Clinical Abstracts
With Comments by Adriane Fugh-Berman, MD
CAM Use by Breast Cancer Patients
October 2000; Volume 2; 80
Source: Lee MM, et al. Alternative therapies used by women with breast cancer in four ethnic populations. J Natl Cancer Inst 2000;92:42-47.
Objective: To assess the types and prevalence of alternative therapy use by Latino, white, black, and Chinese women with breast cancer.
Setting/Method/Subjects: Four hundred thirty-five women were contacted by telephone; 379 subjects (89%) were interviewed in their preferred language. Participation rates were 71% for Chinese, 94% for blacks, 95% for Latinos, and 94% for whites.
Results: The mean age of participants at diagnosis was 56 years. Forty-eight percent had used at least one type of alternative therapy and about one-third used two or more types after breast cancer diagnosis. Most used the therapies only for about three to six months after diagnosis. Half of participants reported discussing use of these therapies with their physicians. More than 90% found alternative therapies to be helpful, and (except for homeopathy) would recommend these therapies to friends. Women who engaged in regular exercise were twice as likely to use alternative therapies as women who reported not engaging in regular exercise. (Latinos who exercised regularly were three times as likely to use alternative therapies as Latinos who did not exercise regularly). Those who used alternative therapies tended to be younger, more educated, have more private insurance, and to be at a later stage of diagnosis. The most popular therapies were dietary therapies (26.6%), megavitamins (8.2%) specialized diets (19.8%), spiritual healing (23.7%), herbal remedies (12.9%), physical methods (14.2%), and psychological methods (9.2%). In terms of use of specific therapies, blacks were more likely than other groups to use spiritual healing (36%); Chinese were more likely to use herbal remedies (22%); and Latinos were most likely to use dietary therapies (30%) and spiritual healing (26%). Among whites, 35% used dietary methods, 23% used spiritual healing, and 21% used physical methods, including massage and acupuncture.
Funding: Supported by the U.S. Army medical research and material command under DAMD 17-94-J4223.
Comments: This is a very interesting survey, especially given the dearth of information on alternative medicine use among minorities (whence the vast majority of "alternative" therapies originated!). The association between regular exercise and CAM use has not been made before to my knowledge; the authors suggest that women who are either more health conscious or more active may be more likely to try alternative therapies. It would be interesting to explore whether exercising and use of CAM treatments is associated with other health-promoting behaviors. Information also was collected on the use of conventional therapies, which brought out some differences. Chinese women were less likely to have a lumpectomy and modified mastectomy and more likely to have a radical mastectomy than other ethnic groups. Chinese and Latino women were less likely to have reconstructive surgery. Fewer whites and Chinese used chemotherapy. And almost twice as many Latino women as other women reported tamoxifen use. Do these differences in use reflect different preferences among ethnic groups, or are practitioners more likely to recommend radical mastectomy to Asian patients? These are issues that must be explored further.
October 2000; Volume 2; 80
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