Our Research:

Objective; A third of adults with breast or prostate cancer use Complementary or Alternative
Medicine (CAM) alongside their primary conventional treatment. We provide a synthesis of
qualitative studies of CAM use in cancer designed to inform practice and policy.
Methods; Meta-ethnographic synthesis.
Results; Papers (26) were located and 6 concepts identified; Control, Connectedness,
Wellbeing, Transformation, Polarization and Integration. Individual patient experiences are
described within the context of patient perceived polarization and integration. CAM and
conventional medicine are often conceptualised medically as occupying opposite ends of a
spectrum establishing a polarised view. Many people with cancer found it hard to talk to their
oncologists about CAM as supportive treatment. This influenced the safe choices they were
able to make about their own care and created a barrier to the relationship they wished to
develop with their conventional physician.
Conclusions; Clinicians who are intolerant of CAM may compromise their therapeutic
relationship with patients. An open approach to the integration of complementary medicine is
likely to make patients with cancer feel more at ease improving their relationship with their
doctors.

Objective: Complementary and Alternative Medicines (CAM) are widely used by patients with fibromyalgia – although the claims of efficacy often lack a strong evidence base. The objective of this review was to critically evaluate the evidence regarding CAMs taken orally or applied topically for the treatment of fibromyalgia.
Methods: Randomised controlled trials of fibromyalgia using CAMs, in comparison to other treatments or placebo, published in English up to March 2009, were eligible for inclusion. They were identified using systematic searches of bibliographic databases: EMBASE, Ovid MEDLINE, Allied and Complementary Medicine, EBM Reviews – ACP Journal Club, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects. The references of all relevant articles were manually searched to identify additional relevant publications. Information was extracted on a) outcomes, and statistical significance, for the CAM under study in relation to the comparison treatment or placebo, b) reported side effects and the methodological quality of the primary studies was determined.
Results: Seven studies on seven CAMs were identified. Their methodological quality was moderate. Three of the studies related to homeopathic care, they were small and used different approaches, but each reported an improvement in pain. The effects of anthocyanidins, capsaicin and S-adenosylmethionine have only been tested in a single study each of which showed at least one statistically significant improved outcome compared to placebo However, the studies of anthocyanidins and capsaicin only demonstrated an improvement in a single outcome, sleep disturbance and tenderness respectively, of several outcomes considered. No evidence of efficacy was found regarding Soy in a single study. Most of these CAMs were free of major adverse effects and usually associated with only minor adverse effects such as dizziness, nausea and stomach upsets. Conclusion: There is insufficient evidence to date on any CAM, taken orally or applied topically, for fibromyalgia. The small number of positive studies lack replication. Further high quality trials are necessary to determine whether these initial findings can be supported by a larger evidence-base.

Context
Complementary and alternative medicines (CAM) are used by pediatric cancer patients but their actual frequency is undetermined. 
Objective
This systematic review summarizes the current evidence on the prevalence of CAM use in pediatric cancer patients and assesses the reported quality of included studies.
Data Sources
We systematically searched six major electronic databases, reference lists of existing reviews, and personal files.
Study Selection
We included full articles about primary research studies (without language restriction) reporting the prevalence of CAM use if all or a defined sub-sample of participants were pediatric cancer patients.
Data Extraction
Detailed information regarding methods and results was extracted from the original articles.  A quality assessment tool was rigorously developed based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement and used to assess reported study quality.  Formal tests of inter-rater agreement were conducted.
Results
We included 28 studies with survey data (collected 1975 -2005) on 3526 children. In 20 studies with 2871 participants the prevalence of any CAM use (since cancer diagnosis) ranged from 6% to 91%; considerable heterogeneity across studies precluded meta-analysis. Study quality was mixed and not correlated with CAM prevalence.  Herbal remedies were the most popular CAM modality followed by diets/nutrition and faith healing.  Commonly reported reasons for CAM use included to help cure or fight the child’s cancer, symptomatic relief, and support of ongoing use of conventional therapy.  There was little evidence of an association between CAM use and patients’ socio-demographic characteristics. 
Conclusions
Many pediatric cancer patients use CAM. It is important that pediatricians are aware of this and encourage open communication with patients and their parents.  Using standardized survey methods and CAM definitions in future studies could improve their quality and help generate comparable data. Our quality assessment tool could prove valuable for other reviews of prevalence studies. 

ObjectivesExisting studies on the use of complementary and alternative medicine (CAM) have produced diverse results regarding the types and prevalence of CAM use due, in part, to variations in the measurement of CAM modalities. A questionnaire that can be adapted for use in a variety of populations will improve CAM utilization measurement. The purposes of this article are to (1) articulate the need for such a common questionnaire; (2) describe the process of questionnaire development; (3) present a model questionnaire with core questions; and (4) suggest standard techniques for adapting the questionnaire to different languages and populations.
MethodsAn international workshop sponsored by the National Research Center in Complementary and Alternative Medicine (NAFKAM) of the University of Tromsø, Norway, brought CAM researchers and practitioners together to design an international CAM questionnaire (I-CAM-Q). Existing questionnaires were critiqued, and working groups drafted content for a new questionnaire. A smaller working group completed, tested, and revised this self-administered questionnaire.
Results The questionnaire that was developed contains four sections concerned with visits to health care providers, complementary treatments received from physicians, use of herbal medicine and dietary supplements, and self-help practices. A priori–specified practitioners, therapies, supplements, and practices are included, as well as places for researcher-specified and respondent-specified additions. Core questions are designed to elicit frequency of use, purpose (treatment of acute or chronic conditions, and health maintenance), and satisfaction. A penultimate version underwent pretesting with “think-aloud” techniques to identify problems related to meaning and format. The final questionnaire is presented, with suggestions for testing and translating.
Conclusions Once validated in English and non-English speaking populations, the I-CAM-Q will provide an opportunity for researchers to gather comparable data in studies conducted in different populations. Such data will increase knowledge about the epidemiology of CAM use and provide the foundation for evidence-based comparisons at an international level.

Objective The study aimed to assess the prevalence of complementary and alternative medicine (CAM) use in a representative cancer population prior to and within six months of diagnosis.

Design Newly diagnosed cancer patients from two UK cancer centres, completed a postal survey about their CAM use prior to and since diagnosis. The sampling framework was purposive and based on national statistics relating to the UK incidence of cancers arising from different sites

Results Three hundred and four newly diagnosed patients completed a postal survey. (51% response). 100 patients (32.9%) used CAM before their cancer diagnosis and 59 of these CAM users continued post diagnosis. Twenty-nine individuals who had not used CAM before began to use it after their cancer diagnosis, creating a total of 88 (28.9%) CAM users in this sample.  Reasons for not using CAM included lack interest, lack of information, lack of endorsement from professionals and satisfaction with conventional care. For those using CAM before diagnosis but not afterwards the most common reason was a lack of expert guidance on what was safe to use. Predictive factors for pre-cancer use were gender (female) and a higher level of education.  Predictors for use after diagnosis included previous use, gender, higher educational level, employment and early stage disease.  The most common therapies after diagnosis were aromatherapy massage and reflexology, both of which were available at both the cancer centres. Forty-five percent of post diagnostic users bought OTC medicines with 75% of these purchases being from outlets where medical advice would not be available. Only one third of the patients informed their consultant of their CAM use.

Conclusion CAM use in cancer patients is common and demonstrates a complex pattern but CAM use post diagnosis is not significantly greater than in the general population.  Some patients purchase OTC medicines without seeking medical advice thus risking drug interactions.  Research to generate information on safety and efficacy of CAM is required for both patients and health professionals.