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Surveys

Use of complementary and alternative therapies by Norwegian cancer patients. Attitudes taken by Norwegian health personnel. ISLAND-2003 Terje Risberg, University Hospital of Tromsø. Surveys. 1992 National multicentre cross-sectional patients based study, n=630

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Surveys

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  1. Use of complementary and alternative therapies by Norwegian cancer patients. Attitudes taken by Norwegian health personnel. ISLAND-2003Terje Risberg, University Hospital of Tromsø

  2. Surveys • 1992 National multicentre cross-sectional patients based study, n=630 • 1990-1996 Follow-up study among patients from Tromsø, n=252 • 1997 Opinions and use among health care workers in Northern Norway, n=386 • 2002 National multicentre study among oncology health care workers, n=508

  3. Use of alternative medicine among Norwegian cancer patients • The Norwegian Radium Hospital, Oslo • Ullevål Hospital, Oslo • Haukeland Hospital, Bergen • Regionsykehuset i Trondheim • Regionsykehuset i Tromsø

  4. Study Characteristics Invited to participate 911 Declined to participate 101 Did not return the questionnaire 128 Lack of written consent 33 Age and diagnosis unknown 7 Use of NCT unknown 12 Available patients 630

  5. Types of alternative therapy used(126 users) Healing by prayers 15 Healing by hand 12 Diets 9 Iscador 8 Homeopathy 7 Herbs and vitamins 6 Nitter therapy 6 Others 3 Combinations 60

  6. Use of Alternative Medicine(Multicenter study, n=630) Tromsø 31 % «Spiritual» 72% Trondheim 13 % «Spiritual» 50 % Bergen 27 % «Spiritual» 71 % Oslo 22 % «Spiritual» 34 % DNR 18 % «Spiritual» 37 %

  7. Longitudinal study: The Tromsø study • Invited to participate: All new patients seen in the dep. Of oncology, July 1990-June 1991 (n=252) • Participants was followed with new questionnaires at 4, 12, 24 and 60 months. Surviving patients participated in telephone interview in 1997

  8. 8 years survival, National multicentre study(n=515) • 350 patients (68%) died during the 8 years of follow-up. 165 were still alive. • 79% (88/112) of CAM users died • 65% (262 / 403) of non-users died • (difference between groups 14%; 95% CI: 5, 22%; 2 =7.40; p=0.007). • Multivariate: adjusted for prognostic factors, p=0,06

  9. Figure 1. Survival by use of CAM (unadjusted analysis) Solid line: no CAM use Dashed line: use of CAM

  10. ECOG=Perfomance status The ECOG scale • ECOG 0 no symptoms n=242 • ECOG 1 some symptoms (light work) n=147 • ECOG 2 rest necessary (capable of self-care) n=73 • ECOG 3 limited self-care, more than 50% in bed n=53

  11. Figure 3. Survival by use of CAM for patients with ECOG1 or above (unadjusted analysis) Solid line: no CAM use Dashed line: use of CAM

  12. Figure 2. Survival by use of CAM for patients with ECOG=0 (unadjusted analysis) Solid line: no CAM use Dashed line: use of CAM

  13. Which cancer patients are the most probable users of CAM • 1. Former users of CAM (40% earlier use) • 2. Patients between 30-60 years • 3. Knowledge of cancer more than 3 mnd • 4. Symptoms of their disease (mild) • 5. Only palliative treatment • 6. In north Norway: women more than men

  14. Why do cancer patients use Non-Conventional Therapy • Medical: • Cure (seldom) • Improvement of general health (common) • “man is a rational animal”: a number of the users are sicker than believed by their physicians. (the “survival study”) • Coping/Psychological • «Do something/together with the family» • «support in an otherwise hopeless situation» • «advocated by others/earlier experiences»

  15. Sorts of Alternative medicine used by the patients Depends on: • Geography • Northern and western parts: «Spiritual forms» • Central parts/Larger cities «Non-spiritual forms» • Age • Young: Healing by prayers (Miracles) • Middle aged: Prayers/ Traditional forms (Homeopathy/Injections etc) • Old age: Very little use of NCT

  16. Attitudes and use of Alternative medicine. (OBS:No differentiation between alternative and complementary therapies)Among physicians, nurses and clerks within North NorwayT. RisbergA. KolstadA. JohansenK. Vingerhagen

  17. Participants 6 different hospitals in north Norway Professionn(%) of invitedMale (n)Female (n) • Physicians 102 (59) 73 29 • Nurses 197 (53) 20 176 • Clerks 64 (65) 1 64 ______________________________________________ 363 94 269 ______________________________________________

  18. Attitudes among physicians, nurses and clerks Number of different health professions that express a positive attitude to alternative medicine Physicians Nurses Clerks (n=102) (n=197) (n=64) % % % __________________________________________________ Total 16 71 72 __________________________________________________

  19. Use of Alternativ Medicine among physicians, nurses and clerks Physicians Nurses Clerks % % % _____________________________________________ Female 24 35 47 Male 7 10 -- _____________________________________________ Total 12 32 47 _____________________________________________

  20. Classification, attitude and use of complementary and alternative medicine among oncology health personnelA Norwegian Multicentre studyA. Kolstad, T. Risberg, E.A. Wist, H. Holte, O. Mella, O. Klepp, T. Wilsgaard, Y. Bremnes, B. Cassileth.

  21. Definition of Alternative medicine versus Complementary medicine • Alternative therapies (AM) were defined as unproved treatments which are promoted as treatment for the disease itself. • Complementary therapies represent treatments aimed at symptom management and to enhance quality of life.

  22. Attitudes to Alternative and Complementary treatments of cancer among oncological health personnel. Number of oncological health personnel expressing an positive attitude Physicians Nurses Clerks Radiotherapists (n=108) (n=242) (n=49) (103) % % % % ____________________________________________________________________ Alternative 6 34 55 31 ____________________________________________________________________ Complementary 49 87 73 63 ____________________________________________________________________

  23. Please classify the methods according to their main use (n=510)

  24. Alternative or Complementary?

  25. Use of Alternative and/or Complementary Medicine among oncology health workers Physicians Nurses Clerks Radiotherapists (n=108) (n=242) (n=49) (103) % % % % ____________________________________________________________________ Alternative 14 41 49 33 ____________________________________________________________________ Complementary 21 50 69 59 ____________________________________________________________________

  26. Use of complementary and alternative methods

  27. Takk for oppmerksomheten

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