Complementary and alternative medicine use by cancer patients commencing curative-intent chemotherapy: survey and educational intervention

Abstract

Aims The aims of this thesis were to establish to what extent adult cancer patients receiving curative-intent chemotherapy potentially compromise their treatment and/or safety by using complementary and alternative medicine (CAM), and to identify which cancer patients use CAM at this time, why they use it, and who are most at risk. Additionally, it aimed to establish whether there was a need for an educational intervention to guide cancer patients on the safe use of CAM with chemotherapy, develop and publish the educational intervention and to evaluate the effectiveness of the intervention through surveying cancer patients and cancer care professionals, particularly doctors. Methods The thesis employed mixed methods, over several phases: a literature review, an observational study of 75 solid tumour patients receiving curative-intent chemotherapy for the first time and then, using results obtained as a framework, an educational brochure intervention was developed. Qualitative methods were used to evaluate the potential acceptance and content of the educational brochure and also to determine the effectiveness of the brochure post publication and intervention. Results Patients receiving chemotherapy may be consuming CAM to treat cancer, to lessen chemotherapy side effects, for symptom management, or to treat conditions unrelated to their cancer. Others may influence cancer patients in their CAM decision-making: practitioners, family, friends, spouse and even casual acquaintances met in waiting rooms and support groups. Cancer patients do not necessarily volunteer their CAM consumption unless asked and prefer their cancer doctor to initiate discussions regarding CAM use. Cancer doctors are reluctant to initiate CAM discussions with their patients. CAM that is systemically absorbed and biologically active is the most likely to interfere with concurrent chemotherapy and potentially cause harm to cancer patients. The curative-intent patient population are most at risk through taking biologically-active CAM adjuvant with chemotherapy, by altering chemotherapy dose intensity, which may adversely affect disease-free and overall survival. Mind-body CAM, which has no biological activity, has shown efficacy above standard care when used for support by patients receiving chemotherapy and, when applied using reasonable patient specific precautions, is safe to use with adjuvant chemotherapy treatment. The curative-intent cancer patient study found 60% of the 75 participants were using CAM at the start of chemotherapy treatment. Biologically-active CAM assessed as having potential to interact with prescribed chemotherapy through diminishing dose intensity was ingested by 27% of patients, all of whom had routinely used CAM prior to cancer diagnosis. This was found to be statistically significant (b= +3.13, P = 0.003). CAM was used by 51% of patients for supportive care reasons and by 28% of patients with the intention of treating their cancer. Thirteen percent of patients were told by a CAM advice-giver not to have chemotherapy. The majority of patients (84%) would have liked to receive information on which CAM is safe to use with chemotherapy in a written handout form, before treatment commencement. Cancer patients receiving chemotherapy reported that the developed and published educational brochure was easy to understand and most (90%, n=30) thought the brochure had enough information to answer their CAM questions. All cancer doctors (100%, n=17) perceived a need for the educational intervention, and recommended the brochure to their patients. All cancer doctors thought the brochure made it easier for them to discuss CAM with their patients. Discussion The majority of patients receiving chemotherapy will consider taking CAM at some time during their treatment. If biologically active, this CAM may alter their chemotherapy effectiveness. Cancer patients may be receiving CAM advice to use biologically-active CAM at the time of receiving chemotherapy from uninformed sources and in some circumstances are advised not to proceed with chemotherapy treatment. There can be a communication gap on CAM use between cancer patients and their cancer doctors, as cancer patients are often reluctant to declare their CAM use or intention and prefer their cancer doctor to ask. Evidence-based guidance on the safe use of CAM with chemotherapy is desired by cancer patients and should be communicated to cancer patients by cancer health professionals to enable patients to make informed decisions on CAM use at that time. The evidence-based CAM-with-chemotherapy patient brochure, developed through this thesis and now in use at adult day cancer care centres in Queensland, may be a useful adjunct for use by cancer doctors and associated cancer health professionals to educate patients on the potential dangers of biologically-active CAM use with chemotherapy and to provide patients with safe CAM alternatives.