Study of MDA Patients Shows Most Have Used Complementary and Alternative Medicine

A recent study completed at The University of Texas M. D. Anderson Cancer Center found that most of the cancer patients surveyed have used some form of complementary and alternative medicine, or CAM, and most of those patients had not discussed it with their physicians.

Of the 453 outpatients surveyed, almost all had heard of CAM, and 83 percent had utilized at least one of the CAM therapies - such as spiritual practices, vitamins and herbs, psychotherapy or some form of exercise. When the spiritual practices and the psychotherapy or support group modalities were not included in the data, 69 percent of the patients still had used one or more CAM therapy approaches.

Results from the study, which is the first such CAM survey conducted by a Comprehensive Cancer Center, were published in the July 2000 issue of the Journal of Clinical Oncology. The alternative therapies - also referred to in these cases as integrative therapies - were used while undergoing traditional therapies directed by cancer specialists.

"When you consider the fact that in 1997, Americans spent more than $34 billion on alternative therapies - herbs, vitamins, natural substances in which no large-scale clinical testing has been done - we thought it was important to obtain some initial statistics in a scientifically organized manner on what type of people are using these therapies and why," explains Dr. S. Eva Singletary, an investigator on the study and chief of breast surgery at M. D. Anderson.

Over the course of six months, outpatients from seven disease sites completed a self-administered questionnaire that classified CAM therapies in seven different categories: special diets, psychotherapy, movement and physical therapy, mind and body therapies, spiritual practices, vitamins and herbs, and other modalities including acupuncture and immuno-augmentative treatment.

Use was highest for spiritual practices at 80 percent. Almost 63 percent of the cancer patients had taken vitamins and herbs, including natural substances such as melatonin, shark or bovine cartilage, homeopathic remedies, essiac tea, mistletoe and folk remedies.

CAM movement and physical therapies were adopted by 60 percent, including guided imagery and visualization, hypnosis, meditation, biofeedback, music therapy and other similar practices.

Contrary to stereotypic assumptions, research found that CAM users were not simply patients who were terminally ill, desperate or uneducated. In fact, among the 69 percent who utilized CAM therapies (not including prayer or psychotherapy options), the study showed the majority of patients had received chemotherapy and were well-educated.

What researchers found alarming was that 65 percent of the surveyed patients did not tell their oncologists about their use of the alternative therapies. Patients in the study cited that they were uncertain that CAM treatments would be of any benefit or that their physicians did not ask.

"This is data that demonstrates widespread use of complementary and alternative medicine by cancer patients," explains Dr. Mary Ann Richardson of the National Institutes of Health's National Center for Complementary and Alternative Medicine (NCCAM). Dr. Richardson led the study while she was with The University of Texas-Houston School of Public Health.

"What is troubling is that many cancer patients continue to take herbs and mega doses of vitamins while receiving chemotherapy or radiation therapy," she says. "They need to discuss the usage of these different therapies with their physicians to ensure that some of these therapies simultaneously coupled with medical treatment won't be harmful at that particular time."

For instance, when a patient is taking gingko biloba - an herb used to sharpen memory - or high doses of vitamin E, they are susceptible to increased bleeding. This could be a problem, Dr. Singletary points out, if a patient is undergoing surgery and physicians aren't aware of these substances.

Or if a woman is simultaneously taking ginseng or soy with Tamoxifen, the effectiveness of the drug could be compromised because these two alternative substances enhance estrogen, while Tamoxifen is taken to reduce it.

"We hope this research encourages both the public and their physicians to keep an open mind and abandon this `Don't ask, don't tell,' policy," Dr. Singletary says.

Although none of the participating patients ceased conventional cancer treatments, they maintained high expectations for the CAM therapies. They hoped for: improved quality of life (77 percent), a boost in their immune system (71 percent), prolonged life (62 percent), relief of symptoms (44 percent) and actual curative results (37 percent).

Dr. Singletary says study researchers hope the collected data will serve a two-fold purpose for the future: to encourage physicians to officially incorporate the use of CAM therapies into the process of obtaining patient histories and that clinical research studies will be conducted to produce reliable data on possible interactions with these therapies and already proven cancer treatments.

In September of 1998, M. D. Anderson established the Place...of wellness, a vehicle for cancer patients - regardless of where they receive care - to explore complementary therapies like many of those referenced in the study. An average of between 700 and 900 people visit the Place...of wellness each month.

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©2006 Texas Medical Center

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