of CAM and the quality of life (QoL), anxiety and depression ... Quality of life and breast cancer. 963 ..... Morris KT, Johnson N, Homer L, Walts D. A comparison of.
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Original Article
Depression, anxiety and quality of life through the use of complementary and alternative medicine among breast cancer patients in Turkey ABSTRACT Background and Aim: Breast cancer is the most common type of cancer amongst women today. The aim of this study was to examine the association between complementary and alternative medicine (CAM) and the quality of life (QoL), anxiety and depression and demographic characteristics of women with breast cancer. Materials and Methods: QoL was measured by the European Organization for Treatment and Research of Cancer quality of life core questionnaire (QLQ‑C30, version 3.0) and anxiety and depression was measured by the hospital anxiety and depression scale. Results: In total, 122 patients with breast cancer were enrolled in the study and 50% (n = 61) of them reported that they were using CAM. The most commonly used CAM methods were stinging nettle (57%) and prayer and spiritual healing (49%). No relationship was found between the use of CAM and the patient’s age, time to diagnosis, cancer stage, chemotherapy use, smoking and residence. However, the analyses showed a positive association between CAM and role functioning (P = 0.014) and financial difficulties (P = 0.011); and a negative association between CAM and emotional functioning (P = 0.033). Conclusions: Based on the previous studies, 20‑83.3% of breast cancer patients among different countries and cultures used CAM. Our results suggested that the use of CAM among women is quite popular, but they showed no correlation between CAM usage and anxiety and depression. In addition, CAM usage was more common in breast cancer patients with a poor emotional and financial status. KEY WORDS: Anxiety, breast cancer, complementary and alternative medicine, depression, quality of life, Turkey
INTRODUCTION Breast cancer is the most common type of cancer among women. Despite the improving survival rate with new treatment strategies, breast cancer is still not a curative disease. There is a tendency toward the use of complementary and alternative medicine (CAM) among cancer patients and the general population world‑wide.[1] Breast cancer patients are more likely to be CAM users than patients with other types of cancer. According to several studies, the prevalence of CAM usage varied anywhere between 20% and 98% respectively. [2‑8] According to the World Health Organization definition, the term CAM is used interchangeably with “traditional medicine” and refers to a broad set of health care practices, including traditional Chinese medicine, acupuncture, herbal preparations, vitamins, homeopathic remedies, music therapy and other psychological, physical and spiritual techniques.[9,10] The aim of the following study was to examine the association between the usage 962
of CAM and the quality of life (QoL), anxiety and depression and demographic characteristics of women with breast cancer living in the southeast region of Turkey. MATERIALS AND METHODS The use of CAM by breast cancer patients were measured with a standard form which they filled out. The form was used to discover the association between CAM usage and depression, anxiety and QoL. All patients were asked if they were using CAMs such as green tea, stinging nettle, prayer and spiritual healing, vitamins, exercise, honey, massage, music, art, dance, meditation, kefir, ginger, black cumin, cinnamon, daisy and carob.
Mehmet Emin Kalender, Hakan Buyukhatipoglu, Ozan Balakan, Ali Suner, Ahmet Dirier1, Alper Sevinc, Feridun Bulbul2, Ali Murat Tatli3, Turgay Ulas4, Celaletdin Camci Departments of Medical Oncology, and 1 Radiation Oncology, Medical Faculty, Gaziantep Oncology Hospital, 2Department of Psychiatry, Medical Faculty, Gaziantep University, Gaziantep, 3 Department of Medical Oncology, School of Medicine, Akdeniz University, Antalya, 4 Department of Medical Oncology, School of Medicine, Harran University, Sanliurfa, Turkey For correspondence: Prof. Hakan, Buyukhatipoglu, Department of Medical Oncology, School of Medicine, Gaziantep University, 27310 Gaziantep, Turkey, E-mail: buyukhatipoglu@ gmail.com
Access this article online Website: www.cancerjournal.net DOI: 10.4103/0973-1482.138010 PMID: *** Quick Response Code:
QoL was measured with the European Organization for Treatment and Research of Cancer (EORTC) quality of life core questionnaire (QLQ‑C30, version 3.0). Anxiety and depression was measured with the hospital anxiety and depression scale (HADS). Journal of Cancer Research and Therapeutics - October-December 2014 - Volume 10 - Issue 4
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Kalender, et al.: Quality of life and breast cancer
The QLQ‑C30 scale includes five functional scales, three symptom scales, one global health status/QoL scale and six single items. Row scores for each item ranged from 0 to 100. A high score for a functional scale indicates a healthier level of functioning. A high score level for the global health status and QoL indicates a better QoL. However, a high score for a symptom scale indicates a higher level of symptomatology and problems.[11] The HADS questionnaire includes seven items which reflect anxiety and seven items which reflect depression. Each item is scored on a scale of 0‑3 points. The total score for the questionnaire ranges from 0 to 21. Scores of 0‑7 are considered “normal,” 8‑10 “borderline” and above 10 represents a mood disorder.[12] Statistical analyses were performed using SPSS 11.0 for Windows (SPSS, Chicago, IL, USA). (We provided the manufacturer details) We used the Student’s t‑test to compare clinical and demographic characteristics between CAM users and non‑users. For the bivariate correlation analyses, we used the Pearson’s correlation test. P < 0.05 was considered to be statistically significant. RESULTS In total, 122 patients with breast cancer were enrolled into the study and 50% (n = 61) of patients reported that they were using at least one type of CAM. Characteristics of patients are demonstrated in Table 1. CAMs that were used by the patients are shown in Table 2. The most commonly used CAM methods were stinging nettle (57%) and prayer and spiritual healing (49%). Eleven patients (18%) began to use CAM according to their doctors’ advice, but the majority of patients (82%) began CAM use by their own volition, or through other people’s advice such as their partners, neighbors, relatives or some other acquaintance. The statistical analysis showed that CAM usage was more common when the education level was higher (P = 0.031).
No relationship was noted between the use of CAM and age, time since diagnosis, cancer stage, chemotherapy use, smoking and residence. The mean results of EORTC QLQ‑C30 and the relationship between CAM usages are shown in Table 3. We found a significant difference between CAM user and non‑users in terms of role functioning (P = 0.014) and financial difficulties (P = 0.011). However, emotional functioning score was higher in non‑CAM users than in CAM users (P = 0.033). (We did not use the abbreviations for emotional functioning, financial difficulties, and role functioning, and performed to the whole manuscript). The relationship between CAM usage and HADS is shown in Table 4. No difference was noted in CAM users and non‑users in terms of anxiety and depression. The RF2 (P = 0.02), EF (P = 0.047), fatigue (P = 0.038), Pain (PA) (P = 0.043) and depression results (P = 0.008) were better in patients with a higher education level. The results of EF (P = 0.006), cognitive functioning (P = 0.027), PA (P = 0.025), dyspnea (P = 0.045) and diarrhea (P
