1. Complementary and Alternative Medicine Use in Gynecologic Cancer Patients Amornrat Supoken, MD Thitima Chaisrisawadsuk, MD Bandit Chumworathayi, MD Department of Obstetrics and Gynecology Faculty of Medicine, Khon Kaen University

2.  In Thailand  Cancer is the third highest cause of death. 1  Gynecologic cancer is the most common cancer in women. 2 1.Ministry of Public Health, 1996; Hangsubcharoen, 1996 2.National Cancer Institute of Thailand, 1994 Introduction

3.  Gynecologic cancer is associated with  a high morbidity & mortality rate  a significant decrease in quality of life Ronald. New Jersey:Parthenose Publishing Group; 1990

4. Introduction  Complementary and alternative medicine (CAM) diverse medical health care systemspractices productsnot conventional medicine  a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. The National Center for Complementary and Alternative Medicine, 2009.

5. Introduction The use of CAM is widespread all over the world. Adams M, Jewell AP. Int Semin Surg Oncol; 2007

6. Introduction  There is emerging evidence to support that quality of life and general well-being is improved in gynecologic cancer patients who use CAM. Adams M, Jewell AP. Int Semin Surg Oncol; 2007

7. Introduction AuthorsProportion of CAM use Richardson, 200099.3% Dy, 200488.2% Swisher, 200249.6% Navo, 200448.0% Vasuratna, 200840.3% Molassiotis, 200539.5%

8. Introduction Authors Proportion of CAM use Richardson, 200099.3% Dy, 200488.2% Swisher, 200249.6% Navo, 200448.0% Vasuratna, 200840.3% Molassiotis, 200539.5%

9. Introduction  In the Northeast of Thailand where many features of population are different from other parts.

10. Introduction  There is no study regarding CAM use in Northeastern part of Thailand.

11. Design and Objective  Design  Descriptive analytical study  Objective proportion typesassociated factors CAM usegynecologic cancer patients  To determine the proportion, types and associated factors of CAM use in gynecologic cancer patients who attend Srinagarind Hospital.

12. Subjects and Methods  Inclusion criteria  Gynecologic cancer patients  > 20 year-old  Able to give their informed consent  >1-month of diagnosis  Exclusion criteria  Use CAM for other reasons

13. After IRB approval in September, 2008 Cross-sectional survey between October to December, 2008 Collect data by one-by-one interview 50 admitted and 50 walk-in gynecologic cancer Inclusion criteria Exclusion criteria gynecologic cancer patients > 1-month of diagnosis >20 year-old able to give their informed consent Use CAM for other reasons Demographic data, Type of CAM Subjects and Methods

14.  Operational definition  Acupuncture  Aromatherapy  Biofeedback  Homeopathy  Hypnotherapy  Yoga  Massage  Naturopathy  Nutritional supplements  Relaxation therapy  Spiritual healing

15. Subjects and Methods  Sample size calculation Pilot study : Proportion 50%; P = 0.5 Z α = 1.96 95%CI; e = 0.1 N = Z α 2 P(1-P)/e 2 N = (1.96) 2 x0.5x0.5/(0.1) 2 N = 96.04

16. Statistical analysis  Descriptive data  Mean + SD  Percentage  Comparative statistics  t-test for continuous data  Fisher’s exact test for categorical data  Z-test for difference for proportions

17. Results Mean age (year old)50.7 OccupationFarmer Marital statusMarried EducationPrimary school DiagnosisCervical cancer StagesI Characteristics of the included participants

18. Results Mean age (year old)50.7 OccupationFarmer Marital statusMarried EducationPrimary school DiagnosisCervical cancer StagesI Characteristics of the included participants

19. Results  The proportion of CAM use was 67% (57.8-76.2%)  The types of CAM were (N=67) Buddhist praying92.5% Herbal medicines40.3% Exercises37.3% Diet modifications23.9% Others34.4%

20. Results  The associated factors CharacteristicsP-values* Age0.38 Occupation0.44 Marital status0.55 Education0.81 Income0.63 Diagnosis0.20 Stages*0.01* Chemotherapy*<0.01*

21. Results  The associated factors CharacteristicsP-values* Age0.38 Occupation0.44 Marital status0.55 Education0.81 Income0.63 Diagnosis0.20 Stages*0.01* Chemotherapy*<0.01*

22. Discussion  CAM use in our study is very common up to 67%.  The most common type of CAM use is Buddhist praying.  The associated factors were stages and chemotherapy.

23. Discussion AuthorsProportion of CAM use Richardson, 200099.3% Dy, 200488.2% Swisher, 200249.6% Navo, 200448.0% Vasuratna, 200840.3% Molassiotis, 200539.5%

24. Discussion AuthorsType of CAM Richardson, 2000- Spiritual practices - Vitamins - Herbs - Movement -physical therapies Swisher, 2002- Acupuncture - Reflexology - Electromagnetic therapy Dy, 2004- Vitamin-mineral Navo, 2004- Herbal products-megavitamins

25. Discussion  Vasuratna et al., 2008  The most popular CAMs used were foods and dietary supplements (45.1%) followed by herbs (37.8%). Vasuratna et al. Poster presented in IGCS; 2008

26. Discussion  The associated factors from other studies  Western country 1 Lower age Higher education level Regular exercise Social class  Asian country 2 Age Advanced stage Higher education level Lee MM, et al. American Journal of Public Health; 2006. 1 Kay S, et al. The Journal of Alternative and Complementary Medicine; 2008. 2

27.  Vasuratna et al., 2008  The statistically significant factors associated with CAM Education (p=0.014) Financial status (p=0.027) Occupation (p=0.003) * Stage of diseases (p<0.001) * Chemotherapy treatment (p<0.001)  The last two factors were also found in our study. Discussion Vasuratna et al. Poster presented in IGCS; 2008

28. Discussion  The possible explanation is the difference in race, religion and cultural context.

29. Discussion  This is the first study regarding proportion and type of CAM use in gynecologic cancer patients in Northeastern, Thailand.

30. Discussion  The primary objective was to determine the proportion of CAM use.  The sample size calculation was based on the primary objective.  This may result in inadequate sample size to give accurate assessment of the associated factors.

31. Discussion  Our results show a high proportion of CAM use.  The effect of CAM use is needed for further research with regard to the benefits and risks.

32. Acknowledgement  Thitima Chaisrisawadsuk, MD  Assoc.Prof. Bandit Chumworathayi, MD  Assoc.Prof. Woraluk Somboonporn, MD

33. Thank you for your attention