Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut 06520-8040, USA.
Int J Radiat Oncol Biol Phys. 2013 Jan 1;85(1):40-6. doi: 10.1016/j.ijrobp.2012.03.025. Epub 2012 Jun 1.
Although complementary and alternative medicine (CAM) utilization in breast cancer patients is reported to be high, there are few data on CAM practices in breast patients specifically during radiation. This prospective, multi-institutional study was conducted to define CAM utilization in breast cancer during definitive radiation.
MATERIALS/METHODS: A validated CAM instrument with a self-skin assessment was administered to 360 Stage 0-III breast cancer patients from 5 centers during the last week of radiation. All data were analyzed to detect significant differences between users/nonusers.
CAM usage was reported in 54% of the study cohort (n=194/360). Of CAM users, 71% reported activity-based CAM (eg, Reiki, meditation), 26% topical CAM, and 45% oral CAM. Only 16% received advice/counseling from naturopathic/homeopathic/medical professionals before initiating CAM. CAM use significantly correlated with higher education level (P<.001), inversely correlated with concomitant hormone/radiation therapy use (P=.010), with a trend toward greater use in younger patients (P=.066). On multivariate analysis, level of education (OR: 6.821, 95% CI: 2.307-20.168, P<.001) and hormones/radiation therapy (OR: 0.573, 95% CI: 0.347-0.949, P=.031) independently predicted for CAM use. Significantly lower skin toxicity scores were reported in CAM users vs nonusers, respectively (mild: 34% vs 25%, severe: 17% vs 29%, P=.017).
This is the first prospective study to assess CAM practices in breast patients during radiation, with definition of these practices as the first step for future investigation of CAM/radiation interactions. These results should alert radiation oncologists that a large percentage of breast cancer patients use CAM during radiation without disclosure or consideration for potential interactions, and should encourage increased awareness, communication, and documentation of CAM practices in patients undergoing radiation treatment for breast cancer.
尽管有报道称乳腺癌患者会使用补充和替代医学（CAM），但针对乳腺癌患者在放疗期间具体使用 CAM 疗法的数据却很少。本前瞻性、多中心研究旨在明确乳腺癌患者在接受根治性放疗期间使用 CAM 的情况。
材料/方法：在放疗结束前一周，对来自 5 个中心的 360 例 0-III 期乳腺癌患者使用经过验证的 CAM 量表和自我皮肤评估进行评估。对所有数据进行分析，以检测使用者与非使用者之间的显著差异。
研究队列中有 54%（194/360）的患者报告使用了 CAM。在 CAM 用户中，71%（142/194）报告使用了活动型 CAM（如灵气疗法、冥想），26%（49/194）报告使用了局部 CAM，45%（88/194）报告使用了口服 CAM。仅 16%（31/194）在开始使用 CAM 之前接受过自然疗法/顺势疗法/医学专业人员的建议/咨询。CAM 的使用与较高的教育水平显著相关（P<.001），与同期激素/放疗的使用呈负相关（P=.010），且在年轻患者中呈使用趋势（P=.066）。多变量分析显示，教育程度（OR：6.821，95%CI：2.307-20.168，P<.001）和激素/放疗（OR：0.573，95%CI：0.347-0.949，P=.031）独立预测了 CAM 的使用。CAM 用户报告的皮肤毒性评分明显低于非使用者（轻度：34%比 25%，重度：17%比 29%，P=.017）。
这是第一项评估乳腺癌患者在放疗期间使用 CAM 情况的前瞻性研究，对这些做法的定义是未来研究 CAM 与放疗相互作用的第一步。这些结果应该提醒放疗科医生，有很大一部分乳腺癌患者在放疗期间会使用 CAM，但没有透露或考虑潜在的相互作用，应该鼓励提高对接受乳腺癌放疗患者的 CAM 实践的认识、沟通和记录。
