Complementary and Alternative Medicine Use and Initiatives in Europe

Complementary and Alternative Medicine (CAM) covers a heterogeneous spectrum of ancient to new-age approaches that purport to prevent or treat disease. By definition, CAM practices are not part of conventional western-style medicine because there is a perception of insufficient proof that they are safe and effective or because they are not taught in conventional medical and nursing schools. Complementary interventions are typically used together with conventional western-style treatments, whereas alternative interventions are used instead of conventional approaches. When combined with conventional practices they are often labeled Integrative Medicine (IM). Many people in the United States (US) use CAM and IM modalities1–7 and its use is increasing.2 In 1990, a national survey estimated that 33.8% of US adults used CAM modalities in the previous year,7 which increased to 42.1% in 19973 and 62% in the 2002 National Health Interview Survey (NHIS).1 These surveys included spiritual healing and "folk" medicine (remedies common, ethnically derived remedies used at home), in the CAM modality definition. Recently published results of the 2007 NHIS used a different CAM modality taxonomy and excluded these practices.2,8,9 When prayer specifically for health reasons was excluded, the 2002 and 2007 NHIS found 36% and 38.3%, respectively, of US adults reported using some form of CAM modality in the last 12 months.1,2 These national surveys only include civilian, noninstitutionalized individuals; they do not include our 1.8 million active duty military personnel and families. In the last 10 years, there has been an increase in interest and use of CAM modalities and IM in the military.9 This important segment of the US population receives health care from both military and civilian practitioners; and is subject to similar health risks as civilians plus additional physical, emotional, and cognitive stress of deployment with associated family separations for both the active duty member and families, and the consequences of combat.10,11 It would not be unexpected for military personnel to seek to improve their health through complementary practitioners, potentially at a greater extent due to health and performance expectations,10 and for the same reasons reported by civilians.1,2,11,12 This interest in CAM has been accelerated by the surge of chronic pain, chronic stress, and chronic symptoms associated with trauma and injuries from over a decade of wars in Iraq and Afghanistan.13 However, until recently there were little data to determine which CAM modalities are being used, how often, by whom, and for what purposes. Recently, these informational gaps are being filled in and the current picture is summarized below. USE OF CAM IN THE MILITARY The use of CAM in the military is higher than in the civilian population. Samueli Institute and Research Triangle International conducted the largest and most comprehensive survey of CAM use in over 16,000 active duty service members in all branches stationed both in the United States and overseas.14 Data were drawn from the 2005 Department of Defense (DoD) Survey of Health Related Behaviors among Active Duty Military Personnel, which draws on a worldwide, random sample of over 40,000 service members from all branches, sexes, races, and ranks.15 It asked about overall CAM use and 19 specific CAM therapies using a methodology that closely matched the NHIS used by the National Center for Complementary and Alternative Medicine.16 This military survey showed that approximately 45% of active duty military personnel reported using at least 1 CAM type in the previous 12 months. CAM use when not counting self-prayer was approximately 36%. The 8 most frequently reported CAM approaches included 4 mind body therapies (prayer for your own health: 24.4%; relaxation techniques: 10.8%; art/music therapy: 7.7%; exercise/movement therapy: 6.8%), 2 biologically based therapies (herbal medicine: 8.9%; high-dose megavitamins: 8.4%), and 2 manipulative and body-based methods (massage therapy: 14.1%; chiropractic: 5.2%). Eleven CAM types were used by <5.0% of respondents and 6 types were used by <1% of personnel. When both surveys were adjusted for the 2000 census bureau demographics, CAM use by military personnel was significantly higher than that of the general population (44.5% vs. 36.0% and 38.3% in the 2 NHIS surveys, respectively, P<0.001). Significantly more military personnel reported use of energy healing, guided imagery therapy, massage therapy, hypnosis, and relaxation techniques than civilians in both NHIS surveys (P<0.001) with more reported use of "folk" remedies, high-dose megavitamins, and spiritual healing by others than the 2002 NHIS survey (P<0.001) and more frequent use of biofeedback than the 2002 NHIS and 2007 NHIS surveys (P<0.001 and P<0.01, respectively). There were no statistical differences in reported use of acupuncture and homeopathy. Overall, the prevalence of CAM use in this study was consistent with smaller military surveys where 49.6% CAM use was reported by military veterans in the Southwestern United States,17 and with 37.2% use of 12 CAM modalities (excluding prayer) in US Navy and Marine Corps personnel.18 The vast majority of CAM health care occurs outside the military health system, some of it provided by TRICARE, the military's health insurance program. However, as in the civilian population, most CAM is paid for out of pocket by military personnel as TRICARE covers very few CAM modalities. Massage therapy, used by 14% or an estimated 137,000 personnel, is not a covered benefit, whereas biofeedback (for certain conditions) is covered. Chiropractic is the only CAM modality that is currently included in a systematic manner in the military health system; however, access to chiropractic practitioners is limited. In 2005, 54% of active duty personnel resided in areas served by chiropractic clinics, and the remaining 46% were not served by clinics because of living overseas (14%), in remote areas (5%), or in US installations without chiropractic clinics (28%).19 Herbal medicines and high-dose vitamins also are not covered by military health care. However, many military installations include a General Nutrition Center store on the premises where these products readily are available. Three CAM modalities (yoga, massage, and imagery), which are commonly used for stress management were used by military populations at an estimated 2.5–7 times the rate of civilians. The fact that military members and their families are seeking and personally paying for these therapies outside both direct military care system and the TRICARE System may reflect access problems in Military Treatment Facilities (MTF), a preference for CAM/IM over traditional modalities (ie, not turning away from traditional medicine but rather turning toward and preferring CAM/IM), growing concern about the results of traditional pharmacologically based treatments, and an increasing interest in and need for appropriate access to CAM modalities within the military health system to decrease symptoms and improve function for military members suffering from the "wounds of war." Unmonitored and uninformed use of CAM modalities in the military may have negative consequences on health and military performance. A number of large randomized, placebo controlled trials of herbal treatments20–22 and acupuncture7,23,24 have been negative, making the substitution of these CAM modalities for proven therapies risky. In addition, some CAM therapies, particularly herbal supplements, have been associated with potential harm through toxicity and herb/pharmaceutical interactions.25,26 Herbal medicines and nutrients in doses well above the Dietary Reference Intakes27 are 2 of the CAM modalities most commonly used by military personnel. With 45% of the over 1million active duty personnel reportedly using CAM modalities, and a steady increase globally, it is important to understand why military personnel are using CAM, the role these therapies should play in their health care, and for military health care providers to recognize, monitor, and integrate CAM modalities into their health care practices. OFFERINGS OF CAM IN MTF Two recent surveys have assessed the use of CAM across DoD medical facilities and evaluated their reported effects and attitudes by health care leaders in military MTFs. The first is in a report entitled "Integrative medicine in the military health system report to congress" by the DoD Undersecretary of Personnel and Readiness (P&R).28 In this survey, 29% (120) of 421 MTFs reported offering a total of 275 CAM programs including 213,515 CAM patient visits in calendar year 2012 for active duty members. The most visits were for chiropractic care (73%) and acupuncture therapy (11%). The report states that, of those doing evaluation of CAM they have found: (1) patients reporting a reduction in anxiety levels and improved sleep with meditation; (2) breath-based practices reportedly helped patients to remain sober and reduced overall stress levels; (3) patients using massage therapy noted 75% improvement of symptoms, including pain; and, (4) overall positive outcomes were reported by 50%–90% of patients using massage therapy. The Report also states that patients practicing yoga had declines in psychological symptoms and improvement in overall health. Over 30 research projects have been funded by DoD and have reported improvements in symptoms and sleep, reduction in anxiety and psychological symptoms across a number of CAM practices being used. The Report concluded that: "There is wide-spread use of CAM therapies across the [Military Health System] MHS. Providers and patients were interested in using CAM therapies even though many are not evidence-based. Some providers have added CAM therapies as an adjunct to conventional therapies for a holistic approach to patient management." The second survey, completed by Samueli Institute did a more in-depth survey of CAM availability across a more limited sample of both MTFs and morale, welfare, and recreation (MWRs) centers. The study examined the CAM services offered during the year 2013 in 47 DoD MTFs, and MWRs locations across all military service branches.29 Information was collected on the prevalence of CAM modalities provided; the attitudes and beliefs towards CAM among the leadership in the different facilities; the obstacles and barriers to access in military facilities; the funding sources for CAM offered at military facilities; and, whether CAM is part of the strategic plan for the future of health care delivery. In addition, information was collected on the provision of CAM treatments for highly prevalent conditions in military personnel (pain, combat-related stress, and rehabilitation), how beneficial medical leaders thought CAM was, and how practitioners were accredited to practice CAM modalities. The results of this survey showed that 30 (70%) of the 47 facilities surveyed provided some type of CAM service with most being provided for active duty service members (70%), followed by family members (43%) and retirees (36%). Less than 9% of the participants reported providing CAM services to federal employees, contractors, or members in the community. Overall, acupuncture and chiropractic were among the top 3 most prevalent practices followed by yoga and massage. For pain management the primary CAM modalities were acupuncture (36.2%), chiropractic or osteopathic medicine (27.7%), and breathing exercises (25.5%). For stress and stress-related conditions, the top modalities were acupuncture (25.5%), breathing exercises (21.3%), and biofeedback (17%). For wellness and fitness, offerings included weight management, diet-based therapies, and movement practices. In this Samueli Institute survey, 57% of medical leaders felt that CAM practices were either beneficial (40%) or highly beneficial (17%) with 40% being neutral on the benefit and 3.3% feeling CAM practices were not beneficial. Despite this generally favorable response, over 75% had no provision or guidelines for CAM use in their strategic plans. Still, 46% funded CAM services out of their general budget, with 12% receiving money from the Office of the Army Surgeon General, 8% receiving congressional money, and 4% private money for CAM. Only 10% reported any research or evaluation of CAM going on in their facility. This survey also examined the challenges to improving access to these practices. Although the majority of leadership responses (57%) rated CAM modalities as highly favorable or favorable, the identified obstacles and barriers for access to CAM in military facilities included (in order of frequency): (1) inadequate space to provide services; (2) patients do not know to ask for CAM; (3) CAM costs too much; (4) CAM is too time consuming; and (5) CAM does not contribute to workload coverage. The prevalence of CAM practices provided by MTFs and MWR across DoD shows 75% availability within MTFs, and 33% within MWR facilities and programs. There were no appreciable differences in availability of CAM across military branches. MINDING THE GAP: ALIGNING PATIENTS, PRACTICE, AND POLICY In the report to Congress by DoD P&R, it was recommended to evaluate CAM programs for safety and effectiveness, as well as cost-effectiveness and consider widespread implementation in the military health system if cost-effective. The criteria for how to do this are specified. Part 199 of Title 32, CFR, governs TRICARE benefits and restricts services to those medically necessary drugs, devices, treatments, or procedures for which safety and efficacy have been proven to be comparable or superior to established therapies. Established criteria state that unproven drugs, devices, treatments, or procedures may not be covered: (1) unless reliable evidence shows that any medical treatment or procedure has undergone well-controlled clinical studies that show maximum tolerated dose, toxicity, safety, or efficacy compared with standard treatment or diagnosis; (2) if the available reliable evidence is considered inadequate by experts who recommend further studies or clinical trials are needed. The criteria for making a determination of proven safe and effective to nationally accepted medical standards are evidence that comes from: (1) well-controlled studies of clinically meaningful endpoints published in referred medical literature; (2) published formal technology assessments; (3) published reports of national professional medical associations; and (4) published reports of national expert opinion organizations. However, these guidelines and criteria and not being applied appropriately to CAM modalities. Biofeedback is the only CAM practice currently covered under TRICARE guidelines, and TRICARE only covers biofeedback therapy for nerve injury, not stress management. The 2 most widely used CAM modalities (chiropractic and acupuncture) are excluded in Title 32 CFR section 199.4 (g) even though neither has been evaluated using TRICARE guidelines. In other words, none of the CAM modalities (with the possible exception of biofeedback) have been evaluated by the DoD or TRICARE using their own guidelines for determining which practices should be covered. Despite this, TRICARE declines to pay for acupuncture but will pay for biofeedback. Chiropractic (which also has not been evaluated by TRICARE guidelines) is provided to DoD beneficiates through MTFs but not through TRICARE. Chiropractic is currently being implemented across DoD even though research on the effectiveness of chiropractic in the DoD is only recently underway because of a Congressional mandate and special appropriation.30 Acupuncture is both widely accepted and used in the DoD and currently the Defense and Veteran's Pain Task Force is training medical practitioners in "Battlefield Acupuncture" (BA). BA is a specific auricular acupuncture protocol developed by Col (Ret) Richard Niemtzow, an Air Force physician, seeking to add a simple nonpharmacological pain management technique that could be used by a broad array of first responders and primary care providers to help reduce pain, reduce medication load, and improve function.31 Acupuncture has been shown to be superior to conventional therapy for several chronic conditions prevalent in the military, and has also been shown not to be due only to placebo effects.32 Samueli Institute has performed a comprehensive systematic review of acupuncture for the Trauma Spectrum Response, an important collection of comorbidities often experienced by service members after deployment.33 Recently, a comprehensive review of self-care CAM modalities for pain has been published in a special issue of Pain Medicine in which reasonable evidence for use of yoga, tai chi, and music were found for the treatment of pain.34 These areas are ripe for evaluation by the military and TRICARE Systems for possible inclusion into the array of services provided. CONCLUSIONS Over a decade of war has left hundreds of thousands of our service members and their families suffering from a range of psychological and physical injuries, many leading to or exacerbating chronic pain. They and their health care providers have surged ahead in seeking out drug-free and self-care healing practices to help them recover and return to wholeness in peacetime. The availability of efficacious CAM modalities adds needed access to a cadre of promising services and practices that promote healing and improved function with less medication and fewer unwanted side effects. However, DoD policy and priorities have not kept up with this surge, leaving the majority of active duty service members, veterans, and their families to fend for themselves, to pay for or go without the beneficial effects of CAM and IM practices. As stated in the DoD P&R report to Congress, "At this time, there are insufficient internal evaluations and reported results to determine whether the CAM programs being provided in the MTFs meet these [TRICARE] criteria." It is time for the DoD to step up their efforts to complete these evaluations and ensure that "sufficient evaluation" occurs in a more timely manner. Our long-suffering heroes deserve nothing less!

Comparative analysis of complementary and alternative medicine (CAM) use in the US cancer and noncancer populations

BackgroundThe use of complementary and alternative medicine (CAM) is growing. However the factors contributing to changes over time and to birth cohort differences in CAM use are not well understood.SettingWe used data from 10186 participants, who were aged 20–69 years at the first cycle of data collection in the longitudinal component of the Canadian National Population Health Survey (1994/95-2010/11). We examined chiropractic and other practitioner-based CAM use with a focus on five birth cohorts: pre-World War II (born 1925–1934); World War II (born 1935–1944); older baby boomers (born 1945–1954); younger baby boomers (born 1955–1964); and Gen Xers (born 1965–1974). The survey collected data every two years on predisposing (e.g., sex, education), enabling (e.g., income), behavior-related factors (e.g., obesity), need (e.g., chronic conditions), and use of conventional care (primary care and specialists).ResultsThe findings suggest that, at corresponding ages, more recent cohorts reported greater CAM (OR = 25.9, 95% CI: 20.0; 33.6 for Gen Xers vs. pre-World War) and chiropractic use than their predecessors (OR = 2.2, 95% CI: 1.7; 2.8 for Gen Xers vs. pre-World War). There was also a secular trend of increasing CAM use, but not chiropractic use, over time (period effect) across all ages. Factors associated with cohort differences were different for CAM and chiropractic use. Cohort differences in CAM use were partially related to a period effect of increasing CAM use over time across all ages while cohort differences in chiropractic use were related to the higher prevalence of chronic conditions among recent cohorts. The use of conventional care was positively related to greater CAM use (OR = 1.8, 95% CI: 1.6; 2.0) and chiropractic use (OR = 1.2, 95% CI: 1.1; 1.4) but did not contribute to changes over time or to cohort differences in CAM and chiropractic use.ConclusionThe higher CAM use over time and in recent cohorts could reflect how recent generations are approaching their healthcare needs by expanding conventional care to include CAM therapies and practice for treatment and health promotion. The findings also underscore the importance of doctors discussing CAM use with their patients.

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.

ObjectiveThis cross-sectional study aimed to assess the prevalence of complementary and alternative medicine (CAM) use and its associated factors among diabetic patients in Fasa, a city in southern Iran. MethodsData were collected from diabetic patients who visited the endocrinology clinics at Fasa University of Medical Sciences. A structured questionnaire was administered to gather information on CAM use, including the types of CAM modalities used, and reasons for use. The patient's demographic and clinical characteristics, such as age, gender, duration of diabetes, glycosylated hemoglobin (HbA1c) levels, and quality of life (QoL) were also recorded. Descriptive statistics were used to determine the prevalence of CAM use, while logistic regression analysis was employed to identify factors associated with CAM use. ResultsA total of 376 diabetic patients participated in the study, with more than 89% reporting CAM use within the past year. Herbal preparations were the most commonly used type of CAM, with a prevalence rate of 99.4%. Factors associated with CAM use included patients’ psychological health, attitude towards the safety of CAM, belief in the synergistic effects of combining routine medications with CAM, and previous positive experiences with CAM. ConclusionThe high prevalence of CAM use highlights the importance of considering it in diabetes management and the need for healthcare professionals’ engagement in open discussions with patients about their CAM practices. Understanding the factors influencing CAM use can inform healthcare providers and policymakers in developing appropriate strategies for integrating CAM approaches into conventional diabetes care.

Editorial: The need for complementary and alternative medicine familiarisation in undergraduate nurse education

We propose 6 core areas of research that should be investigated to achieve a robust knowledge base and to allow stakeholders to make informed decisions. These are: Research into the prevalence of CAM in Europe: Reviews show that we do not know enough about the circumstances in which CAM is used by Europeans. To enable a common European strategic approach, a clear picture of current use is of the utmost importance. Research into differences regarding citizens’ attitudes and needs towards CAM: Citizens are the driver for CAM utilization. Their needs and views on CAM are a key priority, and their interests must be investigated and addressed in future CAM research. Research into safety of CAM: Safety is a key issue for European citizens. CAM is considered safe, but reliable data is scarce although urgently needed in order to assess the risk and cost-benefit ratio of CAM. Research into the comparative effectiveness of CAM: Everybody needs to know in what situation CAM is a reasonable choice. Therefore, we recommend a clear emphasis on concurrent evaluation of the overall effectiveness of CAM as an additional or alternative treatment strategy in real-world settings. Research into effects of context and meaning: The impact of effects of context and meaning on the outcome of CAM treatments must be investigated; it is likely that they are significant. Research into different models of CAM health care integration: There are different models of CAM being integrated into conventional medicine throughout Europe, each with their respective strengths and limitations. These models should be described and concurrently evaluated; innovative models of CAM provision in health care systems should be one focus for CAM research. We also propose a methodological framework for CAM research. We consider that a framework of mixed methodological approaches is likely to yield the most useful information. In this model, all available research strategies including comparative effectiveness research utilising quantitative and qualitative methods should be considered to enable us to secure the greatest density of knowledge possible. Stakeholders, such as citizens, patients and providers, should be involved in every stage of developing the specific and relevant research questions, study design and the assurance of real-world relevance for the research. Furthermore, structural and sufficient financial support for research into CAM is needed to strengthen CAM research capacity if we wish to understand why it remains so popular within the EU. In order to consider employing CAM as part of the solution to the health care, health creation and self-care challenges we face by 2020, it is vital to obtain a robust picture of CAM use and reliable information about its cost, safety and effectiveness in real-world settings. We need to consider the availability, accessibility and affordability of CAM. We need to engage in research excellence and utilise comparative effectiveness approaches and mixed methods to obtain this data. Our recommendations are both strategic and methodological. They are presented for the consideration of researchers and funders while being designed to answer the important and implicit questions posed by EU citizens currently using CAM in apparently increasing numbers. We propose that the EU actively supports an EU-wide strategic approach that facilitates the development of CAM research. This could be achieved in the first instance through funding a European CAM coordinating research office dedicated to foster systematic communication between EU governments, public, charitable and industry funders as well as researchers, citizens and other stakeholders. The aim of this office would be to coordinate research strategy developments and research funding opportunities, as well as to document and disseminate international research activities in this field. With the aim to develop sustainability as second step, a European Centre for CAM should be established that takes over the monitoring and further development of a coordinated research strategy for CAM, as well as it should have funds that can be awarded to foster high quality and robust independent research with a focus on citizens health needs and pan-European collaboration. We wish to establish a solid funding for CAM research to adequately inform health care and health creation decision-making throughout the EU. This centre would ensure that our vision of a common, strategic and scientifically rigorous approach to CAM research becomes our legacy and Europe’s reality. We are confident that our recommendations will serve these essential goals for EU citizens.

Use of complementary and alternative medicine among breast cancer patients in Hungary: A descriptive study

BackgroundThere is growing interest in the use of complementary and alternative medicine (CAM) throughout the world, however previous research done in Japan has focused primarily on CAM use in major cities. The purpose of this study was to develop and distribute a Japanese version of the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q) to assess the use of CAM among people who visit rural Japanese family medicine clinics.MethodsUsing a Japanese version of the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q), a cross-sectional survey was conducted in three rural family medicine clinics. All patients and those accompanying patients who met inclusion criteria were eligible to participate. Data were entered into SPSS Statistics and analyzed for use by age, gender, and location.ResultsOf the 519 respondents who participated in the project, 415 participants reported CAM use in the past 12 months (80.0%). When prayer is excluded, the prevalence of CAM use drops to 77.3% in the past year, or 403 respondents. The most common forms of CAM used by respondents were pain relief pads (n = 170, 32.8%), herbal medicines/supplements (n = 167, 32.2%), and massage by self or family (n = 166, 32.0%). Female respondents, individuals with higher levels of education, and those with poorer overall health status were more likely to use CAM than respondents without these characteristics. Only 22.8% of CAM therapies used were reported to physicians by survey participants.ConclusionsThese data indicate that CAM use in rural Japan is common. The results are consistent with previous studies that show that Japanese individuals are more interested in forms of CAM such as pain relief pads and massage, than in mind-body forms of CAM like relaxation and meditation. Due to the high utilization of certain CAM practices, and given that most CAM users do not disclose their CAM use to their doctors, we conclude that physicians in rural Japan would benefit by asking about CAM use during patient interviews, and by familiarizing themselves with the potential benefits and risks of commonly used CAM modalities.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6882-14-360) contains supplementary material, which is available to authorized users.

Although complementary and alternative medicine (CAM) is widely used in the pediatric population, research on the use of these therapies in the pediatric oncology population is of mixed quality. In this multicenter survey, we investigated the prevalence of CAM use, possible determinants of use, and parental attitude towards communication and research on CAM therapies. The prevalence of CAM use in the past 12 months was assessed by using a questionnaire based on the European guidelines on CAM research, filled out by parents of children visiting pediatric oncology outpatient clinics of six academic hospitals in the Netherlands. The questionnaire consisted of 26 questions on the child's clinical status, CAM use, and attitude towards communication and research on CAM therapies. One hundred and twenty-two of 288 respondents (42.4 %) reported CAM use. The most frequently used categories were homeopathy (18.8 %) and dietary supplements (11.5 %). Female gender and parental CAM use were significant predictors for the use of CAM (p < 0.001). Only one third of the parents had discussed CAM use with their pediatric oncologist. More than 80 % of the respondents identified a need for information about CAM from their pediatrician and 85.7 % was positive towards research on CAM. Half of the parents were interested in participating in future CAM trials. Conclusion, with more than 40 % of parents of Dutch pediatric oncology patients providing complementary and alternative medicine to their child and with lacking evidence on efficacy and safety of most CAM modalities, there is a clear need for high-quality research in this field. This study shows that most parents have an open attitude towards CAM research and that almost half of the parents would consider participating in future CAM trials, paving the way for research on CAM and aiming for its evidence-based use in pediatric oncology.

The prevalence of complementary and alternative medicine (CAM) use among women in the United States is high. Little is known about how CAM use may differ based on sexual orientation. Study aims were to measure the prevalence of CAM use in a community sample of women, explore differences in CAM use patterns by sexual orientation, and identify correlates of CAM use. Analyses were based on women (Total N = 879; n = 479 lesbians) enrolled in the Epidemiologic STudy of HEalth Risk in Women (ESTHER) Project, a cross-sectional heart-disease risk-factor study. Data were collected through convenience sampling of adult females in Pittsburgh, PA (2003-2006). Main outcome measures included lifetime and past 12-month CAM use, and types of CAM modalities used in the past 12 months. The prevalence of having ever used CAM was 49.8%, with 42% having reported CAM use within the past 12 months. Lesbians had greater odds of having ever used CAM (adjusted odds ratio [AOR] = 1.68 [95% confidence interval (CI): 1.23, 2.28]) and of having used CAM in the past 12 months (AOR = 1.44 [CI: 1.06, 1.97]) than heterosexuals. In multivariate analyses, correlates of lifetime and past 12-month CAM use included being lesbian, white, higher educated, and a large-city resident; experiencing perceived discrimination in a health care setting; and having a greater spirituality rating and a history of a diagnosed mental health disorder. Past 12-month CAM use was also associated with having a provider of usual health care. Among women who used CAM within the past 12 months, heterosexuals had significantly higher yoga participation rates than lesbians. Sexual orientation is important in understanding lifetime and past 12-month CAM use. Because of the high prevalence of CAM use found in this study, medical practitioners should inquire about the CAM practices of female patients, particularly lesbians.

Use of complementary and alternative medicine by children in Europe: Published data and expert perspectives

12019 Background: Cancer patients are more likely to use complementary and alternative medicine (CAM) than non-cancer patients for immune enhancement and symptom relief. Cancer patients with immigration background may seek out CAM use more readily due to the influence from their cultural background. Methods: We carried out a prospective questionnaire study surveying the use of 21 CAM types to cancer patients between 10/23/2015 and 10/31/2020, to evaluate the association of CAM use with patients’ age, sex, cancer types, stages, race/ethnicity, birthplace, immigration duration, first language, marital status, levels of poverty, education and anxiety. Results: 658 patients were included in this analysis. The median age was 62 years old. The prevalence of CAM use was 66.11%. CAM use was higher in females (71.98%) than the males (54.34%) (p = 1.13x10-5), and higher in patients ≥ 38 years old (67.09%) than &lt; 38 years old (46.88%) (p = 0.0215). Patients of African American descent (both US born and foreign born) (n = 198) had statistically higher CAM use (72.73%) than the Caucasians and Others (including Middle-Eastern, Multi-Racial and Others) (n = 266) (63.53%) (p = 0.0371). There was no difference of CAM use between the US born patients (n = 301, CAM use 68.77%) and the immigrants (n = 347, CAM use 63.98%) as a whole; however, Asian born immigrants (n = 106) had statistically less CAM use (53.77%) than the US born and other non-Latin American born (n = 397, CAM use 66.50%) (p = 0.0161), while the Latin-American born had a trend towards higher CAM use (74.83%, P = 0.0608). The number of years living in the US by the immigrants did not have an association with CAM use. Among psychosocial economic factors, married patients had a lower CAM use (61.23%) than the unmarried group (defined as divorced, separated, widowed, or single status, 70.85%) (p = 0.0102). The levels of education, poverty and anxiety did not show a statistical difference in relation to CAM use. Earlier stages of disease had numerically higher CAM use than stage 4 patients, and patients with breast and GYN cancers had higher CAM use (72.30%, p = 0.00252), consistent with the data on the higher CAM use in females. Prayer and spirituality and Dietary medicine were the 2 most common CAM types used (25.91% and 16.12%, respectively). African Americans of the combined US and Non-US origin showed the highest rate of using Prayer and spirituality (84.72%), versus Hispanics (71.19%), Caucasians (53.85%), and Asians (40.32%). Chiropractic therapy was exclusively used by Caucasian CAM users (9.38%). Conclusions: Among cancer patients of multi-ethnic groups with immigration background served in a community hospital in Brooklyn, New York, CAM use appeared to be higher in the African American patients, and lower in the patients born in Eastern Asia, as compared to the US born, or to Caucasians. Cultural roots appeared to be a strong influencing factor among all the medical and socioeconomic factors.

Objectives: We determined the prevalence and correlates of complementary and alternative medicine (CAM) use among patients with bipolar disorder. Methods: Patients with bipolar disorder recruited from a large urban mental health facility from 2004 to 2006 completed a baseline questionnaire on CAM use, demographics, treatment perspectives, and behaviors. Additional data on current medications and clinical features were ascertained via chart review. Multivariable logistic regression was used to determine the patient sociodemographic, clinical, and treatment factors associated with use of different CAM practices. Results: Of 435 patients, the mean age was 49 years; 77% were white, 13% were black, and 10% other race/ethnicity. Patients reported a wide range of CAM use, including prayer/spiritual healing (54%), meditation (53%), vitamins or herbs (50%), and weight loss supplements (22%). Multivariable analyses controlling for sociodemographic, clinical, and treatment factors revealed that patients of other racial/ethnic groups (other than whites or Blacks), those diagnosed with bipolar spectrum disorders (other than bipolar I disorder), and those prescribed anticonvulsants (eg, valproic acid, carbamazepine), or atypical antipsychotics were most likely to use CAM. Conclusions: A substantial number of patients diagnosed with bipolar disorder is using CAM. CAM use may be popular among patients with this illness because conventional pharmacotherapy for managing bipolar symptoms can also disrupt quality of life. Mental health providers should be aware of CAM use among patients with bipolar disorder and assess the potential impact of CAM use on treatment course. Psychopharmacology Bulletin. 2007;40(3):104-115.

ABSTRACTAimTo investigate complementary and alternative medicines (CAM) knowledge and use in patients on warfarin and matched controls, and the association between CAM use and adverse events (bleeding or clotting).MethodA retrospective cohort study was undertaken in the emergency department of a Melbourne hospital. Patients in the warfarin and control groups were those taking/not taking warfarin, respectively (groups matched for age and gender). An investigator‐administered questionnaire was used to collect data on CAM knowledge and use, and bleeding/clotting events during the previous 6 months. The international normalised ratio (INR) data during the previous 6 months were obtained from medical and pathology records.Results246 warfarin and 246 control group patients were enrolled. Approximately 50% in each group indicated that they knew of the potential for CAM–drug interactions. Only 60 (24%) patients in the warfarin group reported having been advised about CAM use. Compared to controls, a similar proportion of warfarin patients reported CAM use (29% vs 37%; p = 0.07) and significantly fewer used a CAM known to interact with warfarin (‘interacting CAM‘) (11% vs 19%; p = 0.03). In the warfarin group, CAM users and non‐users reported a similar number of events below and above their therapeutic INR range and when the INR exceeded 5. CAM users in the warfarin group tended to have more abnormal bleeding events (42% vs 30%; p = 0.06) but a similar number of clotting events (9% vs 10%; p = 0.8) than CAM non‐users. Warfarin patients who used ‘interacting CAM’ had significantly more clotting events than those who used CAM not known to interact with warfarin (18% vs 2%; p = 0.02).ConclusionCAM knowledge in people on warfarin was poor. ‘Interacting CAM' used concomitantly with warfarin may be associated with increased rates of clotting events.