Complementary and Alternative Therapy Use in Gynecologic Oncology: Implications for Clinical Practice

Abstract

Complementary and alternative medical (CAM) practices are those healthcare practices that are not currently an integral part of conventional medicine, but many of these approaches are being integrated into comprehensive cancer care. The National Center for Complementary and Alternative Medicine (NCCAM) has grouped CAM into five major domains: alternative medical systems such as traditional oriental medicine and homeopathy; mind‐ body interventions including meditation, prayer, and mental healing; biologically based treatments such as melatonin, herbs, shark cartilage, and high-dose vitamins; manipulative and body-based methods including chiropractic manipulation, massage, and other hands-on techniques; and energy therapies of which therapeutic touch, Reiki, and Qi gong are a few [1]. By some estimates, use of CAM in the general population rose from 34% in 1990 to 42% in 1995, and visits to CAM practitioners jumped from 427 million to 629 million visits [2, 3]. Cancer patients commonly use CAM to prevent, palliate, and treat their disease. Prevalence of use has been documented at 69% in outpatients in a comprehensive cancer center in the South [4], 50% in a multiethnic population of breast cancer patients in the San Francisco Bay area [5], and 63% among participants in intramural clinical trials at NIH [6]. Furthermore, 55% of colorectal cancer survivors reported using vitamins, minerals, or nutritional supplements while participating in a chemoprevention trial [7]. Many patients seek spiritual support and other CAM approaches after diagnosis to improve survival, quality of life, symptoms, and side effects related to conventional cancer treatment. Although CAM use has been associated with greater personal distress in breast cancer patients [8], it has been associated with more active coping in other cancer populations [9]. Overall, cancer patients who use CAM tend to be younger, more educated, in higher income brackets, women, and treated with chemotherapy. Although CAM is believed to be important for women with gynecologic cancer [10], little is known about the prevalence of and reasons for use of CAM in this population. In one published study of 161 gynecologic outpatients in a Midwest clinic, 66% used CAM [11]. Most women believed that CAM was beneficial and spent an average of $711 on these therapies. Prayer was the most widely used (40%) as were green tea (17%), nutritional supplements (17%), exercise (16%), and garlic (16%). Of the 69 women in active cancer treatment, use was slightly lower (58%) and expenditures higher ($1178). A