1. Use of complementary and alternative therapies by Norwegian cancer patients. Attitudes taken by Norwegian health personnel. ISLAND-2003 Terje Risberg, University Hospital of Tromsø

2. Surveys 1992National multicentre cross-sectional patients based study, n=630 1990-1996Follow-up study among patients from Tromsø, n=252 1997Opinions and use among health care workers in Northern Norway, n=386 2002National multicentre study among oncology health care workers, n=508

4. Use of alternative medicine among Norwegian cancer patients The Norwegian Radium Hospital, Oslo Ullevål Hospital, Oslo Haukeland Hospital, Bergen Regionsykehuset i Trondheim Regionsykehuset i Tromsø

5. Study Characteristics Invited to participate911 Declined to participate101 Did not return the questionnaire128 Lack of written consent 33 Age and diagnosis unknown 7 Use of NCT unknown 12 Available patients 630

6. Types of alternative therapy used (126 users) Healing by prayers15 Healing by hand12 Diets 9 Iscador 8 Homeopathy 7 Herbs and vitamins 6 Nitter therapy 6 Others 3 Combinations60

7. Use of Alternative Medicine (Multicenter study, n=630) Tromsø 31 % «Spiritual» 72% Trondheim 13 % «Spiritual» 50 % Bergen 27 % «Spiritual» 71 % Oslo 22 % «Spiritual» 34 % DNR 18 % «Spiritual» 37 %

8. Longitudinal study: The Tromsø study Invited to participate: All new patients seen in the dep. Of oncology, July 1990-June 1991 (n=252) Participants was followed with new questionnaires at 4, 12, 24 and 60 months. Surviving patients participated in telephone interview in 1997

10. 8 years survival, National multicentre study (n=515) 350 patients (68%) died during the 8 years of follow-up. 165 were still alive. 79% (88/112) of CAM users died 65% (262 / 403) of non-users died (difference between groups 14%; 95% CI: 5, 22%;  2 =7.40; p=0.007). Multivariate: adjusted for prognostic factors, p=0,06

11. Figure 1. Survival by use of CAM (unadjusted analysis) Solid line: no CAM use Dashed line: use of CAM

12. ECOG=Perfomance status The ECOG scale ECOG 0no symptoms n=242 ECOG 1some symptoms (light work)n=147 ECOG 2rest necessary (capable of self-care)n=73 ECOG 3limited self-care, more than 50% in bedn=53

13. Figure 3. Survival by use of CAM for patients with ECOG1 or above (unadjusted analysis) Solid line: no CAM use Dashed line: use of CAM

14. Figure 2. Survival by use of CAM for patients with ECOG=0 (unadjusted analysis) Solid line: no CAM use Dashed line: use of CAM

15. Which cancer patients are the most probable users of CAM 1.Former users of CAM (40% earlier use) 2.Patients between 30-60 years 3.Knowledge of cancer more than 3 mnd 4. Symptoms of their disease (mild) 5.Only palliative treatment 6. In north Norway: women more than men

16. Why do cancer patients use Non-Conventional Therapy Medical: –Cure (seldom) –Improvement of general health (common) –“man is a rational animal”: a number of the users are sicker than believed by their physicians. (the “survival study”) Coping/Psychological –«Do something/together with the family» –«support in an otherwise hopeless situation» –«advocated by others/earlier experiences»

17. Sorts of Alternative medicine used by the patients Depends on: –Geography Northern and western parts: «Spiritual forms» Central parts/Larger cities «Non-spiritual forms» –Age Young: Healing by prayers (Miracles) Middle aged: Prayers/ Traditional forms (Homeopathy/Injections etc) Old age: Very little use of NCT

18. Attitudes and use of Alternative medicine. (OBS:No differentiation between alternative and complementary therapies) Among physicians, nurses and clerks within North Norway T. Risberg A. Kolstad A. Johansen K. Vingerhagen

19. Participants 6 different hospitals in north Norway Profession n (%) of invited Male (n)Female (n) –Physicians102 (59) 73 29 –Nurses197 (53)20 176 –Clerks 64 (65) 1 64 ______________________________________________ 36394 269 ______________________________________________

20. Attitudes among physicians, nurses and clerks Number of different health professions that express a positive attitude to alternative medicine Physicians Nurses Clerks (n=102) (n=197) (n=64) % % % __________________________________________________ Total16 7172 __________________________________________________

21. Use of Alternativ Medicine among physicians, nurses and clerks Physicians Nurses Clerks % % % _____________________________________________ Female243547 Male 710-- _____________________________________________ Total123247 _____________________________________________

22. Classification, attitude and use of complementary and alternative medicine among oncology health personnel A Norwegian Multicentre study A. Kolstad, T. Risberg, E.A. Wist, H. Holte, O. Mella, O. Klepp, T. Wilsgaard, Y. Bremnes, B. Cassileth.

24. Definition of Alternative medicine versus Complementary medicine Alternative therapies (AM) were defined as unproved treatments which are promoted as treatment for the disease itself. Complementary therapies represent treatments aimed at symptom management and to enhance quality of life.

26. Attitudes to Alternative and Complementary treatments of cancer among oncological health personnel. Number of oncological health personnel expressing an positive attitude Physicians Nurses ClerksRadiotherapists (n=108)(n=242)(n=49)(103) % ____________________________________________________________________ Alternative6345531 ____________________________________________________________________ Complementary49877363 ____________________________________________________________________

27. Please classify the methods according to their main use (n=510)

28. Alternative or Complementary?

29. Use of Alternative and/or Complementary Medicine among oncology health workers PhysiciansNurses ClerksRadiotherapists (n=108)(n=242)(n=49)(103) % ____________________________________________________________________ Alternative14414933 ____________________________________________________________________ Complementary21506959 ____________________________________________________________________

30. Use of complementary and alternative methods

33. Takk for oppmerksomheten