Introduction
Complementary medicine and alternative medicine are popular among patients with various diseases; however, they are most often used by cancer patients.
The history of alternative medicine dates back to the 18th century. Currently, alternative medicine is widely used in many countries, and since the 1990s, experts have observed that spending on unconventional therapies increased significantly.1
In Poland, interest in unconventional therapy among cancer patients and their relatives is on the rise. However, it is difficult to estimate how often various alternative medicine modalities are used. There is still no epidemiological research in this area. Therefore, the results of the current survey constitute a source of information for physicians working with oncological patients on a daily basis.
The aim of this survey was to assess the awareness of cancer patients about the available complementary and alternative therapies. The study aims to determine which alternative medicine methods are most often chosen by Polish patients with cancer, and why and when do they choose them.
Patients and methods
An anonymous survey entitled “Use of alternative medicine methods in the treatment of cancer” consisting of 30 questions (10 on demographic data and 20 on awareness of alternative medicine methods) was made available in an electronic form between April 26, 2020 and May 30, 2020. Popular social media were used and made available to representatives of breast cancer organizations who disseminated the survey among patients. A total of 286 responses were obtained. The anonymous survey did not have the features of an experiment, which was confirmed by the Bioethical Committee of the Poznan University of Medical Science.
Statistical analysis
The analysis was carried out using the IBM SPSS Statistics 26 program (IBM Co., Armonk, New York, United States). The significance level was set at a P value of 0.05. The statistic values for the χ2 test for data independence were calculated. The Cramer V coefficient was calculated to assess the strength of association. In order to detail the occurring relationships, the z test was used to compare the structure indices (percentage value). Bonferroni correction was applied.
Results
Characteristics of the surveyed group
A total of 280 women (97.9%) and 6 men (2.1%) participated in the survey. The survey group mainly included young people, up to 50 years old (194 [67.9%]), followed by persons aged 51 to 65 years (81 [28.3%]). There were significantly fewer elderly people aged 66 to 75 years (9 [3.1%]) and older than 75 years (2 [0.7%]).
The survey was mostly completed by patients with breast cancer (274 [95.8%]). Almost half of the patients received cancer therapy for less than a year (136 [47.6%]), and one-third for 2 to 3 years (95 [33.2%]). In the remaining participants, the treatment lasted at least 4 years (55 [19.2%]).
The survey was mostly completed by patients with cancer in early stages, that is, without distant metastases: 76 (26.6%) in stage I, 116 (40.6%) in stage II, and 74 (25.9%) in stage III. Only 20 people (7%) had cancer in the stage of dissemination (stage IV).
The vast majority of respondents underwent surgical treatment (234 [81.8%]). A total of 212 underwent chemotherapy (74.1%), 192 hormone therapy (67.1%), 173 radiotherapy (60.5%), and 20 immunotherapy (7%).
Main analysis
More than two-thirds of respondents (196 [68.5%]) were able to define an alternative medicine method as “treatment not supported by scientific evidence,’’ 50 respondents (17.5%) thought it was “treatment with proven efficacy” (z test, P <0.001), and 40 (14%) were unable to answer this question.
The vast majority associated “alternative medicine methods of cancer treatment” with unconventional methods (208 [72.7%]) and with natural medicine (194 [67.8%]). These 2 answers were indicated by a comparable proportion of patients (z test, P = 0.2), followed by dietary supplements (122 [42.7%]), homeopathy (78 [27.3%]), or complementary medicine (36 [12.6%]) All of those answers were indicated significantly less frequently than the first 2 answers (z test, in each case P <0.01).
About two-thirds of respondents (196 [68.5%]) deemed an alternative medicine method as supportive treatment in cancer, and less than one-third of respondents (78 [27.3%]) claimed that it has no or little impact on cancer treatment. Eighteen respondents (6.3%) thought that alternative medicine methods replaced conventional treatment, and 13 (4.5%) did not know what these methods were for.
Comparable number of respondents did not have experience with alternative medicine methods (154 [53.8%]) or used its various forms (132 [46.2%]) (z = 1.84; P = 0.07). The most common premise for using unconventional therapies was the “willingness to self-support in the fight against cancer” (121 [42.3%]).
From the entire study population, 50 (17.5%) began therapy after the diagnosis of cancer and 51 (17.8%) during cancer treatment, 18 (6.3%) after the end of cancer therapy, 14 (4.9%) after the progression of the disease, 5 (1.7%) were not satisfied with conventional therapy, 3 (1%) after occurrence of pain.
A total of 112 patients (39.2%) did not consult their physician about the possibility to include unconventional treatment, which was significantly less than the number of patients who did consult their physician (z test, P = 0.02).
Seventy-two respondents declared that they never mentioned any additional therapy to the physician (25.2%), 52 were afraid (18.2%), 42 (14.7%) told their physician as soon as they started treatment, and 4 (1.4%) after the end of treatment. The physicians advised against using alternative medicine methods in 31 patients (10.8%) who decided to tell them.
The most common types and alternative treatment methods that patients chose are shown in Table 1. Regular use of alternative medicine methods was declared by 100 respondents (35%).
Method | Value |
|---|---|
Types of alternative medicine methods | |
Alternative medical systems such as homeopathy, acupuncture | 22 (7.7) |
Mind-body intervention such as meditation, hypnosis, music therapy | 32 (11.2) |
Pharmacological treatment not supported by scientific evidence | 27 (9.4) |
Manual therapy methods, eg, therapeutic massage | 17 (5.9) |
Natural products such as herbs | 118 (41.3) |
Spiritual therapies | 17 (5.9) |
Energy healing therapy, eg, therapeutic touch, bioresonance, magnetic field therapy | 14 (4.9) |
Exercise-based therapy, eg, yoga, t’ai chi | 34 (11.9) |
Nutritional therapies such as diets, vitamins, supplements | 143 (50) |
I have not used alternative medicine methods | 71 (24.8) |
Specific alternative medicine methods | |
Aromatherapy | 9 (3.1) |
Bioresonance | 12 (4.2) |
Hypnosis | 2 (0.7) |
Homeopathy | 28 (9.8) |
Yoga | 41 (14.3) |
Pharmacological treatment with unproven efficacy | 35 (12.2) |
Ayurvedic medicine | 4 (1.4) |
Therapeutic massage | 20 (7) |
Tibetan medicine | 3 (1) |
Meditation | 33 (11.5) |
Prayer | 90 (31.5) |
Music therapy | 23 (8) |
Naturopathy | 29 (10.1) |
Magnetic field therapy | 2 (0.7) |
Cognitive and behavioral therapy | 13 (4.5) |
Traditional Chinese medicine | 2 (0.7) |
T’ai chi | 2 (0.7) |
Osteopathy | 13 (4.5) |
I have not used alternative medicine methods | 73 (25.5) |
Data are presented as number (percentage). | |
The analysis of costs incurred by patients using unconventional methods was as follows: 84 respondents (29.4%) spent up to 100 PLN per month, which was more than 66 (23.1%) who spent between 100 and 500 PLN, but the difference did not reach the level of statistical significance (z test, P = 0.08). A total of 112 people (39.2%) did not answer this question.
Dependency study
There was a dependence between age and knowledge about alternative medicine methods (Cramer V = 0.286, P <0.001). Younger persons did not know what alternative modalities are used to treat cancer more often than older.
There was a dependence between the place of residence and the impact on alternative medicine methods of cancer treatment (Cramer V = 0.209, P = 0.01). Individuals from larger towns and cities were significantly more likely to believe that alternative medicine methods have no or little impact on cancer treatment compared with those from small towns and villages.
There was a dependence between education and association of alternative medicine methods of cancer treatment with complementary medicine (Cramer V = 0.182, P = 0.02).
There was a dependence between education and awareness of alternative medicine methods in oncology (Cramer V = 0.238, P = 0.001). Also, the higher the education, the more often the respondents were aware of alternative medicine methods in oncology.
Discussion
The results of our survey present information on the awareness of Polish cancer patients about alternative medicine methods as well as a summary of the most frequently used therapies and monthly costs incurred by them. The expenses for alternative medicine methods in Poland are difficult to estimate due to lack of data, which increases the importance of the current study.
The respondents had good awareness of alternative medicine and 68.5% of them correctly defined it. The main source of information was the Internet (75.5%) and most of the respondents never talked to the attending physician (1%). Studies indicate that patients are more likely to talk about using alternative medicine methods if asked by their physician.2
About one-third of patients (35%) who participated in our study used unconventional methods on a regular basis and almost the same number of patients did so occasionally (31.5%). A meta-analysis of the survey of over 65 000 cancer patients conducted by Horneber et al3 indicated that as many as 49% of cancer patients in the 21st century admitted to using alternative medicine.
The Internet is the main source of information for patients worldwide about cancer, therapy, prognosis, and alternative treatment methods, which is indicated by our results and by studies from other countries.4,5 The most important support, apart from family and relatives, should be the physician, who also should be the source of factual knowledge.
Literature search showed that the interest in alternative or unconventional medicine grows with the severity of cancer, and the relapse or progression of disease.6-8 In our study, the majority of respondents were patients with cancer without distant metastases (82.9%), yet the interest in alternative medicine was quite high, about half of them used different methods (46.2%). The patients mainly used diet (50%), natural means, such as herbs (41.3%), meditation (11.2%), acupuncture (7.7%), massages (5.9%) or physical activity (11.9%). Less than 10% received additional pharmacological treatment, which is more frequently observed among patients with disseminated disease.
Alternative medicine methods become more common in everyday clinical practice. Data from our survey and other foreign studies should be analyzed with great care. In 2007, United States citizens spent 33.9 billion USD for visits at unconventional medicine clinics and alternative therapy products.9 The monthly costs incurred by Polish patients are sometimes a significant part of their budget.
Limitation of the study
The survey was conducted online only. The study has its limitations due to a rather homogeneous group of respondents, that is, women with breast cancer. Thus, our analyses focused on this particular population, and was not extrapolated to patients with other cancer diagnoses.
Conclusions
It is necessary to disseminate education on alternative medicine among patients and physicians as well as to encourage dialogue on this subject. Only about one-fourth of respondents did not use any type of alternative medicine.
Mikołaj Bartoszkiewicz, MSc, Department of Chemotherapy, The Greater Poland Cancer Center, ul, Garbary 15, 61-866 Poznań, Poland, phone: +48 61 885 04 80, email: m.bartoszkiewicz@ump.edu.pl
September 14, 2020.
October 20, 2020.
November 3, 2020.
None declared.
Kufel-Grabowska J, Bartoszkiewicz M, Litwiniuk M. The use of complementary and alternative medicine among cancer patients. Pol Arch Intern Med. 2021; 131: 83-85. doi:10.20452/pamw.15669
- 1.
- Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA. 1998; 280: 1569-1575.Crossref
- 2.
- Chang KH, Brodie R, Choong MA, et al. Complementary and alternative medicine use in oncology: a questionnaire survey of patients and health care professionals. BMC Cancer. 2011; 196.Crossref
- 3.
- Horneber M, Bueschel G, Dennert G, Less D, et al. How many cancer patients use complementary and alternative medicine: a systematic review and metaanalysis. Integr Cancer Ther. 2012; 11: 187-203.Crossref
- 4.
- Broom A, Tovey P. The role of the Internet in cancer patients’ engagement with complementary and alternative treatments. Health. 2008; 12: 139-155.Crossref
- 5.
- Page SA, Mannion C, Heilmann Bail L, Verhoef MJ. CAM information online: an audit of Internet information on the “Bill Henderson Protocol”. Complement Ther Med. 2010; 18: 206-214.Crossref
- 6.
- Ponholzer A, Struhal G, Madersbacher S. Frequent use of complementary medicine by prostate cancer patients. European Urology. 2003; 43: 604-608.Crossref
- 7.
- Gross AM, Liu Q, Bauer-Wu S. Prevalence and predictors of complementary therapy use in advanced-stage breast cancer patients. J Oncol Pract. 2007; 3: 292-295.Crossref
- 8.
- Velicer CM, Ulrich CM. Vitamin and mineral supplement use among us adults after cancer diagnosis: a systematic review. J Clin Oncol. 2008; 26: 665-673.Crossref
- 9.
- Nahin RL, Barnes PM, Stussman BJ, Bloom B. Costs of complementary and alternative medicine (CAM) and frequency of visits to CAM practitioners: United States, 2007. Natl Health Stat Report. 2009; 18: 1-14.