Relief of Symptoms, Side Effects, and Psychological Distress Through Use of Complementary and Alternative Medicine in Women With Breast Cancer
Purpose/Objectives: To identify use of complementary and alternative medicine (CAM) for relief of symptoms and side effects among women diagnosed with breast cancer and to identify demographic and clinical factors associated with the use of CAM in these patients.
Design: A descriptive, cross-sectional survey.
Setting: Clinics and community groups in the Tampa Bay area and community groups in a rural midwestern area.
Sample: A convenience sample of 105 predominantly Caucasian women (X age = 59 years) with a diagnosis of breast cancer was recruited from the Tampa Bay area and a rural midwestern area.
Methods: The instrument used to gather the data was the Use of Complementary Therapies Survey. The reasons for choosing 33 individual CAM treatments were tabulated. The frequency of use was calculated according to four reasons: (a) to reduce physical symptoms or side effects, (b) to reduce psychological distress, (c) to gain a feeling of control over treatment, or (d) because of dissatisfaction with traditional medical care. Least-squares regression models were fit to identify independent demographic and clinical predictors of CAM therapy use.
Main Research Variables: Use of CAM for relief of physical and psychological distress.
Findings: Patients used all categories of CAM therapies to reduce physical symptoms and side effects. The most frequently cited reason for use of CAM was to reduce the symptom of psychological distress, whereas the lowest frequency of CAM use was because of dissatisfaction with traditional medical care. Traditional and ethnic medicines frequently were used to reduce physical symptoms and side effects, followed by diet and nutritional supplements. The most frequently used CAM therapy category cited for gaining a feeling of control over treatment was use of diet and nutritional supplements. Previous chemotherapy and having more than a high school education were associated with more frequent use of diet and nutritional supplements and stress-reducing techniques.
Conclusions: Frequency of specific use according to type of CAM was higher and more specific than reported in other studies. Patients who had undergone chemotherapy were most likely to use CAM.
Implications for Nursing: Oncology nurses are in a key position to identify which symptoms or side effects patients are experiencing and which CAM therapies may be helpful to relieve patients' symptoms related to treatment and psychological distress related to their cancer.
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References
Adler, S.R., & Fosket, J.R. (1999). Disclosing complementary and alternative medicine use in the medical encounter: A qualitative study in women with breast cancer. Journal of Family Practice, 48, 453-458.
Alferi, S.M., Antoni, M.H., Ironson, G., Kilbourn, K.M., & Carver, C.S. (2001). Factors predicting the use of complementary therapies in a multiethnic sample of early-stage breast cancer patients. Journal of the American Medical Women's Association, 56, 120-123, 126.
Arathuzik, D. (1994). Effects of cognitive-behavioral strategies on pain in cancer patients. Cancer Nursing, 17, 207-214.
Astin, J.A. (1998). Why patients use alternative medicine: Results of a national study. JAMA, 279, 1548-1553.
Balneaves, L.G., Kristjanson, L.J., & Tataryn, D. (1999). Beyond convention: Describing complementary therapy use by women living with breast cancer. Patient Education and Counseling, 38, 143-153.
Barroso, J., McMillan, S., Casey, L., Gibson, W., Kaminski, G., & Meyer, J. (2000). Comparison between African-American and white women in their beliefs about breast cancer and their health locus of control. Cancer Nursing, 23, 268-276.
Barton, D.L., Loprinzi, C.L., Quella, S.K., Sloan, J.A., Veeder, M.H., Egner, J.R., et al. (1998). Prospective evaluation of vitamin E for hot flashes in breast cancer survivors. Journal of Clinical Oncology, 16, 495-500.
Beaver, K., Luker, K.A., Owens, R.G., Leinster, S.J., Degner, L.F., & Sloan, J.A. (1996). Treatment decision making in women newly diagnosed with breast cancer. Cancer Nursing, 19, 8-19.
Beck, S.L. (1991). The therapeutic use of music for cancer-related pain. Oncology Nursing Forum, 18, 1327-1337.
Begbie, S.D., Kerestes, Z.L., & Bell, D.R. (1996). Patterns of alternative medicine use by cancer patients. Medical Journal of Australia, 165, 545-548.
Bennett, M., & Lengacher, C. (1999). Use of complementary therapies in a rural cancer population. Oncology Nursing Forum, 26, 1287-1294.
Bleiker, E.M., Pouwer, F., van der ploeg, H.M., Leer, J.W., & Ader, H.J. (2000). Psychological distress two years after diagnosis of breast cancer: Frequency and prediction. Patient Education and Counseling, 40, 209-217.
Boon, H., Brown, J.B., Gavin, A., Kennerd, M.A., & Stewart, M. (1999). Breast cancer survivors' perceptions of complementary/alternative medicine (CAM): Making the decision to use or not to use. Qualitative Health Research, 9, 639-653.
Boon, H., Stewart, M., Kennard, M.A., Gray, R., Sawka, C., Brown, J.B., et al. (2000). Use of complementary/alternative medicine by breast cancer survivors in Ontario: Prevalence and perceptions. Journal of Clinical Oncology, 18, 2515-2521.
Bourjolly, J. (1999). Locus of control among black and white women with breast cancer: A preliminary study. Journal of Psychosocial Oncology, 17(1), 21-31.
Bremer, B.A., Moore, C.T., Bourbon, B.M., Hess, D.R., & Bremer, K.L. (1997). Perceptions of control, physical exercise, and psychological adjustment to breast cancer in South African women. Annals of Behavioral Medicine, 19, 51-60.
Burstein, H.J., Gelber, S., Guadagnoli, E., & Weeks, J.C. (1999). Use of alternative medicine by women with early-stage breast cancer. New England Journal of Medicine, 340, 1733-1739.
Carpenter, J.S., & Andrykowski, M.A. (1999). Menopausal symptoms in breast cancer survivors. Oncology Nursing Forum, 26, 1311-1317.
Carpenter, J.S., Andrykowski, M.A., Cordova, M., Cunningham, L., Studts, J., McGrath, P., et al. (1998). Hot flashes in postmenopausal women treated for breast carcinoma. Prevalence, severity, correlates, management, and relation to quality of life. Cancer, 82, 1682-1691.
Cassileth, B.R. (1999). Complemenatary and alternative cancer medicine. Journal of Clinical Oncology, 17(11, Suppl.), 44-52.
Cimprich, B. (1999). Pretreatment symptom distress in women newly diagnosed with breast cancer. Cancer Nursing, 22, 185-194.
Classen, C., Koopman, C., Angell, K., & Spiegel, D. (1996). Coping styles associated with psychology adjustment to advanced breast cancer. Health Psychology, 15, 434-437.
Couzi, R.J., Helzlsouer, K.J., & Fetting, J.H. (1995). Prevalence of menopausal symptoms among women with a history of breast cancer and attitudes toward estrogen replacement therapy. Journal of Clinical Oncology, 13, 2737-2744.
Crocetti, E., Crotti, N., Feltrin, A., Ponton, P., Geddes, M., & Buiatti, E. (1998). The use of complementary therapies by breast cancer patients attending conventional treatment. European Journal of Cancer, 3, 324-328.
De Brabander, B., Gertis, P., & Hellermans, J. (1997). Self-reported locus of control is based on feelings of depression as well as on asymmetry in activation of cerebral hemispheres. Psychological Reports, 80(3, Pt. 2), 1227-1232.
Downer, S.M., Cody, M.M., McCluskey, P., Wilson, P.D., Arnott, S.J., Lister, T.A., et al. (1994). Pursuit and practice of complementary therapies by cancer patients receiving conventional treatment. BMJ, 309, 86-89.
Dundee, J.W., Ghaly, R.G., Fitzpatrick, K.T., Abram, W.P., & Lynch, G.A. (1989). Acupuncture prophylaxis of cancer chemotherapy-induced sickness. Journal of the Royal Society of Medicine, 82, 268-271.
Dundee, J.W., & Yang, J. (1990). Prolongation of the antiemetic action of P6 acupuncture by acupressure in patients having cancer chemotherapy. Journal of the Royal Society of Medicine, 83, 360-362.
Eisenberg, D.M., Davis, R.B., Ettener, S.L., Appel, S., Wilkey, S., Van Rompay, M., et al. (1998). Trends in alternative medicine use in the United States, 1990-1997: Results of a follow-up national survey. JAMA, 280, 1569-1575.
Ernst, E., Willoughby, M., & Weihmayer, T.H. (1995). Nine possible reasons for choosing complementary medicine. Perfusion, 11, 356-358.
Erwin, D.O., Spatz, T.S., Stotts, R.C., Hollenberg, J.A., & Deloney, L.A. (1996). Increasing mammography and breast self-examination in African American women using the Witness Project Model. Journal of Cancer Education, 11, 210-215.
Fawcett, J., Sidney, J.S., Hanson, M.J., & Riley-Lawless, K. (1994). Use of alternative health therapies by people with multiple sclerosis: An exploratory study. Holistic Nursing Practice, 8(2), 36-42.
Filshie, J., & Redman, D. (1985). Acupuncture and malignant pain problems. European Journal of Surgical Oncology, 11, 389-394.
Fisher, P., & Ward, A. (1994). Complementary medicine in Europe. BMJ, 309, 107-111.
Furnham, A., & Rawlinson, A. (1996). Beliefs about the efficacy of complementary medicine: A vignette study. Complementary Therapies in Medicine, 4, 85-89.
Gray, C.M., Tan, A.W., Pronk, N.P., & O'Connor, P.J. (2002). Complementary and alternative medicine use among health plan members. A cross-sectional survey. Effective Clinical Practice, 5, 17-22.
Halstead, M.T., & Hull, M. (2001). Struggling with paradoxes: The process of spiritual development in women with cancer. Oncology Nursing Forum, 28, 1534-1544.
Harpham, W.S. (2001). Alternative therapies for curing cancer: What do patients want? What do patients need? CA: A Cancer Journal for Clinicians, 51, 131-136.
Hauser, S.P. (1991). Unproven methods in oncology. European Journal of Cancer, 27, 1549-1551.
Holland, J.C. (1982). Why patients seek unproven cancer remedies: A psychological perspective. CA: A Cancer Journal for Clinicians, 32, 10-14.
Johnson, J.E., Fieler, V.K., Wlasowicz, G.S., Mitchell, M.L., & Jones, L.S. (1997). The effects of nursing care guided by self-regulation theory on coping with radiation therapy. Oncology Nursing Forum, 24, 1041-1050.
Kelner, M., & Wellman, B. (1997). Who seeks alternative health care? A profile of the users of five modes of treatment. Journal of Alternative and Complementary Medicine, 3, 127-140.
Knobf, M.T. (2001). The menopausal symptom experience in young mid-life women with breast cancer. Cancer Nursing, 24, 201-210.
Lavery, J.F., & Clarke, V.A. (1996). Causal attributions, coping strategies, and adjustment to breast cancer. Cancer Nursing, 19, 20-28.
Lehto, R., & Cimprich, B. (1999). Anxiety and directed attention in women awaiting breast cancer surgery. Oncology Nursing Forum, 26, 767-772.
Lengacher, C.A., Bennett, M.P., Kip, K.E., Berarducci, A., & Cox, C.E. (2003). Design and testing of the use of a complementary and alternative therapies survey in women with breast cancer. Oncology Nursing Forum, 30, 811-821.
Lerner, I.J., & Kennedy, B.J. (1992). The prevalence of questionable methods of cancer treatment in the United States. CA: A Cancer Journal for Clinicians, 42, 181-191.
MacLennan, A.H., Wilson, D.H., & Taylor, A.W. (1996). Prevalence and cost of alternative medicine in Australia. Lancet, 347, 569-573.
Meyer, T.J., & Mark, M.M. (1995). Effects of psychosocial interventions with adult cancer patients: A meta-analysis of randomized experiments. Health Psychology, 14, 101-108.
Miller, A., & Champion, V. (1997). Attitudes about breast cancer and mammography: Racial, income, and educational differences. Women and Health, 26(1), 41-63.
Molassiotis, A. (2000). A pilot study of the use of progressive muscle relaxation training in the management of post-chemotherapy nausea and vomiting. European Journal of Cancer Care, 9, 230-234.
Montbriand, M.J. (1995). Decision tree model describing alternate health care choices made by oncology patients. Cancer Nursing, 18, 104-117.
Montbriand, M.J. (1997). The 1996 Schering Lecture. An inquiry into the experiences of oncology patients who leave biomedicine to use alternative therapies. Canadian Oncology Nursing Journal, 7, 6-13.
Moschen, R., Kemmler, G., Schweigkofler, H., Holzner, B., Dunser, M., Richter, R., et al. (2001). Use of alternative/complementary therapy in breast cancer patients—A psychological perspective. Supportive Care in Cancer, 9, 267-274.
Pasacreta, J.V. (1997). Depressive phenomena, physical symptom distress, and functional status among women with breast cancer. Nursing Research, 46, 214-221.
Quella, S.K., Loprinzi, C.L., Barton, D.L., Knost, J.A., Sloan, J.A., LaVasseur, B.I., et al. (2000). Evaluation of soy phytoestrogens for the treatment of hot flashes in breast cancer survivors: A North Central Cancer Treatment Group Trial. Journal of Clinical Oncology, 18, 1068-1074.
Rees, R.W., Feigel, I., Vickers, A., Zollman, C., McGurk, R., & Smith, C. (2000). Prevalence of complementary therapy use by women with breast cancer. A population-based survey. European Journal of Cancer, 36, 1359-1364.
Richardson, M.A., Post-White, J., Grimm, E.A., Moye, L.A., Singletary, S.E., & Justice, B. (1997). Coping, life attitudes, and immune responses to imagery and group support after breast cancer treatment. Alternative Therapies in Health and Medicine, 3(5), 62-70.
Richardson, M.A., Sanders, T., Palmer, J.L., Greisinger, A., & Singletary, S.E. (2000). Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology. Journal of Clinical Oncology, 18, 2505-2514.
Richardson, M.A., & White, J.D. (2000). Complementary/alternative medicine and cancer research: A national initiative. Cancer Practice, 8(1), 45-48.
Ritz, L.J., Nissen, M.J., Swenson, K.K., Farrell, J.B., Sperduto, P.W., Sladek, M.L., et al. (2000). Effects of advanced nursing care on quality of life and cost outcomes of women diagnosed with breast cancer. Oncology Nursing Forum, 27, 923-932.
Segar, M.L., Katch, V.L., Roth, R.S., Garcia, A.W., Portner, T.I., Glickman, S.G., et al. (1998). The effect of aerobic exercise on self-esteem and depressive and anxiety symptoms among breast cancer survivors. Oncology Nursing Forum, 25, 107-113.
Sims, S. (1986). Slow stroke back massage for cancer patients. Nursing Times, 82, 47-50.
Smiley, M.R., McMillan, S.C., Johnson, S., & Ojeda, M. (2000). Comparison of Florida Hispanic and non-Hispanic Caucasian women in their health beliefs related to breast cancer and health locus of control. Oncology Nursing Forum, 27, 975-984.
Sparber, A., Bauer, L., Curt, G., Eisenberg, D., Levin, T., Parks, S., et al. (2000). Use of complementary medicine by adult patients participating in cancer clinical trials. Oncology Nursing Forum, 27, 623-630.
Spiegel, D., & Bloom, J.R. (1983). Group therapy and hypnosis reduce metastatic breast carcinoma pain. Psychosomatic Medicine, 45, 333-339.
Taylor, S.E., Lichtman, R.R., Wood, J.V., Bluming, A.Z., Dosik, G.M., & Leibowitz, R.L. (1985). Illness-related and treatment-related factors in psychological adjustment to breast cancer. Cancer, 55, 2506-2513.
Truant, T., & Bottorff, J. (1999). Decision making related to complementary therapies: A process of regaining control. Patient Education and Counseling, 38, 131-142.
Van Patten, C.L., Olivotto, I.A., Chambers, G.K., Gelmon, K.A., Hislop, T.G., Templeton, E., et al. (2002). Effects of soy phytoestrogens on hot flashes in postmenopausal women with breast cancer: A randomized, controlled clinical trial. Journal of Clinical Oncology, 20, 1449-1455.
Verhoef, M.J., Hagen, N., Pelletier, G., & Forsyth, P. (1999). Alternative therapy use in neurologic diseases. Use in brain tumor patients. Neurology, 52, 617-622.
Vincent, C., & Furnham, A. (1996). Why do patients turn to complementary medicine? An empirical study. British Journal of Clinical Psychology, 35(Pt. 1), 37-48.
Yates, P., Beadle, G., Clavarino, A., Najman, J., Thomson, D., Williams, G., et al. (1993). Patients with terminal cancer who use alternative therapies: Their beliefs and practices. Sociology of Health and Illness, 15, 199-216.
Zaloznik, A. (1994). Unproven (unorthodox) cancer treatments: A guide for healthcare professionals. Cancer Practice, 2, 19-24.