Perceptions and Attitudes of Clinical Oncologists on Complementary and Alternative Medicine
A Nationwide Survey in Japan I n their survey, Hyodo et al. 1 concluded that negative perceptions regarding complementary and alternative medicine (CAM) products persist among clinical oncologists in Japan. On behalf of the Italian National Institute of Health, a project concerning CAM was initiated in Italy. As part of this project, we designed a survey to investigate the use of CAM by cancer patients based on previous surveys. [2][3][4] Between May 2001 and August 2002, 426 cancer inpatients who were admitted to 4 institutions located in different areas of Italy were asked to answer a 30-question, self-administered survey concerning the use of CAM for their neoplasia. Approximately 10% of the patients declared that they had used CAM remedies for their cancer. The remedies used most often were herbal and botanical treatments, homeopathy, dietary regimens, and energy healing. The main reasons for using CAM were concern for the adverse effects of conventional anticancer treatments, to increase the patient's well-being, and to increase the chance of cure. Factors demonstrating statistical significance for CAM use were female gender, residency in northern Italy, duration of the cancer of Ն 12 months, and previous multiple conventional anticancer treatments. Age, education, marital status, profession, and type of cancer did not appear to influence the decision to use CAM. The preferential choice of herbal and botanical treatments may be explained by the constant bombardment by mass media, prompting the return to a more "natural" lifestyle. We believe CAM remedies are viewed by cancer patients as more of a support with which to better cope with conventional oncologic treatments rather than as an alternative to these treatments. It is worthwhile to note that 63% of the patients declared that they had not informed their treating oncologist about their use of CAM and in only 52% of the cases had CAM been prescribed by a physician. We are aware that a thorough reflection on the physician-patient relationship is needed. Even if 383 patients declared that they had never used CAM for their neoplasia, 66% of the sample patients wished for an interaction between conventional treatments and CAM. The belief that conventional anticancer treatments bear an intense level of physical and psychologic suffering still is deeply rooted. Therefore, patients often are desperately seeking help to minimize their suffering. In this setting, we agree with Hyodo et al. when they state that strategic efforts are needed to provide guidance for patients so that they may better interpret the medical information. Given the lack of proven effectiveness of CAM treatments, oncologists need to be aware of the magnitude of this problem.