Understanding pharmacists' engagement with selected forms of complementary and alternative medicine: A cross-sectional survey of health and dietary supplements

It was a big scandal when the former president of South Korea was hospitalized to remove a needle from his lung which had been used for acupuncture [1]. Also in South Korea, a famous actress, after being diagnosed with advanced-stage gastric cancer, decided to be treated with acupuncture and moxibustion [2]. This use of complementary and alternative medicine (CAM) is not a Korean phenomenon but a global one. It was not long ago that Steve Jobs, the renowned cofounder of Apple, died of pancreatic neuroendocrine cancer after initially rejecting potentially life-saving surgery for years in favor of alternative treatments such as acupuncture, dietary supplements, and juices [3]. CAM has now become a popular choice as a treatment modality and is even selected by highly educated patients in many countries [4, 5]. The US National Center for Complementary and AlternativeMedicine defines CAM as “a group of diverse medical and healthcare systems, practices, and products that are not currently part of conventional medicine” [5]. CAM has been used by itself or with conventional medicine for a wide spectrum of diseases from mild forms such as musculoskeletal problems to incurable forms such as degenerative or malignant diseases. CAM is commonly used in neurologic diseases, including Parkinson’s disease (PD). PD is a representative neurodegenerative disorder in the aged with four cardinal motor symptoms: resting tremor, cogwheel rigidity, slowness of movement, and postural imbalance. Motor symptoms are usually controllable by dopaminergic agents, but many nonmotor symptoms of PD are less well controlled. PD cannot be cured or delayed by conventional medicine, including pharmaceuticals and surgery. Currently, CAM is filling a gap between the desire for a cure and the lack of and treatment options. There are no good systematic data on how many people use CAM instead of standard treatment with conventional medicines in PD patients in Korea. However, according to one survey on CAM use among PD patients in Korea [6], 76 % of these patients had experienced CAM, which is much higher than other reports in Western countries [7–9]. The reasons for CAM use were (1) mostly to improve PD symptoms, (2) to improve the general state of health, (3) to relieve pain or constipation, and so on [6]. These trends were similar to the results of Western studies [7, 8]. Herbal medicines, health supplement foods, and acupuncture were used most often, whereas physical therapies such as yoga, massage, and other types of rehabilitation were used less often than in Western countries [6]. Nearly 70 % of CAM users had taken herbal medicines as prescribed by Korean oriental medicine physicians [6]. In another report, CAM was concentrated mainly on dietary supplements and Korean oriental medicine [10]. In Korea, the meaning of conventional medicine [5] is somewhat different from that in Western countries. Korean oriental medicine is recognized as a form of medicine along with “Western” medicine by law in Korea. There is an oriental medical license and the public insurance system J.-Y. Kim Department of Neurology, Inje University Seoul Paik Hospital, Seoul, South Korea

No data exist on the percentage of licensed nurses in Sweden who practise a form of complementary and alternative medicine (CAM). To investigate the use, practice, perception and knowledge of CAM among a representative sample of licensed nurses in Sweden. A cross-sectional descriptive anonymous survey on CAM-related issues was distributed between April and June 2012 to 1200 licensed nurses who were member of the Swedish Association of Health Professionals (Vårdförbundet). A total of 335 nurses (28%) responded to the survey of which 83% reported to have used at least one CAM method for self-care. Massage (59.7%), dietary supplements (51.3%) and mind-body therapies (24.8%) were most frequently used. CAM practice was reported by 11 and 43% of the nurses wished to practise a CAM method in the future. Main barriers for practise of CAM were lack of knowledge, lack of scientific evidence and little knowledge on legislative issues concerning CAM. A high proportion (73%) of nurses never or seldom asked patients about CAM use although 59.1% opined that health-care personnel should inform clients about CAM when they ask for it. Having knowledge about CAM was found to be significantly (p<0.05) associated with a higher odds of respondents to ask their patients about CAM use (OR 3.3; CI 1.4-7.6). Similar findings on CAM use, knowledge and perception were observed in a confirmatory analysis among an additional convenience sample of 625 nurses in Sweden. Licensed nurses in Sweden seemed to have an overall positive attitude towards CAM. Although CAM practice was low, a substantial number wished to practise a CAM method in the future. Main barrier for CAM practise and communication was lack of knowledge and evidence, emphasizing the need for structural education, information and research on CAM in Sweden.

A s the incidence of diabetes increases to epidemic proportions, people with diabetes are turning more and more to alternative therapies to help manage this condition, despite the availability of numerous traditional therapies. In fact, Americans spent almost $34 billion out of pocket on complementary and alternative products, practitioner visits, and materials in 2007, according to data from the National Health Interview Survey.1 It is important for health care practitioners not only to be aware of what dietary supplements their patients are taking, but also to understand how these supplements work and their possible side effects. First, it is helpful to be familiar with some terminology. The acronym CAM stands for “complementary and alternative medicine.” According to the National Center for Complementary and Alternative Medicine, CAM consists of medical and health care systems, practices, and products that are not generally considered part of conventional medicine. Examples of CAM therapies include acupuncture, biofeedback, chelation therapy, yoga, hypnosis, reiki or energy healing, massage, dietary therapies, meditation, tai chi, and dietary supplements. Complementary medicine is used along with conventional medicine, whereas alternative medicine is used in place of conventional medicine. In the United States, 38% of adults (or 4 in 10) and 12% of children (or 1 in 9) use some form of complementary medicine. People with diabetes are ~ 1.6 times more likely to use CAM therapies than people without diabetes.2 Dietary supplements are one form of oral CAM therapy. The Dietary Supplement Health and Education Act (DSHEA) of 1994 defines a dietary supplement as a “product taken by mouth that contains a dietary ingredient intended to supplement the diet.” These dietary ingredients may consist of “vitamins, minerals, herbs, amino acids, and other botanicals and substances such as enzymes, organ tissues, glandulars, and metabolites.” Dietary supplements can take various forms, …

Role of Complementary and Alternative Medicine in Cardiovascular Diseases

Complementary and Integrative Therapies in Psychiatry

Complementary and Alternative Medicine and Psychiatry

Japanese doctors' attitudes to complementary medicine

Herbal dietary supplements are the most popular form of complementary and alternative medicine (CAM) therapy — they are used by over 38 million US adults. However, treatments involving dietary supplements could potentially interact with prescription medications and have a negative impact on patient outcomes. Despite safety concerns, previous studies indicate that most patients do not discuss CAM use with their physicians. In this preliminary study we set out to: (1) conduct a computer assisted chart review of notes from multiple sclerosis (MS) patients to identify the documentation level of CAM use; and (2) investigate whether any herbal supplement in the resulting list is known to have a negative interaction with prescription drugs commonly taken by MS patients. The outcomes of this study will be used to inform the design of a system to collect CAM information from both patients and physician notes and issue alerts for potential negative interactions. Five percent of the analyzed notes contained descriptions of CAM use, 63% of which were Biologically-Based Practices. The notes containing actual mentions of CAM represent a small percentage when compared with the number reported by studies that obtained their data directly from patients. These numbers indicate that the use of CAM is indeed underreported in patient notes. Among the 19 types of herbs which use was positively identified, four had moderate interactions and one had minor interactions with commonly prescribed MS medications. Our findings suggest the need to collect more accurate data on CAM use in order to provide adequate surveillance of drug-herb interactions

Background: Among women at high risk of breast cancer, there are limited data on the prevalence of use of lifestyle modifications and complementary and alternative medicine (CAM) for the purpose of breast cancer prevention. We examined use of lifestyle modifications and CAM in a diverse cohort of women at high breast cancer risk, including associations between the behaviors and perceived and model-based risk. Methods: We used cross-sectional data from 810 non-Hispanic white and Hispanic women with no personal history of breast cancer enrolled in the Metropolitan New York Registry (MNYR) of Breast Cancer Families, one of six international sites of the National Cancer Institute's Breast Cancer Family Registry. Self-reported current lifestyle modifications (dietary change, exercise), use of CAM (multivitamins, herbal supplements, other dietary supplements, and prayer), perceived breast cancer risk, and breast cancer risk factors were assessed via a computer assisted telephone interview. The International Breast Cancer Intervention Study (IBIS) model, a validated breast cancer risk model for high-risk women, was used to estimate 10-year breast cancer risk. Relative risk regression models were used to examine associations between use of lifestyle modifications and CAM and perceived and model-based risk. Results: The large majority of the sample (92.8%) reported current use of ≥1 lifestyle modification or CAM modality, and 16.4% reported using ≥1 specifically for breast cancer prevention. Among all women, 46.1 % used dietary change, 73.0% used exercise, 55.9% use multivitamins, 17.8% used herbal supplements, 51.5% used dietary supplements, and 44.7% used prayer. Non-Hispanic whites were more likely than Hispanics to use dietary change (p&amp;lt;0.001), exercise (p=0.002), other supplements (p=0.05), and prayer (p&amp;lt;0.001) specifically for breast cancer prevention. Hispanics were more likely than non-Hispanic whites to perceive their risk of breast cancer to be lower than the risk in the general population (p&amp;lt;0.0001). Model-based risk was significantly higher in non-Hispanic whites (7.1% ± 7.9% vs. 5.1% ± 6.5%; p&amp;lt;0.0001). In multivariable analyses, below average perceived risk of breast cancer was associated with prayer (RR: 1.43; 95% CI: 1.05, 1.96) and with the use of a higher number of lifestyle modifications and/or CAM modalities (RR: 1.23; 95% CI: 1.05-1.45) among non-Hispanic whites. Among Hispanics only, higher model-based risk was associated with current exercise (RR: 1.46; 95% CI: 1.02, 2.09). There was no association between perceived risk and current exercise, dietary change, and the use of multivitamins, herbal supplements or other supplements. Model-based risk did not appear to be a significant predictor of dietary change or use of herbal supplements, other supplements, or prayer. Conclusions: Use of lifestyle modifications and CAM modalities is common among women at high risk for breast cancer, but patterns of use differed by ethnicity. Compared to non-Hispanic whites, Hispanic women were less likely to engage in breast cancer prevention behaviors, including dietary change and exercise, and were less likely to accurately perceive their breast cancer risk. Neither perceived risk nor model-based risk appear to be strong predictors of these behaviors. Future research should investigate motivations for the use of these modalities and awareness of evidence-based recommendations among women at high risk of breast cancer. Citation Format: Cristina Valdovinos, Mary Beth Terry, Yuyan Liao, Ann Johnston, Heather Greenlee. Lifestyle modifications and use of complementary and alternative medicine in relation to perceived and model-based breast cancer risk among women at high risk of developing breast cancer. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr A07.

Introduction: The use of complementary and alternative medicine (CAM) in cancer patients has been documented in major cities across USA, Canada, Europe, Nigeria, and Saudi Arabia. These studies suggest that cancer patients on chemotherapy simultaneously use CAMs. In Ireland, there have been two studies in pediatric cancer centers that have documented the use of CAM. To our knowledge, no study has examined the use of CAM in the adult population in Ireland. Method: A cross-sectional survey was conducted at a single adult cancer center over a three-week period. The survey was offered to all oncology and hematology patients attending the medical day unit. Results: The survey was completed by 81 patients, 51 of them were females (63%). The majority (93.8%) of the patients in our sample were in the age range of 41-80. 47 (58%) of the patients reported using CAM concurrently with conventional chemotherapy. The average cost of CAM was under €20 per month, but five patients (6.2%) spent over €100 per month. The major reasons for taking CAM were to enhance quality of life (23.5%), improve psychological/emotional wellbeing (17.3%), improve immunity (16%), relieve side effects of cancer (9.9%), relieve side effects of treatment (8.6%), and to directly treat/cure cancer (2.5%). Patients using CAM reported their source of information as healthcare professionals (30.9%), family/friends (19.8%), media (13.6%), and CAM practitioners (2.5%). Out of 81 patients, only 27 (33.3%) discussed the use of CAM with a healthcare professional involved in their care, of which 18.2% asked regarding interactions with the conventional therapy, 18.2% asked regarding CAM effectiveness and the type to use, 16.7% asked advice whether to pursue it, and 15.2% asked regarding safety of CAM. From the 26 patients using CAM who did not discuss with HCP the reasons cited were that they were never asked by the HCP (25.9%), did not think it was important to discuss with the HCP (13.0%), and 61.1% did not specify their reason. Of the 81 patients, 18 consumed herbal products (13.6% green tea, 8.6% flax seed, 3.7% evening primrose, 2.5% soy supplements), 34 used dietary supplements (28.4% vitamins, 12.3% minerals, 3.7% fish oils), and 21 used other CAMs (8.6% massage, 7.4% meditation/mind-body technique, 7.4% acupuncture, 6.2% reflexology, 2.5% reiki). Conclusion: The use of CAM in adult cancer patients has not been well documented in Ireland. As demonstrated from the pilot study, adult cancer patients in Ireland do seek out CAMs when simultaneously receiving chemotherapy, highlighting the importance for physicians to explicitly ask all patients regarding their intentions of CAM in order to provide safe and evidence-based options. This cancer center appeared to not have patients pursuing ayurvedic or Chinese medicine. However, similar conclusions cannot be made for other urban centers with more diverse population mixes with differing cultural experiences and attitudes to CAM. Citation Format: Karmali S, Markey G, Killian M, Ahmed G, Bird BR, Murphy CG. Use of complementary and alternative medicine in cancer patients receiving chemotherapy in Ireland [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-14-05.

BackgroundBreast cancer patients are increasingly seeking Complementary and Alternative Medicine (CAM) therapies with the hope of alleviating the burden of the disease and improving their quality of life (QOL). The objective of this study was to assess the prevalence, types, socio-demographic and disease-related correlates as well as characteristics of CAM use (including disclosure to treating physicians) among breast cancer patients in Beirut, Lebanon. A secondary objective was to evaluate the association between CAM use and QOL.MethodsA cross-sectional survey was conducted on breast cancer patients recruited from two major referral centers in Beirut: a philanthropic hospital and a private academic medical center. In face-to-face interviews, participants completed a questionnaire of three sections: socio-demographic and lifestyle characteristics, breast cancer condition, and CAM use. Three to four weeks following these interviews, the secondary QOL assessment was carried out via telephone using the Arabic version of the Functional Assessment of Cancer Therapy-Breast questionnaire. The main outcome in this study, CAM use, was defined as using CAM at least once after breast cancer diagnosis.ResultsA total of 180 breast cancer patients completed the survey (response rate: 94.6 %). Prevalence of CAM use was 40 %. Using multivariate logistic regression, CAM use was negatively associated with age (OR: 0.96, CI: 0.92-0.99), treatment at the philanthropic hospital (OR: 0.13, CI: 0.05-0.35) and was positively associated with an advanced stage of the disease (OR: 4.20, CI: 1.65-10.69). Among study participants recruited from both sites, the most commonly used CAM was ‘special food’ followed by ‘herbal teas’, ‘diet supplements’ and ‘Spiritual healing’. Only 4 % of CAM users cited health professionals as influencing their choice of CAM and only one in four patients disclosed CAM use to their treating physician. There was no significant association between CAM use and QOL.ConclusionsThe findings of this study revealed a prevalent CAM use among Lebanese breast cancer patients. Furthermore, physicians’ role in orienting CAM use was found to be marginal as patients relied mainly on family and media for their choice of CAM and were less likely to disclose CAM use to their treating physicians.Electronic supplementary materialThe online version of this article (doi:10.1186/s12906-015-0969-9) contains supplementary material, which is available to authorized users.

Complementary and alternative medicine are treatments administered alone or in combination with conventional medical treatments. Data on complementary and alternative medicine use in children with kidney and urinary tract diseases are limited. In this cross-sectional study, the frequency and preferred methods of complementary and alternative medicine use and factors associated with their use were evaluated in 201 patients (48% female; median age, 11years; median disease duration, 5.1years) with kidney and urinary tract diseases and 260 healthy (without chronic disease) controls. Data were collected through a questionnaire-based interview and patients' medical records. Herbal and dietary supplements, including fish oil, were the most commonly used complementary and alternative medicine agents in both groups. There was no difference in herbal and dietary supplement use between the groups when fish oil was excluded (29% vs. 28%; p = 0.88). Herbal and dietary supplements were mainly used to improve/mitigate renal disease (52%). Logistic regression analysis revealed that disease duration > 7years (odds ratio (OR), 3.70; 95% confidence interval (CI), 1.48-9.20), current use of six or more drugs (OR, 5.6; 95% CI, 1.28-24.41), and recurrent urinary tract infection or nephrolithiasis (OR, 3.92; 95% CI, 1.02-15.09) were the independent risk factors for herbal and dietary supplement use, except fish oil. Middle socioeconomic status was associated with decreased herbal and dietary supplement use, except fish oil, compared with low socioeconomic status (OR, 0.30; 95% CI, 0.11-0.81). Herbal and dietary supplements were used by 78% patients, despite knowing that these products could have side effects; only 42% of the patients shared the information about herbal and dietary supplement use with their doctors.Conclusion: Herbal and dietary supplement use is frequent in children with kidney and urinary tract diseases. Educating health professionals regarding such use is mandatory for developing strategies to prevent critical consequences. What is Known: • Complementary and alternative medicine (CAM) practices are therapeutic approaches that do not have sufficient efficacy and safety evidence. • CAM is widely used in healthy children and in certain chronic diseases. What is New: • Herbal and dietary supplements (HDSs) were the most commonly used method in kidney and urinary tract diseases. • Duration of disease, number of drugs, and socioeconomic status are determinants of HDS use except fish oil.

Complementary and alternative medicine (CAM) refers to nonconventional methods used to treat diseases and has been gaining global acceptance, including in Palestine. The growing interest in CAM and its various modalities highlights the need to understand its prevalence, types, and associated patient satisfaction among osteoarthritis (OA) patients. A cross-sectional study was conducted among OA patients attending hospitals in the study setting. Eligible participants were interviewed face-to-face via a structured questionnaire adapted from a previous regional study and developed on the basis of a comprehensive literature review. The data collected included sociodemographic characteristics, CAM use, and satisfaction levels. Of the 399 participants, 252 (63.2%) reported using CAM for OA management. Commonly used therapies include herbal medicine (49.9%), dietary supplements (26.6%), and various forms of prophetic medicine. Most CAM users reported a noticeable level of satisfaction with the therapies they used. CAM use is prevalent among OA patients in northern Palestine. This highlights the need to increase public awareness of CAM practices and their potential interactions with conventional treatments. Healthcare providers should stay informed about CAM options to guide patients appropriately. Further research is needed to establish stronger evidence regarding the efficacy and safety of CAM.

An international survey of the use and attitudes regarding alternative medicine by patients with inflammatory bowel disease

There is a perception of increasing and widespread use of alternative medicine for inflammatory bowel disease (IBD). We assessed the usage of alternative therapies among patients with IBD, whether there were similar or contrasting variables that were predictive of such use, and contrasted the use in four different centers in North America and Europe. Patients in four IBD centers completed a self-administered questionnaire regarding alternative medicine. The centers were in Cork, Los Angeles, Stockholm, and Winnipeg. Patient demographics, the use of 18 types of alternative medicine, and attitudes towards alternative and conventional medicine were compared. A multiple logistic regression analysis was used. Fifty-one percent of 289 patients used some form of alternative medicine. The percentages of use by site were Cork = 31%, Los Angeles = 68%, Stockholm = 32%, and Winnipeg = 57%. The six most commonly used therapies in descending order were: exercise (28%), prayer (18%), counseling (13%), massage (11%), chiropractic (11%), and relaxation (10%). Only 7% used acupuncture or homeopathy and 5% used herbal medicine. The highest odds ratios (confidence intervals [CIs]) for using any form of alternative medicine were associated with: being single 3.1 (1.7-5.7), Los Angeles patient 4.4 (2.3-8.3), Winnipeg patient 2.7 (1.3-5.9), and an increase of alternative medicine use of 2.7% for every M.D. visit (CI, 2-11%/visit). The patient age, gender, disease diagnosis, or duration of disease were not predictive of any type of alternative medicine use. Regarding attitudes, respondents from Cork were most favorable toward alternative medicine use and least favorable toward conventional medicine. Based on attitudes, subjects were more likely to use alternative medicine if they were not satisfied with conventional therapy, viewed hospitals as dangerous places, thought that alternative medicine practitioners should have a role in hospitals, and felt their medical situation was hopeless. Fifty-one percent of respondents used some form of alternative medicine. The use was greater among the North American patients than the European ones. Respondents were more likely to use alternative medicine if they were single, in a higher income bracket, and an urban dweller.