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Research on the role of complementary and alternative medicine (CAM) in the care of patients with cancer
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Last modified date:21 March 2007
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There is increasing public interest in, and use of, complementary and alternative medicine - particularly among patients with cancer. In response to the House of Lords Select Committee's desire to foster high-quality research into the CAM genre, and surveys which indicate that on average a third of patients with cancer had used some form of CAM; the Department of Health Research and Development Programme commissioned three projects.
These projects aim to contribute to a better understanding of the demand for CAM therapies and their effects on patient-centred outcomes among patients with cancer. They are focussed upon CAM therapies as an adjunct to conventional forms of treatment and in palliative/supportive care. The outputs will help to inform both the provision of integrated services within the NHS and the future research agenda for CAM in the cancer field.
Contact details and project aims
Complementary and alternative medicine (CAM) and the care of patients with cancer
Project reference no: 09/02
Lead researcher: Dr Philip Tovey
Principal Research Fellow
School of Healthcare Studies
Baines Wing, University of Leeds
Woodhouse Lane
Leeds LS2 9UT
0113-343-1186
Abstract
Complementary and alternative medicine (CAM) has achieved an exponential growth over the last two decades. There is strong evidence of its popularity amongst users and this trend is particularly pronounced in the area of cancer. However, it is also clear that services are often provided on an ad hoc basis, frequently by individual advocates rather than through co-ordinated strategy. Policy announcements in cancer care more broadly have recently emphasised a more 'rounded', and evidence based, approach. However, as the application of 'evidence' is not an objective process, effective health care planning on the role of CAM in cancer services will be dependent upon achieving an understanding of sites of integration and the motivations and perspectives of their stakeholders.
The aim of this project is to gain a clearer understanding of the demand for, use of, and decision making about, CAMs amongst cancer service users in order to inform the development of policy, practice and future research on CAM in cancer care. To achieve this we will address three sets of research questions that mirror and extend those detailed in the brief. These questions deal with issues such as the development of patient preferences, influences on decision making, expectations and interpretations of 'success', the role of varying forms of evidence etc. The project will complement (and be informed by) an existing ESRC/MRC funded project on CAM and cancer currently being led by the lead applicant.
This will be a 30 month qualitative study combining semi-structured interviews with in depth case studies. This combination allows us to both select participants according to specific criteria (such as stage of cancer) as well as providing the means to trace processes of decision making within the context of individuals' lives. We will select a sample of 80 cancer service users for interview. We will purposively sample to achieve a spread of ages (adults only), a variety of involvement with CAMs, an equal number of men and women, a range of cancer types, social class diversity, and representation across ethnic groups. We will aim to include an equal number from each of the four groups identified in the commissioning brief: patients receiving potentially curative treatment (including surgery, radiotherapy and/or chemotherapy); patients who have received potentially curative treatment and are now clinically free of disease; patients with metastatic disease who are receiving or have been recommended orthodox anti-cancer treatment; and, patients with advanced disease who are receiving or are candidates for palliative care. Given the importance of the practitioner - patient relationship we will also interview around 30 professionals. Service user and professional interviews will be conducted concurrently in order that insights from one source can inform data collection with the other. We will follow this phase with case studies of 8 service users. By use of diaries as a method of data collection, this phase will allow us to track real life processes. A multi-audience, multi method dissemination strategy will be used in order to maximise the potential of the work to inform policy and practice.
Start date: 1 September 2003
End date: 28 February 2006
Total cost: £146,992
Outcome: The report of this study enhances understanding of how cancer patients engage with CAM issues and will help to inform policy development and service delivery for cancer patients.
A study of the use of complementary and alternative therapies among people undergoing cancer treatment
Project reference no: 28/02
Lead researcher: Professor Jessica Corner, Professor in Cancer & Palliative Care, University of Southampton
Investigators:
Dr Sian Maslin-Prothero, Senior Lecturer, University of Southampton
Dr George Lewith, Senior Research Fellow and Honorary Consultant Physician, Complementary Medicine Research Unit, Southampton
Dr Jane Maher, Clinical Oncologist, West Hertfordshire NHS Trust, Rickmansworth Road, Northwood, Middlesex
Aim
The aim of this study was to explore in detail the ways in which CAM is used by patients with cancer following diagnosis and as they undergo cancer treatment and, to examine the perceived value of CAM in coping with cancer, cancer treatment in recovery
Objectives
More specifically the objectives were to:
- Identify the patterns of CAM use among a diverse sample of patients in two cancer centres; one centre where CAM use is an integral part of service provision; and a cancer centre where no special emphasis is placed on CAM, comparing these with previous population based studies.
- Explore in detail with patients who have chosen to use CAM, their motivations for using CAM; comparing these with a group of patients who do not use CAM.
- Examine, using patients' accounts of their cancer illness experience, the relationship between CAM use and the cancer illness and treatment trajectory, to create a detailed map of the uses and reported effects of CAM.
- Analyse the health outcomes associated with CAM use in the context of cancer treatment as reported by patients.
- Idenitfy CAM therapies that warrant further formal evaluation for their potential contribution to cancer treatment.
- Develop understanding of CAM use among patients with cancer as a naturally occuring system of consumer-led and self-managed health care.
Background to study
Estimates suggest that one third of all cancer patients regularly access and use complementary and alternative medicine (CAM) while undergoing cancer treatment or while recovering from treatment. CAM is therefore an important component of the cancer illness/treatment journey, yet much of this is undeclared to the cancer treatment team and little is known about its value or about the motivations for using CAM. Significant expenditure on CAM is being made by patients, and to a lesser extent the NHS, but few data exist as to the benefits of using CAM therapies. The existing literature demonstrates that little is understood about the motivations for people using CAM following a diagnosis of cancer, or what outcomes may result in terms of enhanced quality of life, amelioration of treatment side effects, or indeed in survival. Studies point to the potential value of qualitative research methods so that the issues outlined may be elucidated. Detailed work, using qualitative research approaches is needed into the complex ways in which CAM are used as part of the illness journey with cancer and also to identify where and how CAM may be of benefit, for example in relation to ameliorating cancer treatment side effects or in managing symptoms.
The report is now available via the link below.
Male cancer patients' views on and use of complementary and alternative medicine (CAM): a qualitative study
Project reference no.: 29/02
Lead researcher: Dr Alison Shaw, Division of Primary Health Care, University of Bristol
Background
Cancer is a major public health issue and cause of mortality in the UK and remains one of the most feared diagnoses for patients. There has been an increase in public interest and use of CAM in general and it is estimated that many cancer patients use CAM. However, there is little rigorous research evidence on the use of CAM among cancer patients in the UK. Much of the previous research on CAM use has been conducted in the U.S.A and Canada, but this has limited applicability to the UK context because of cultural differences and differences in systems of health care provision. Further, much of the previous research has used quantitative approaches such as the survey, but there has been little rigorous qualitative research on CAM use in general, or more specifically on CAM use for cancer. In addition, previous research has either given little detailed attention to gender issues or has focused on women's use of CAM in relation to breast or gynaecological cancers - there is little existing research on male cancer patients' views and use of CAM.
Research questions
This study will address the following research questions: How are male cancer patients' preferences for or against CAM treatments determined? What are male cancer patients' expectations of cancer care and how far, and in what ways, are these met by CAM therapies? What aspects of different CAM treatments and of the therapeutic relationship are particularly valued by male cancer patients and how do these compare with their experiences of orthodox treatments?
Methods
Following a review of the literature, a qualitative interview study will be conducted. In-depth interviews will be used to collect data on two occasions, about 6 months apart, from a sample of 30-45 patients purposefully recruited from a variety of provider settings to meet a range of sampling criteria. The interview schedule will include a range of pre-set topics but will be flexible to allow participants to introduce issues of importance to them. The interviews will be audio-taped and fully transcribed. Following the principles of Grounded Theory methodology, data collection and analysis will be closely interwoven throughout this study. The transcripts will be analysed for key categories, themes and concepts relating to patients' views and experiences of conventional and CAM treatments for cancer. Analysis will involve coding the qualitative data for key emerging issues, themes and categories.The constant comparative method (Glaser and Strauss, 1967) will be central, with every element of data continually being compared with other elements to allow the development of core categories and themes, from which theory will emerge. Data will be collected and analysed until saturation occurs.
Start date: 01 September 2003
End date: 30 September 2005
Total cost: £78,691
Outcomes: The final report from this research is attached. The study informs supportive and palliative care for cancer patients, providing evidence on male cancer patients' CAM use, about which little was known. It will help NHS and CAM service providers develop a more integrated approach to cancer care for men.
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