589347
research-article2015
ICTXXX10.1177/1534735415589347Integrative Cancer TherapiesOjukwu et al
Article
Complementary and Alternative Medicine Use Among Overweight and Obese Cancer Survivors in the United States
Integrative Cancer Therapies 2015, Vol. 14(6) 503–514 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1534735415589347 ict.sagepub.com
Mary Ojukwu, BS1, Justice Mbizo, MS, DrPH2, Bryan Leyva, BA3, Oluwadamilola Olaku, MD, MPH1,4, and Farah Zia, MD1
Abstract Purpose. The purpose of the study was to determine the prevalence of complementary and alternative medicine (CAM) use among US cancer survivors; examine whether use varies by underweight/normal weight, overweight, and obese body mass index status; determine reasons for use; and document disclosure rates of CAM use to medical professionals. Methods. Data for 1785 cancer survivors were obtained from the 2007 National Health Interview Survey and CAM supplement. The prevalence and associations of CAM use in the previous 12 months were compared among underweight/normal weight, overweight, and obese adult cancer survivors. Results. Nearly 90% of cancer survivors used at least one type of CAM therapy in the 12 months preceding the survey. Those who were overweight, but not obese, were more likely to use a CAM modality compared to normal/underweight respondents. Over two thirds (71%) reported using CAM therapy for general health and wellness and 39.3% used CAM because a health care provider recommended it. Disclosure rates of CAM use to conventional medical professionals varied widely by CAM modality. Conclusions. An overwhelming majority of US cancer survivors use CAM for a variety of reasons. Overweight cancer survivors may be more likely to use CAM than those who are underweight, normal weight, or obese. Cancer survivors should be screened by medical providers for the use of CAM therapies; furthermore, prospective clinical research evaluating the efficacy and safety of biologically based CAM therapies, often used by cancer survivors, is important and necessary for the well-being of this population. Keywords alternative, cancer, complementary, medicine, obese, overweight, survivors
Introduction The American Cancer Society estimated that 1.6 million new cases of cancer would be diagnosed in the United States in 2014,1 and approximately 20% of all cases are attributed to weight, weight gain, and obesity.2 A study conducted by the International Agency for Research on Cancer concluded that obesity was a cause of 11% of colon cancer cases, 9% of postmenopausal breast cancer cases, 39% of endometrial cancer cases, 25% of kidney cancer cases, and 37% of esophageal cancer cases.3 With obesity a common risk factor for cancer, many cancer patients may be overweight or obese at the time of diagnosis.4,5 Excess weight has been shown to have profound effects on cancer progression and prognosis. For example, obesity is associated with increased risk of positive surgical margins,6 cancer recurrence,7,8 higher grade and larger tumors,9 and cancer death.10 Prior studies have also shown an association between weight status and chemotherapy resistance5,9,11-14 and indicated that obese cancer patients are at increased risk of developing problems following surgery, including wound complication,
lymphedema, second cancers, and chronic diseases such as cardiovascular disease and diabetes.15 Increased illness burden and poor outcomes experienced by overweight and obese cancer survivors may encourage the use of additional health care modalities, such as complementary and alternative medicine (CAM), that are beyond the scope of conventional medicine.16-18 The National Center for Complementary and Alternative Medicine (NCCAM) defines CAM as a group of heterogeneous 1
Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, Bethesda, MD, USA 2 University of West Florida, Pensacola, FL, USA 3 Process of Care Research Branch, National Cancer Institute, Bethesda, MD, USA 4 Kelly Services Incorporated, Rockville, MD, USA Corresponding Author: Oluwadamilola Olaku, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD 20892, USA. Email: [email protected]
Downloaded from ict.sagepub.com at CMU Libraries - library.cmich.edu on November 9, 2015
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Integrative Cancer Therapies 14(6)
health care systems, practices, and products that are outside the realm of conventional medicine.19 Several studies have examined the prevalence, trends, and reasons for CAM use among the US cancer population.18,20-26 A recent metaanalysis of 152 studies from 18 countries concluded that CAM use is highest in the United States and that over the past 30 years, especially after year 2000, the proportion of cancer patients using CAM has increased.27 Boon et al’s study on trends in CAM use by breast cancer survivors showed that use of CAM therapies increased from 67% to 82% between 2002 and 2005.28 CAM use among cancer survivors may be motivated by a variety of reasons,29 including improving overall well-being, preventing complications and illness, managing cancer-related symptoms and late-effects, and promoting a healthier lifestyle.30,31 Moreover, a large proportion of patients may use CAM for weight loss and weight control.32 Despite extensive research examining CAM use within various cancer subpopulations, there is a knowledge gap on the patterns and prevalence of CAM use in the increasing overweight or obese US cancer survivor population. Information on the prevalence and associations of CAM use among this population can guide clinicians as they provide care to cancer survivors who are using nonconventional therapies and treatments. Moreover, it can guide the development of interventions to promote appropriate and informed use of effective evidence-based CAM practices among this population and may form the basis for much discussion on CAM, especially as it relates to its integration into routine care. Therefore, using data from the 2007 National Health Interview Survey (NHIS) and CAM supplement, this study sought to (a) determine the prevalence and patterns of CAM use among US cancer survivors; (b) examine whether there are differences in CAM use by underweight/normal weight, overweight, and obese body mass index (BMI) status; and (c) describe reasons for CAM use within this population as well as disclosure rates to medical professionals.
Methods Data Source The data for this study were obtained from the 2007 NHIS, an annual cross-sectional survey of a representative sample of the civilian, noninstitutionalized US household population. The NHIS is conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics and is composed of questions from core and supplemental questionnaires. The supplemental questionnaire queries about the 36 types of CAM therapies commonly used in the United States.33 NHIS data are collected through personal interviews conducted in respondent’s home and uses a multistage sampling design. The response rate for the
sample adult component of the NHIS in 2007 was 87.1%,33 and details of the survey procedures and methodology can be found elsewhere.34
Measures Cancer Survivorship Status. In this study, cancer survivors include persons with a history of cancer diagnosis (ie, respondents who answered “yes” to the question, “Have you ever been told by a doctor or other health professional that you had cancer or a malignancy of any kind?”), regardless of whether or not they had symptoms of cancer at the time of the survey. The current cancer status (ie, active disease or remission) was not assessed in the survey. If the respondents reported a history of cancer, they were asked the cancer site (ie, “What kind of cancer was it?”). There were 23 393 (30.9%) respondents who answered the question, “Have you ever been told by a doctor or other health professional that you had cancer or a malignancy of any kind?” Of these, 1785 (7.6%) respondents diagnosed with cancer were included in this study. In order to compare with prior research on CAM use22 and to maintain a sufficient sample size, those reporting non–melanoma skin cancer were included in our final sample. Body Mass Index. We defined BMI as weight (kg)/(height (m))2 and categorized weight status using the following categories: underweight/normal weight (BMI
research-article2015
ICTXXX10.1177/1534735415589347Integrative Cancer TherapiesOjukwu et al
Article
Complementary and Alternative Medicine Use Among Overweight and Obese Cancer Survivors in the United States
Integrative Cancer Therapies 2015, Vol. 14(6) 503–514 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1534735415589347 ict.sagepub.com
Mary Ojukwu, BS1, Justice Mbizo, MS, DrPH2, Bryan Leyva, BA3, Oluwadamilola Olaku, MD, MPH1,4, and Farah Zia, MD1
Abstract Purpose. The purpose of the study was to determine the prevalence of complementary and alternative medicine (CAM) use among US cancer survivors; examine whether use varies by underweight/normal weight, overweight, and obese body mass index status; determine reasons for use; and document disclosure rates of CAM use to medical professionals. Methods. Data for 1785 cancer survivors were obtained from the 2007 National Health Interview Survey and CAM supplement. The prevalence and associations of CAM use in the previous 12 months were compared among underweight/normal weight, overweight, and obese adult cancer survivors. Results. Nearly 90% of cancer survivors used at least one type of CAM therapy in the 12 months preceding the survey. Those who were overweight, but not obese, were more likely to use a CAM modality compared to normal/underweight respondents. Over two thirds (71%) reported using CAM therapy for general health and wellness and 39.3% used CAM because a health care provider recommended it. Disclosure rates of CAM use to conventional medical professionals varied widely by CAM modality. Conclusions. An overwhelming majority of US cancer survivors use CAM for a variety of reasons. Overweight cancer survivors may be more likely to use CAM than those who are underweight, normal weight, or obese. Cancer survivors should be screened by medical providers for the use of CAM therapies; furthermore, prospective clinical research evaluating the efficacy and safety of biologically based CAM therapies, often used by cancer survivors, is important and necessary for the well-being of this population. Keywords alternative, cancer, complementary, medicine, obese, overweight, survivors
Introduction The American Cancer Society estimated that 1.6 million new cases of cancer would be diagnosed in the United States in 2014,1 and approximately 20% of all cases are attributed to weight, weight gain, and obesity.2 A study conducted by the International Agency for Research on Cancer concluded that obesity was a cause of 11% of colon cancer cases, 9% of postmenopausal breast cancer cases, 39% of endometrial cancer cases, 25% of kidney cancer cases, and 37% of esophageal cancer cases.3 With obesity a common risk factor for cancer, many cancer patients may be overweight or obese at the time of diagnosis.4,5 Excess weight has been shown to have profound effects on cancer progression and prognosis. For example, obesity is associated with increased risk of positive surgical margins,6 cancer recurrence,7,8 higher grade and larger tumors,9 and cancer death.10 Prior studies have also shown an association between weight status and chemotherapy resistance5,9,11-14 and indicated that obese cancer patients are at increased risk of developing problems following surgery, including wound complication,
lymphedema, second cancers, and chronic diseases such as cardiovascular disease and diabetes.15 Increased illness burden and poor outcomes experienced by overweight and obese cancer survivors may encourage the use of additional health care modalities, such as complementary and alternative medicine (CAM), that are beyond the scope of conventional medicine.16-18 The National Center for Complementary and Alternative Medicine (NCCAM) defines CAM as a group of heterogeneous 1
Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, Bethesda, MD, USA 2 University of West Florida, Pensacola, FL, USA 3 Process of Care Research Branch, National Cancer Institute, Bethesda, MD, USA 4 Kelly Services Incorporated, Rockville, MD, USA Corresponding Author: Oluwadamilola Olaku, Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD 20892, USA. Email: [email protected]
Downloaded from ict.sagepub.com at CMU Libraries - library.cmich.edu on November 9, 2015
504
Integrative Cancer Therapies 14(6)
health care systems, practices, and products that are outside the realm of conventional medicine.19 Several studies have examined the prevalence, trends, and reasons for CAM use among the US cancer population.18,20-26 A recent metaanalysis of 152 studies from 18 countries concluded that CAM use is highest in the United States and that over the past 30 years, especially after year 2000, the proportion of cancer patients using CAM has increased.27 Boon et al’s study on trends in CAM use by breast cancer survivors showed that use of CAM therapies increased from 67% to 82% between 2002 and 2005.28 CAM use among cancer survivors may be motivated by a variety of reasons,29 including improving overall well-being, preventing complications and illness, managing cancer-related symptoms and late-effects, and promoting a healthier lifestyle.30,31 Moreover, a large proportion of patients may use CAM for weight loss and weight control.32 Despite extensive research examining CAM use within various cancer subpopulations, there is a knowledge gap on the patterns and prevalence of CAM use in the increasing overweight or obese US cancer survivor population. Information on the prevalence and associations of CAM use among this population can guide clinicians as they provide care to cancer survivors who are using nonconventional therapies and treatments. Moreover, it can guide the development of interventions to promote appropriate and informed use of effective evidence-based CAM practices among this population and may form the basis for much discussion on CAM, especially as it relates to its integration into routine care. Therefore, using data from the 2007 National Health Interview Survey (NHIS) and CAM supplement, this study sought to (a) determine the prevalence and patterns of CAM use among US cancer survivors; (b) examine whether there are differences in CAM use by underweight/normal weight, overweight, and obese body mass index (BMI) status; and (c) describe reasons for CAM use within this population as well as disclosure rates to medical professionals.
Methods Data Source The data for this study were obtained from the 2007 NHIS, an annual cross-sectional survey of a representative sample of the civilian, noninstitutionalized US household population. The NHIS is conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics and is composed of questions from core and supplemental questionnaires. The supplemental questionnaire queries about the 36 types of CAM therapies commonly used in the United States.33 NHIS data are collected through personal interviews conducted in respondent’s home and uses a multistage sampling design. The response rate for the
sample adult component of the NHIS in 2007 was 87.1%,33 and details of the survey procedures and methodology can be found elsewhere.34
Measures Cancer Survivorship Status. In this study, cancer survivors include persons with a history of cancer diagnosis (ie, respondents who answered “yes” to the question, “Have you ever been told by a doctor or other health professional that you had cancer or a malignancy of any kind?”), regardless of whether or not they had symptoms of cancer at the time of the survey. The current cancer status (ie, active disease or remission) was not assessed in the survey. If the respondents reported a history of cancer, they were asked the cancer site (ie, “What kind of cancer was it?”). There were 23 393 (30.9%) respondents who answered the question, “Have you ever been told by a doctor or other health professional that you had cancer or a malignancy of any kind?” Of these, 1785 (7.6%) respondents diagnosed with cancer were included in this study. In order to compare with prior research on CAM use22 and to maintain a sufficient sample size, those reporting non–melanoma skin cancer were included in our final sample. Body Mass Index. We defined BMI as weight (kg)/(height (m))2 and categorized weight status using the following categories: underweight/normal weight (BMI
