Upload
stephany-davis
View
215
Download
2
Embed Size (px)
Citation preview
Complementary and Alternative Medicine Use
in Gynecologic Cancer Patients
Amornrat Supoken, MD Thitima Chaisrisawadsuk, MD Bandit Chumworathayi, MD
Department of Obstetrics and Gynecology
Faculty of Medicine, Khon Kaen University
In Thailand
Cancer is the third highest cause of death.1
Gynecologic cancer is the most common cancer in women.2
1. 1996 19Ministry of Public Health, ; Hangsubcharoen, 96
2. 1994National Cancer Institute of Thailand,
Introduction
Introduction
Gynecologic cancer is associated with
a high morbidity & mortality rate
a significant decrease in quality of life
Ronald. New Jersey:Parthenose Publishing Group; 1990
Introduction
Complementary and alternative medicine (CAM) a group of diverse medicaldiverse medical and
health care systemshealth care systems, practicespractices, and productsproducts that are notnot generally considered part of conventional medicineconventional medicine.
The National Center for Complementary and Alternative Medicine , 2009.
Introduction
The use of CAM is widespread all over the world.
Adams M, Jewell AP. Int Semin Surg Oncol; 2007
Introduction
There is emerging evidence to support that quality of life and general well-being is improved in gynecologic cancer patients who use CAM.
Adams M, Jewell AP. Int Semin Surg Oncol; 2007
Introduction
Authors Proportion of CAM use
Richardson, 2000 99.3%
Dy, 2004 88.2%
Swisher, 2002 49.6%
Navo, 2004 48.0%
Vasuratna, 2008 40.3%
Molassiotis, 2005 39.5%
Introduction
Authors Proportion of CAM use
Richardson, 2000 99.3%
Dy, 2004 88.2%
Swisher, 2002 49.6%
Navo, 2004 48.0%
Vasuratna, 2008 40.3%
Molassiotis, 2005 39.5%
Introduction
In the Northeast of Thailand where many features of population are different from other parts .
Design and Objective
Design Descriptive analytical study
Objective To determine the proportionproportion,
typestypes and associated factorsassociated factors of CAM useCAM use in gynecologic cancergynecologic cancer patientspatients who attend Srinagarind Hospital.
Subjects and Methods
Inclusion criteria Gynecologic cancer patients > 20 year-old Able to give their informed
consent>1-month of diagnosis
Exclusion criteriaUse CAM for other reasons
After IRB approval in September, 2008
Cross-sectional survey between
October to December, 2008
Collect data by one-by-one interview
50 admitted and 50 walk-in gynecologic cancer
Inclusion criteriaExclusion criteria
gynecologic cancer patients > 1-month of diagnosis>20 year-old able to give their informed consent
Use CAM for other reasons
Demographic data, Type of CAM
Subjects and Methods
Subjects and Methods
Operational definitionAcupuncture
AromatherapyBiofeedbackHomeopathyHypnotherapyYoga
MassageNaturopathyNutritional
supplementsRelaxation therapySpiritual healing
Subjects and Methods
Sample size calculationPilot study : Proportion 50%; P = 0.5
Zα= 1.96
95%CI; e = 0.1
N = Zα2P(1-P)/e2
N = (1.96)2x0.5x0.5/(0.1)2
N = 96.04
Statistical analysis
Descriptive data Mean + SD Percentage
Comparative statistics t-test for continuous data Fisher’s exact test for
categorical dataZ-test for difference for
proportions
Results
Mean age (year old) 50.7
Occupation Farmer
Marital status Married
Education Primary school
Diagnosis Cervical cancer
Stages I
Characteristics of the included participants
Results
Mean age (year old) 50.7
Occupation Farmer
Marital status Married
Education Primary school
Diagnosis Cervical cancer
Stages I
Characteristics of the included participants
Results
The proportion of CAM use was 67% (57.8-76.2%)
The types of CAM were (N=67)
Buddhist praying 92.5%
Herbal medicines 40.3%
Exercises 37.3%
Diet modifications 23.9%
Others 34.4%
Results
The associated factors
Characteristics P-values*
Age 0.38
Occupation 0.44
Marital status 0.55
Education 0.81
Income 0.63
Diagnosis 0.20
Stages* 0.01*
Chemotherapy* <0.01*
Results
The associated factors
Characteristics P-values*
Age 0.38
Occupation 0.44
Marital status 0.55
Education 0.81
Income 0.63
Diagnosis 0.20
Stages* 0.01*
Chemotherapy* <0.01*
Discussion
CAM use in our study is very common up to 67%.
The most common type of CAM use is Buddhist praying.
The associated factors were stages and chemotherapy.
Discussion
Authors Proportion of CAM use
Richardson, 2000 99.3%
Dy, 2004 88.2%
Swisher, 2002 49.6%
Navo, 2004 48.0%
Vasuratna, 2008 40.3%
Molassiotis, 2005 39.5%
Discussion
Authors Type of CAMRichardson, 2000 - Spiritual practices
- Vitamins- Herbs- Movement -physical therapies
Swisher, 2002 - Acupuncture- Reflexology- Electromagnetic therapy
Dy, 2004 - Vitamin-mineral
Navo, 2004 - Herbal products-megavitamins
Discussion
Vasuratna et al., 2008
The most popular CAMs used were foods and dietary supplements (45.1%) followed by herbs (37.8%).
Vasuratna et al. Poster presented in IGCS; 2008
Discussion
The associated factors from other studies Western country1
• Lower age• Higher education level• Regular exercise• Social class
Asian country2
• Age• Advanced stage• Higher education level
Lee MM, et al. American Journal of Public Health; 2006.1
Kay S, et al. The Journal of Alternative and Complementary Medicine; 2008.2
Vasuratna et al., 2008
The statistically significant factors associated with CAM
• Education (p=0.014)• Financial status (p=0.027)• Occupation (p=0.003)• * Stage of diseases (p<0.001) • * Chemotherapy treatment (p<0.001)
The last two factors were also found in our study.
Discussion
Vasuratna et al. Poster presented in IGCS; 2008
Discussion
This is the first study regarding proportion and type of CAM use in gynecologic cancer patients in Northeastern, Thailand.
Discussion
The primary objective was to determine the proportion of CAM use.
The sample size calculation was based on the primary objective.
This may result in inadequate sample size to give accurate assessment of the associated factors.
Discussion
Our results show a high proportion of CAM use.
The effect of CAM use is needed for further research with regard to the benefits and risks.
Acknowledgement
Thitima Chaisrisawadsuk, MD
Assoc.Prof. Bandit Chumworathayi, MD
Assoc.Prof. Woraluk Somboonporn, MD