surveys
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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. 1992National multicentre cross-sectional patients based study, n=630 - PowerPoint PPT PresentationTRANSCRIPT
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Use of complementary and alternative therapies by Norwegian cancer patients. Attitudes taken by
Norwegian health personnel.
ISLAND-2003
Terje Risberg, University Hospital of Tromsø
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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
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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
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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
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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
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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 %
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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
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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
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Figure 1. Survival by use of CAM (unadjusted analysis)Solid line: no CAM useDashed line: use of CAM
Years since questionnaire0 2 4 6 8
0.00
0.25
0.50
0.75
1.00
141
24
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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
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Figure 3. Survival by use of CAM for patients with ECOG1 or above (unadjusted analysis)Solid line: no CAM useDashed line: use of CAM
Years since questionnaire0 2 4 6 8
0.00
0.25
0.50
0.75
1.00
247
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Figure 2. Survival by use of CAM for patients with ECOG=0 (unadjusted analysis)Solid line: no CAM useDashed line: use of CAM
Years since questionnaire0 2 4 6 8
0.00
0.25
0.50
0.75
1.00
117
17
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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
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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»
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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
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Attitudes and use of Alternative medicine.
(OBS:No differentiation between alternative and complementary therapies)
Among physicians, nurses and clerks within North Norway
T. RisbergA. Kolstad
A. JohansenK. Vingerhagen
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Participants
6 different hospitals in north Norway
Profession n (%) of invited Male (n) Female (n)
– Physicians 102 (59) 73 29– Nurses 197 (53) 20 176– Clerks 64 (65) 1 64______________________________________________
363 94 269______________________________________________
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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__________________________________________________
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Use of Alternativ Medicine among physicians, nurses and clerks
Physicians Nurses Clerks
% % %
_____________________________________________
Female 24 35 47
Male 7 10 --
_____________________________________________
Total 12 32 47_____________________________________________
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Classification, attitude and use of complementary and alternative medicine among oncology health personnel A Norwegian Multicentre study
A. Kolstad, T. Risberg, E.A. Wist, H. Holte, O. Mella, O. Klepp, T. Wilsgaard, Y. Bremnes, B. Cassileth.
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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.
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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
____________________________________________________________________
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Please classify the methods according to their main use (n=510)
Method/Therapy
% Alternative
% Comp. Med
% Conventional
% Do not know
% Not known
therapy
Healing by hand 64 19 0 12 5 Cure by prayer 58 24 1 11 6 Homeopathy 54 38 2 4 2 Iscador (Mistletoe) 52 20 3 10 15 *Nitter 44 29 1 6 20 High-dose vitamin 42 30 3 11 14 Herbal, biological 37 37 1 9 16 Diet therapy 31 48 2 9 10 Zone therapy 29 61 1 5 4 Meditation 24 65 1 7 3 Acupuncture 21 74 3 2 1 Applied Kinesiology 20 21 1 9 49 Aromatherapy 18 72 1 5 4 Music /Art therapy 17 75 1 5 2 Therapeutic touch 17 62 2 7 12 Visualization 14 42 1 11 32 Ayurveda 12 6 0 9 73 Massage 11 81 4 5 0
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Alternative or Complementary?
Method/ Therapy
Altern Med
CompMed
Conv Med
Don´t know
Unknown therapy
Physician Acupuncture 10 87 2 1 0 Nurse Acupuncture 24 70 3 2 1 Physician Homeopathy 81 15 0 3 1 Nurse Homeopathy 46 44 2 5 3 Physician Reflexology 47 41 0 7 4 Nurse Reflexology 25 66 1 4 4 Physician Iscador 77 15 0 6 2 Nurse Iscador 45 21 3 11 19 Physician Ayurveda 27 6 0 4 63 Nurse Ayurveda 8 6 1 10 76
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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
____________________________________________________________________
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Use of complementary and alternative methods Methode Physicians Nurses Clerks Radio
theraphistsn
Massage 9 59 10 28 105Acupuncture 8 56 12 27 103Homeopathy 2 53 15 17 87Aromatherapy 5 41 7 14 67Zone therapy 1 28 7 8 44Music /Art therapy 1 28 2 1 32Cure by prayer 2 19 4 2 27Meditation 1 18 4 4 27Diet therapy 5 13 4 5 26Herbal, biological therapy 3 12 3 4 22Therapeutic touch 0 20 0 2 22High-dose vitamin therapy 1 11 3 2 17Healing by hand 6 2 5 3 16Visualization 0 13 2 1 16Applied Kinesiology 0 6 3 0 9Ayurveda 0 1 2 1 4*Nitterkur or equivalent 0 2 0 0 2Iscador (Mistletoe) 0 1 0 0 1Other ………………………… 3 7 0 2 12
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Takk for oppmerksomheten