Feb. 8, 2005 More than a third of cancer patients in Europe make use of complementary and alternative medicine (CAM), according to one of the largest surveys undertaken of CAM in cancer.
In the first Europe-wide study of CAM, a team of international researchers found that its use varied from a low of just under 15% of cancer patients in Greece to a high of nearly three-quarters of patients in Italy.
Writing in Annals of Oncology (Thursday 3 February) lead author Dr Alex Molassiotis said that their survey of nearly 1,000 patients showed that it was vital that health professionals were aware of CAM use and able to educate patients, and that the EU was involved in regulating it more efficiently.
"Irrespective of what health professionals believe about CAM and how dismissive they might be, our findings show that patients are using, and will continue to use CAM. So, this will probably necessitate rethinking the provision of medical and healthcare education, broadening our understanding of the concept of medicine and working towards integrating into mainstream healthcare services those CAM therapies for which there is evidence of effectiveness," said Dr Molassiotis, who is Reader in cancer and supportive care at the University of Manchester School of Nursing, Midwifery and Social Work, the leading research department of nursing in the UK.
The survey of 956 patients was carried out by members of the European Oncology Nursing Society through patient questionnaires in clinics in 14 countries. Patients' age ranged from 17 to 91 years. Over 60% were women.
It found that that CAM users tended to be female, younger and more highly educated and that pancreatic, liver, bone and brain cancer patients (i.e. patients with poor prognosis) used CAM significantly more often than other patients.
Length of treatment ranged from as little as one month up to 18 years, with a mean of 27 months. In most countries around a third used CAM, with only Italy, the Czech Republic and Switzerland showing high levels of use and Greece showing very low levels.
A total of 58 different CAM therapies were used with the five most frequently used broad categories being similar across most countries. Herbs were the most common treatment – used in 13 of the 14 countries and the number one CAM treatment in nine. Most of the herbs were specific to each country. Homeopathy was among the top five in seven countries as were medicinal teas, with vitamins or minerals featuring in the top five in nine countries. Six countries – Israel, Denmark, Italy, Spain, Greece and Iceland featured strongly where spiritual therapies were concerned.
Patients spent, on average, €123 a month on CAM. The maximum monthly reported amount was €4,140. However, more than half paid nothing as most remedies were available free e.g. herbs collected themselves or supplied by family or friends.
Most patients said they used CAM because they wanted to increase their body's ability to fight the disease (50%), improve physical well-being (40%), or emotional well-being (35%). However, there were some differences in the reasons for using CAM and the actual benefits experienced. For example, although the primary reason for choosing CAM was to boost the ability to fight cancer only 22% found it of benefit, while 42% found it helped their emotional well-being although only 35% gave that as their reason for use.
Thirty-three different types of CAM practitioners were consulted, but over 6% were treated by their family doctor. Most had learnt about CAM from friends (56%), family (29%) or the media (28%), while 18% were informed by their physician. Under 10% had heard via the internet.
Overall, patients tended to be satisfied and felt their particular therapy was effective, with only 3% saying it was useless. On a scale of 0-7, the mean satisfaction rating was 5.27 and the mean perceived effectiveness rating was 5.04. Fourteen patients (4.4%) reported side-effects, mostly transient and all related to herb use.
Of the patients who did not use CAM, 43% said they were happy with conventional treatment, 34% said they had never thought of CAM and 15% did not believe in it. Other reasons included discouragement by their family, lack of information or inability to pay.
Dr Molassiotis said the study had limitations arising from a variety of difficulties in conducting Europe- wide research e.g. problems maintaining consistency, no access to medical records, specific ethics committees' requirements etc., so that did have to be borne in mind when evaluating the results.
"Nevertheless, although CAM use in Europe is lower than in the US according to North American surveys, our study indicates that the average mean use in Europe has increased since a review of 29 studies was published in 1998."
Research funding for CAM has increased, he said, but was still very low – only around 0.31% of all medical research funding in the UK, for example.
"We cannot overemphasise the need to increase the evidence base of CAM therapies using methodologies that are appropriate and sensitive. It's also important from an economic point of view as CAM is a multibillion Euro business – in fact the second biggest growth industry – and some patients pay large sums out of their own pockets to access it.
"We must also have appropriate legislation and regulation in Europe as there are wide variations across countries. Since it appears that CAM is here to stay, the EU needs to consider broader policies, common laws and rationalisation of available legislation," Dr Molassiotis concluded.
 Use of complementary and alternative medicine in cancer patients: a European Survey. Annals of Oncology. doi:10.1093/annonc/mdi110.
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