Volume 44, June 2019, Pages 143-150  https://doi.org/10.1016/j.ctim.2019.04.008Get rights and content Cancer is a leading cause of death in the world,1 and is the second leading cause of death in Turkey.2 The main treatment modalities for cancer are radiation therapy, chemotherapy, surgery, biologic therapy, and goal-directed therapy. Each type of cancer requires a special treatment regimen. Treatment methods can be used alone or in combination with others, depending on the type of cancer and its stage.3 The main goal of cancer treatment is to treat and control the cancer and to provide palliative care for it (to control symptoms to improve quality of life).3 However, cancer and the conventional therapy applied to treat it can cause different symptoms, such as nausea, vomiting, mucositis, diarrhea, constipation, bone marrow suppression, alopecia, skin reactions, pain, fatigue and depression.3,4 Despite improvements in conventional therapy and higher survival rates, complementary and alternative medicine (CAM) therapies have been increasingly used in parallel with conventional therapy over the last few decades across the world.5,6 Several studies have been conducted in different countries to determine the prevalence of CAM use. For example, it was found that 57.6% of cancer patients in the United States used at least one CAM type,7 a study of cancer patients from 14 different countries in Europe determined the rate of CAM use as 35.9%5; and another study found that 83.5% of cancer patients in China used CAM therapies.8 Studies conducted in Turkey have reported the rate of CAM use in cancer patients to be between 36.0 and 71.5%.9, 10, 11, 12, 13, 14 Summary of studies conducted in Turkey on the use of CAM in cancer patients given in Table 1. Some traditional and complementary practices based on religious beliefs, philosophy and societal experiences have been used in the past and present in Turkey.15 Particularly herbal products, religious practices (charms/praying)13,15 and traditional practices such as cupping, leech and maggot therapy16 have been used. People who are far away from modern life and have lower socioeconomic and education levels use CAM more frequently in Turkey.13 The use and preference of CAM vary by religion, lifestyle and cultural structure.17 Factors such as easy access to CAM products or local availability, lower prices, and people accepting these methods as beneficial as a result of previous experiences and beliefs about recovering by using CAM methods increase the use and preference of CAM.11,13,17 Studies report that the most common reasons for using CAM are to treat cancer or reduce risk of recurrence5,6 to reduce the side effects of conventional therapy,5 to strengthen the immune system,6 to improve health5,6 and to enhance quality of life.3 The meta-analyses of relevant randomized controlled trails conducted in recent years has shown that some CAM therapies have positive effects on disease symptoms and the quality of life of individuals with cancer. Studies have shown that acupuncture is effective on the management of cancer-based fatigue18 and pain (more effective when used with drug therapy rather than conventional drug therapy administered by itself)19 while physical activity has been found to be effective on increasing physical functions and the quality of life of patients who completed cancer treatment.20 Similarly, the meta-analyses of relevant randomized controlled trials found that (i) yoga was effective for improving mental health (anxiety, depression and stress) of patients with cancer21 and (ii) mindfulness-based therapy was effective for reducing anxiety and depression of patients with cancer.22 Guides recommending the administration of some evidence-based CAM therapies such as acupuncture, exercising, meditation and yoga along with conventional care or suggesting the administration of these methods at integrative oncology treatment centers were established.23,24 The number of integrative oncology centers/integrative medical clinics that administer evidence-based complementary and integrative treatments in Europe25 and in the United States7,26 gradually increases at the present time. In Turkey, the Ministry of Health has issued and implemented the “Regulation on Traditional and Complementary Medicine Practices”.16 In addition, the Turkish Traditional and Complementary Medicine Institute was established. The aim of this institute is to ensure the use of evidence-based traditional and complementary practices/therapies integrated with conventional medicine.27 Traditional and complementary medicine practice centers have also been established in university hospitals and other training and research hospitals in Turkey. These centers administer some of 15 traditional and complementary medicine practices provided in the regulation which include acupuncture, apitherapy, phytotherapy, hypnosis, leech and maggot therapies, homeopathy, chiropractic, cupping, mesotherapy, prolotherapy, osteopathy, ozone therapy, reflexology and music therapy.16 Cultural differences affect the method and frequency of use of CAM.6,28 It has also been reported that different socio-demographic28 and clinical features6,8 affect CAM use. In recent years, only a limited number of studies have been conducted on this subject in Turkey using cancer patients from different geographical regions and examining the CAM therapies used by cancer patients, the frequency of use of CAM therapies, and the clinical and sociodemographic factors affecting CAM use.12,13,14 The common results obtained in these studies indicate that the rate of CAM use is high and that the most commonly used CAM therapy is herbal products. It has also been reported that the majority of patients do not report the CAM therapy they use to health care providers.10, 11, 12 However, although the clinical benefits of some CAM therapies have been proven, some herbal products may generate side effects on patients and interact with other medicines, including chemotherapy drugs.24,29,30 Therefore, herbal treatments that interact with other medicines should not be used together with immunotherapy, chemotherapy and radiotherapy or before surgery. At the same time, cancer patients should also be evaluated before treatment begins to determine whether they use herbal medicines (Grade of recommendation: IB).24 Today, knowing the CAM therapies used by patients, their reasons for using CAM and the factors affecting their tendency to use CAM has increasingly become important for both health personnel and patient health. Cancer and its treatment result in many physical and psychological side effects and also reduce the quality of life of patients.4 Quality-of-life is a measure used to describe health-related physical, psychological and social well-being, and to assess the outcome of the relevant treatment.31 One of the important goals of cancer treatment is to improve the quality of life of patients by controlling the symptoms.3 Improving the quality of life is considered to be one of the primary reasons for using CAMs in the treatment of cancer patients.32 Different studies about the effects of CAM therapies used for cancer patients on their quality of life report different results.6,33 Therefore, it is important to determine the effects of CAM therapies, which are increasingly used for cancer patients, on quality of life. However, very little is known regarding difference between quality of life of CAM user and non-user patients. There is only one study in Turkey evaluating the quality of life in cancer patients who use and who do not use CAM.11 This study aims to evaluate the frequency of use of CAM therapies among cancer patients, the types of CAM therapies they used, the demographic and clinical factors affecting their tendency to use CAM, and the difference between quality of life of CAM user and non-user patients in western Turkey. This cross-sectional study was carried out between March and June 2016 in the chemotherapy unit of an education and research hospital located in Mugla, Turkey. The consecutively enrolled patients who received chemotherapy in the unit between these dates and who met the study criteria indicated below were included in the study. A previous study reported that the means standard deviation and quality of life (group 1 = 0.79 ± 0.58, group 2 = 1.10 ± 0.68) CAM users and non-users in cancer patients. Ethical approval was obtained from the University Scientific Research and Publication Ethics Committee on February 8, 2016 (protocol no. 5). Permission to conduct the study was also obtained from the education and research hospital administrators. All patients were given information about the study, and written informed consent was obtained from all patients. The data were collected by all researchers using the following forms. 1. Demographic, clinical, and CAM use question form: A two-part question form was developed to obtain information about patients’ demographics, clinical features and properties of CAM therapies they used. The first part includes 12 questions about patients’ socio-demographics and clinical characteristics. The second part, which was prepared in line with previous studies,5,6,34 consists of 9 questions on the CAMs used by the SPSS version 19.0 (IBM SPSS Statistics for Windows, Armonk, NY: IBM Corp) was used for the statistical analysis of the data obtained in the study. Descriptive statistics (mean, number, and percentage) were used to determine patients’ demographics, clinical features and properties of the CAM therapies they used. The chi-square test was used to compare demographic and clinical characteristics of the CAM user and non-user patients. As the data were not normally distributed, the Mann-Whitney U test The mean age of the patients was 60.31 ± 11.32 years (ranging between 32 and 83 years). Of the patients, 54% were ≥60 years old, 50.2% were female, 82.9% were married, 76.8% were elementary/secondary school graduates, 53.1% had a middle/high income, 60.2% were city-dwellers, 90.0% were unemployed/retired (88.6% of the women were unemployed), and 98.6% had health insurance. According to their clinical features, the mean time of diagnosis was 25.70 ± 27.55 months, where 60.7% of the patients In this study which was conducted in western Turkey, 46.4% of the patients used any type of CAM. Studies conducted in different regions of Turkey have reported the rate of CAM use in cancer patients to be between 36.0 and 71.5%.9, 10, 11, 12, 13, 14 Chemotherapy is one of the most important factors affecting the use of CAM therapies. Patients usually start using CAMs to reduce the side effects of chemotherapy.37 Geographical area and culture also affect the frequency and method of CAM use.6,28, This study was conducted in just one of the health institutions located in a province of Turkey. Patients in the study sample were not selected with a specific probability (non-random sample). Patients who met the study inclusion criteria were included in the study sample. Therefore, the study results cannot be generalized to all patients. This study found that about half of the cancer patients receiving chemotherapy used CAMs, that the most commonly used CAM therapy was herbal products, that education was a factor affecting patients’ CAM use behaviors, that there was no significant difference between quality-of-life scores of CAM users and non-users. Considering that herbal products are the most commonly used CAM therapy, doctors/nurses should assess patients in terms of using CAM therapies to determine their possible side There was no funding for this study. The authors declare no conflicts of interest that may have influenced this work.
Understanding cultural perception of pain and determining the methods used for pain management contribute to the assessment of the pain experienced by nursing students. The aim of this study is to determine the effect of culture on nursing students' perception of pain and the modern, cultural, and traditional methods they use for pain self-management. This study is a cross-sectional descriptive study. This study was carried out with 319 nursing students between March 1 and May 1, 2020. For data collection, a questionnaire created by the researchers after literature review and the Pain Beliefs Scale were used. Data were evaluated using SPSS Statistics 20.0 program. The type of pain experienced most often by nursing students is headache (56.7%). The pain they experienced negatively affected daily activities. The mean score of those who used cultural method of psychologic beliefs for reducing pain was statistically significant (p < .05). Nursing students generally use massage, warm shower, and herbal tea drinking for pain management. The psychologic belief scores of those who applied these traditional methods of pain reduction were high. Patients with cancer experience many side effects due to its nature and usual treatments. Sleep disorders and anorexia are the most commonly reported symptoms in cancer patients undergoing chemotherapy. The present study aimed to investigate the effect of Benson's Relaxation Response (BRR) on sleep quality and anorexia in cancer patients undergoing chemotherapy. In the present clinical trial, a total of 84 patients were enrolled and randomly divided into two groups of experimental and control. Benson's relaxation response was administered to the experimental group twice a day over 5 consecutive days. Data was collected using St. Mary's Hospital Sleep Questionnaire (SMHSQ) and anorexia questionnaire with Visual Analog Scale (VAS). The results of our study showed a significant improvement in the sleep quality in the experimental group at 24 (p = 0.02) and 48 (p = 0.001) hours after the intervention compared to the control group. Benson's relaxation response (BRR) also had a significant effect on the anorexia in the experimental group at 24 (7.5 ± 1.6) and 48 (6.9 ± 2.1) hours after the intervention compared to the control group. No side effects were reported during the study and follow-up period. Benson's relaxation response as a complementary method may improve sleep quality and anorexia in cancer patients undergoing chemotherapy. Further studies with greater sample size and longer follow-up period are needed to confirm the current findings. Population-based information on the costs of complementary medicine for treatment-related side effects in patients with breast cancer is scarce. We aimed to investigate the prevalence and expenditure on complementary medicine in patients with breast cancer who experienced treatment-related side effects. Two datasets were analyzed: 1) a 2017 survey on direct and indirect costs for treatment-related side effects, which was completed by 100 patients with stage 0-IV breast cancer, and 2) a Korean representative cross-sectional survey (Patient Survey 2014) that examined the prevalence of integrative medicine in 41 patients with breast cancer. The direct and indirect costs for treatment-related side effects. In the first dataset, the mean total direct medical cost for complementary medicine was US$1,584 and the mean indirect cost was US$6,988 per patient per year. Some patients (6%) visited non-medical institutions to utilize complementary medicine and additionally spent US$460 per patient per year. Approximately one-third of participants reported a substantial-to-heavy financial burden for using complementary medicine. However, only 17% of patients got information about complementary medicine through their physician. In the second dataset, 49% of patients with breast cancer who were discharged from Korean Medicine hospitals in Patient Survey 2014 data indicated that integrative medicine had been used. Despite some complementary medicine could be reimbursed by National Health Insurance in Korea, a considerable number of patients reported an economic burden associated with their use of complementary medicine. Strategies for guiding patients to receive evidence-based and cost-effective complementary medicine are needed. As the popularity of complementary and alternative medicines (CAM) is increasing, it is important to understand the characteristics of people that make them to be attracted toward CAM and influence their attitudes. The purpose of the present study was to examine the associations between the socio-demographic characteristics of people as assessed by the a five-factor model and the attitudes toward CAM modalities among Turkish academicians. An online survey was completed by 227 academicians who were working in three leading universities of Turkey. The academicians were queried anonymously on socio-demographics and which CAM modalities they utilized, by filling out the Ten-Item Personality Inventory (TIPI) and the Holistic Complementary and Alternative Health Questionnaire (HCAMQ). In regard to the intention of using a CAM modality in the academicians, 75.3% of the academicians specified an intention to use at least one form of CAM in their lives. Among all the academicians surveyed, 38.8% reported using at least one form of CAM in the previous year. The most widely used forms of CAM observed were herbal therapies and mind-body therapies (18.5%), touch-based therapies (15.4%), and multi-vitamin (4.8%). The ratio of CAM usage in the previous year was observed to be lower in the academicians working in the health-related professions. The present study also identified that the academicians with openness personality-type exhibited greater positive attitudes toward CAM (p < 0.05). The findings of the present study indicated that the academicians who are open to experience, as assessed by the five-factor model of personality, exhibited greater positive attitudes toward CAM. More than 60% of academicians agreed that CAM should be integrated into the curriculum, the remaining participants were unsure and disagreed. Therefore, the required feasibility studies to integrate CAM courses into the curriculum of Turkish medical and nursing schools are recommended as a priority. Cancer patients in all cultures are high consumers of herbal medicines (HMs) usually as part of a regime consisting of several complementary and alternative medicine (CAM) modalities, but the type of patient, the reasons for choosing such HM-CAM regimes, and the benefits they perceive from taking them are poorly understood. There are also concerns that local information may be ignored due to language issues. This study investigates aspects of HM-CAM use in cancer patients using two different abstracting sources: Medline, which contains only peer-reviewed studies from SCI journals, and in order to explore whether further data may be available regionally, the Thai national databases of HM and CAM were searched as an example. The international and Thai language databases were searched separately to identify relevant studies, using key words chosen to include HM use in all traditions. Analysis of these was undertaken to identify socio-demographic and clinical factors, as well as sources of information, which may inform the decision to use HMs. Medline yielded 5638 records, with 49 papers fitting the criteria for review. The Thai databases yielded 155, with none relevant for review. Factors associated with HM-CAM usage were: a younger age, higher education or economic status, multiple chemotherapy treatment, late stage of disease. The most common purposes for using HM-CAM cited by patients were to improve physical symptoms, support emotional health, stimulate the immune system, improve quality of life, and relieve side-effects of conventional treatment. Several indicators were identified for cancer patients who are most likely to take HM-CAM. However, interpreting the clinical reasons why patients decide to use HM-CAM is hampered by a lack of standard terminology and thematic coding, because patients' own descriptions are too variable and overlapping for meaningful comparison. Nevertheless, fears that the results of local studies published regionally are being missed, at least in the case of Thailand, appeared to be unfounded. About half of patients with cancer use complementary and alternative medicine (CAM). So far, data on melanoma patients are missing. The aim of our study was to evaluate the prevalence and predictors for the use of CAM in this patient group. All patients with melanoma being attended at one of 7 skin cancer centres in Germany between March 2012 and March 2013 were invited to take part in a survey using a structured questionnaire on CAM. The physicians filled in a second part on the diagnosis, state and former and current therapy. Nearly half of the 1089 participants (41.0%) used CAM and half of those using CAM (56.8%) marked that this made them feel better. Biological-based CAMs which consists of substances taken were used by 25.9% of all patients (63.1% of those using CAM). Predictors of CAM use were education, psychological support, interest in CAM and previous CAM use. CAM users show higher physical activity, more often use psychosocial help and have contact with a self-help group. Family and friends (41.0%) as well as print media (41.7%) are the main sources of information. Most important reasons to use CAM are to strengthen one's own forces (57.7%) or the immune system (63.4%) and to be able to do something for oneself (53.7%). Communication on CAM should become a regular topic in counselling melanoma patients. To increase safety, patients and physicians must have access to evidence-based information on these methods and their interactions with modern cancer treatments. The use of CAM including herbal medicine as the most preferred CAM modality, among cancer patients who are taking prescription medications has shown to be highly prevalent worldwide as well as in several Middle Eastern countries, with a high percentage of the patients do not disclose their CAM use to treating physician. The current study aimed to evaluate the patterns of CAM use among two cohorts of cancer patients in Palestine over a three-year period, and to identify socio-demographic factors that are associated with CAM use. Across-sectional survey of patients attending outpatient cancer clinics. The method was based on a semi-structured questionnaire. In order to identify safety-related concerns associated with the products listed, a literature search was conducted using different databases (PubMed, Micromedex, AltMedDex, and the Natural Medicine Comprehensive Database). In 472 cancer patients including 372 of the 2011 cohort; and 100 of the 2014 cohort, the overall prevalence of CAM use was 69.5%. CAM users were more likely to be ≤65 years old, village resident, being in the midst of chemotherapy, to have high interest spiritual quest, and to have no other chronic diseases. A significant number of CAM users reported using herbal preparations (98.3%, and 89.6% in the two study cohorts, respectively). In the current study, a total of 40 plant taxa belonging to 23 botanical families were reported by ≥3 cancer patients in the two cohort groups. The top most commonly used plant in the 2011 cohort group was Arum palaestinum (43.5%), while Ephedra foeminea emerged as the top most commonly utilized plant (from 0.0% in 2011 to 55.2% in the 2014 cohort), mainly due to a recent publicizing and portraying of the plant in the local media as an effective cancer herbal remedy. Safety-related concerns were associated with 33 (82.5%) herbs, including herb-drug interactions with altered pharmacokinetics (8, 20% herbs), direct toxic effects (16, 40% herbs), and increased in vitro response of cancer cells to chemotherapy (30, 75% herbs). CAM use, especially herbal medicine in cancer is highly prevalent in Palestine. This study has demonstrated the role of the media on the emergence of new CAM herbal therapies among cancer patients in Palestine, and discussed its potential implications on patients and for oncologists who are treating them. Some of the most widely used herbal medicines by cancer patients in the present work are known to interact with conventional anticancer drugs. Hence, the disclosure of the use of herbal remedies by patients to health professionals with sufficient training in CAM use is important for the later in order to assess whether there are any possible herbal drug interactions and/or harmful drug reactions. and purpose: Complementary and Alternative Medicine(CAM) has been greatly used in cancer patients. This research aimed to explore the research priorities of CAM for cancer patient's treatment. Web of Science(WoS), HistCite, BibExcel, GunnMap and VOSviewer were used to extract and visualize information. 2768 articles published in 789 journals were indexed in the WoS from 1989 to 2018. The USA(n = 1009) and Technion-Israel Institute Technology(n = 58) were the most prolific country and institution, respectively. Keywords co-occurrence analysis indicated that the research hotspots around the world formed five clusters, so did the author co-citation analysis. The research priorities of the top-five countries, the top-three prolific authors and the co-citation core authors were also discussed, which reveals the differences and similarities among them. This study delineates a framework for better understanding the situational use of CAM in cancer patients, which could help health care workers to prioritize and organize future research. |
What are the reasons for using CAM among patients?
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