Marja J. Verhoef

Quality of life in brain tumor patients: the relative contributions of depression, fatigue, emotional distress, and existential issues.

Neuropsychiatric problems, and how they interact to impact on quality of life (QOL) in brain tumor patients, are generally poorly understood. The objectives of this study were: (1) to document the prevalence of depression, fatigue, emotional distress, and existential issues in a sample of brain tumor patients (2) to examine the interconnectedness of these problems, and (3) to explore their relationship with disease-related variables and QOL. This is a cross-sectional, questionnaire-based survey of 73 patients with primary brain tumors who presented to a neurological clinic at a tertiary cancer centre for ongoing care. Data for 60 participants (29 women, 31 men) who completed validated questionnaires were retained for analysis. Results showed that there was a high burden of depressive symptoms as measured by the Beck Depression Inventory-II (mean score 11.1, SD 7.4), with 38% of the sample scoring in the clinically depressed range. Overall QOL scores for this sample were similar to a reference sample of brain tumor patients. The scores on the existential subscale of the McGill Quality of Life questionnaire were comparable to those of a reference sample of cancer patients receiving ongoing care (mean score 7.2; SD 1.7). Fifty per cent of the sample could be classified as struggling with existential issues. Although scores reflecting depression, fatigue, emotional distress, and existential problems were interrelated, the presence of depressive symptoms was the single most important independent predictor of QOL in this cohort of brain tumor patients. Implications for treatment are discussed.

Reasons for and Characteristics Associated With Complementary and Alternative Medicine Use Among Adult Cancer Patients: A Systematic Review

Purpose: To conduct a systematic review of reasons for and sociodemographic and disease characteristics associated with complementary and alternative medicine (CAM) use in cancer patients. Methods: Eligible studies were identified by searching the following databases: Alt Health Watch, AMED, CINAHL, CancerLit, PremMEDLINE, MEDLINE, Pub-Med, Ingenta, EMBASE, and Health Star, as well as reference lists in review articles. Only English-language articles published between 1994 and 2004 were included. Search terms included CAM and oncology/cancer , decision making and CAM and oncology/cancer , treatment decision making and CAM and oncology/cancer , and health care choices and CAM and oncology/cancer . Results: Fifty-two eligible studies were identified and summarized. These studies were conducted in 14 different countries, with the largest number of studies being completed in the United States (34.6%). A therapeutic response, wanting control, a strong belief in CAM, CAM as a last resort, and finding hope were the most commonly cited reasons for using CAM. Age, socioeconomic status, and gender were the dominant characteristics associated with CAM use. Conclusion: Reasons for and characteristics associated with CAM use among cancer patients have been studied extensively. Future CAM research among cancer patients should focus on identifying decision-making processes and building theoretical decision-making models. These can be used in the development of decisional aids for patients when confronted with the choice to use CAM as part of their cancer treatment.

Complementary medicine use by patients with inflammatory bowel disease.

Objective:The purpose of this study was to establish the degree and determinants of the use of complementary therapies by patients with inflammatory bowel disease (IBD) and their reasons for seeking them.Methods:The first phase was a cross-sectional survey of 134 patients with IBD (98 with Crohns disease, 34 with ulcerative colitis, and two indeterminate) using a mailed, structured questionnaire (response rate 70%). Determinants of complementary medicine use were examined using logistic regression. The second phase was an in-depth exploration using personal interviews of the beliefs and perceptions of 14 complementary medicine users about the management of their disease. Analysis was performed using standard qualitative techniques and the identification of important, patient-identified themes about the management of IBD.Results:Complementary therapies had been used by 51% of patients in the previous 2 yr. Current use was reported by 33%, of whom one-half were using it for their IBD. Vitamins and herbal products were the most commonly reported therapies. In multivariate analysis, duration of disease > 10 yr and a history of hospitalization were independent predictors of complementary medicine use. The side effects and lack of effectiveness of standard therapies were the most commonly cited reasons for seeking complementary medicine. Sixty-two percent had told their doctor about their use of complementary medicine.Conclusions:Complementary medicine use is common in patients with IBD, especially among those with a longer duration of disease or a history of hospitalization.

Why do patients seek a second opinion or alternative medicine

The objectives of the study were (a) to determine psychosocial determinants of two measures of health care use: seeking a second opinion and alternative medicine use, and (b) to assess whether changes in these two measures of health care use had taken place during the past 4 to 5 years. All patients attending a university-based gastroenterology clinic were asked to complete a self-administered questionnaire. The response rate was 83% (N = 341). Health locus of control, scepticism toward medicine, satisfaction with health care, and perceived health status were included as potential determinants. Sixteen percent (21) of the new patients (95% confidence interval, 10.0-22.8) sought a second opinion compared to 7.5% (95% confidence interval, 4.3-10.7) 5 years ago. Seeking a second opinion was negatively related to internal locus of control, perceived health status, and demanding to know all details of treatment. Eight percent (28) of all patients (95% confidence interval, 5.3-11.1) saw an alternative practitioner for the same problem for which they saw the gastroenterologist compared to 9% (95% confidence interval, 6.2-12.8) 4 years ago. Using alternative medical care was positively related to scepticism toward conventional medicine and negatively related to perceived health status and satisfaction with clinic physicians. Knowledge about the incidence and determinants of these behaviors provides valuable information for clinicians in communicating with their patients and may eventually result in cost containment.

A simple, non-invasive marker of gastric damage: sucrose permeability

Disaccharides do not cross intact gastrointestinal mucosa to any appreciable extent unless there is damage to the epithelium. Furthermore, since sucrose is rapidly broken down in the small intestine, the absorption of intact sucrose implies damage to proximal epithelium. We have reported that measurement of sucrose permeability detects gastric damage in animals. Whilst such a non-specific test could not replace endoscopy, it might represent a clinically useful technique to identify patients who would benefit from endoscopy. 189 patients underwent endoscopy and assessment of sucrose permeability to evaluate the effectiveness of increased sucrose permeability in the prediction of endoscopic findings. The endoscopist was blinded to results of the sucrose assay. Gastric damage, particularly ulcers and severe gastritis, was successfully detected with this technique. Increased sucrose permeability, however, did not reliably detect mild gastritis, oesophagitis, or duodenal disease. The sensitivity of the test for gastric ulceration was 84% and specificity in predicting an abnormal endoscopy was 96%. Measurement of sucrose permeability is a simple way of screening for gastric damage. It has a sensitivity similar to that for upper gastrointestinal radiology and provides a new way to effectively screen large populations at risk of gastric damage.

Complementary and alternative medicine use by Canadian patients with inflammatory bowel disease: results from a national survey.

OBJECTIVES:Previous studies of complementary and alternative medicine (CAM) use by patients with inflammatory bowel disease (IBD) have relied on samples from specialty clinics. The aim of this study was to determine the prevalence of use and perceived outcomes of CAM in a large, diverse IBD populationMETHODS:A postal survey of the members of the Crohns and Colitis Foundation of Canada gathered data on demographic, disease, and conventional IBD treatment characteristics, and on the use and perceived effects of CAM. Respondents were characterized as not using CAM, as past or present users of CAM for their IBD, or as present users of CAM for other reasons. Comparisons between groups were made with the χ2 test.RESULTS:The final sample included 2847 IBD patients. Current or past use of CAM for IBD was reported by 1332 patients, of whom 666 continued their use of CAM. Use was lowest in the eastern provinces and highest in the west. Only 15% had used CAM before their IBD diagnosis. Herbal therapies were the most commonly used (41% of CAM users). Improvements in sense of well-being, IBD symptoms, and sense of control over the disease were the most commonly reported benefits. Only 16% of prior CAM users reported any adverse effect of CAM use. A complementary practitioner was consulted by 34%. During the previous year, 46% had spend more than

A population-based survey of complementary and alternative medicine use in men recently diagnosed with prostate cancer.

250 on CAM.CONCLUSIONS:Use of CAM by IBD patients is very common. Most of these patients attribute significant benefits to their CAM use. Few report significant adverse events.

Anterior knee pain: a review.

Purpose: To determine prevalence and patterns of use of complementary and alternative medicine (CAM) among men recently diagnosed with prostate cancer. Study Design: Men, diagnosed with prostate cancer over a 10-month period in British Columbia, Canada, were randomly selected to obtain a population-based sample. Methods: Surveys, addressing patient demographics, types of CAM therapies, and CAM information resources utilized, reasons for use, and disclosure to physician(s), were mailed to 1108 men newly diagnosed with prostate cancer. A 42% response rate was obtained. Results: Thirty-nine percent of patients used CAM therapies with the most common being herbal supplements (saw palmetto), vitamins (vitamin E), and minerals (selenium). The most common reasons given for choosing to use CAM therapies were to (1) boost the immune system and (2) prevent recurrence. The majority of men (58%) had told their physician(s) about their CAM use, but few utilized either their family physician (15%) or their oncologist (7%) as sources of CAM information. CAM users most commonly consulted friends or family (39%) or the Internet (19%) for information about CAM. CAM users were more likely than nonusers to delay (9%) or decline (4%) conventional treatment. Respondents who had never used CAM had typically never thought about it or did not have enough information about the treatments. Conclusions: More than one third of recently diagnosed prostate cancer patients utilize some form of CAM therapy, and the majority disclose their use to their physician(s). However, they tend to rely on anecdotal information for their CAM decision making. Dissemination of reliable CAM information is one key to helping men navigate this difficult arena.

Use of complementary and alternative medicine by patients with inflammatory bowel disease

ObjectiveTo establish whether there is consensus in the areas of definition, classification, assessment, diagnostic tests, and management of anterior knee pain. Data sourcesA Medline search for the years 1988–1995 was performed using the terms patellofemoral joint, knee joint and pain, injury and rehabilitation, and anterior knee pain. In addition, references from selected papers were examined. Study selectionA total of 77 references specifically related to anterior knee pain were reviewed in the areas of definition, classification, assessment, diagnostic tests, and management. Although a small number of these papers were analytic in their study design, most of the papers reviewed were descriptive. Data extractionDefinitive statements on anterior knee pain in the areas noted herein were extracted and summarized. Similar statements were then grouped as indicative of general consensus. Independent and divergent statements were also summarized for each area of anterior knee pain. Data synthesisMost of the literature related to anterior knee pain is subjective in nature and demonstrates limited consensus among experts. There is no generally accepted definition or classification of anterior knee pain. There was some agreement on the assessment, use of diagnostic tests, and management of anterior knee pain, but there are no definitive or objective management outcome criteria. ConclusionsThe scientific literature on anterior knee pain is sparse. This review supports a need for the development of consensus guidelines for anterior knee pain. A consensus approach to anterior knee pain could result in the more efficient use of high-yield diagnostic tests, the use of more effective and standardized protocols for assessment and treatment, increased patient satisfaction, and recommendations on fitness counseling and early prevention.

Can sonography predict the outcome in patients with Achillodynia

&NA; In this review article we provide a broad overview of complementary and alternative medicine (CAM) use in inflammatory bowel diseases (IBDs), including prevalence of use, common therapies used, and reasons for and factors associated with CAM use. CAM is commonly used by those suffering from IBD. Multiple forms of CAM are used to treat IBD, and often patients use multiple CAM therapies and continue to use conventional medical therapies. Patients using CAM report benefits that extend beyond simply improved disease control. Using CAM allows patients to exert a greater degree of control over their disease and its management than they are afforded by conventional medicine. There is limited evidence on the efficacy of CAM therapies in IBD. It is important for physicians caring for those with IBD to be familiar with common forms of CAM and to be able to provide general counseling to their patients about CAM use. Inflamm Bowel Dis 2011