Use of complementary and alternative medicine and prayer among a national sample of cancer survivors compared to other populations without cancer

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Summary

Objectives

Extensive use of complementary and alternative medicine (CAM) among cancer survivors has been described in literature, but the rate has not previously been compared to other groups in a true population sample.

Methods

We performed a cross-sectional study using data from the 2002 National Health Interview Survey to determine the prevalence of CAM and prayer for health (PFH) use among cancer survivors and compared the rates of such use among cancer survivors with the US general and other chronic diseased populations while controlling for key socio-demographic factors.

Results

Among 31,044 adult survey respondents, 1904 had a prior cancer diagnosis, of whom 40% reported CAM and 62% reported PFH use during the year before the survey. The top three CAM modalities were herbs (20%), deep breathing (14%) and meditation (9%). Controlling for other factors, cancer survivors used more CAM than the general population (adjusted odds ratio [OR] 1.36, 95% confidence interval [CI] 1.20–1.53), but similar to those with chronic symptomatic illness (p = 0.5). Cancer survivors used PFH more than the general population (OR 1.87, 95% CI 1.66–2.10) and all other groups (p < 0.001). The greater CAM and PFH use by cancer survivors was seen in both recent and distant diagnoses (>10 years).

Conclusion

A previous cancer diagnosis is associated with a modest increase in CAM use compared with the general population but similar to other chronic symptomatic illnesses; however, cancer survivors are more likely to pray for health than all other populations Exploring CAM and prayer use in clinical settings may help clinicians better understand the needs of their patients.

Introduction

The use of complementary and alternative medicine (CAM) has undergone a substantial growth among the US general population during the early to mid 1990s,1, 2 with some leveling off since 1997.3, 4 At the same time, research suggests an extensive CAM use among cancer survivors, with estimates as high as 83%.5, 6, 7, 8, 9, 10, 11, 12, 13, 14 Managing symptom and psychological distress and hoping to prevent cancer recurrence have been cited as some of the reasons that motivate cancer survivors to use CAM.14, 15, 16, 17

Despite of the emerging literature describing CAM use among cancer survivors, several limitations exist. There remains some disagreement about what is CAM. While some studies included prayer as part of CAM definition, others did not. Most early studies are based primarily on specialized populations, often drawing from single referral cancer centers or are limited to a specific tumor (mostly breast), making their findings difficult to generalize to the broader US cancer survivor population. In addition, the lack of a coincident comparison with other chronic diseases and the general population prevents a clear understanding of the impact of a cancer diagnosis on CAM use.

Understanding CAM use among cancer survivors in the context of other populations may provide insight into the motivations behind such use and therefore, the degree to which traditional medical care has not met the needs of cancer survivors. This knowledge can help us improve the delivery of cancer and post-cancer care. We decided to examine prayer for health (PFH) separately from non-prayer based CAM (referred to as CAM for the rest of paper) to better characterize the pattern of these unconventional health practices among diverse populations. The objectives of this study were to: (1) determine the prevalence and predictors of CAM and PFH use among a nationally representative group of cancer survivors and (2) determine whether CAM and PFH use among cancer survivors differed from the general US population and other chronic disease groups.

Section snippets

Methods

The study population includes all of the adults who participated in the 2002 National Health Interview Survey (NHIS), an annual multistage survey conducted in a nationally representative sample of the civilian non-institutionalized population of the United States. The NHIS survey was conducted through confidential in-person interviews by the Centers for Disease Control and Prevention's National Center for Health Statistics.3 The data for this study was extracted from the Sample Adult Core

Study population characteristics

In 2002, 31,044 individuals aged ≥18 years were interviewed. The overall response rate was 74.3%.3 Of these individuals, forty-eight individuals (0.16%) did not answer the cancer diagnosis question and were excluded from further analysis. Individuals who had been diagnosed with non-melanoma skin cancer only were classified as non-cancer controls rather than cancer survivors (n = 358).18 Our final sample consisted of 1904 cancer survivors and 29,092 non-cancer controls for most analyses. In

Discussion

Previous research has shown extensive CAM use among cancer survivors, but little is known whether such use is greater than individuals without history of cancer. Using a population based sample, we found that a previous cancer diagnosis is associated with a modest increase in CAM use when compared to the general population but not to other chronic symptomatic illnesses such as arthritis. However, cancer survivors pray for health more than all other groups.

In this study, we demonstrated that CAM

Acknowledgement

Dr. Mao is supported by a T32 training grant from NIH/NCCAM. The funding agency had no role in the design and conduct of the study.

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