Application of alternative medicine in gastrointestinal cancer patients

Bacground/Aim. Alternative medicine is a set of therapeutic procedures which are no part of official practice. At present, the use of alternative medicine among cancer patients is significant and the purpose of this study was to get more information on the methods and products of alternative medicine. Thus, the aim of the study was to determine the frequency of the use of alternative medicine among gastrointestinal cancer patients. Methods. The research was conducted using an anonymous questionnaire in writing. We included 205 patients with the diagnosis of gastrointestinal malignancy in the study but the questionnaire was fulfilled by 193 patients and the presented data were based on their answers. The questions were about the sociodemographic characteristics of the patients, the reasons for their use of alternative medicine, and their information sources about alternative medicine. We divided existing alternative therapies into 6 categories: herbal therapy, special diets, psychotherapy, body-mind therapy, spiritual therapy, and other supplements. Results. A total of 48 (24.9%) patients did not use any type of alternative therapy; 145 (75.1%) patients used at least one product and 124 (64.25%) patients used herbal preparations (beetroot juice was consumed by 110 [56.99%] patients); 136 (70.5%) patients were informed about alternative therapies by other patients.; 145 (75.1% ) used alternative medicine to increase the chances for cure; 88 (45.6%) of interviewed patients would like to participate in future research in this field. Conclusion. The use of alternative medicine is evidently significant among cancer patients. Further research should be conducted in order to find out interactions of these products with other drugs and potential advantages and disadvantages of this form of treatment.


Introduction
The use of alternative medicine (AM) among human beings dates back before Hippocrates and classical medicine.Each period in the evolution and development of human race has been characterized by its own diseases and their methods of cure.The lack of appropriate drugs made people rely on the powers of sorcerers and herbalists.However, in spite of the present use of modern diagnostic and therapeutic procedures, alternative medicine has not been abandoned.When we say alternative medicine, we refer to treatment that has not been founded on the evidence of its efficacy and tolerable harmfulness, which are the basics of classical medicine.According to the World Health Organisation (WHO) definition, alternative medicine refers to various measures of healthcare protection that are beyond the scope of official healthcare sector 1 .In recent years, the use of alternative medicine has tremendously been increased all over the world and it still has a rising trend 2 .In western countries, the increase is between 6 and 69 percent 3 .Several studies that were conducted in various regions of Turkey report the incidence of alternative medicine usage from 23 to 61 percent 4 .It should be mentioned that the concept of alternative medicine -its products and methods -differs from country to country.In the USA, biologically based therapy and acupuncture belong to alternative medicine while in China these methods are considered as the treatments of classical medicine 1 .In addition, psychotherapy (help rendered by psychiatrist, social worker, or psychologist) is a type of treatment that belongs to official healthcare sector; however, in earlier published papers its use in the treatment of cancer patients is mentioned in the context of alternative medicine 5 .
Many cancer patients use the methods of alternative medicine concomitantly with conventional oncology treatments, ie radiotherapy, chemotherapy, and surgery.Why is the use of alternative medicine so extensive today?The answer can be found in the fact that human beings have innate instinct to alleviate suffering and pain by means of all possible treatments and in the existence of excellent media advertising of alternative medicine products and methods 6 .It seems that alternative medicine of today is an international phenomenon, which gradually turns into a powerful industry with an enormous turnover of the capital 5 .In addition, it gains an increasing medical, economical, and social significance.
The aim of the study was to determine the frequency of the use of alternative medicine among gastrointestinal cancer patients.

Methods
The study was conducted from October 2009 to June 2010 at the Oncology Institute of Vojvodina.A 205 patients diagnosed with gastroenterology malignancies were included in the study.All the included patients had metastatic disease stage 4 and all either used or were still using alternative medicine concomitantly with standard therapy.
The investigation was anonymous and the patients were given a written questionnaire to circle the answers to each question.When a patient did not consent to participate in the study, the questionnaire was returned to the investigator.The questions were related to sociodemographic characteristics of the patients, their level of education, and disease stage.In addition, the patients were also asked to give the sources of alternative medicine information, about their wish to obtain new knowledge about AM, and their reason for AM usage.A group of questions covered the methods and products of AM that were grouped as: (1) biologically based therapy (special teas, Aloe vera, beetroot, blackberry wine, etc.); (2) special diets (macrobiotic, Breuss, vegetarian diets); (3) psychotherapy (psychiatrist, psychologist, social worker); (4) mind-body therapy (hypnotherapy, meditation, bioenergy, massage, yoga); (5) spiritual therapy (prayers); (6) other supplements (shark products, clay, petroleum, etc.).
As already mentioned, psychotherapy is a treatment that belongs to the official healthcare sector, but in earlier published papers, its use in the treatment of cancer patients is mentioned in the context of alternative medicine.We compared the obtained results with the results of other authors.
If more than one of abovementioned categories reported, an examinee was classified as the user of alternative medicine.Examinees were allowed to circle more than one of the suggested answers.

Results
A total of 12 (5.85%) of 205 included patients did not consent to participate in the investigation and returned the questionnaire.We found sex difference among participants not statistically significant.We included 120 (58.53%) men and 85 (41.46%) women, the median age was 63.5 years (range, 32-84 years).We did not find any statistically significant difference between sociodemographic characteristics (the place of residence and education level) of the patients and frequency of alternative medicine use (p > 0.05) (Table 1).The examinees were classified as users of alternative medicine if they used at least one type of alternative medicine.Among 193 patients who answered the questionnaire 48 (24.9%) did not use any type or product of alternative medicine.The number of patients who used at least one AM Nikoli I, et al.Vojnosanit Pregl 2012; 69 (11): 947-950.
product/type was 145 (75.1%).The share between the use of biologically based therapies and other supplements was equal (124, 64.25%) (Table 2).Beetroot juice (110, 56.99%) was most commonly used from the group of biologically based therapies and whey (91, 47.15%) from the group of supplements (Table 3).The most common information sources on alternative were those provided by the relatives, other patients, and neighbours (136, 70.5%).Written information (magazines, brochures, and books) were reported by 61 (31.6%) of the examinees, while 49 (25.4%) of the study participants obtained information by means of electronic media (TV, Internet).
The enquiry regarding their willingness to participate in similar studies in future showed that 88 (45.6%) of examinees gave positive answer, 61 (31.6%) refused further involvement, and 44 (22.8%) were indecisive about their participation (Table 4).Regarding the reason for using alternative medicine, 145 (75.1%) of interviewed patients reported increased chances for healing when combined with standard oncology treatments, 92 (47.7%) patients used AM to improve their immunity, 53 (27.5%) chose this way to prolong life, and 36 (18.6%) of patients believed that this would result in complete cure of malignant disease (Table 5).

Discussion
The use of alternative medicine among oncology patients has been increased during the last decades 7 .In our study, 145 out of 193 interviewed patients were using or had used one of AM products.Numerous studies related the knowledge and use of AM among oncology patients have recently been conducted in different countries.Researching conducted in Canada showed that the frequency of AM use was 45% 8 .Studies conducted in 14 European countries reported that 36% of cancer patients use one or more types of AM 8 .The results obtained in our study showed that the share between the use of biologically based therapies and other supplements was equal.Beetroot juice, blackberry wine, and whey as dietary supplements were most commonly used among the interviewed patients.According to literature data, beetroot (Beta vulgaris) is an alternative medicine product with a history of longtime use in various world cultures.In ancient Rome, it was used for treating high temperature and constipation.In Eastern Europe, beetroot has been used for healing headache and toothache since 16th century.Its use in the treatment of cancers patients dates hundred years back.Beetroot is one of the most useful vegetables with great healing properties and high content of carbon hydrates, iron, calcium, phosphorus, potassium, and fibrous tissues.In addition, beetroot contains powerful inhibitors of carcinogenesis (betaine and betacyanin); it is a relatively low-price and easily accessible product that has no side effects after consuming.We believe that these characteristics are the main reason for its common use by oncology patients including our sample of patients from Vojvodina.Although beetroot and its products are consumed all over the world, we could not find explanation why beetroot, in spite of all its positive characteristics, was not among the top products of alternative medicine in surrounding and other countries of the world.A study performed in Turkey published similar results; biologically based AM products were on the top of use and nettle was the most popular plant 4 .In the United States, 58.78% of cancer patients prefer meditation, homeotherapy, and hypnotherapy as AM treatment 9,10 .In our country, these methods are not so popular and are less used by cancer patients (16.6%).An interesting result of our study was the fact that none of interviewed patients mentioned the help of psychiatrist, social worker, psychologist, or prayers in handling mental health problems that always accompany any malignant disease.In Nigeria, the use of spiritual therapy -prayer -is in the second place among oncology patients 6 .
Regarding the sources for obtaining information on alternative medicine the majority of patients (136, 70.5%) from our study relied on their relatives and other patientsusers of AM.It shows the importance of interpersonal communication between the users of alternative medicine and the fact that patients, largely, believe in other people's experience when deciding about use of AM.
Many previous studies show that the use of AM is higher among female patients and patients with higher levels of education 11 .The results of our study failed to show statistically important difference among patients with gastrointestinal malignant disease in correlation to their age, sex, and sociodemographic characteristics; it reflects a universal wish of cancer patients to help them in any possible way including the methods that are not scientifically based.Because 88 (45.6%) of the examinees would like to participate in similar studies we concluded that cancer patients, in spite of the progress in medical treatment of malignant disease, had a great interest in alternative medicine therapies.Our study showed that cancer patients who use AM did not stop to believe in doctors' opinion.They wish to maximize their chances for the cure by combining the methods of alternative medicine with conventional oncology treatments.Our patients emphasized the importance for alleviation of disease symptoms, prolongation of life, and the improvement of their immunity by means of alternative medicine.In the USA and Turkey, 63% of patients wish to reach complete cure from the disease by means of alternative medicine; in our study, this reason was at the last place.It is also believed that many patients do not inform their physicians about the use of alternative medicine.The results of several studies conducted a few years ago found that half of the examined patients did not report the use of alternative medicine to their physicians 12 .As it is evident that alternative medicine is widely accepted among oncology patients, the oncologists should be timely informed about the use of AM among their patients.The boom of the alternative medicine during the last decade has partly been caused by increased number of people that want to take an independent part in their healthcare protection; and partly because of understanding that medical science has not succeed yet in the struggle to find the cure against malignant diseases for more than three decades 13,14 .In addition, our results pointed out the importance of educating both patients and medical professionals about all aspects of alternative medicine, especially the risks of its use to prevent any possible side effect.The oncologists must inform their patients about benefits and side effects of alternative medicine.Future investigations related to AM should be targeted to clear up the safety and efficacy of AM treatments.

Conclusion
The use of alternative medicine is evidently significant among oncology patients (75.1%).Biologically based products in combination with standard oncology treatment are most frequently used to increase the chances for cure.Our patients obtained information on alternative medicine from their relatives or other patients with similar experiences.Future studies should be focused to patients' education provided by their physicians and other medical professionals, as well as to researching the interaction between antioneoplastic agents and products of alternative medicine.