CAM in the Treatment of Women with Cancer

1. CAM in the Treatment of Women with Cancer Eran Ben-Arye M.D. The complementary & traditional medicine unit Department of Family Medicine Haifa, Israel

2. What is CAM? “Medical interventions not taught widely at US medical schools or generally not available in US hospitals” Eisenberg 1993 Eran Ben-Arye M.D.

3. “An art and science that treats and prevents disease by focusing on empowering patients to create a condition of optimal health.” American Holistic Medical Organization Pauline Thomas ערן בן אריה - היחידה לרפואה משלימה ומסורתית

4. Alternative medicine Conventional medicine Eran Ben-Arye M.D.

5. Eran Ben-Arye M.D. Complementary Conventional

6. NCCAM - National Center for Complementary and Alternative Medicine NIH NCI OAM – 1992 NCCAM - established in 1998 Mission: To explore CAM healing practices in the context of rigorous science, train CAM researchers, and disseminate authoritative information to the public and professionals Budget: FY 1992 $2 million (OAM) FY 2005 $123 million National Center for Complementary and Alternative Medicine OCCAM - established in 1998 Mission: To coordinate and enhance the activities of the National Cancer Institute (NCI) in the arena of CAM Budget: FY 1998 $28 million FY 2003 $119 million OCCAM - The Office of Cancer Complementary and Alternative Medicine

7. תחומי טיפול שיטות טיפול מערכתיות מסורתיות רפואת צמחים תזונה משלימה רפואת גוף-נפש מגע ותנועה טיפולים "אנרגטיים" "הילינג" אלקטרומגנטים טיפולים ביו-פרמקולוגיים מהי רפואה משלימה ? ערן בן-אריה- היחידה לרפואה משלימה ומסורתית

8. Traditional systems of medical practice Construction Symptoms Practitioner Synthesis Diagnosis Eran Ben-Arye M.D. The complementary & traditional medicine unit

9. Systems of medical practice in Israel Western Homeopathy Naturopathy Anthroposophical medicine Oriental Traditional Chinese medicine Ayurvedic medicine Indigenous Traditional medicine among Jewish and Arab ethnic groups Eran Ben-Arye M.D. The complementary & traditional medicine unit

10. Why discuss CAM in cancer treatment ? Efficacy Safety Demand Does it work? Is it safe? Do patients use it? Why? Eran Ben-Arye M.D.

11. Use of CAM in Israel: 2000 vs. 2003 Shmueli & Shuval. IMAJ. 2004 Use of CAM in USA National survey 1997 Eisenberg et al. JAMA. 1998 Consultations with CAM providers during the previous year Over-all CAM use during the previous year 42% Interviews conducted with 2500 respondents representing Israeli Jewish urban population aged 45-75 years 6.1 % 1993 9.8 % 2000 Consultations with CAM providers 1/3 of 42 % Eran Ben-Arye M.D. The complementary & traditional medicine unit

12. Do patients with cancer use CAM? 16% Hospital settingU.K. Downer. BMJ. 1994 16% Cancer centerUSA. Coss. Cancer Pract. 1998 33% Geriatric patientsUSA. Wyatt.Cancer Pract.1999 42% Pediatric patientsCanada. Fernandez. J Clin Oncol. 1998 53% Outpatient oncology unit.Switzerland. Schweiz Med Wochenschr. 1991 83% M.D. AndersonUSA. Richardson J Clin Oncol. 2000 Eran Ben-Arye M.D.

13. Determinants of the use of complementary therapies by patients with cancer Paltiel et al. J Clin Oncol. 2001 Questionnaires to 1,027 patients attending ambulatory and inpatient hematology or oncology facilities at three hospitals CAM use since the diagnosis 51% CAM use in the past 3 months 35% Eran Ben-Arye M.D. The complementary & traditional medicine unit

14. Determinants of the use of complementary therapies by patients with cancer Paltiel et al. J Clin Oncol. 2001 Recent CAM use was significantly associated with Female sex Age 35 to 59 years More education Coming to the hospital by private car Advanced disease status Having a close friend or a relative with cancer Attending support groups or individual counseling Eran Ben-Arye M.D. The complementary & traditional medicine unit

15. CAM use in GYN cancer Swisher et al. St. Louis, Gynecol Oncol. 2002 49% Navo et al. M.D. Anderson Cancer Center J Clin Oncol. 2004 women with gynecologic or breast malignancies 48 %

16. Why do patients with cancer use CAM? Are patients looking for alternative magic potion practitioner meaning ? Eran Ben-Arye M.D.

17. Determinants of the use of complementary therapies by patients with cancer Paltiel et al. J Clin Oncol. 2001 Individually examined psychosocial variables associated with recent CAM use: Needs unmet by conventional medicine Incomplete trust in the doctor Eran Ben-Arye M.D. The complementary & traditional medicine unit

18. Helplessness Changed outlook or beliefs since the diagnosis of cancer Eran Ben-Arye M.D. The complementary & traditional medicine unit

19. Reasons indicated by patients in Switzerland From: Morant et al. Schweiz Med Wochenschr. 1991.Berger et al. Dtsch Med Wochenschr. 1989 Why Do everything possible “Building up resistance” “Softer” medicine Holistic Using one’s forces Successful cures Disappointment with conventional medicine Eran Ben-Arye M.D.

20. בחירה Eran Ben-Arye בדיקה עצמית מסע שאלה התבוננות סיכון סיכוי מזל הסתברות

21. Do CAM users seek alternative to conventional medicine or a complementary treatment ? Tamara Lischka Eran Ben-Arye M.D. The complementary & traditional medicine unit

22. Overall ratings of relationship with practitioners CAM = Conventional Use of CAM by breast cancer survivors in Ontario Boon et al. J Clin Oncol 2000 CAM practitioners were rated more highly: “He/she provides emotional support” “He/she listens carefully to what I say” CAM practitioners were rated more highly: “I can trust him/her to tell the truth” “He/she is up-to-date in knowledge” Eran Ben-Arye M.D. The complementary & traditional medicine unit