Evidence-Based Complementary and Alternative Medicine

Complementary and Alternative Medicine Use and Initiatives in Europe

Role of Complementary and Alternative Medicine in Cardiovascular Diseases

9057 Background: The incidence of CAM use among patients with cancer is higher when compared to the general population. However, there are few studies examining CAM use in NHL survivors, and limited data are available regarding beliefs in CAM. This study was conducted to examine the prevalence of CAM use in NHL, define CAM beliefs among NHL survivors, and explore differences between patients with indolent and aggressive lymphoma. Methods: Newly diagnosed lymphoma patients were prospectively enrolled within 9 months of diagnosis in the University of Iowa/Mayo Clinic SPORE Molecular Epidemiology Resource from 2002-2008. NHL patients who completed the 3-year post diagnosis questionnaire, which includes questions regarding CAM use and beliefs, were included in this study. Chi-squared tests and Wilcoxon rank-sum tests were used to assess the association of CAM use with prognostic and demographic factors. Results: 719 patients were included with a median age of 63 years (range 22-92). 53% were male. Overall, 636 (89%) reported ever using CAM. 78% of patients used vitamins and 54% alternative therapies (chiropractic (36%) and massage therapy (24%)). Among CAM users, 141 (22%) believe CAM can assist the body to heal, 123 (19%) believe CAM can relieve cancer symptoms, 115 (18%) believe CAM use gives a feeling of control, 106 (17%) believe CAM can boost immunity, 24 (4%) believe CAM can cure cancer, and 35 (6%) believe CAM can prevent the spread of cancer. Female gender was associated with increased overall CAM use (p<0.0001) as well as use of vitamins (p<0.0001), herbal supplements (p=0.006) and alternative therapy (p=0.0002) specifically for cancer. Older age was also associated with increased vitamin use (p=0.005) and decreased herbal supplements use (p=0.008). There was no significant difference in overall CAM use between those with follicular lymphoma grades I-II (n=195, 91%) and non-relapsed diffuse large B-cell lymphoma (n=151, 87%), although massage therapy was utilized more often by FL survivors (29% versus 18%, p=0.005). Conclusions: CAM modalities are used by the majority of NHL survivors (89%). The assessment of CAM use and education regarding potential harms is imperative for the NHL survivor.

Integrative medicine and culture: toward an anthropology of CAM.

C omplementary and alternative medicine (CAM) refers to a wide range of clinical therapies outside of conventional medicine.1 The term “complementary” refers to therapies that are used in conjunction with conventional medicine, whereas “alternative” medicine includes therapies that are used in place of conventional medicine. The term “integrative” medicine has been advocated by some CAM providers and researchers as representing a combination of conventional medicine, CAM, and evidence-based medicine.2 The National Center for Complementary and Alternative Medicine, a federal scientific agency for CAM research, categorizes CAM into five domains: biologically based practices, mind-body medicine, manipulation and body-based practices, energy medicine, and whole-medical systems (Table 1). Biologically based practices and mind-body medicine are the most common CAM modalities used and studied for the treatment of diabetes in the West and are the focus of this review. In the United States, CAM is frequently used by adults, with 40% reporting use in the past 12 months.3 An estimated 34% of adults with diabetes use some type of CAM therapy.4 The estimated out-of-pocket expense in 2007 on CAM therapies was $44 billion.5 Although some CAM therapies have been shown to affect glycemic control, the clinical efficacy and mechanism of many CAM therapies for diabetes is controversial, and safety issues are a concern. Adverse effects of many CAM therapies are not well documented. Because patients with diabetes often take multiple prescription medications, there exists the potential for herb-drug and herb-dietary supplement interactions, leading to adverse events.6,7 At least 63% of the general population do not disclose use of CAM therapies to their physicians.8 The purpose of this clinical review is to discuss selected CAM therapies frequently used for patients with diabetes and to provide a framework to advise patients on CAM use. INBRIEF More than …

ObjectivesInflammatory bowel disease (IBD) constitutes a challenging and long‐lasting burden for pediatric patients. The management of IBD is multifaceted involving conventional medication but also dietary measures. An increasing number of patients are turning to complementary and alternative medicine (CAM) in their quest to alleviate IBD‐related symptoms and improve their overall well‐being. We therefore investigated the patterns of CAM use and associated patients' and disease characteristics to identify indicators of CAM use in pediatric IBD patients in Switzerland.MethodsPediatric and adolescent patients enrolled in the Swiss IBD Cohort Study, a nationwide prospective cohort study, completed a questionnaire about CAM and supplementation use as well as dietary restrictions. Associations of CAM use with disease characteristics including conventional medication and patient‐recorded outcomes were analyzed.ResultsA total of 111 pediatric IBD patients (59 Crohn′s disease, 41 ulcerative colitis, 11 IBD unclassified) answered the questionnaire. Sixty‐five percent (72/111) of patients used at least one CAM since diagnosis, 73% (81/110) took vitamins and micronutrient supplements and 53% (59/111) followed dietary restrictions. The latter was in 68% self‐imposed and significantly associated with CAM use in multivariable models (odds ratio [OR]: 4.48; 95% confidence interval [CI]: 1.84–10.92). CAM use was not associated with IBD subtype, need for biologicals or extraintestinal manifestations. Health‐related quality of life (HRQOL) and disease activity did not differ between CAM and no‐CAM users.ConclusionCAM use as well as self‐imposed dietary restrictions are frequent in IBD patients, whereby both are closely interrelated. While CAM users do not have higher HRQOL compared to no‐CAM users, they subjectively report an improvement in health associated with CAM use.

The use of Complementary and Alternative Medicine (CAM) among Italian children: A cross-sectional survey

Use of complementary and alternative medicine (CAM) is common among Latinos living with HIV in the United States (US)–Mexico border region. Health providers may vary in their approach to communicating acceptance or non acceptance of CAM use, which can undermine patient confidence in disclosing CAM use. Patient–provider communication about CAM is important because certain types of CAM can affect antiretroviral therapy (ART) adherence. We undertook the present binational study to understand US and Mexican provider beliefs, and perceptions surrounding CAM use among Latino patients, and to learn if and how CAM communication occurs. Between July and December 2010, we conducted in-depth, qualitative interviews in Tijuana and San Diego. Analysis procedures drew upon principles of Grounded Theory. The sample was comprised of 19 HIV-health care providers, including 7 women and 12 men. Emerging CAM-related themes were: Provider's perceptions, attitudes and knowledge about CAM; CAM types and modalities; and patient–provider CAM communication. Many clinicians were uncomfortable supporting CAM use with their patients. San Diego providers reported more frequent instances of CAM use among Latino patients than Tijuana providers. Providers from both cities reported that patients infrequently disclose CAM use and almost half do not routinely ask patients about CAM practices. Most of the providers acknowledged that they lack information about CAM, and are concerned about the drug interaction as well as the effects of CAM on adherence. Our findings have important implications for understanding provider communication surrounding CAM use in a highly transnational population and context. Because CAM use may undermine ART adherence and is highly prevalent among Latinos, provider communication about CAM is critical to improved health outcomes among HIV-positive Latinos. Considering the significant growth of US Latinos, especially in the US–Mexico border region, assessment of Mexican and US provider training and communication needs surrounding Latino patient CAM use is warranted.

Background: There is increasing evidence for the extensive use of complementary and alternative medicine (CAM) by patients with psoriasis. Clinical research in the arena of CAM and psoriasis treatment is evolving and includes some randomized controlled trials. Objective: To study CAM use among patients with psoriasis attending a dermatology clinic in a major university hospital in northern Israel. Prevalence, reasons for CAM use and its relevance to doctor-patient communication were emphasized. Methods: Semistructured interviews were conducted with psoriasis patients in a dermatology clinic. Consent was obtained for 78 patients. Post-visit questionnaires were given to 5 physicians. Results: Seventy-eight patients with psoriasis were interviewed and 77 were studied. Sixty-two percent used CAM. Fifty-eight percent of users had seen a CAM practitioner. The study found a trend of CAM use among patients with psoriasis from Arab compared to Jewish descent (p = 0.087). CAM users reported on average 2 different CAM modalities. Herbal medicine and nutritional treatments ranked first, followed by homeopathy, traditional Chinese medicine and nutritional supplements. The main reason for CAM use was stated to be to do everything to heal the disease, followed by a quest for improved quality of life. Others mentioned an interest in a less toxic treatment, disappointment with conventional treatment and stress reduction. Well over half of the study participants and their dermatologists did not initiate a discussion about CAM use. The dermatologists’ ability to predict CAM use in their patients was relatively low. Conclusion: There is growing evidence of extensive CAM use among patients with psoriasis. Most patients use CAM as a complementary treatment, rather than an alternative to conventional treatment. Teaching CAM should be integrated into the dermatology residency curriculum. Dermatologists need to increase their awareness of CAM use by their patients in order to improve therapeutic communication.

Complementary and alternative medicine in paediatrics in daily practice—A European perspective

1013 Background: We sought to compare change in complementary and alternative medicine (CAM) use from enrollment into a randomized BRCA1/2 testing project to CAM use one-year following results disclosure. We also explored factors influencing new CAM use at one-year by women not using CAM at program entry, including BRCA1/2 test result, anxiety, cancer-related surveillance behaviors, and prophylactic surgical choices. Methods: A matched cohort of 243 high-risk women completed questionnaires at enrollment into BRCA1/2 randomized control trial (with semi-structured counseling intervention) and one-year post results disclosure. Women were asked about their use of several types of CAM, including ingestible, behavioral and physical modalities. Assessment of the pattern of change in CAM use from baseline to one-year was done using McNemar's Test of Change for Paired Samples. Correlates of new CAM use at one-year were explored using logistic regression models for the subset of 113 women (46.5%) who did not report CAM use at enrollment into the testing program. Results: Among women that changed their CAM behavior from baseline enrollment to one-year following BRCA1/2 results disclosure, there was a significantly higher proportion that changed from no CAM use to CAM use among the overall cohort (p=. 01), women without cancer (p=. 003), BRCA1/2 carriers (p=. 03), and among women randomized to the genetic counseling intervention arm of the study (p=. 009). Additionally, new CAM use at one-year was positively associated with the reported number of cancer-related surveillance behaviors for both healthy women and cancer survivors. Conclusions: High-risk women who have received BRCA1/2 testing may adopt new CAM use in the first year post disclosure. Healthy high-risk women and cancer survivors may utilize both CAM and other cancer-related surveillance strategies. The correlation between CAM use and genetic counseling deserves further study. No significant financial relationships to disclose.

Complementary and alternative medicine (CAM) use is high among people with multiple sclerosis (MS), yet there are no reports on the association between CAM use and health-related quality of life (HRQL) in MS. To examine this relationship, a cross-sectional survey and SF-12 was used to collect demographic and HRQL data from 1667 survey respondents. Factors examined for their association with CAM use included, age, gender, race, self-reported disease severity, disease-modifying drug (DMT) use, MS duration, MS type, education level, physical and mental well-being. Multiple regression analysis revealed that female gender, high education level, longer MS duration, lower physical well-being and not using DMT were independent factors associated with both ‘ever’ and ‘current’ CAM use. The finding that a drop in physical component score (PCS) of the SF-12 is independently associated with an increased odds of ‘ever’ CAM use, ‘current’ CAM use, and ‘past’ CAM reflect an association of CAM use with PCS regardless of time of use. Although, temporality of this relationship cannot be established, as this was a cross-sectional study, a longitudinal study is warranted so that we can establish if HRQL is predictive for CAM use in MS.

Only a few studies assessed the prevalence and the predictors of complementary and alternative medicine (CAM) use specifically in melanoma patients. The aim of this study was to assess the extent of CAM use in Turkish melanoma patients. To assess the extent of CAM use and to compare sociodemographic and clinical characteristics between users and non-users in melanoma patients. One hundred melanoma patients who were seen in outpatient clinics were included in a survey using questionnaire on CAM use. Twenty-seven patients used at least one type of CAM, the majority of which were herbs (73%). Turmeric (curcumin) was the most popular herb that was used alone or in conjunction with various other herbs (41%). Living in rural areas was significantly associated with CAM use (p = 0.02). The most common reason for CAM use was intent to cure of the disease (52%). The primary source of information about CAM was a close friend or a family contact (44%). CAMs were generally used together with conventional anticancer treatment modalities (64%) and they were ingested on a regular base (72%). CAMs could easily be acquired at regular herbal stores (88%). The patients experienced almost no adverse effects with CAM use; and most cases (71%) had confidence in CAM. About half of the patients consulted with their physicians about CAM use. Minority, nearly one fourth of the melanoma cases used at least one type of CAM, the majority of which were herbs and turmeric (curcumin) was the most popular agent.

Complementary and alternative medicine (CAM) among hospitalised patients: Reported use of CAM and reasons for use, CAM preferred during hospitalisation, and the socio-demographic determinants of CAM users

BACKGROUND: Use of complementary and alternative medicine (CAM) is common among IBD patients (1). The CAM modalities used include a wide specter of health care practices and therapies (2). In a previous study from this population, we found that almost one third of the patients used CAM 10 years after diagnosis (3). The aim of this follow-up study was to assess CAM use in IBD patients 20 years after diagnosis. METHODS: The Inflammatory Bowel South-Eastern Norway (IBSEN) study is a population based study with a prospective design. From January 1990 to December 1993, all newly diagnosed patients with IBD from a well defined area in South Eastern Norway were included in the cohort. The 20-year follow-up was conducted between 2011 and 2014 and included a structured interview, a review of patient records, a clinical examination, laboratory tests, and a questionnaire regarding CAM use. RESULTS: Of the 599 invited to attend the 20-year follow - up visit, 78.5% (UC = 314, CD = 156) participated in the follow- up study, whereof 93% (UC = 293 and CD = 146) completed the CAM questionnaire, 49% men. In total 122/439 (28%) reported use of CAM for their IBD, and 6% reported current CAM use. A significantly higher proportion women than men (60% vs 40%, P = 0.02) reported to use CAM. CAM users were younger (49 years) than the non-users (56 years), P < 0.001. A significantly higher proportion CD patients compared to UC patients (34% vs 25%, P = 0.04) reported CAM use. Treatment with CAM occurred more frequently in patients with more than one relapse the last year than in patients in remission (35% vs 21%, P = 0.003). The 3 most commonly used types of CAM were acupuncture 63/122 (52%), homeopathy 49/122 (40%) and herbal medicine 47/122 (39%). The 2 most common reasons for using CAM was as (1) a supplement to conventional treatment (41%) and (2) lack of effect from conventional medicine (32%). CONCLUSION(S): One third of the IBD patients reported CAM use 20 years after diagnosis. Prevalence of CAM use was comparable in the 10-year and 20-year follow- up. CAM use was more common among women, in younger patients, in UC patients, and in those with disease activity.