- Email: [email protected]
Complementary and alternative medicines used by cancer patients to cope with chemotherapy-induced constipation
Complementary Therapies in Clinical Practice 39 (2020) 101108
Contents lists available at ScienceDirect
Complementary Therapies in Clinical Practice journal homepage: http://www.elsevier.com/locate/ctcp
Complementary and alternative medicines used by cancer patients to cope with chemotherapy-induced constipation € _ Ismail Toygar a, *, Oznur Usta Yes¸ilbalkan a, Merve Kürkütlü b, Abdullah Aslan c a
Ege University, Faculty of Nursing, Internal Nursing Department, Izmir, Turkey Medical Park Hospital, Nurse, Izmir, Turkey c _ Ege University, Faculty of Medicine, Tülay Aktas¸ Oncology Hospital, Izmir, Turkey b
A R T I C L E I N F O
A B S T R A C T
Keywords: Complementary medicine Cancer Constipation Attitudes
Objectives: The aim of this study was to evaluate complementary and alternative medicines (CAM) used by cancer patients to cope with chemotherapy-induced constipation, and attitudes of the patients toward CAM. Methods: This descriptive study was conducted in an adult oncology unit of a university hospital with 214 cancer patients receiving chemotherapy. Data were collected with the Patient Identification Form and Holistic Com plementary and Alternative Medicine Questionnaire (HCAMQ). Results: Of the participants, 21.5% had information about CAM, the main source of information was the internet and social media (54.8%), and 31.8% used CAM in coping with chemotherapy-induced constipation. The most common method was phytotherapy (97.1%). The most commonly used herb was apricot (39.4%); the HCAMQ mean score was 34.3 (�4.6). Conclusion: Cancer patients frequently use CAM to cope with chemotherapy-induced constipation and the most common CAM used by patients is phytotherapy.
1. Introduction Cancer is a common health problem in Turkey and internationally. Cancer and the side effects of treatment cause many symptoms and negatively affect patients. Gastrointestinal, respiratory, genitourinary, fatigue, and nutritional symptoms are the most common symptoms appearing in cancer patients [1]. Among cancer patients who are receiving chemotherapy, con stipation (%31.9) is the third most common gastrointestinal symptom after nausea (59.6%) and anorexia (46%) [2]. With opioid treatment, the rate of constipation increases up to 85.7% in individuals suffering from cancer-related pain. The presence of constipation significantly re duces the quality of life of cancer patients. Constipation affects physical function, mental status, pain, social functions, roles and overall well-being of individuals [3]. The first step in the management of constipation caused by various types of cancer is prevention and stool softeners, laxatives, stimulants, and opioid antagonists are used [4]. In addition to pharmacological management, in the management of constipation other methods such as encouraging adequate fluid intake, high-fiber food consumption, mobility and regulation of toilet habits [5]. However, despite these
attempts, constipation remains an important problem for cancer patients. Most individuals who are experiencing constipation are using com plementary and alternative medicine (CAM). Some of the patients re ported that they think CAM is safer and therefore they prefer CAM over modern medicines [6]. It is reported that CAM usage frequency varies between 9% and 88% in cancer patients internationally and the average is around 40%. In Turkey, the prevalence is approximately 48% [7]. However, there is a gap in the literature regarding the frequency of CAM use for chemotherapy-induced constipation in cancer patients in Turkey. The aim of this study was to evaluate the frequency of CAM usage and the methods used to cope with chemotherapy-induced constipation in cancer patients living in Turkey and their attitudes toward CAM. 2. Materials and methods 2.1. Sample and setting The study used a descriptive research design. All patients admitted to the oncology department of a university hospital between March and October 2019, who were 18 years and old, had cancer diagnosis for six
* Corresponding author. Department of Internal Medicine Nursing, Ege University, PO Box 309, Bornova, Izmir, Turkey. _ Toygar). E-mail address: [email protected] (I. https://doi.org/10.1016/j.ctcp.2020.101108 Received 8 January 2020; Received in revised form 21 January 2020; Accepted 27 January 2020 Available online 28 January 2020 1744-3881/© 2020 Elsevier Ltd. All rights reserved.
_ Toygar et al. I.
Complementary Therapies in Clinical Practice 39 (2020) 101108
months or more and had received chemotherapy for three months or more participated in the study. Patients with chronic constipation were excluded from the study. A convenience sample of 214 patients was used.
Table 1 Distribution of characteristics.
participants’
Gender
2.1.1. Data collection A patient identification form developed by the researchers and the Holistic Complementary and Alternative Medicine Attitude Scale were used to collect data. _ Patient Identification Form: This form consists of 11 questions including the patient’s age, gender, marital status, income level, edu cation level, disease duration, CAM information status, opioid use status, herbal methods, and CAM usage for chemotherapy-induced constipation. Holistic Complementary and Alternative Medicines Question naire (HCAMQ): This is an 11 item, the self-completed questionnaire that measures attitudes to complementary and alternative medicine and holistic health beliefs. The lowest score in this questionnaire is 11 and the highest score is 66. A lower score indicates a more positive attitude towards holistic health belief and CAM. The questionnaire is valid and reliable for Turkish society. Chronbach’s alpha of the Turkish version of the scale was reported as 0.72 [8]. Chronbach’s alpha value of the scale in this study was 0.84.
Marital Status Education Level Income Level Living in Ref.
socio-demographic
and
Male Female Married Single Primary School High School University Income less than the expense Income is equal to the expense Income is higher than the expense Village Town City Metropolitan
disease-related n
%
85 129 178 36 109 49 56 52 117 45 18 24 51 121
39.7 60.3 83.2 16.8 51.0 22.9 26.2 24.3 54.7 21.0 8.4 11.2 23.8 56.5
X� SD Age Disease Duration (Month)
50.6 � 15.3 24.0 � 30.9
Table 2 Distribution of patients’ CAM-Related characteristics.
2.2. Data analysis Information on CAM
Data analysis was performed with SPSS 25.0. Descriptive data are presented by number (n), average and percentage (%). A t-test and oneway analysis of variance (ANOVA) were used to compare the total scores and sub-dimensions of the scale. A Post-Hoc Dunn test was used for multi-group comparisons.
Source of information
CAM usage
2.3. Ethics
Who recommended the CAM?
Written permission was obtained from the Medical Research Ethical Committee of the relevant university (Protocol: 19-6.1T/55), the hos pital (54148036-100). Informed consent was read and signed by each participant. All principles of the Helsinki declaration were followed throughout the study.
CAM Method Used as
Yes No Health professionals Internet and social media Press Scientific Books Other Patients Yes No Health professionals Internet and social media Scientific Books Other Patients Phytotherapy Music Therapy Complementary Alternative
n
%
72 142 11 46 9 8 10 68 146 19 7 2 38 66 2 32 36
21.5 78.5 13.1 54.8 10.7 9.5 11.9 31.8 68.2 28.8 10.6 3.0 57.6 97.1 2.9 47.1 52.9
3. Results Table 3 Herbs and usage details of the participants.
The mean age of the participants was 50.6 (�15.3) years and the mean disease duration was 24.0 (�30.9) months. Most participants were female (60.3%) and married (83.2%), and were primary school gradu ates (51.0%). Other sociodemographic and disease-related characteris tics are presented in Table 1. Of the participants, 21.5% had information on CAM and the main source of this information was the internet and social media (54.8%). Of the participants, 31.8% reported that they were using at least one CAM. They used the method mainly on the recommendation of other patients (57.6%) (Table 2). Among the participants, the most common method used by patients was phytotherapy with 97.1%. The most commonly used substance for chemotherapy-induced constipation was apricot, followed by olive oil, ginger and herbal teas. The most frequently consumed part of the plants was fruit (90.4%), and the most common form of consumption was eating (43.9%) (Table 3). A statistically significant difference was found between males and females in terms of the CAM sub-dimension (p ¼ 0.040) and the ques tionnaire total score (p ¼ 0.040). A statistically significant difference was found between the educational level of the patients and the holistic health subscale (p ¼ 0.020) and the total score of the scale (p ¼ 0.005). A statistically significant relationship was found between where they are living and the holistic health (p ¼ 0.016) and the total score of the scale (p ¼ 0.007) (Table 4).
Herbs/Herbal Product
The part of the herbs
Consuming
2
Apricot Olive oil Ginger Herbal teas Herbal drugs Black mulberry Black cumin oil Molasses Linden Arugula Fig Corn Fruit Leaf Body Root Boil and drink Direct drink Eat Other
n
%
26 19 5 4 3 2 2 1 1 1 1 1 57 2 2 2 10 22 29 5
39.4 28.8 7.6 6.1 4.6 3.0 3.0 1.5 1.5 1.5 1.5 1.5 90.4 3.2 3.2 3.2 15.2 33.3 43.9 7.6
_ Toygar et al. I.
Complementary Therapies in Clinical Practice 39 (2020) 101108
In the current study, apricot was the most commonly used herb. Zhong et al. (2016) reported that the most commonly used mixture in Chinese herbal medicine is Ma-Zi-Ren-Wan (MZRW), which also con tains apricot [15]. Nimruzi et al. (2015) reported that the fruit part of apricot was used for constipation [16]. Internationally, apricot is one of the most widely used herbal therapies in our country. Another herbal product commonly used by the patients in our study is olive oil. Ishikawo Ramos et al. (2014) reported that olive oil is a frequently used and effective method [17]. This aspect of our study is consistent with the literature. We found that cancer patients had positive attitudes towards CAM. Wode et al. (2019) reported that CAM use is widespread and individuals’ attitude towards CAM is positive [11]. Our study is consistent with the literature in this respect.
Table 4 Distribution of the total scale and sub-dimension of HCAMQ in groups. Holistic Health
Complementary and Alternative Medicine
Total
Gender Male
9.8 � 3.0
24.2 � 3.2
Female
9.5 � 3.7
24.2 � 3.8
p ¼ 0.601
p ¼ 0.040
Education Level Primary School
35.1 � 4.0 33.8 � 4.9 p¼ 0.046
10.3 � 3.6
24.9 � 3.5
High School
8.7 � 2.6
23.9 � 3.8
University
9.5 � 3.4
24.8 � 3.4
p ¼ 0.020
p ¼ 0.287
9.2 � 3.2 9.8 � 3.5 9.8 � 3.6 11.9 � 3.7 p ¼ 0.016
24.6 � 3.7 23.9 � 2.9 25.9 � 4.3 25.3 � 2.5 p ¼ 0.104
33.8 33.7 35.8 37.2 p¼ 0.007
9.8 � 3.5
24.5 � 3.3
9.6 � 3.6
24.6 � 3.4
9.6 � 2.9
24.8 � 4.3
p ¼ 0.961
p ¼ 0.893
9.8 � 3.4
24.6 � 3.6
34.3 � 4.4 34.3 � 4.4 34.4 � 5.3 p¼ 0.969 34.3 � 4.6
Living in Ref. Metropolitan City Town Village Income Level Income less than the expense Income is equal to the expense Income is higher than the expense Total
35.1 � 4.4 32.6 � 5.0 34.2 � 4.1 p¼ 0.005
4.1. Limitations The study was conducted with participants diagnosed with cancer, but there was no particular cancer group. The participants were patients admitted to the hospital, the study is not necessarily generalizable. 4.2. Implications for practice Health professionals should be aware of high CAM usage among cancer patients who are experiencing chemotherapy-induced con stipation. The main source of the information on CAM is possibly un reliable. To provide patient information, the attitudes of health professionals should be improved. Health professionals also have to improve their knowledge of CAM. Thereby, patients may consult health professionals instead of unreliable sources. 5. Conclusion Wea found that CAM is common in coping with chemotherapyinduced constipation, herbal therapy is the most commonly used method, and individuals’ attitude towards CAM is positive. It was determined that individuals’ information sources on CAM were mainly internet and social media instead of scientific sources or health professionals.
4. Discussion The use of CAM is becoming increasingly common in Turkey and internationally. Cancer patients also use CAM in managing various symptoms. The aim of this study was to determine the CAM used to cope with chemotherapy-induced constipation and the attitude of individuals toward CAM. We found that only 21.5% of the patients had information on CAM and the main source of this information was the internet and social media (54.8%). Shih et al. (2009) reported that friends are the main source of information on CAM [9]. Farooqui et al. (2016) reported that the media and internets were the third main sources of information on CAM after friends and family members [10]. Wode et al. (2019) reported that the internet is the main source of information on CAM [11]. Pre sumably, with the increasing role of the internet and social media, the source of information about CAM has also changed. In our study, 31.8% of the patients were using at least one CAM. In a study conducted in the United Kingdom, Posadzki et al. (2013) reported the use of CAM in a 12-month period as 41.1% [12]. Horneber et al. (2012) reported the use of CAM in cancer patients as being 40% in a systematic review of studies conducted in five different regions (Australia, Canada, Europe, New Zealand, United States) [7]. Wode et al. (2019) reported that CAM use was 34% lifelong and 26% after cancer diagnosis [11]. The results of our study are congruent with the literature in this respect. We found that two cancer patients (%2.9) were using music therapy to cope with chemotherapy-induced constipation. In the literature, there was no relationship reported between music therapy and constipation. However, constipation is associated with a high level of anxiety [13]. Music therapy is well known for its effect on anxiety [14]. We consider that this may be the reason for using music therapy for chemotherapy-induced constipation.
Funding There were not any funding to conduct study. Declaration of competing interest None. CRediT authorship contribution statement _ Ismail Toygar: Conceptualization, Methodology, Formal analysis, € Writing - original draft, Visualization. Oznur Usta Yes¸ ilbalkan: Conceptualization, Writing - review & editing, Data curation, Supervi sion. Merve Kürkütlü: Conceptualization, Methodology, Resources, Data curation. Abdullah Aslan: Conceptualization, Methodology, Data curation. Acknowledgement € We thank all patients for their collaboration and Su Ozgür for sta tistical analysis. Appendix A. Supplementary data Supplementary data to this article can be found online at https://doi. org/10.1016/j.ctcp.2020.101108. 3
_ Toygar et al. I.
Complementary Therapies in Clinical Practice 39 (2020) 101108
References
[9] V. Shih, J.Y.L. Chiang, A. Chan, Complementary and alternative medicine (CAM) usage in Singaporean adult cancer patients, Ann. Oncol. 20 (4) (2009) 752–757. [10] M. Farooqui, M.A. Hassali, A.K.A. Shatar, M.A. Farooqui, F. Saleem, N. ul Haq, et al., Use of complementary and alternative medicines among Malaysian cancer patients: a descriptive study, J. Tradit., Complementary Med. 6 (4) (2016) 321–326. [11] K. Wode, R. Henriksson, L. Sharp, A. Stoltenberg, J.H. Nordberg, Cancer patients’ use of complementary and alternative medicine in Sweden: a cross-sectional study, BMC Compl. Alternative Med. 19 (1) (2019) 62, 1-11. [12] P. Posadzki, L.K. Watson, A. Alotaibi, E. Ernst, Prevalence of use of complementary and alternative medicine (CAM) by patients/consumers in the UK: systematic review of surveys, Clin. Med. 13 (2) (2013) 126–131. [13] S.T. Hosseinzadeh, S. Poorsaadati, B. Radkani, M. Forootan, Psychological disorders in patients with chronic constipation, Gastroenterol. Hepatol. Bed Bench 4 (3) (2011) 159. [14] J.H. Wakim, S. Smith, C. Guinn, The efficacy of music therapy, J. PeriAnesthesia Nurs. 25 (4) (2010) 226–232. [15] L.L. Zhong, G. Zheng, L. Das Ge, C.Y. Lin, T. Huang, L. Zhao, et al., Chinese herbal medicine for constipation: zheng-based associations among herbs, formulae, proprietary medicines, and herb–drug interactions, Chin. Med. 11 (1) (2016) 28, 111. [16] M. Nimrouzi, M.M. Zarshenas, Holistic approach to functional constipation: perspective of traditional Persian medicine, Chin. J. Integr. Med. (2015) 1–6. [17] C.I. Ramos, A.F.A. de Lima, D.G. Grilli, L. Cuppari, The short-term effects of olive oil and flaxseed oil for the treatment of constipation in hemodialysis patients, J. Ren. Nutr. 25 (1) (2015) 50–56.
[1] A. Jim� enez, R. Madero, A. Alonso, V. Martínez-Marín, Y. Vilches, B. Martínez, et al., Symptom clusters in advanced cancer, J. Pain Symptom Manag. 42 (1) (2011) 24–31. [2] K. S� anchez-Lara, E. Ugalde-Morales, D. Motola-Kuba, D. Green, Gastrointestinal symptoms and weight loss in cancer patients receiving chemotherapy, Br. J. Nutr. 109 (5) (2013) 894–897. [3] L. Abramowitz, N. B�eziaud, L. Labreze, V. Giardina, C. Causs�e, B. Chuberre, et al., Prevalence and impact of constipation and bowel dysfunction induced by strong opioids: a cross-sectional survey of 520 patients with cancer pain: DYONISOS study, J. Med. Econ. 16 (12) (2013) 1423–1433. [4] L.K. Do Shoemaker, B. Estfan, R. Induru, T.D. Walsh, Symptom management: an important part of cancer care, Cleve. Clin. J. Med. 78 (1) (2011) 25–34. [5] S.L. Librach, M. Bouvette, C. De Angelis, J. Farley, D. Oneschuk, J.L. Pereira, Canadian consensus development group for constipation in patients with advanced progressive illness. Consensus recommendations for the management of constipation in patients with advanced, progressive illness, J. Pain Symptom Manag. 40 (5) (2010) 761–773. [6] E.P. Cherniack, Use of complementary and alternative medicine to treat constipation in the elderly, Geriatr. Gerontol. Int. 13 (3) (2013) 533–538. [7] M. Horneber, G. Bueschel, G. Dennert, D. Less, E. Ritter, M. Zwahlen, How many cancer patients use complementary and alternative medicine: a systematic review and metaanalysis, Integr. Canc. Ther. 11 (3) (2012) 187–203. [8] B. Erci, Attitudes towards holistic complementary and alternative medicine: a sample of healthy people in Turkey, J. Clin. Nurs. 16 (4) (2007) 761–768.
4
Contents lists available at ScienceDirect
Complementary Therapies in Clinical Practice journal homepage: http://www.elsevier.com/locate/ctcp
Complementary and alternative medicines used by cancer patients to cope with chemotherapy-induced constipation € _ Ismail Toygar a, *, Oznur Usta Yes¸ilbalkan a, Merve Kürkütlü b, Abdullah Aslan c a
Ege University, Faculty of Nursing, Internal Nursing Department, Izmir, Turkey Medical Park Hospital, Nurse, Izmir, Turkey c _ Ege University, Faculty of Medicine, Tülay Aktas¸ Oncology Hospital, Izmir, Turkey b
A R T I C L E I N F O
A B S T R A C T
Keywords: Complementary medicine Cancer Constipation Attitudes
Objectives: The aim of this study was to evaluate complementary and alternative medicines (CAM) used by cancer patients to cope with chemotherapy-induced constipation, and attitudes of the patients toward CAM. Methods: This descriptive study was conducted in an adult oncology unit of a university hospital with 214 cancer patients receiving chemotherapy. Data were collected with the Patient Identification Form and Holistic Com plementary and Alternative Medicine Questionnaire (HCAMQ). Results: Of the participants, 21.5% had information about CAM, the main source of information was the internet and social media (54.8%), and 31.8% used CAM in coping with chemotherapy-induced constipation. The most common method was phytotherapy (97.1%). The most commonly used herb was apricot (39.4%); the HCAMQ mean score was 34.3 (�4.6). Conclusion: Cancer patients frequently use CAM to cope with chemotherapy-induced constipation and the most common CAM used by patients is phytotherapy.
1. Introduction Cancer is a common health problem in Turkey and internationally. Cancer and the side effects of treatment cause many symptoms and negatively affect patients. Gastrointestinal, respiratory, genitourinary, fatigue, and nutritional symptoms are the most common symptoms appearing in cancer patients [1]. Among cancer patients who are receiving chemotherapy, con stipation (%31.9) is the third most common gastrointestinal symptom after nausea (59.6%) and anorexia (46%) [2]. With opioid treatment, the rate of constipation increases up to 85.7% in individuals suffering from cancer-related pain. The presence of constipation significantly re duces the quality of life of cancer patients. Constipation affects physical function, mental status, pain, social functions, roles and overall well-being of individuals [3]. The first step in the management of constipation caused by various types of cancer is prevention and stool softeners, laxatives, stimulants, and opioid antagonists are used [4]. In addition to pharmacological management, in the management of constipation other methods such as encouraging adequate fluid intake, high-fiber food consumption, mobility and regulation of toilet habits [5]. However, despite these
attempts, constipation remains an important problem for cancer patients. Most individuals who are experiencing constipation are using com plementary and alternative medicine (CAM). Some of the patients re ported that they think CAM is safer and therefore they prefer CAM over modern medicines [6]. It is reported that CAM usage frequency varies between 9% and 88% in cancer patients internationally and the average is around 40%. In Turkey, the prevalence is approximately 48% [7]. However, there is a gap in the literature regarding the frequency of CAM use for chemotherapy-induced constipation in cancer patients in Turkey. The aim of this study was to evaluate the frequency of CAM usage and the methods used to cope with chemotherapy-induced constipation in cancer patients living in Turkey and their attitudes toward CAM. 2. Materials and methods 2.1. Sample and setting The study used a descriptive research design. All patients admitted to the oncology department of a university hospital between March and October 2019, who were 18 years and old, had cancer diagnosis for six
* Corresponding author. Department of Internal Medicine Nursing, Ege University, PO Box 309, Bornova, Izmir, Turkey. _ Toygar). E-mail address: [email protected] (I. https://doi.org/10.1016/j.ctcp.2020.101108 Received 8 January 2020; Received in revised form 21 January 2020; Accepted 27 January 2020 Available online 28 January 2020 1744-3881/© 2020 Elsevier Ltd. All rights reserved.
_ Toygar et al. I.
Complementary Therapies in Clinical Practice 39 (2020) 101108
months or more and had received chemotherapy for three months or more participated in the study. Patients with chronic constipation were excluded from the study. A convenience sample of 214 patients was used.
Table 1 Distribution of characteristics.
participants’
Gender
2.1.1. Data collection A patient identification form developed by the researchers and the Holistic Complementary and Alternative Medicine Attitude Scale were used to collect data. _ Patient Identification Form: This form consists of 11 questions including the patient’s age, gender, marital status, income level, edu cation level, disease duration, CAM information status, opioid use status, herbal methods, and CAM usage for chemotherapy-induced constipation. Holistic Complementary and Alternative Medicines Question naire (HCAMQ): This is an 11 item, the self-completed questionnaire that measures attitudes to complementary and alternative medicine and holistic health beliefs. The lowest score in this questionnaire is 11 and the highest score is 66. A lower score indicates a more positive attitude towards holistic health belief and CAM. The questionnaire is valid and reliable for Turkish society. Chronbach’s alpha of the Turkish version of the scale was reported as 0.72 [8]. Chronbach’s alpha value of the scale in this study was 0.84.
Marital Status Education Level Income Level Living in Ref.
socio-demographic
and
Male Female Married Single Primary School High School University Income less than the expense Income is equal to the expense Income is higher than the expense Village Town City Metropolitan
disease-related n
%
85 129 178 36 109 49 56 52 117 45 18 24 51 121
39.7 60.3 83.2 16.8 51.0 22.9 26.2 24.3 54.7 21.0 8.4 11.2 23.8 56.5
X� SD Age Disease Duration (Month)
50.6 � 15.3 24.0 � 30.9
Table 2 Distribution of patients’ CAM-Related characteristics.
2.2. Data analysis Information on CAM
Data analysis was performed with SPSS 25.0. Descriptive data are presented by number (n), average and percentage (%). A t-test and oneway analysis of variance (ANOVA) were used to compare the total scores and sub-dimensions of the scale. A Post-Hoc Dunn test was used for multi-group comparisons.
Source of information
CAM usage
2.3. Ethics
Who recommended the CAM?
Written permission was obtained from the Medical Research Ethical Committee of the relevant university (Protocol: 19-6.1T/55), the hos pital (54148036-100). Informed consent was read and signed by each participant. All principles of the Helsinki declaration were followed throughout the study.
CAM Method Used as
Yes No Health professionals Internet and social media Press Scientific Books Other Patients Yes No Health professionals Internet and social media Scientific Books Other Patients Phytotherapy Music Therapy Complementary Alternative
n
%
72 142 11 46 9 8 10 68 146 19 7 2 38 66 2 32 36
21.5 78.5 13.1 54.8 10.7 9.5 11.9 31.8 68.2 28.8 10.6 3.0 57.6 97.1 2.9 47.1 52.9
3. Results Table 3 Herbs and usage details of the participants.
The mean age of the participants was 50.6 (�15.3) years and the mean disease duration was 24.0 (�30.9) months. Most participants were female (60.3%) and married (83.2%), and were primary school gradu ates (51.0%). Other sociodemographic and disease-related characteris tics are presented in Table 1. Of the participants, 21.5% had information on CAM and the main source of this information was the internet and social media (54.8%). Of the participants, 31.8% reported that they were using at least one CAM. They used the method mainly on the recommendation of other patients (57.6%) (Table 2). Among the participants, the most common method used by patients was phytotherapy with 97.1%. The most commonly used substance for chemotherapy-induced constipation was apricot, followed by olive oil, ginger and herbal teas. The most frequently consumed part of the plants was fruit (90.4%), and the most common form of consumption was eating (43.9%) (Table 3). A statistically significant difference was found between males and females in terms of the CAM sub-dimension (p ¼ 0.040) and the ques tionnaire total score (p ¼ 0.040). A statistically significant difference was found between the educational level of the patients and the holistic health subscale (p ¼ 0.020) and the total score of the scale (p ¼ 0.005). A statistically significant relationship was found between where they are living and the holistic health (p ¼ 0.016) and the total score of the scale (p ¼ 0.007) (Table 4).
Herbs/Herbal Product
The part of the herbs
Consuming
2
Apricot Olive oil Ginger Herbal teas Herbal drugs Black mulberry Black cumin oil Molasses Linden Arugula Fig Corn Fruit Leaf Body Root Boil and drink Direct drink Eat Other
n
%
26 19 5 4 3 2 2 1 1 1 1 1 57 2 2 2 10 22 29 5
39.4 28.8 7.6 6.1 4.6 3.0 3.0 1.5 1.5 1.5 1.5 1.5 90.4 3.2 3.2 3.2 15.2 33.3 43.9 7.6
_ Toygar et al. I.
Complementary Therapies in Clinical Practice 39 (2020) 101108
In the current study, apricot was the most commonly used herb. Zhong et al. (2016) reported that the most commonly used mixture in Chinese herbal medicine is Ma-Zi-Ren-Wan (MZRW), which also con tains apricot [15]. Nimruzi et al. (2015) reported that the fruit part of apricot was used for constipation [16]. Internationally, apricot is one of the most widely used herbal therapies in our country. Another herbal product commonly used by the patients in our study is olive oil. Ishikawo Ramos et al. (2014) reported that olive oil is a frequently used and effective method [17]. This aspect of our study is consistent with the literature. We found that cancer patients had positive attitudes towards CAM. Wode et al. (2019) reported that CAM use is widespread and individuals’ attitude towards CAM is positive [11]. Our study is consistent with the literature in this respect.
Table 4 Distribution of the total scale and sub-dimension of HCAMQ in groups. Holistic Health
Complementary and Alternative Medicine
Total
Gender Male
9.8 � 3.0
24.2 � 3.2
Female
9.5 � 3.7
24.2 � 3.8
p ¼ 0.601
p ¼ 0.040
Education Level Primary School
35.1 � 4.0 33.8 � 4.9 p¼ 0.046
10.3 � 3.6
24.9 � 3.5
High School
8.7 � 2.6
23.9 � 3.8
University
9.5 � 3.4
24.8 � 3.4
p ¼ 0.020
p ¼ 0.287
9.2 � 3.2 9.8 � 3.5 9.8 � 3.6 11.9 � 3.7 p ¼ 0.016
24.6 � 3.7 23.9 � 2.9 25.9 � 4.3 25.3 � 2.5 p ¼ 0.104
33.8 33.7 35.8 37.2 p¼ 0.007
9.8 � 3.5
24.5 � 3.3
9.6 � 3.6
24.6 � 3.4
9.6 � 2.9
24.8 � 4.3
p ¼ 0.961
p ¼ 0.893
9.8 � 3.4
24.6 � 3.6
34.3 � 4.4 34.3 � 4.4 34.4 � 5.3 p¼ 0.969 34.3 � 4.6
Living in Ref. Metropolitan City Town Village Income Level Income less than the expense Income is equal to the expense Income is higher than the expense Total
35.1 � 4.4 32.6 � 5.0 34.2 � 4.1 p¼ 0.005
4.1. Limitations The study was conducted with participants diagnosed with cancer, but there was no particular cancer group. The participants were patients admitted to the hospital, the study is not necessarily generalizable. 4.2. Implications for practice Health professionals should be aware of high CAM usage among cancer patients who are experiencing chemotherapy-induced con stipation. The main source of the information on CAM is possibly un reliable. To provide patient information, the attitudes of health professionals should be improved. Health professionals also have to improve their knowledge of CAM. Thereby, patients may consult health professionals instead of unreliable sources. 5. Conclusion Wea found that CAM is common in coping with chemotherapyinduced constipation, herbal therapy is the most commonly used method, and individuals’ attitude towards CAM is positive. It was determined that individuals’ information sources on CAM were mainly internet and social media instead of scientific sources or health professionals.
4. Discussion The use of CAM is becoming increasingly common in Turkey and internationally. Cancer patients also use CAM in managing various symptoms. The aim of this study was to determine the CAM used to cope with chemotherapy-induced constipation and the attitude of individuals toward CAM. We found that only 21.5% of the patients had information on CAM and the main source of this information was the internet and social media (54.8%). Shih et al. (2009) reported that friends are the main source of information on CAM [9]. Farooqui et al. (2016) reported that the media and internets were the third main sources of information on CAM after friends and family members [10]. Wode et al. (2019) reported that the internet is the main source of information on CAM [11]. Pre sumably, with the increasing role of the internet and social media, the source of information about CAM has also changed. In our study, 31.8% of the patients were using at least one CAM. In a study conducted in the United Kingdom, Posadzki et al. (2013) reported the use of CAM in a 12-month period as 41.1% [12]. Horneber et al. (2012) reported the use of CAM in cancer patients as being 40% in a systematic review of studies conducted in five different regions (Australia, Canada, Europe, New Zealand, United States) [7]. Wode et al. (2019) reported that CAM use was 34% lifelong and 26% after cancer diagnosis [11]. The results of our study are congruent with the literature in this respect. We found that two cancer patients (%2.9) were using music therapy to cope with chemotherapy-induced constipation. In the literature, there was no relationship reported between music therapy and constipation. However, constipation is associated with a high level of anxiety [13]. Music therapy is well known for its effect on anxiety [14]. We consider that this may be the reason for using music therapy for chemotherapy-induced constipation.
Funding There were not any funding to conduct study. Declaration of competing interest None. CRediT authorship contribution statement _ Ismail Toygar: Conceptualization, Methodology, Formal analysis, € Writing - original draft, Visualization. Oznur Usta Yes¸ ilbalkan: Conceptualization, Writing - review & editing, Data curation, Supervi sion. Merve Kürkütlü: Conceptualization, Methodology, Resources, Data curation. Abdullah Aslan: Conceptualization, Methodology, Data curation. Acknowledgement € We thank all patients for their collaboration and Su Ozgür for sta tistical analysis. Appendix A. Supplementary data Supplementary data to this article can be found online at https://doi. org/10.1016/j.ctcp.2020.101108. 3
_ Toygar et al. I.
Complementary Therapies in Clinical Practice 39 (2020) 101108
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