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Prevalence of Complementary and Alternative Medicine Use in Cancer Patients

Prevalence of Complementary and Alternative Medicine Use in Cancer Patients

ABSTRACT: Interest in complementary and alternative medicine (CAM) has grown dramatically over the past several years. Cancer patients are always looking for new hope, and many have turned to nontraditional means. This study was conducted to determine the prevalence of complementary and alternative medicine use in cancer patients and what if any agents are being used. Approximately, 100 adult cancer patients in a private nonprofit South Florida hospital completed a descriptive cross-sectional survey questionnaire. The mean age of participants was 59 years; 42 patients were male and 58, female. According to survey results, 80% of patients reported using some type of CAM; 81% took vitamins, 54% took herbal products, 30% used relaxation techniques, 20% received massages, and 10% used home remedies. Among patients who took vitamins, 65% said they took a multivitamin, 39% took vitamin C, and 31%, vitamin E. The most common herbal remedies used were green tea, Echinacea, shark cartilage, grape seed extract, and milk thistle. Meditation and deep breathing were the two most common relaxation techniques practiced. A large majority of cancer patients are using CAM. In light of the growing interest in CAM, health-care professionals need to be educated about the most common therapies used. [ONCOLOGY 15:1267-1283, 2001]

The use of complementary and alternative medicine (CAM)
has grown dramatically over the past 10 years. Alternative medicine refers to
treatment options used in place of conventional medicine, whereas complementary
medicine refers to therapies used in conjunction with, but not instead of,
conventional medicine.[1] In 1990, Eisenberg and colleagues conducted a survey
of the prevalence of unconventional therapy use in the United States.[1] The
investigators found that 34% of respondents used at least one type of
unconventional therapy in the past year. The majority used CAM to treat chronic
rather than life-threatening conditions.

Because of the growing popularity of these therapies, the National Institutes
of Health (NIH) established the Office of Alternative Medicine (OAM) in 1992.[2]
The OAM became the National Center for Complementary and Alternative Medicine (NCCAM)
through a congressional mandate in 1998. The primary purpose of the NCCAM is to
conduct and support basic and applied clinical research and research training on
CAM. Two of its main focuses are to evaluate the safety and efficacy of widely
used natural products and to support pharmacologic studies evaluating drug

When still designated as the OAM, this office classified alternative medicine
into seven categories: (1) diet and nutrition, (2) mind-body techniques,
(3) bioelectromagnetics, (4) alternative systems of medical practice
(traditional and folk remedies), (5) pharmacologic and biological treatments,
(6) manual healing methods, and (7) herbal medicine.[3] Overall, the NIH defines
"alternative medicine" as therapies that are unproved.[4]

Today, CAM is used primarily to provide symptomatic relief or as preventive
therapy for common disease states including arthritis, cardiovascular conditions
(hypertension, hyperlipidemia), and illnesses that might be avoided or
alleviated through enhancement of the immune system (coughs, colds).[5] A more
recent study by Eisenberg and colleagues showed that the use of alternative
medicine in the United States has risen to 42% as of 1997.[6] Independent
variables that have contributed to the rapid growth of CAM use include distrust
of and/or dissatisfaction with conventional medical care, a desire for control
over health matters, a holistic health philosophy, chronic health problems, and
overall poor health status.[7]

CAM and Cancer

The use of CAM among cancer patients is also rapidly expanding. In this
patient population, CAM is generally used to minimize the side effects of or
serve as an alternative to conventional chemotherapy.[3] A recent review of 26
surveys showed that the prevalence of CAM use among cancer patients ranged from
7% to 64%.[8] This wide range may be attributed to differences in the
definitions of CAM used by each group of investigators and/or differences in
patient populations specific to the study site.

Currently, there is much concern about this trend because CAM is often
perceived as "natural" and, therefore, harmless.[9] However, it is
important to remember that some conventional medicines are derived from plants
and are among the more toxic medicines available today. Examples include digoxin
(foxglove) and vinca alkaloids (Madagascar periwinkle). Among the most common
types of CAM being used, herbal therapies can interact with conventional
medicines and various disease states or organ systems, leading to significant

Besides the potential harm associated with the use of CAM, another major
concern is the avoidance or abandonment of conventional therapy and its
implications. This is most important in cancer patients who are diagnosed early
and have a limited window of opportunity in which to benefit from conventional


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