The use of alternative medicine therapies for cancer patients varies from 7% to 64% in published studies with an average prevalence of 31.4% [Ernst, 1998 #2103].7 Interestingly, it appears that up to 72% of those patients using alternative therapies do not inform their doctors.1 Many patients hold high expectations for their alternative medicines. Most patients who utilize complementary therapy expect it to improve the quality of their life, over 70% expect it to boost their immune system and 62% believe that it will prolong
*The term conventional medicine refers to medicine as practiced by holders of MD (medical doctor) or DO (doctor of osteopathy) degrees, some of whom may also practice complementary and alternative medicine. Other terms for conventional medicine are allopathy, Western, regular and mainstream medicine, and biomedicine (source: http://nccam.nih.gov).
+These are the categories within which NCCAM has chosen to group the numerous CAM practices; others employ different broad groupings (source: http://n ccam.nih.gov).
their life. As many as 37% of CAM users anticipate that the therapy will cure their disorder.4 Lazar and O'Connor reported several factors influencing the use of complementary or alternative medicine including: the attempt to control side effects; the need to be involved and to have some control over their therapy; the desire to avoid toxicities of conventional medicines; and the diagnosis of a disease for which proper treatment is lacking.5 Those that choose not to use complementary medicine (CM) do so for a variety of reasons including satisfying results from conventional medicine and confidence in medical professionals.6
We have previously demonstrated that up to 43% of clinically localized prostate cancer patients treated with curative intent were found to use at least one form of CM. In this study, vitamins and herbal therapies were found to be among the most prevalent forms of complementary therapies. It was also demonstrated that higher pretreatment Gleason scores were associated with increased usage of CM.7 Other studies have shown a positive correlation with increased socioeconomic status and education.8 These data led us to carry out another study to query as to the specific complementary therapies being used, the time frame of this usage, and the major motivational aspects and sources of information involved in this decision.
In this study, information from 238 patients with localized prostate cancer treated with curative intent by radical surgery or radiation, including brachytherapy, was included. A total of 37% of patients acknowledged using some type of complementary therapy. Our data indicate similar overall use of CM among the treatment groups. The most common CM type was vitamins, utilized by 35% of patients, followed by herbal products and dietary changes used by 12% of respondents. Vitamin E and lycopene were the most commonly used single items in each group, respectively, while the most common dietary change was decreased fat intake. A total of 43% of patients began using CM before starting conventional treatment, while 32% began after initiation of such treatment. The majority of patients who utilized CM indicated they would never discontinue these therapies. The most common reason for using CM was the patient's impression that it made them feel better and, secondarily, that it helped cure their cancer. Physicians were listed as the most common source of information regarding CM. Surprisingly, almost twice as many patients identified physicians as being advocates of CM than critics of this type of care. Many patients felt that their urologist or radiation oncologist was neutral or chose not to discuss the topic of CM with patients. However, for those physicians that did discuss this topic with patients, more patients felt that their urologist or radiation oncologist encouraged the use of complementary therapies than discouraged their use.
Since alternative therapies may alter results of standard cancer therapies,9 produce side effects and confound results of clinical trials, new patient evaluations should include questions concerning any herbal preparations or practice of any alternative methods of cancer treatment. The potential confounding effects due to alternative medicine use are particularly relevant in a disease such as prostate cancer, whose status is assessed by biochemical markers (i.e. prostate specific antigen - PSA). The most compelling finding is that several of these botanical therapies have shown striking clinical effects on human prostate cancer9 as well as in experimental in vitro studies. This will be discussed in more detail below.
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