Cancer is a disease characterized by uncontrolled cell growth, local tissue invasion and then metastasis.1 Cancer is responsible for 8.2 million deaths. That is the second leading cause of death after cardiovascular disease. About half of men and one-third of women have cancer during their lifetime, and today millions of people are living with cancer. Most common cancers are breast cancer, lung and bronchial cancers, prostate cancer, colon and rectal cancer, and bladder cancer. In United States, 231.840 new cases of invasive breast cancer and 60.290 cases of breast cancer ‘in situ’ are diagnosed among women.2 In Indonesia the prevalence of cancer in 2013 is 1.4% of the population or about 347,792 people, 0.5% of them suffer from breast cancer. Sumatera Barat (one of a province in Indonesia) was rank on 3rd top position after Yogyakarta and East Kalimantan.3
The main treatment for cancer is a combination of surgery, radiation, chemotherapy and biological therapy.1 Some of the patients also use CAM therapy, a treatment which uses products/procedures that are not considered as part of conventional treatment.2 The CAM therapy that commonly used by cancer patients is herbal medicines together with homeopathy, vitamins/minerals, spiritual therapy and relaxation.4-9 Most of the patients who use CAM treatment usually because they are not satisfied with conventional treatment only.10
The CAM user population is widely spread in the world and continues to increase from year to year. More than one-third of cancer patients (35.9%) worldwide were reported used some form of CAM medicine variations.11 In the United States, about 38% of adults and 12% of children use some form of CAM.12 In South Korea 67% of breast cancer patients used CAM in treatment.13 In Malaysia the use of cam is also very popular.14-15 In Indonesia, CAM therapies are used more than 40% of the population and 70% of them was villagers.3 The Minister of Health Regulation state that CAM treatment was a continuous service effort as a promotive, preventive, curative and rehabilitative.16 This study is aimed to explore the CAM usage and the reasons of using CAM among breast cancer patients in a public hospital in Padang, Indonesia.
This study was a descriptive study with the cross-sectional design done in three months for all patients suffering from breast cancer in oncology unit in a public hospital in Padang, Indonesia. The breast cancer patients who are unable to communicate well and/or are unwilling to take part in the study were excluded. Data were collected by structured interview for patients who use CAM and open interview for patients who not use CAM.
A total of 92 breast cancer patients were included in the study. Five of patients were unable to communicate well and two others were not willing to participate in the study, so total patients as respondents were 85. Using the CAM among the respondents is shown in Table 1 and 2.
|Use the CAM||55||65|
|Use the CAM but now it has stopped||22||26|
|Never use the CAM||8||9|
The patients who have never used CAM, the main reason was that the efficacy and outcome of therapy were unclear. The result was similar with another study which reported there is no improvement on survival and on patient’s quality of life.17-20 Meanwhile, Molassiotics reported, another reason why respondents choose not to use CAM was that they were satisfied with their conventional therapy and because they did not trust in CAM.9
In patients who have use CAM, they have specific individual reasons. The main reason is that the patients’ belief that CAM therapy would give benefit to support their health. Similar with the previous study reported that patients have an expectation CAM could improve their body’s ability to fight on disease and improve quality of life.8-10,21-22
Most of the respondents used biological-based therapies as an option in using the CAM, i.e. herbal medicine (92.72%). Similar to this study, Molassiotics9 and Gulluoglu23 reported that herbal remedies, treatment with tea, vitamins and minerals, spiritual therapy, homeopathy and relaxation techniques were most popular CAM therapy in cancer patients. Other study reported that herbal medicines and dietary supplements were widely used to overcome side effects of conventional cancer treatment and several studies have done to prove the efficacy of CAM as well.23 The CAM usage, especially herbal medicines, most likely influenced by the community tradition in using natural medicines. According to Algier,24 use of herbal medicines compared to other CAM therapies was influenced by cultures. Other factors were because of herbal remedies also popular, readily available, inexpensive in price and belief that natural product was safe for a body as well. This was supported by Teng25 which state that high prevalence of CAM usage in Chinese society was influenced by traditions, religious and belief, as well as money they spend for conventional treatments.
The patients also use the mind and body therapy, such as with praying and meditation. Praying was a form of meditation directed directly to God.26 Praying was a spiritual need and teaches how to overcome spiritual pressure.27 Praying was an individual behaviour that can also affect self-satisfaction and social support.28 Praying was often associated with one’s faith, but Swisher22 states that there was no difference in the type of CAM therapy used with one’s level of faith.
Meditation is a relaxation technique to calm the body and mind by focusing on an object, repeating words or mantras and regulating breathing techniques. This type of therapy indicates a change in the result of the biochemical compound including lowering blood pressure and lowering stress.26 In this study, meditation was not included as popular CAM choice for participants as only one of them used meditation.
The patients in this study also used Chinese medicine to treat their disease. It was reported that Chinese medicine derived from herbs worked synergistically with medical treatment and could decrease effects of toxicity, stress, and fatigue from cancer treatment itself.24
In addition, few respondents were using acupuncture and acupressure. According to the National Institutes of Health2 acupuncture was a treatment, procedure or techniques that involve the stimulation of the anatomical location of the skin by certain techniques and by penetrating the skin with a thin needle. In contrast to acupuncture, acupressure is a treatment technique by providing pressure using the thumb, finger or elbow at certain points on the muscles that can stimulate the ability of self to be healing naturally. Acupressure was believed to reduce muscle tension and facilitate the distribution of oxygen and nutrients to all parts of the body. Based on the study done by Bokmand and Flyger29 acupuncture can reduce sleep disorders and was a good and safe treatment for women with breast cancer. Acupuncture and acupressure were also effective in reducing nausea and vomiting due to cancer treatment.30
Source of information in using CAM usually was not just single information. Few studies reported different results where most patients get CAM information, especially herbal medicines, that information came from drug vendors themselves.9,17,24,31-32 In this study, most of the participants got information from family or friends (70.91%) and from advertising through TV, radio, newspaper, internet, book, etc. (29.09%). Only 5.45% patients had consulted the CAM therapies that they used to health personnel. This is similar to others study where most of breast cancer patients do not seek advice from the medical practitioner about the CAM they want to use.13,25,33
Therefore, it is important for health personnel to ask about CAM was used by patients during cancer treatment and educate patients about the potential dangers of CAM if they used them as treatment primarily as treatment because the benefits of CAM use were unproven.22 Boon34 also states how important medical staff knew about using of CAM in breast cancer patients because of lack of research that could expose safety, efficacy, and interaction of those treatment techniques with conventional treatment. Some experts believe that herbal medicines interact significantly with drugs so advice patients not to use herbal therapy during treatment.22 Some herbal medicines were hepatotoxic and therefore harmful when combined with some chemotherapy drugs.35 According to Swisher22 another important reason for consulting CAM use with medical staff was to clarify the reasons why patients use CAM. Medical staff should identify the quality of life of patients such as anxiety, depression, nausea and fatigue that often leads to patient dissatisfaction. Medical staff should also improve personal relationships to discuss other therapies that they use outside of conventional therapy.
Majority of breast cancer patients use CAM, especially biological-based therapies. The information resources are family and friends, while few of them have consulted their CAM to health personnel. It is recommended that health workers, especially clinical pharmacists, explore information about CAM use by patients and may provide information on appropriate CAM use. Further research is conducted on the efficacy, safety, side effects, and potential interactions of CAM therapies with medicaments received by patients from conventional medicine.