Complementary and alternative medicine use by patients with cancer in Wales: a cross sectional survey

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Abstract

Objectives: To determine the prevalence and cost of complementary and alternative medicine (CAM) use, and examine perceived satisfaction and reasons for using CAM. Design and setting: Cross sectional survey of 1697 patients with breast, prostate, lung or neurological cancer registered with a single NHS authority in Wales. Participants: One thousand and seventy-seven (64%) of patients, aged 18 years or over with cancer diagnosis of at least 3 months, returned analysable questionnaires. Thirty patients were interviewed by telephone. Main outcome measures: Number and proportion that had used CAM in the past 12 months, the types of CAM used, expenditure, satisfaction, demographic characteristics, and reasons for using CAM. Results: Five hundred and thirty-four, 49.6% (95% CI 46.6–52.6) of participants, reported using at least one type of CAM during the past 12 months: 221, 16.4% (95% CI 14.3–18.8), had consulted a CAM practitioner (average cost per person, £28 per month); 166, 15.4% (95% CI 13.4–17.7), indicated using CAM techniques (average cost per person, £16 per month); 456, 42.3% (95% CI 39.4–45.3), reported using over-the-counter diets, remedies or supplements (average cost per person, £10 per month). Dissatisfaction with CAM use was low, and most users indicated that they represented value for money. CAM users were more likely to be female, younger, better qualified, and to have used CAM before their current illness than non-users. Patients used CAM primarily for symptom relief and relaxation. Conclusions: Nearly half the cancer patients in this study had used CAM. A co-ordinated approach to quality assurance, information and advice, and the assessment of risk/benefit and cost effectiveness of CAM use is needed.

Section snippets

INTRODUCTION

Complementary and alternative medicine (CAM) was defined as ‘diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine’.1 National surveys of the general population have found that CAM use is widespread throughout the post-industrial world,2., 3., 4., 5., 6. although the reasons for using CAM are not well understood.7 Surveys focusing on CAM

PARTICIPANTS AND METHODS

Participants were registered with a single oncology NHS Trust in South East Wales. Ethical approval was sought from the authority’s Local Research Ethics Committee and permission to contact patients was given by their physician. The patient database was searched between 1 January 1997 and 31 January 2001 for all patients aged 18 years or over who had been diagnosed with breast, prostate, lung or neurological cancer for at least 3 months and with no record of death. A sample size of 1225 was

DATA ANALYSIS

The questionnaire data were analysed using SPSS for Windows. The reliability of data entry was checked for the first 300 questionnaires. Prevalence data were reported with 95% confidence intervals using the recommended (Wilson) method,11 χ2 statistical tests were used to compare proportions, and backwards stepwise logistic regression was used to determine factors predicting the use of practitioner therapies. Included in the regression analysis were sex, age, qualifications after the age of 18

Data quality

One thousand and seventy-seven usable questionnaires were returned and the response rate was 64% (1077/1697), after taking account of 96 uncontactable patients (primarily through Post Office returns and notification of death). The error rate for data entry was 0.29%. The interview data suggested that visits to practitioners of herbal medicine were over-reported in the questionnaire survey consequently this data was excluded from the analysis. The representativeness of the sample was calculated

DISCUSSION

A substantial number of patients with cancer in South East Wales reported using CAM, the lowest estimate was that over 30% had used some type of CAM in the past 12 months. Users were more likely to be female, younger, better qualified, and to have used CAM before their current illness than non-users. Type of cancer diagnosis did not predict CAM use. Out-of-pocket costs of CAM were generally modest and most users reported value for money. Dissatisfaction was low, but one in four respondents were

Acknowledgements

We thank the following people for their help: Eleanor Catuzzo, Sally Hicks, Sue Paskell, Rebecca Rees, Mike Robling, and Lucie Sanders; all participants in the survey especially those who were interviewed.

Philip Harris Senior Lecturer, School of Health and Social Sciences, University of Wales Institute Cardiff, Western Avenue, Cardiff, Wales CF5 2YB, UK. Tel.: +44 (0) 29 2041 6894; Fax: +44 (0) 29 2041 6985; E-mail: [email protected]

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Philip Harris Senior Lecturer, School of Health and Social Sciences, University of Wales Institute Cardiff, Western Avenue, Cardiff, Wales CF5 2YB, UK. Tel.: +44 (0) 29 2041 6894; Fax: +44 (0) 29 2041 6985; E-mail: [email protected]

Funding Wales Office of Research and Development, grant number: SG00/307.

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