Demographic and clinical characteristics of the cases according to the groups using and not using CAM

Of the 39 patients who had never tried these alternative treatments, 43.6% considered trying them. [Table 2] shows 147 (43.4%) patients using CAM, the reasons for taking these treatments, their expectations while taking them, when and for how long they started using CAM, whether they continued these treatments, whether they had side effects, and whether they benefit from these treatments. [Table 3] shows where the patients using CAM have heard about these treatments, the monthly cost of these treatments, whether they have informed their follow-up doctor about it, whether they found these treatments to be effective from their medical treatments, and whether there was anyone who had applied them before. The distribution of treatment types used by patients who have tried CAMs is shown in [Table 4].

Findings related to the experiences of cases who have tried alternative treatment before (n = 147)

Findings related to the experiences of subjects who had previously tried CAM (n = 147)

Frequency distributions of alternative treatment types used/tried by subjects who have tried CAM

All variables found to be p < 0.25 as a result of univariate statistical analyses were included in the regression model as candidate factors. There is no candidate level effect statistically when the characteristics such as education level and place of residence were taken into the regression model as confounding factors. The factors that were the most deciding in differentiating the groups who tried an alternative treatment and those who did not, respectively, income level and duration of diagnosis. Regardless of other factors, those with an income between 1,000 and 3,000 TL were 2.85 (95% CI: 1.617–5.030) times more likely to seek alternative treatment than those with an income below 1,000 TL. This difference was 3.03 (95% CI: 1.431–6.421) times higher for those with an income of more than 3,000 TL (p < 0.001 and p = 0.004). When adjustments were made for other factors, the tendency to choose alternative treatment increased 1.860 times (95% CI: 1.045–3.308) statistically in patients who had been diagnosed for 1 to 5 years compared with those diagnosed less than 1 year ago (p = 0.035). In [Table 5], the combined effects of the factors that are thought to be determinative in differentiating these two groups were analyzed by multivariate logistic regression analysis.

Examination of the effects of factors thought to be determinative in differentiating the groups using and not using CAM therapy together with multivariate logistic regression analysis—alternative table

Discussion

Classical treatment methods such as surgery, chemotherapy, radiotherapy, and endocrine therapy can cause many physical and psychological side effects such as fatigue, nausea, vomiting, anxiety, pain, and depression in breast cancer patients.[12] [13] Patients seek to get rid of these side effects and improve their quality of life, so CAMs are among the methods frequently used in breast cancer patients.[14] [15] In this study, which we conducted with 338 patients in our clinic, 147 (43.4%) of the patients were using CAMs. Various studies in the literature show that this rate varies between 20 and 80%.[15] [16] This rate varies similarly in studies conducted in our country.[17] [18]

In our study, no statistically significant difference was found between the use of CAM and the patients' mean age, marital status, number of children, educational status, place of residence, occupation, active employment or not, and family history. However, the income level of the group using CAM was found to be statistically significantly higher than the group that did not use it. Independent of other factors, it was determined that those with an income level of 1,000 to 3,000 TL were 2.8 times more likely to turn to alternative treatment, and those with an income of more than 3,000 TL were found to be 3.03 times more likely. Similar to our study, in the study conducted in China in 2004 on the use of CAM in patients followed up with breast cancer, an increase in the use of CAM was found with an increase in income level.[19] This is because patients cannot allocate additional budgets for these treatments.

There are studies in the literature showing that patients with a life expectancy of less than 1 year apply to these treatments more frequently.[20] In our study, no significant difference was found in terms of the stage of the disease and these treatments. When adjusted for other factors, orientation to alternative treatment was found to be statistically significant 1.8 times more in those who were diagnosed for 1 to 5 years compared with those who were diagnosed less than 1 year ago. It was thought that the reason for this was the prolongation of the treatment period, increase in exposure to drug side effects, and accordingly, personal research and referral from the patient's relatives.

There are many herbs and herbal products that cancer patients frequently use, but the interaction between drugs used in cancer treatment and herbal products can be high.[21] [22] In our study, the majority of our patients who applied to CAM were using herbal treatments. Herbal treatments were most often used in admixture. The single most commonly used methods were turmeric, nettle, ginger, and linden. Similar to our study, there are studies in which herbal treatment options are frequently used.[23] It was thought that the reason for frequent referral to herbal treatments was because patients thought that herbal treatments were safer, cheaper, and easily accessible. Since herbal CAMs may interact with many therapeutic agents, it is important to warn patients about this issue. It was understood that methods such as psychotherapy, aromatherapy, meditation, acupuncture, homeopathy, relaxation exercises, which were determined to be used frequently in studies conducted in Europe, were less tried for cancer treatment. Also, in case of Turkey, since the patients did not have sufficient knowledge on this subject, the same was perceived.[24]

Since the majority of the patients in our study believed that these treatments were beneficial, they resorted to these methods to cure their diseases and to support the treatment given by their doctors. They started CAMs most often with the suggestion of their friends. Again, the majority of patients stated that these treatments were less effective than their original treatment. These findings were also consistent with the literature.[25] About 38.8% of the patients told like how side effects. However, 61.2% of the patients did not report the use of CAM stating that they did not find it necessary. This situation may be because patients believe that these treatments are innocent and do not have enough information about the toxicities that may develop. Only 5% of the patients stated that they developed side effects related to CAM. This rate was thought to be low because the patients did not attribute the side effects they experienced to CAMs.

The most important limitation of this study is that it is single-centered and cross-sectional. For this reason, it may not reflect the CAM usage of the whole country. It is possible to reach more comprehensive results with a study involving a multicenter design.

Conclusion

Our study showed that the use of CAM was quite high in breast cancer patients. Doctors should question this situation in every patient, and patients should be informed about their decisions. Thus, it may be possible to protect patients from possible side effects and interruption of treatment because of them.

Conflict of Interest

There is no conflict of interest.

Ethics

The research was conducted out in line with the principles of the Declaration of Helsinki and was approved by the local ethical committee (No. 2020/31), dated 11.06.2020. The patients were included in the study after the written consent form was read and their signed consent was obtained. After oral explanation was given to illiterate patients and their consent was obtained, a questionnaire was administered in the presence of their attendants.

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Publication History

Article published online:
02 July 2022

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