Use of complementary and alternative therapies by Norwegian cancer patients. Attitudes taken by

Norwegian health personnel.

ISLAND-2003

Terje Risberg, University Hospital of Tromsø

Surveys • 1992 National multicentre cross-sectional patients

based study, n=630

• 1990-1996 Follow-up study among patients from Tromsø, n=252

• 1997 Opinions and use among health care workers in Northern Norway, n=386

• 2002 National multicentre study among oncology health care workers, n=508

Use of alternative medicine among Norwegian cancer patients

• The Norwegian Radium Hospital, Oslo

• Ullevål Hospital, Oslo

• Haukeland Hospital, Bergen

• Regionsykehuset i Trondheim

• Regionsykehuset i Tromsø

Study Characteristics

Invited to participate 911

Declined to participate 101

Did not return the questionnaire 128

Lack of written consent 33

Age and diagnosis unknown 7

Use of NCT unknown 12

Available patients 630

Types of alternative therapy used (126 users)

Healing by prayers 15

Healing by hand 12

Diets 9

Iscador 8

Homeopathy 7

Herbs and vitamins 6

Nitter therapy 6

Others 3

Combinations 60

Use of Alternative Medicine(Multicenter study, n=630)

Tromsø 31 % «Spiritual» 72%

Trondheim 13 % «Spiritual» 50 %

Bergen 27 % «Spiritual» 71 %

Oslo 22 % «Spiritual» 34 %

DNR 18 % «Spiritual» 37 %

Longitudinal study: The Tromsø study

• Invited to participate: All new patients seen in the dep. Of oncology, July 1990-June 1991 (n=252)

• Participants was followed with new questionnaires at 4, 12, 24 and 60 months. Surviving patients participated in telephone interview in 1997

8 years survival, National multicentre study (n=515)

• 350 patients (68%) died during the 8 years of follow-up. 165 were still alive.

• 79% (88/112) of CAM users died • 65% (262 / 403) of non-users died• (difference between groups 14%; 95% CI: 5, 22%; 2 =7.40; p=0.007).

• Multivariate: adjusted for prognostic factors, p=0,06

Figure 1. Survival by use of CAM (unadjusted analysis)Solid line: no CAM useDashed line: use of CAM

Years since questionnaire0 2 4 6 8

0.00

0.25

0.50

0.75

1.00

141

24

ECOG=Perfomance status

The ECOG scale

• ECOG 0 no symptoms n=242• ECOG 1 some symptoms (light work) n=147• ECOG 2 rest necessary (capable of self-care) n=73• ECOG 3 limited self-care, more than 50% in bed n=53

Figure 3. Survival by use of CAM for patients with ECOG1 or above (unadjusted analysis)Solid line: no CAM useDashed line: use of CAM

Years since questionnaire0 2 4 6 8

0.00

0.25

0.50

0.75

1.00

247

Figure 2. Survival by use of CAM for patients with ECOG=0 (unadjusted analysis)Solid line: no CAM useDashed line: use of CAM

Years since questionnaire0 2 4 6 8

0.00

0.25

0.50

0.75

1.00

117

17

Which cancer patients are the most probable users of CAM

• 1. Former users of CAM (40% earlier use)

• 2. Patients between 30-60 years

• 3. Knowledge of cancer more than 3 mnd

• 4. Symptoms of their disease (mild)

• 5. Only palliative treatment

• 6. In north Norway: women more than men

Why do cancer patients use Non-Conventional Therapy

• Medical: – Cure (seldom)– Improvement of general health (common)– “man is a rational animal”: a number of the users are

sicker than believed by their physicians. (the “survival study”)

• Coping/Psychological– «Do something/together with the family»– «support in an otherwise hopeless situation»– «advocated by others/earlier experiences»

Sorts of Alternative medicine used by the patients

Depends on:– Geography

• Northern and western parts: «Spiritual forms»• Central parts/Larger cities «Non-spiritual forms»

– Age• Young: Healing by prayers (Miracles)• Middle aged: Prayers/ Traditional forms

(Homeopathy/Injections etc)• Old age: Very little use of NCT

Attitudes and use of Alternative medicine.

(OBS:No differentiation between alternative and complementary therapies)

Among physicians, nurses and clerks within North Norway

T. RisbergA. Kolstad

A. JohansenK. Vingerhagen

Participants

6 different hospitals in north Norway

Profession n (%) of invited Male (n) Female (n)

– Physicians 102 (59) 73 29– Nurses 197 (53) 20 176– Clerks 64 (65) 1 64______________________________________________

363 94 269______________________________________________

Attitudes among physicians, nurses and clerks

Number of different health professions that express a positive attitude to alternative medicine

Physicians Nurses Clerks (n=102) (n=197) (n=64)

% % %__________________________________________________

Total 16 71 72__________________________________________________

Use of Alternativ Medicine among physicians, nurses and clerks

Physicians Nurses Clerks

% % %

_____________________________________________

Female 24 35 47

Male 7 10 --

_____________________________________________

Total 12 32 47_____________________________________________

Classification, attitude and use of complementary and alternative medicine among oncology health personnel A Norwegian Multicentre study

A. Kolstad, T. Risberg, E.A. Wist, H. Holte, O. Mella, O. Klepp, T. Wilsgaard, Y. Bremnes, B. Cassileth.

Definition of Alternative medicine versus Complementary medicine

• Alternative therapies (AM) were defined as unproved treatments which are promoted as treatment for the disease itself.

• Complementary therapies represent treatments aimed at symptom management and to enhance quality of life.

Attitudes to Alternative and Complementary treatments of cancer among oncological health

personnel.

Number of oncological health personnel expressing an positive attitude

Physicians Nurses Clerks Radiotherapists

(n=108) (n=242) (n=49) (103)

% % % %

____________________________________________________________________

Alternative 6 34 55 31

____________________________________________________________________

Complementary 49 87 73 63

____________________________________________________________________

Please classify the methods according to their main use (n=510)

Method/Therapy

% Alternative

% Comp. Med

% Conventional

% Do not know

% Not known

therapy

Healing by hand 64 19 0 12 5 Cure by prayer 58 24 1 11 6 Homeopathy 54 38 2 4 2 Iscador (Mistletoe) 52 20 3 10 15 *Nitter 44 29 1 6 20 High-dose vitamin 42 30 3 11 14 Herbal, biological 37 37 1 9 16 Diet therapy 31 48 2 9 10 Zone therapy 29 61 1 5 4 Meditation 24 65 1 7 3 Acupuncture 21 74 3 2 1 Applied Kinesiology 20 21 1 9 49 Aromatherapy 18 72 1 5 4 Music /Art therapy 17 75 1 5 2 Therapeutic touch 17 62 2 7 12 Visualization 14 42 1 11 32 Ayurveda 12 6 0 9 73 Massage 11 81 4 5 0

Alternative or Complementary?

Method/ Therapy

Altern Med

CompMed

Conv Med

Don´t know

Unknown therapy

Physician Acupuncture 10 87 2 1 0 Nurse Acupuncture 24 70 3 2 1 Physician Homeopathy 81 15 0 3 1 Nurse Homeopathy 46 44 2 5 3 Physician Reflexology 47 41 0 7 4 Nurse Reflexology 25 66 1 4 4 Physician Iscador 77 15 0 6 2 Nurse Iscador 45 21 3 11 19 Physician Ayurveda 27 6 0 4 63 Nurse Ayurveda 8 6 1 10 76

Use of Alternative and/or Complementary Medicine among oncology health workers

Physicians Nurses Clerks Radiotherapists

(n=108) (n=242) (n=49) (103)

% % % %

____________________________________________________________________

Alternative 14 41 49 33

____________________________________________________________________

Complementary 21 50 69 59

____________________________________________________________________

Use of complementary and alternative methods Methode Physicians Nurses Clerks Radio

theraphistsn

Massage 9 59 10 28 105Acupuncture 8 56 12 27 103Homeopathy 2 53 15 17 87Aromatherapy 5 41 7 14 67Zone therapy 1 28 7 8 44Music /Art therapy 1 28 2 1 32Cure by prayer 2 19 4 2 27Meditation 1 18 4 4 27Diet therapy 5 13 4 5 26Herbal, biological therapy 3 12 3 4 22Therapeutic touch 0 20 0 2 22High-dose vitamin therapy 1 11 3 2 17Healing by hand 6 2 5 3 16Visualization 0 13 2 1 16Applied Kinesiology 0 6 3 0 9Ayurveda 0 1 2 1 4*Nitterkur or equivalent 0 2 0 0 2Iscador (Mistletoe) 0 1 0 0 1Other ………………………… 3 7 0 2 12

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