Complementary and Alternative Medicine Use

in Gynecologic Cancer Patients

Amornrat Supoken, MD Thitima Chaisrisawadsuk, MD Bandit Chumworathayi, MD

Department of Obstetrics and Gynecology

Faculty of Medicine, Khon Kaen University

In Thailand

Cancer is the third highest cause of death.1

Gynecologic cancer is the most common cancer in women.2

1. 1996 19Ministry of Public Health, ; Hangsubcharoen, 96

2. 1994National Cancer Institute of Thailand,

Introduction

Introduction

Gynecologic cancer is associated with

a high morbidity & mortality rate

a significant decrease in quality of life

Ronald. New Jersey:Parthenose Publishing Group; 1990

Introduction

Complementary and alternative medicine (CAM) a group of diverse medicaldiverse medical and

health care systemshealth care systems, practicespractices, and productsproducts that are notnot generally considered part of conventional medicineconventional medicine.

The National Center for Complementary and Alternative Medicine , 2009.

Introduction

The use of CAM is widespread all over the world.

Adams M, Jewell AP. Int Semin Surg Oncol; 2007

Introduction

There is emerging evidence to support that quality of life and general well-being is improved in gynecologic cancer patients who use CAM.

Adams M, Jewell AP. Int Semin Surg Oncol; 2007

Introduction

Authors Proportion of CAM use

Richardson, 2000 99.3%

Dy, 2004 88.2%

Swisher, 2002 49.6%

Navo, 2004 48.0%

Vasuratna, 2008 40.3%

Molassiotis, 2005 39.5%

Introduction

Authors Proportion of CAM use

Richardson, 2000 99.3%

Dy, 2004 88.2%

Swisher, 2002 49.6%

Navo, 2004 48.0%

Vasuratna, 2008 40.3%

Molassiotis, 2005 39.5%

Introduction

In the Northeast of Thailand where many features of population are different from other parts .

Introduction

There is no study regarding CAM use in Northeastern part of Thailand.

Design and Objective

Design Descriptive analytical study

Objective To determine the proportionproportion,

typestypes and associated factorsassociated factors of CAM useCAM use in gynecologic cancergynecologic cancer patientspatients who attend Srinagarind Hospital.

Subjects and Methods

Inclusion criteria Gynecologic cancer patients > 20 year-old Able to give their informed

consent>1-month of diagnosis

Exclusion criteriaUse CAM for other reasons

After IRB approval in September, 2008

Cross-sectional survey between

October to December, 2008

Collect data by one-by-one interview

50 admitted and 50 walk-in gynecologic cancer

Inclusion criteriaExclusion criteria

gynecologic cancer patients > 1-month of diagnosis>20 year-old able to give their informed consent

Use CAM for other reasons

Demographic data, Type of CAM

Subjects and Methods

Subjects and Methods

Operational definitionAcupuncture

AromatherapyBiofeedbackHomeopathyHypnotherapyYoga

MassageNaturopathyNutritional

supplementsRelaxation therapySpiritual healing

Subjects and Methods

Sample size calculationPilot study : Proportion 50%; P = 0.5

Zα= 1.96

95%CI; e = 0.1

N = Zα2P(1-P)/e2

N = (1.96)2x0.5x0.5/(0.1)2

N = 96.04

Statistical analysis

Descriptive data Mean + SD Percentage

Comparative statistics t-test for continuous data Fisher’s exact test for

categorical dataZ-test for difference for

proportions

Results

Mean age (year old) 50.7

Occupation Farmer

Marital status Married

Education Primary school

Diagnosis Cervical cancer

Stages I

Characteristics of the included participants

Results

Mean age (year old) 50.7

Occupation Farmer

Marital status Married

Education Primary school

Diagnosis Cervical cancer

Stages I

Characteristics of the included participants

Results

The proportion of CAM use was 67% (57.8-76.2%)

The types of CAM were (N=67)

Buddhist praying 92.5%

Herbal medicines 40.3%

Exercises 37.3%

Diet modifications 23.9%

Others 34.4%

Results

The associated factors

Characteristics P-values*

Age 0.38

Occupation 0.44

Marital status 0.55

Education 0.81

Income 0.63

Diagnosis 0.20

Stages* 0.01*

Chemotherapy* <0.01*

Results

The associated factors

Characteristics P-values*

Age 0.38

Occupation 0.44

Marital status 0.55

Education 0.81

Income 0.63

Diagnosis 0.20

Stages* 0.01*

Chemotherapy* <0.01*

Discussion

CAM use in our study is very common up to 67%.

The most common type of CAM use is Buddhist praying.

The associated factors were stages and chemotherapy.

Discussion

Authors Proportion of CAM use

Richardson, 2000 99.3%

Dy, 2004 88.2%

Swisher, 2002 49.6%

Navo, 2004 48.0%

Vasuratna, 2008 40.3%

Molassiotis, 2005 39.5%

Discussion

Authors Type of CAMRichardson, 2000 - Spiritual practices

- Vitamins- Herbs- Movement -physical therapies

Swisher, 2002 - Acupuncture- Reflexology- Electromagnetic therapy

Dy, 2004 - Vitamin-mineral

Navo, 2004 - Herbal products-megavitamins

Discussion

Vasuratna et al., 2008

The most popular CAMs used were foods and dietary supplements (45.1%) followed by herbs (37.8%).

Vasuratna et al. Poster presented in IGCS; 2008

Discussion

The associated factors from other studies Western country1

• Lower age• Higher education level• Regular exercise• Social class

Asian country2

• Age• Advanced stage• Higher education level

Lee MM, et al. American Journal of Public Health; 2006.1

Kay S, et al. The Journal of Alternative and Complementary Medicine; 2008.2

Vasuratna et al., 2008

The statistically significant factors associated with CAM

• Education (p=0.014)• Financial status (p=0.027)• Occupation (p=0.003)• * Stage of diseases (p<0.001) • * Chemotherapy treatment (p<0.001)

The last two factors were also found in our study.

Discussion

Vasuratna et al. Poster presented in IGCS; 2008

Discussion

The possible explanation is the difference in race, religion and cultural context.

Discussion

This is the first study regarding proportion and type of CAM use in gynecologic cancer patients in Northeastern, Thailand.

Discussion

The primary objective was to determine the proportion of CAM use.

The sample size calculation was based on the primary objective.

This may result in inadequate sample size to give accurate assessment of the associated factors.

Discussion

Our results show a high proportion of CAM use.

The effect of CAM use is needed for further research with regard to the benefits and risks.

Acknowledgement

Thitima Chaisrisawadsuk, MD

Assoc.Prof. Bandit Chumworathayi, MD

Assoc.Prof. Woraluk Somboonporn, MD

Thank you for

your attention