03:55pm Saturday 19 October 2019

Attitudes about Complementary and Alternative Medicine Predict Use Among Cancer Patients, Penn's Abramson Cancer Center Finds

PHILADELPHIA – A cancer patient’s expectations about the benefits of complementary and alternative (CAM) and their perceived access to CAM therapies are likely to guide whether or not they will use those options, according to a new study published ahead of print in the journal CANCER from researchers at Abramson Cancer Center of the University of Pennsylvania.  The team found that attitudes and beliefs about CAM were found to be a better predictor of CAM usage than socio-demographic factors alone – such as race, sex, or education – which are often used to describe CAM users but stop short of fully explaining what drives people to use them.

The findings may help cancer centers develop more patient-centered programs that remove barriers and better serve diverse groups as they work to better integrate the services into traditional cancer care.

CAM therapies, such as yoga and acupuncture, are becoming more common among cancer survivors looking to improve their quality of life, and have been shown to reduce pain, fatigue, and psychological distress. While clinical and socio-demographic factors (sex, race and education) are useful in describing this group, they provide limited opportunity to understand what prompts a patient to use the therapies or barriers against utilization.

In one of the first studies to explore those questions, the team, including senior author Jun Mao, MD, MSCE, an associate professor of Family Medicine and Community Health in the Perelman School of Medicine at the University of Pennsylvania, who also directs the Integrative Oncology program in the ACC, and first author Joshua Bauml, MD, an assistant professor in the division of Hematology/Oncology, found that specific attitudes and beliefs, such as expectation of therapeutic benefits, patient-perceived barriers (cost, access), and opinions of patients’ physician and family members, were much more likely to affect patients’ use than clinical and demographic characteristics alone.

The team also found that beliefs and attitudes varied by key socio-demographic factors such as sex, race, and education. Patients who were younger, female, and those who had a college education tended to expect greater benefits from CAM. Nonwhite patients reported more perceived barriers, such as transportation issues and more concern over side effects, compared with white patients, but their expectations concerning the therapies’ benefits were similar.

To investigate the usage of CAM, the team conducted a survey-based study of almost 1,000 patients with thoracic, breast, and gastrointestinal cancers at the ACC between June 2010 and September 2011. Attitudes and beliefs were collected using a Penn-developed instrument based upon the Theory of Planned Behavior.

“Our findings emphasize the importance of patients’ attitudes and beliefs about CAM and may predict patients’ CAM use following cancer diagnoses,” said Mao, who is also an associate professor in the department of Epidemiology and Biostatistics at Penn.  With over 60 percent of cancer patients utilizing CAM following cancer diagnoses, many academic and community cancer centers are trying to incorporate CAM into conventional cancer care in response to patient needs and demands, he added.

This is the first to study to quantify the beliefs and attitudes about CAM in cancer patients. Also, while prior research often focused solely on women with breast cancer, the researchers included patients from various tumor groups. 

Finally, they are the first group to quantify that attitudes and beliefs about CAM differ by important socio-demographic groups, thereby highlighting the need for a more individualized approach when clinically integrating CAM into conventional cancer care.

“By aligning with patients’ expectations, removing unnecessary barriers, such as cost and access, and engaging patients’ social and support networks, we can develop patient-centered clinical programs that better serve diverse groups of cancer patients regardless of sex, race, and education levels,” Bauml said.

In addition to Mao and Bauml, other Penn authors on the study include Sagar Chokshi, Eun-ok Im, Qing Li, and Corey Langer.  The study was supported with grants from the Penn Institute on Aging Pilot Research Grants and the National Institutes of Health (1K23 AT004112-05).


Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System, which together form a $4.9 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report‘s survey of research-oriented medical schools. The School is consistently among the nation’s top recipients of funding from the National Institutes of Health, with $409 million awarded in the 2014 fiscal year.

The University of Pennsylvania Health System’s patient care facilities include: The Hospital of the University of Pennsylvania — recognized as one of the nation’s top “Honor Roll” hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; Chester County Hospital; Penn Wissahickon Hospice; and Pennsylvania Hospital — the nation’s first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2014, Penn Medicine provided $771 million to benefit our community.

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