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      Cancer patients’ use of complementary and alternative medicine in Sweden: a cross-sectional study

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          Abstract

          Background

          Access to and advice on Complementary and Alternative Medicine (CAM) are uncommon within Swedish conventional cancer care and little is known about cancer patients’ own use of CAM. The aim of this cross-sectional study was to explore Swedish cancer patients´ patterns of CAM use, their experiences and preferences.

          Methods

          Questionnaires were distributed consecutively to 1297 cancer patients at a university hospital’s out-patient oncology units. The response rate was 58% ( n = 755). Descriptive statistics were used to analyze the survey data. A logistic regression model was used to investigate the association between CAM use and gender, age and level of education. Open-ended responses were analyzed, using qualitative content analysis.

          Results

          Lifetime CAM use was reported by 34% ( n = 256), and 26% ( n = 198) used CAM after cancer diagnosis. Being female, younger and having higher education predicted CAM use. Most commonly used methods were natural products including vitamins and minerals and relaxation. Main reasons for CAM use were improvement of physical, general and emotional wellbeing and increasing the body’s ability to fight cancer. Satisfaction with CAM usage was generally high. Reported adverse effects were few and mild; 54% of users spent < 50 Euro a month on CAM. One third had discussed their CAM use with cancer care providers. More than half of all participants thought that cancer care providers should be able to discuss (58%) and to consider (54%) use of CAM modalities in cancer care.

          Conclusions

          Despite limited access and advice within conventional cancer care, one fourth of Swedish cancer patients use CAM. The insufficient patient-provider dialogue diverges with most patients’ wish for professional guidance in their decisions and integration of CAM modalities in conventional cancer care. Concurrent and multimodal CAM use implies challenges and possibilities for cancer care that need to be considered.

          Electronic supplementary material

          The online version of this article (10.1186/s12906-019-2452-5) contains supplementary material, which is available to authorized users.

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          Most cited references29

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          Use of complementary and alternative medicine in cancer patients: a European survey.

          A Molassiotis, P. Fernadez-Ortega, D Pud … (2005)
          The aim of this study was to explore the use of complementary and alternative medicine (CAM) in cancer patients across a number of European countries. A descriptive survey design was developed. Fourteen countries participated in the study and data was collected through a descriptive questionnaire from 956 patients. Data suggest that CAM is popular among cancer patients with 35.9% using some form of CAM (range among countries 14.8% to 73.1%). A heterogeneous group of 58 therapies were identified as being used. Herbal medicines and remedies were the most commonly used CAM therapies, together with homeopathy, vitamins/minerals, medicinal teas, spiritual therapies and relaxation techniques. Herbal medicine use tripled from use before diagnosis to use since diagnosis with cancer. Multivariate analysis suggested that the profile of the CAM user was that of younger people, female and with higher educational level. The source of information was mainly from friends/family and the media, while physicians and nurses played a small part in providing CAM-related information. The majority used CAM to increase the body's ability to fight cancer or improve physical and emotional well-being, and many seemed to have benefited from using CAM (even though the benefits were not necessarily related to the initial reason for using CAM). Some 4.4% of patients, however, reported side-effects, mostly transient. It is imperative that health professionals explore the use of CAM with their cancer patients, educate them about potentially beneficial therapies in light of the limited available evidence of effectiveness, and work towards an integrated model of health-care provision.
          Article 0 comments Cited 275 times – based on 0 reviews     Review now
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            How many cancer patients use complementary and alternative medicine: a systematic review and metaanalysis.

            Markus Horneber, Gerd Bueschel, Gabriele Dennert … (2012)
            No comprehensive systematic review has been published since 1998 about the frequency with which cancer patients use complementary and alternative medicine (CAM). MEDLINE, AMED, and Embase databases were searched for surveys published until January 2009. Surveys conducted in Australia, Canada, Europe, New Zealand, and the United States with at least 100 adult cancer patients were included. Detailed information on methods and results was independently extracted by 2 reviewers. Methodological quality was assessed using a criteria list developed according to the STROBE guideline. Exploratory random effects metaanalysis and metaregression were applied. Studies from 18 countries (152; >65 000 cancer patients) were included. Heterogeneity of CAM use was high and to some extent explained by differences in survey methods. The combined prevalence for "current use" of CAM across all studies was 40%. The highest was in the United States and the lowest in Italy and the Netherlands. Metaanalysis suggested an increase in CAM use from an estimated 25% in the 1970s and 1980s to more than 32% in the 1990s and to 49% after 2000. The overall prevalence of CAM use found was lower than often claimed. However, there was some evidence that the use has increased considerably over the past years. Therefore, the health care systems ought to implement clear strategies of how to deal with this. To improve the validity and reporting of future surveys, the authors suggest criteria for methodological quality that should be fulfilled and reporting standards that should be required.
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              Reasons for and characteristics associated with complementary and alternative medicine use among adult cancer patients: a systematic review.

              H Boon, Lynda G Balneaves, Marja Verhoef … (2005)
              To conduct a systematic review of reasons for and sociodemographic and disease characteristics associated with complementary and alternative medicine (CAM) use in cancer patients. Eligible studies were identified by searching the following databases: Alt Health Watch, AMED, CINAHL, CancerLit, PremMEDLINE, MEDLINE, Pub-Med, Ingenta, EMBASE, and Health Star, as well as reference lists in review articles. Only English-language articles published between 1994 and 2004 were included. Search terms included CAM and oncology/cancer, decision making and CAM and oncology/cancer, treatment decision making and CAM and oncology/cancer, and health care choices and CAM and oncology/cancer. Fifty-two eligible studies were identified and summarized. These studies were conducted in 14 different countries, with the largest number of studies being completed in the United States (34.6%). A therapeutic response, wanting control, a strong belief in CAM, CAM as a last resort, and finding hope were the most commonly cited reasons for using CAM. Age, socioeconomic status, and gender were the dominant characteristics associated with CAM use. Reasons for and characteristics associated with CAM use among cancer patients have been studied extensively. Future CAM research among cancer patients should focus on identifying decision-making processes and building theoretical decision-making models. These can be used in the development of decisional aids for patients when confronted with the choice to use CAM as part of their cancer treatment.
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                Author and article information

                Contributors
                Kathrin Wode:
                ORCID: http://orcid.org/0000-0001-6449-6349
                kathrin.wode@sll.se
                Roger Henriksson: roger.henriksson@umu.se
                Lena Sharp: lena.sharp@sll.se
                Anna Stoltenberg: amstoltenberg@gmail.com
                Johanna Hök Nordberg: johanna.hok@ki.se
                Journal
                Journal ID (nlm-ta): BMC Complement Altern Med
                Journal ID (iso-abbrev): BMC Complement Altern Med
                Title: BMC Complementary and Alternative Medicine
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-6882
                Publication date (Electronic): 13 March 2019
                Publication date PMC-release: 13 March 2019
                Publication date Collection: 2019
                Volume: 19
                Electronic Location Identifier: 62
                Affiliations
                [1 ]Regional Cancer Center Stockholm Gotland, Box 6909, 102 39 Stockholm, Sweden
                [2 ]ISNI 0000 0000 9241 5705, GRID grid.24381.3c, Department for Upper Gastrointestinal Cancer, , K42, Karolinska University Hospital, ; 141 86 Stockholm, Sweden
                [3 ]ISNI 0000 0001 1034 3451, GRID grid.12650.30, Department of Radiation Sciences, , Umeå University, ; 901 87 Umeå, Sweden
                [4 ]ISNI 0000 0001 1034 3451, GRID grid.12650.30, Department of Nursing, , Umeå University, ; 901 87 Umeå, Sweden
                [5 ]ISNI 0000 0004 1937 0626, GRID grid.4714.6, Department of Learning, Informatics, , Management and Ethics, Division of Innovative Care Research, Karolinska Institutet, ; 171 77 Stockholm, Sweden
                [6 ]Department of Neurobiology, Caring Sciences and Society, Division of Nursing, 23 300 141 83 Huddinge, Sweden
                [7 ]ISNI 0000 0004 1937 0626, GRID grid.4714.6, Department of Physiology and Pharmacology, , Karolinska Institutet, ; 171 77 Stockholm, Sweden
                Author information
                http://orcid.org/0000-0001-6449-6349
                Article
                Publisher ID: 2452
                DOI: 10.1186/s12906-019-2452-5
                PMC ID: 6417272
                PubMed ID: 30866916
                SO-VID: df9a4745-4bcf-4370-ac49-eaada345d62d
                Copyright © © The Author(s). 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 26 September 2018
                Date accepted : 30 January 2019
                Funding
                Funded by: Regional Cancer Center Stockholm Gotland
                Award ID: Grant 2013
                Award Recipient :
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Complementary & Alternative medicine
                Keywords: complementary and alternative medicine/utilization,oncology,cross-sectional studies,cancer,adult,integrative oncology,sweden,europe,epidemiology,evidence-based medicine
                Data availability:
                ScienceOpen disciplines: Complementary & Alternative medicine
                Keywords: complementary and alternative medicine/utilization, oncology, cross-sectional studies, cancer, adult, integrative oncology, sweden, europe, epidemiology, evidence-based medicine

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