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060399 Use of Alternative Medicine by Women with Early -Stage
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Short Description: of alternative medicine. Administrative delay and lack of consent ... Patients were asked about the use of alternative medicine during ...
Content Inside: U S E O F A LT E R N AT I V E M E D I C I N E BY WO M E N W I T H E A R LY- STAG E B R E AST C A N C E R Special Article USE OF ALTERNATIVE MEDICINE BY WOMEN WITH EARLY-STAGE BREAST CANCER HAROLD J. BURSTEIN, M.D., PH.D., SHARI GELBER, M.S., EDWARD GUADAGNOLI, PH.D., AND JANE C. WEEKS, M.D. ABSTRACT native medicine. These practices have entered main- Background We analyzed the use of alternative stream society and culture; surveys now find that 30 medicine by women who had received standard to 40 percent of the U.S. public uses alternative therapy for early-stage breast cancer diagnosed be- medicine so defined.1-3 tween September 1993 and September 1995. Retrospective or cross-sectional studies have ex- Methods A cohort of 480 patients with newly diag- amined the use of alternative medicine among the nosed early-stage breast cancer was recruited from population at large1-3 and among patients with can- a Massachusetts statewide cohort of women partic- cer.4-11 Collectively, these studies have established ipating in a study of how women choose treatment that level of income, amount of education, and age for cancer. Alternative medical treatments, conven- are all strongly predictive of the rate of use of alter- tional therapies, and health-related quality of life were examined. native medicine, which includes "mind" therapies Results New use of alternative medicine after sur- such as mental imagery, hypnosis, and relaxation and gery for breast cancer was common (reported by "body" therapies such as acupuncture, chiropractic, 28.1 percent of the women); such use was not asso- and herbal treatments. In addition, most people ciated with choices about standard medical thera- who use alternative medicine also see physicians. pies after we controlled for clinical and sociodemo- It is not known what motivates people to use alter- graphic variables. A total of 10.6 percent of the native medicine. The failure of standard health care, women had used alternative medicine before they changes in the health care delivery system, patients' were given a diagnosis of breast cancer. Women need for autonomy, or a preference for "holistic" or who initiated the use of alternative medicine after "natural" therapy, and chronic health problems have surgery reported a worse quality of life than women all been suggested as contributing factors.2,12-15 Cul- who never used alternative medicine. Mental health 16 scores were similar at base line among women who tural differences, varying beliefs about medicine, decided to use alternative medicine and those who and the marketplace17 are also likely to affect the did not, but three months after surgery the use of al- availability and use of alternative medicine. ternative medicine was independently associated The nature of the relation between alternative and with depression, fear of recurrence of cancer, lower standard medical treatment is unclear. Are alternative scores for mental health and sexual satisfaction, and practices truly complementary to conventional care, more physical symptoms as well as symptoms of or do they represent a substitute for standard care?18 greater intensity. All groups of women reported im- Studies of alternative medicine have not attempted proving quality of life one year after surgery. to distinguish between the widely prevalent health Conclusions Among women with newly diag- and lifestyle practices encompassed within alterna- nosed early-stage breast cancer who had been treat- tive medicine and the initiation of these practices in ed with standard therapies, new use of alternative medicine was a marker of greater psychosocial dis- response to particular changes in health. tress and worse quality of life. (N Engl J Med 1999; We conducted a longitudinal study of the use of 340:1733-9.) alternative medicine by a cohort of women with ear- ©1999, Massachusetts Medical Society. ly-stage breast cancer. By following this population of patients, who had well-established prognoses and therapeutic options, over time, it was possible to ex- plore the relation between alternative medicine and ITHIN the past 20 years, the defini- tion of alternative medicine has come to include a variety of behavioral tech- W From the Department of Adult Oncology (H.J.B., J.C.W.) and the Cen- niques (e.g., spiritual techniques and ter for Outcomes and Policy Research (S.G., J.C.W.), DanaFarber Cancer Institute and Harvard Medical School; and the Department of Health Care relaxation methods) and clinical approaches (such as Policy, Harvard Medical School (E.G.) -- all in Boston. Address reprint re- massage, herbal remedies, and chiropractic) that had quests to Dr. Weeks at the DanaFarber Cancer Institute, 44 Binney St., not previously been considered components of alter- Boston, MA 02115, or at jane_weeks@dfci.harvard.edu. Vo l u m e 3 4 0 Nu m b e r 2 2 · 1733 Downloaded from www.nejm.org on June 15, 2008 . For personal use only. No other uses without permission. Copyright © 1999 Massachusetts Medical Society. All rights reserved.
