Complementary and alternative medicine use in Chinese women with breast cancer: A Taiwanese survey

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1 Complementary and alternative medicine use in Chinese women with breast cancer: A Taiwanese survey Dr Fang-Ying (Sylvia) Chu Department of Nursing, Tzu Chi College of Technology, Hua Lien, Taiwan 1

2 BACKGROUND The most common type of cancer The 4th leading cause of cancer death in Taiwanese women Physical, psychological, and psychosocial challenges Using CAMs to improve quality of life (QOL) 2

3 Definition of CAM The National Centre for Complementary and Alternative Medicine (USA) define: CAM is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of orthodox medicine. (NCCAM, 2005, p.1) 3

4 NCCAM five domains Alternative medical systems Mind-body interventions Biologically-based therapies Manipulative and body-based methods Energy therapies Biofield therapies Bioelectromagnetic-Based therapies 4

5 The prevalence of CAM use by cancer patients Reference Australia 15%~87.5% Kremser et al., 2008 UK 30%~73% Molassiotis et al., 2005; Rees et al., 2000 USA 20%~84% Boon et al., 2000; Helyer et al., 2006; Shen et al., Taiwan 15%~82% Chang & Li, 2004; Hsin, Chiu, Hu, Cheng, & Chen, 1996; Lin, 1999; Liu et al.,

6 RESEARCH QUESTIONS What is the prevalence rate of CAM use in this sample group? What is the most common type of CAM use? How do they satisfy with and benefit from CAM use? What is the association between the CAM use and selected variables, including demographics (age, education, income), treatment (surgery type, chemotherapy), and QOL? 6

7 AIMS 1. To determine the prevalence and modalities of CAM use by Taiwanese women with breast cancer 2. To measure the level of satisfaction and perceived benefits of CAM use 3. To measure the level of quality of life (QOL) 4. To identify the predictors of CAM use 7

8 METHODS Setting and sample A cross-sectional survey A convenience sample of outpatients from a medical centre with oncology/haematology clinics in the east of Taiwan. Eligibility criteria included: (a) female, (b) aware of their disease, (c) being treated or completed treatments, (d) capable to understand Chinese or Taiwanese, (e) able to provide the informed consent. 8

9 Instrument 11-item: demographics & clinical data 9-item: descriptions regarding to CAM use 2-item: satisfaction scale & effectiveness scale (7- point Likert scale) EORTC QLQ-C30 Data collection procedures Ethical approval Pilot tested with 30 Taiwanese breast cancer patients Face-to-face structured interview Performed by the researcher 9

10 Data analysis SPSS for Window Version 19.0 Descriptive statistics (Frequencies, percentages, mean & SD) Logistic regression The level for statistical significance p <

11 RESULTS Sample characteristics A total of 196 breast cancer participated in the study. The mean age of this sample was 52.5 years (SD = 8.72),majority had completed high school education (37.2%), were Buddhists (45.6%), married (84.4%), and employed (46.4%). An average household income was NT$546,040 per annum (SD = $188,400.36). The mean of the time since the diagnosis was 25.5 months (SD = 11.5) 11

12 Table 1: Demographic Characteristics of Sample (N = 196) Characteristic Frequency (n) Percent (%) Age (years) < > Education Primary school + less Secondary school High school Above high school Marital status Married Single never married Widowed Divorced

13 Continued Characteristic Frequency (n) Percent (%) Religion Buddhism Taoism No religion Protestant Catholic Income per annum (New Taiwanese Dollar)* < NT$ 300,000 (<AUD$ 9,836) NT$ 300, , (AUD$ 9, ,393) NT$ 500, , (AUD$ 16, ,950) NT$ 500, , *1 Australian Dollar = 30.5 New Taiwanese Dollar 13

14 Table 2: Clinical Characteristics of Sample (N = 196) Characteristic Frequency (n) Percent (%) Time since diagnosis < 1 year > 1-2 years > 2-3 years > 3-4 years > 4 years Stage of disease Stage Stage I Stage II Stage III Stage IV Type of surgery No surgery Mastectomy Lumpectomy

15 Continued Characteristic Frequency (n) Percent (%) Recurrence of disease Yes No Type of adjuvant treatment Chemotherapy Yes No Radiotherapy Yes No Hormone therapy Yes No *CAM use Yes No *CAM = complementary and alternative medicine. 15

16 Table 3: The Mean Scores and Standard Deviation of EORTC QLQ- C30 (N = 196) Variables Mean* SD Functional scales Physical function Role function Emotional function Cognitive function Social function Global health status/qol Symptom scales Fatigue Nausea and vomiting Pain Symptom items Dyspnoea** Insomnia** Appetite disturbance** Constipation** Diarrhea** Financial difficulties** *Higher scores of Functional scales and Global QOL represent the better QOL. Lower score of symptom scales and financial difficulty indicate the better QOL.. 16

17 CAM use The most common 3 types of CAM use Chinese medicine (64.5%) Dietary supplement products (24.9) Physical movement or exercises (16.6%) Sources of information Friends (50.1%) Family (45.7%) Most common reasons for CAM use To increase the body s ability to fight cancer (50.3%) To improve physical well-being (38.0) To improve emotional well-being and to increase hope and optimism (25%) Perceived satisfaction and effectiveness with CAM The mean score for satisfaction was 5.32 out of 7 (SD = 1.53) The mean score for perceived effectiveness was 5.13 out of 7 (SD = 1.58) A significant positive correlation between the level of satisfaction with the use of CAM and perceived effectiveness of CAM use (r = 0.82, p < ) 17

18 Table 4: Logistic analysis for the predictors of CAM use (N = 196) B SE Wald DOF P value ***OR Confidence interval Lower Upper Age * Educational level Household income * ** * p < 0.05 ** p < 0.01 *** OR = odds ratio 18

19 DISCUSSION The high prevalence of CAM use in Taiwanese women with cancer. Younger age, education, and income were found to be significant factors predicting CAM use in this study. In the context of Chinese culture, Traditional Chinese Medicine is rooted in ancient belief system. Findings suggest that the main sources of information are informal and unscientific, which may have consequences for the patients. 19

20 LIMITATIONS A small convenience sample from one hospital, and therefore, does not represent the general cancer population in Taiwan. Inherent in survey methodology, respondent perceptions may differ from what actually happens or exists. The possibility of incorrect interpretation of questions must be considered. The study was cross-sectional in design, thus no cause and effect relationship can be drawn from the results. 20

21 CONCLUSIONS CAM is used as complementary therapy rather than as an alternative to Western medicine, in this population. Initiating communication regarding CAM with patients and being able to guide patients in appropriate and safe CAM use is imperative. Filling the gap and creating partnerships between western conventional medicine and CAM practitioners may have great utility. Incorporating CAM education in health professional curriculum is vital as patients are using these therapies in large numbers. Funding research into effectiveness of CAM is vital. 21

22 Acknowledgements All participants Professor Wendy Chaboyer Professor Marianne Wallis Dr Brigid Gillespie Research grant of Tzu Chi College of Technology 22

23 Thanks for attending Q&A 23

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