapy use; compared with colorectal-cancer patients, those with breast cancer were significantly more likely to see alternative providers or take dietary supplements.
"Because of the possibility of negative drug-herb interactions, as well as the possibility that supplement use could interfere with chemotherapy, health-care providers need to be aware that supplement use is common among cancer patients," Patterson said.
For example, antioxidants such as vitamins C and E may reduce the effectiveness of chemotherapy, while herbs such as yew needle and the herbal tea essiac have been associated with heart and kidney impairment, particularly when taken in conjunction with certain cancer drugs.
"Anyone who is in active cancer treatment should talk to their medical team about the use of vitamins and supplements, which may need to be curtailed during treatment," she said.
The study findings suggest several key messages for healthcare practitioners. "First, since most therapies were used to enhance overall health and well-being, it seems unlikely that patients would substitute these therapies for conventional medicine," Patterson said.
"Second, doctors should be wary of discounting alternative medicine, given that the majority of patients overwhelmingly feel it improves their quality of life. It is important for clinicians to show an open attitude toward alternative medicine if they want patients to engage in frank and honest discussion of these choices."
Knowledge regarding patient use of alternative medicine also is important, she said, because such use may signal difficulties in coping with the cancer or its treatments and may indicate the need for referral to mental health services or a support group. Use of alternative medicine also may indicate a patient is motivated to make healthy lifestyle changes.
"Such patients may benefit from consultation with a nutritionist, physical therapist or other healthcare professional," she said.
The survey was based on telephone interviews with 356 adults who had been diagnosed with breast, prostate or colon cancer between February 1997 and December 1998. The group was divided equally among men and women, with equal representation among the three types of cancer.
One limitation to the study, Patterson noted, is that use of alternative medicine could be high in western Washington for a variety of reasons. Vitamin use is highest in the western United States compared to other areas of the nation. Also, health insurers in Washington are required by state law to provide coverage for licensed alternative providers. As such, the results of this survey may not be applicable to cancer patients in other states with less liberal coverage of alternative-health services, she said.
"Regardless of incidence of alternative-medicine use in Washington, other studies also indicate that alternative-medicine use is common in patients with cancer. For this reason, we recommend that longitudinal studies be conducted to investigate associations of alternative-medicine use with survival and quality of life in cancer patients," Patterson said. "Such studies are needed urgently."
The team at Fred Hutchinson's Public Health Sciences Division led the study, which was supported by grants from the National Cancer Institute and funds from Fred Hutchinson. Researchers at Bastyr University in Kenmore, Washington, and Oregon Health & Science University in Portland, Oregon, also consulted on the project.