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Cancer patients stick with doctors

Monday 27 April 2009

Only one in five cancer patients turn to alternative medicines, and “most of those did not think it would cure them” according to BBC news. The news comes from a survey of 200 UK patients, which found that only 22% of them used complementary and alternative medicine. This was much lower than had been found by studies on US patients, reporting that up to 80% used complementary therapies.

The survey also found that among those people using complementary and alternative medicine (CAM), most “did not think it would cure them” but thought complementary medicine “should be available on the NHS”. Few cancer patients told their doctors what complementary medicines they were using.

The results of this study gives insight into the frequency of CAM use in an urban UK setting and the reasons behind this use. As the survey only looked at patients in London and filling in the questionnaire was voluntary, the results may not be representative of cancer patients as a whole or cancer patients in different parts of the UK. It is important that cancer patients considering using CAM discuss the issue with their doctor to make sure it will not interfere with any treatment they are receiving.

Where did the story come from?

This research was conducted by Dr T Newsom-Davis and colleagues from Imperial College London School of Medicine. The study was reported to be independent of funding bodies and was published in the peer-reviewed Quarterly Journal of Medicine.

What kind of scientific study was this?

This was a cross-sectional survey, asking cancer patients about their use of complementary and alternative medicine (CAM).

The researchers distributed CAM questionnaires to all registered cancer patients attending the outpatient oncology departments of two teaching hospitals in London during 2007. CAM’s were defined as any medicine, vitamin supplement or food supplement not prescribed by conventional medical doctors.

The questionnaires included 20 questions about use of CAM, type of CAM used, motivation behind using CAM if used, opinions about likely effectiveness of CAM, and thoughts about the patient-doctor relationship. Seventeen questions had yes or no answers, while the other three were rated on a numerical scale from one (strongly disagree) to five (strongly agree).

The collection of questionnaires was stopped once 200 correctly filled in forms had been submitted. Approximately two-thirds (64%) of those completing the questionnaires were women, and people with all major cancer types were covered (including prostate, breast, lung, colorectal and ovarian cancer). Those completing the survey also ranged in ages and had varying times since diagnosis.

The researchers obtained information about the patients’ type of cancer, duration of cancer and age from their medical records. They then compared the characteristics of those who used CAM with those who did not.

What were the results of the study?

Of the 200 people who filled in the questionnaire, 44 (22%) reported using CAM. The most frequently used CAMs were multivitamin formulations (24 people), with five people reporting using selenium, four people omega-3 oils, three people homeopathy and two people or fewer for other CAMs.

There was a higher proportion of females among CAM users (75%) than among CAM non-users (60%). CAM users also tended to be younger than CAM non-users. There was no statistically significant difference in tumour types among CAM users and non-users. Over half of those who used CAM (57%) did so while receiving active cancer treatment; the remainder did so during follow-up treatment.

Twenty people of the 44 taking CAM (45%) reported that their oncologist knew about their CAM use, 12 (27%) reported that their oncologist did not know, and 12 (27%) were unsure or did not answer this question. Only 15 of the people using CAM had consulted a CAM therapist, with most having done so in the UK.

The most common reasons for people to use CAM was to feel better (31 of the 44 people), because it was recommended to them by a friend, family member or CAM therapist (29 people) or because they thought it would help their cancer (20 people).

Few people felt that CAM would make them live longer (seven people), that it was safer than conventional medicine (three people)  that there was more medical experience supporting CAM than conventional medication (four people), or reported that they were using CAM because  they were unhappy with their oncologist (two people).

Most people taking CAM (36 people, 82%) trusted their prescribed medication more than CAM. Only one patient taking CAM (2%) thought CAM was more likely to cure them, while 32 (73%) thought that conventional medicine was more likely to do so, and 11 (25%) did not know or did not answer. 

Eighteen patients (41%) reported that they had noticed effects on their health from CAM, while 15 patients had not noticed effects (34%).

What interpretations did the researchers draw from these results?

The researchers concluded that CAM use by cancer patients in the UK was less common than reported use in other countries. They say that people using CAM are “realistic about its likely benefits”.

They suggest that medical professionals “should not feel threatened” by patients using CAM, but instead “focus on understanding the reasons behind it”.

What does the NHS Knowledge Service make of this study?

This study provides interesting information about the use and perception of CAM among cancer patients.

There are a few points to note when interpreting this study:

  • This study looked at a relatively small number of cancer patients receiving treatment in only two oncology departments in London. This means its results may not be representative of CAM use in other parts of the UK.
  • Filling in the questionnaire was voluntary, so it is possible that those who chose to fill out the questionnaire may have had different views and CAM usage from those who declined taking the survey.
  • Some patients may not have wanted to let their doctors know that they were using CAM, and therefore either not filled in the questionnaire, or not disclosed their CAM usage in the questionnaire. This would result in under-estimating the proportion of people using CAM. However, only 7% of patients filling in the questionnaire felt that their doctors thought that CAM was ‘bad’, suggesting that most would not feel a need to hide their use of CAM.
  • It was unclear whether types of CAM were listed in the questionnaire. Some people might not realise exactly what qualified as CAM and what did not.

It is important that cancer patients considering using CAM should tell their doctors in order to ensure that the product or treatment in question will not interfere with any conventional medical treatment they are receiving.

Analysis by Bazian
Edited by NHS Website

Links to the headlines

Complementary therapies snubbed.

BBC online, 26 April 2009

Links to the science

Newsom Davis, Kenny L, Al-Shakarachi et al.

Voodoo dolls and the cancer patient: patients do trust their doctors.

QJM 2009 102(5):311-319