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© 2002 American Public Health Association
RESEARCH AND PRACTICE |
Marion M. Lee, Jeffrey S. Chang, and Margaret R. Wrensch are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Bradly Jacobs is with the Osher Center for Integrative Medicine, Department of Medicine, University of California, San Francisco.
Correspondence: Requests for reprints should be sent to Marion M. Lee, PhD, MPH, Department of Epidemiology and Biostatistics, University of California, Box 0560, San Francisco, CA 94143-0560 (e-mail: mlee{at}epi.ucsf.edu).
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INTRODUCTION |
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 TOP INTRODUCTION METHODSRESULTSDISCUSSION AND CONCLUSIONSReferences |
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In the United States, prevalence rates of complementary and alternative medicine (CAM) use in the general population have increased in recent years (e.g., from 33.8% in 1990 to 42.1% in 1997).1 Among cancer patients, rates of CAM use are usually higher than among the general population.2–5 Few studies have specifically targeted prostate cancer patients,6–9 and, to our knowledge, no study has examined ethnic differences in CAM use among prostate cancer patients. In the present research, we examined prevalence rates and correlates of CAM use among men from 4 ethnic groups (White, Black, Hispanic, and Asian, including Chinese, Filipino, and Japanese) residing in the San Francisco Bay Area.
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METHODS |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSION AND CONCLUSIONSReferences |
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Study participants were male San Francisco Bay Area residents between the ages of 40 and 89 years who had been diagnosed with (histologically confirmed) primary invasive localized, regional, or remote prostate cancer. Men diagnosed in 1998 were identified by ethnicity through the regional tumor registry operated by the Northern California Cancer Center. We conducted telephone interviews from September 1999 through April 2001 with a standardized questionnaire in the participant’s language of choice (English, Spanish, Mandarin, or Cantonese).
The questionnaire collected information on demographic characteristics; acculturation (country of birth and language spoken at home); family history of prostate cancer; participation in religious, recreational, professional, or other social groups; other illnesses; smoking status; alcohol consumption; exercise; types of conventional therapy undergone for prostate cancer; and types of CAM used for prostate cancer (Table 1
). Details on the types of CAM that were included were described in an earlier article.2
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The primary outcome of interest was prevalence of CAM use related to prostate cancer diagnosis. Chi-square tests were used in comparisons of demographic characteristics of CAM users and nonusers.
Logistic regression analyses were conducted to determine associations between covarying variables and CAM use (Table 2). Variables that were significant at the P < .05 level and variables that had odds ratios of 1.5 or more or of 0.5 or less in univariate analyses were entered into a multivariate logistic regression model to determine their relative importance in association with CAM use.
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Statistical analyses were performed with SAS, version 8.10 (SAS Institute Inc, Cary, NC). All P values were 2-tailed.
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RESULTS |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSION AND CONCLUSIONSReferences |
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Of 690 men reachable by telephone, 543 (79%) completed a 30-minute telephone interview. Overall, 30% of our participants used at least 1 type of CAM. CAM users were slightly younger than nonusers (65.5 vs 66.9 years; P = .07), and they were more likely to be college graduates (65.0% vs 53.8%; P = .02). CAM users and nonusers were similar in terms of income level, country of birth, and marital status.
Table 1
shows percentages of men using specific types of CAM by ethnicity. As can be seen, prevalence rates of CAM use and types of CAM used varied greatly according to ethnicity. Table 2 presents data on factors associated with CAM use. It is evident that factors influencing CAM use varied by ethnicity as well.
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DISCUSSION AND CONCLUSIONS |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSION AND CONCLUSIONSReferences |
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Among our respondents, the overall prevalence of CAM use related to prostate cancer was 30%, which is within the range of rates previously reported among prostate cancer patients (27.4%–43%).6–9 Consistent with previous investigations,2,7,10–15 our study found that CAM use was associated with younger age, higher educational level, regular exercise, influence on the part of friends and relatives with prostate cancer, and participation in social or religious groups.
To our knowledge, this is the first study of CAM therapy use among prostate cancer patients to involve significant percentages of non-English-speaking (15%) and Asian (20%) participants. When we examined members of each ethnic group separately, we found differences in correlates of CAM use. Among members of different ethnic groups, it is likely that use is influenced by individual cultural norms and experiences.16
This study involved several limitations. First, the study population, from the ethnically diverse San Francisco Bay Area, may not be comparable to samples from other parts of the country with different ethnic compositions. Second, we included only 3 Asian ethnic groups, and thus the results may not be representative of all Asian ethnic groups in the United States. Finally, because the study was cross sectional, the associations found may not reflect effects of 1 factor on another.
It is important for physicians to ascertain whether their patients are using CAM, in that many CAM therapies may affect the body’s physiological functioning and be associated with drug interactions.17–19 In addition, previous studies have shown that CAM use may be related to emotional distress.13,20 Initiating discussions regarding CAM use and reasons for use may be a good way for physicians to assess patients’ emotional status and to provide emotional support.
In light of the ethnic differences in correlates of CAM use revealed in our study, future research should examine patterns of CAM use and reasons associated with use among different racial/ethnic groups. Such ethnicity-specific data will be important in helping physicians understand motivations behind CAM use and in facilitating effective discussions with patients.
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Acknowledgments |
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This research was supported by the California Cancer Research Program (grant 99-00535V-10239).
We thank Scarlett Lin, Jade Lin, Vance Ingalls, Veronica Gov, Sue Zhou, Guillermo Torano, Jeffrey Chu, Maria Diaz-Mendez, Michael Hsu, Garrett Tichauer, Casey Hart, Rita Leung, and Christine Choy for their assistance in various stages of the study.
Human Participant Protection
Because the data for this study were gathered through telephone interviews, written consent was not obtained. However, we did obtain verbal consent via telephone from each participant before we began the interview process. This process was approved by the Committee on Human Subject Research at the University of California, San Francisco.
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Footnotes |
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M. M. Lee, B. Jacobs, and M. R. Wrensch contributed to the study concept and design. All of the authors contributed to the acquisition, analysis, and interpretation of data and to the drafting of the brief.
Accepted for publication June 4, 2002.
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References |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSION AND CONCLUSIONSReferences |
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1. Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey. JAMA. 1998;280:1569–1575.
2. Lee MM, Lin SS, Wrensch MR, Adler SR, Eisenberg D. Alternative therapies used by women with breast cancer in four ethnic populations. J Natl Cancer Inst. 2000;92:42–47.
3. Sparber A, Bauer L, Curt G, et al. Use of complementary medicine by adult patients participating in cancer clinical trials. Oncol Nurs Forum. 2000;27:623–630.[Medline]
4. Von Gruenigen VE, White LJ, Kirven MS, Showalter AL, Hopkins MP, Jenison EL. A comparison of complementary and alternative medicine use by gynecology and gynecologic oncology patients. Int J Gynecol Cancer. 2001;11:205–209.[Medline]
5. Adler SR, Fosket JR. Disclosing complementary and alternative medicine use in the medical encounter: a qualitative study in women with breast cancer. J Fam Pract. 1999;48:453–458.[Medline]
6. Nam RK, Fleshner N, Rakovitch E, et al. Prevalence and patterns of the use of complementary therapies among prostate cancer patients: an epidemiological analysis. J Urol. 1999;161:1521–1524.[Medline]
7. Kao GD, Devine P. Use of complementary health practices by prostate carcinoma patients undergoing radiation therapy. Cancer. 2000;88:615–619.[Medline]
8. Lippert MC, McClain R, Boyd JC, Theodorescu D. Alternative medicine use in patients with localized prostate carcinoma treated with curative intent. Cancer. 1999;86:2642–2648.[Medline]
9. Lubeck DP, Litwin MS, Flanders SC, Henning JM, Carroll PR. Use of complementary and alternative medicine (CAM) treatments among a cohort of newly diagnosed prostate cancer patients: data from CapSUREO [abstract]. Abstract Book Assoc Health Serv Res. 1999;16:37.
10. Richardson MA, Sanders T, Palmer JL, Greisinger A, Singletary SE. Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology. J Clin Oncol. 2000;18:2505–2514.
11. Gotay CC, Hara W, Issell BF, Maskarinec G. Use of complementary and alternative medicine in Hawaii cancer patients. Hawaii Med J. 1999;58:94–98.[Medline]
12. Crocetti E, Crotti N, Feltrin A, Ponton P, Geddes M, Buiatti E. The use of complementary therapies by breast cancer patients attending conventional treatment. Eur J Cancer. 1998;34:324–328.
13. Paltiel O, Avitzour M, Peretz T, et al. Determinants of the use of complementary therapies by patients with cancer. J Clin Oncol. 2001;19:2439–2448.
14. Leung JM, Dzankic S, Manku K, Yuan S. The prevalence and predictors of the use of alternative medicine in presurgical patients in five California hospitals. Anesth Analg. 2001;93:1062–1068.
15. Astin JA. Why patients use alternative medicine: results of a national study. JAMA. 1998;279:1548–1553.
16. Maskarinec G, Shumay DM, Kakai H, Gotay CC. Ethnic differences in complementary and alternative medicine use among cancer patients. J Altern Complementary Med. 2000;6:531–538.[Medline]
17. Smolinske SC. Dietary supplement-drug interactions. J Am Med Womens Assoc. 1999;54:191–192, 195.
18. Ang-Lee MK, Moss J, Yuan CS. Herbal medicine and perioperative care. JAMA. 2001;286:208–216.
19. DiPaola RS, Zhang H, Lambert GH, et al. Clinical and biologic activity of an estrogenic herbal combination (PC-SPES) in prostate cancer. N Engl J Med. 1998;339:785–791.
20. Burstein HJ, Gelber S, Guadagnoli E, Weeks JC. Use of alternative medicine by women with early-stage breast cancer. N Engl J Med. 1999;340:1733–1739.
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