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Patient demographics influence CAM use
Older patients, women and patients with some college education reported that they expected to benefit from complementary and alternative medicine as a cancer treatment more than other patient subgroups, according to the results of a cross-sectional survey.
Tailoring complementary and alternative medicine (CAM) programs to address patients’ perceived beliefs and attitudes may lead to greater use of this form of patient-centered care, according to the researchers.
“We found that specific attitudes and beliefs — such as expectation of therapeutic benefits, patient-perceived barriers regarding cost and access, and the opinions of patients’ physician and family members — may predict patients’ use of complementary and alternative medicine following cancer diagnoses,” Jun Mao, MD, MSCE, associate professor of family medicine and community health at the University of Pennsylvania’s Ronald Perelman School of Medicine, said in a press release. “We also found that these beliefs and attitudes varied by key socio-demographic factors such as sex, race and education, which highlights the need for a more individualized approach when clinically integrating CAM into conventional cancer care.”
Data indicate nearly 67% of patients with cancer use CAM, according to study background. Previous population studies identified factors associated with CAM use; however, no prior study assessed the reasons for or perceived barriers against CAM use in certain patient populations.
Mao and colleagues sent a cross-sectional survey to 1,188 patients treated at the breast, thoracic and gastrointestinal medical oncology clinics at the University of Pennsylvania’s Abramson Cancer Center. Patients self-reported covariates including sex, race, age, education level, employment status and marital status.
The survey assessed patients’ attitudes and beliefs related to CAM treatments — which included acupuncture, chiropractic care, special diet, energy healing, expressive arts therapy, herbs, homeopathy, massage, supplemental vitamins other than daily vitamins and yoga — into three domains: expected benefits, perceived barriers and subjective norms.
The cross-sectional survey had a response rate of 81.6% (n = 969). Sixty-eight percent of the participants were aged 65 years or younger, 63.4% were women and 78.6% were white.
Overall, 58.5% of participants reported using some form of CAM following their cancer diagnosis. Vitamins, herbs, relaxation techniques and special diets represented the most frequently reported CAM modalities.
Patients aged 65 years or older, female patients, patients with some college education and actively employed patients reported a significantly greater expected benefit from CAM (P < .001 for all). A history of cancer surgery (P = .011) and increasing interval following diagnosis (P = .0071) also acted as significant predictive factors for a greater expected benefit.
Patients who used CAM treatments expected a greater benefit than nonusers (P < .001).
Researchers then evaluated perceived barriers to CAM. Nonwhite patients perceived a greater barrier to CAM treatment than white patients (P = .001). A subanalysis identified transportation to CAM appointments and concerns regarding adverse events as primary barriers among nonwhite patients.
Patients treated with chemotherapy also perceived greater barriers related to CAM treatment (P = .024).
However, older age (P = .027), female sex (P = .0091), some college education (P < .001) and employment (P = .032) continued to be factors associated with fewer perceived CAM barriers.
Researchers also observed that factors associated with subjective norms were consistent with the previous domains. Older patients, women, college-educated patients and the employed reported positive subjective norms regarding CAM use.
In a multivariate analysis, older patient age (P < .001) and completion of some college (P = .002) continued to be associated with CAM utilization. CAM also was associated with the absence of chemotherapy (P = .025) and an interval of greater than 12 months since diagnosis (P = .002 and .001). However, in multivariate analyses that included attitudes and beliefs, age no longer demonstrated a significant association with CAM use.
The researchers acknowledged several limitations, including the inclusion of only three malignancy groups and the lack of prospective validation.
“Our findings emphasize the importance of patients’ attitudes and beliefs about CAM as we seek to develop integrative oncology programs in academic medical centers and community hospitals,” Joshua M. Bauml, MD, of the Integrative Oncology Executive Committee at the University of Pennsylvania, said in a press release. “By aligning with patients’ expectations, removing unnecessary structural barriers, and engaging patients’ social and support networks, we can develop patient-centered clinical programs that better serve diverse groups of cancer patients regardless of sex, race and education levels.” – by Cameron Kelsall
Disclosure: One researcher reports research support from the National Institute of Arthritis and Musculoskeletal and Skin Diseases.