Department of Surgery

Deakin University Honours Project #4

Supervisor(s)

Prof David Watters, Dr Eileen Moore

 

 

Location

Department of Surgery, Deakin University; University Hospital Geelong, Barwon Health.

 

 

Project description

Complementary or alternative medicines (CAM) are commonly used in the community.  A number of alternative medicines are known to interact with commonly prescribed drugs, and a number are known to affect blood clotting (as well as other physiological effects).  A previous study at University Hospital Geelong in 2013 identified that up to 46% of surgical patients had used complementary or alternative medicines at some time, 21.5% were current CAM users at the time of admission for surgery.  Despite this high rate of CAM use, medical histories recorded <2% of CAM use amongst patients.  The previous study identified that most CAM users were female, and the most common CAM used was Omega-3 fish oil products.  The current study will aim to confirm these trends and to determine what the impacts of these may be on surgical outcomes.  Therefore, the prevalence of alternative medicine use in surgical inpatients, and the outcomes of surgery and post-operative complications will be studied. 

 

Patients admitted for elective and emergency surgery within a six month period in 2016 will be recruited.  Main outcome measures will be the rate of CAM use among patients admitted for surgery, and information about what types of CAM are used.  Medical records will be assessed to evaluate whether patient CAM use is recorded in medical histories.  Surgical outcomes and post-operative complications (such as length of hospital stay, re-admission, and rate of infection) will be studied to investigate impacts of CAM use.

 

Complementary and alternative medicines (CAM) encompass a wide range of modalities; the most common of which are psychological and spiritual therapies (65%), vitamins and minerals (46%), and herbal medicines (42%).[1] More females access CAM than males (59% versus 36%)[2]; other predictors for CAM use include vegetarian diet, age younger than 50 years, fatigue, bowel changes, recommendation to use CAM by a physician, and recommendation to use chemotherapy.[1]  Patterns of CAM use has been extensively studied in cancer patients, and especially amongst patients with breast cancer.[3-9] A high rate of CAM use of between 45% and 49.6% is seen amongst cancer patients in the UK[10], Canada[11], and Norway.[12]

 

Among colorectal cancer patients, between 21.5% and 83.3% of surgical patients use CAM at admission for surgery.[1,2,13,14] Differences between these studies may be reflective of trends in CAM use in the study populations, or differences in modalities for CAM use which are included in the definitions used, or differences in demographics between study populations themselves (e.g. CAM use amongst older patients, over 50 years of age, is less common than among younger patients).  A further confounder is that the rate of CAM use is very high amongst patients with irritable bowel syndrome, for which one review suggests there is evidence to support the efficacy of hypnotherapy, herbal supplements and probiotic use.[15] Including larger numbers of these patients in the populations studied will tend to overestimate CAM utilisation amongst cancer patients.  Therefore there is a need to establish very clear definitions for what constitutes CAM use and to study the impacts of these in very well defined patient groups.  This information will aide surgical teams to provide best practice advice to their patients for starting, continuing, or ceasing the use of CAMs.     

 

Complementary or alternative medicines are commonly used in the community.  A number of alternative medicines are known to interact with commonly prescribed drugs, and a number are known to affect blood clotting (as well as other physiological effects).  It is not known that utilization of CAMs may be very high amongst patients seen for colorectal surgery, however it is not known what impacts these may have on surgical outcomes.  The purpose of this study is to determine the prevalence of alternative medicine use in surgical inpatients.  The outcome of surgery in terms of complications will be studied. 

 

 

 

 

REFERENCES

[1]   Tough SC, Johnston DW, Verhoef MJ, Arthur K, Bryant H. Complementary and alternative medicine use among colorectal cancer patients in Alberta, Canada. Altern Ther Health Med 2002;8:54–6, 58–60, 62–4.

[2]   Harrison BG, Balakrishnan V, Watters DA, Dunning T. The prevalence and effect of Complementary and Alternative Medicines (CAM) on surgical outcomes. Annual Scientific Congress, Auckland NZ. Barwon Health, 2013.

[3] R.E. Gray, M. Fitch, V. Goel, E. Franssen, M. Labrecque. Utilization of complementary/alternative services by women with breast cancer. J Health Soc Policy, 16 (2003), pp. 75–84.

[4]   J. Shen, R. Andersen, P.S. Albert, N. Wenger, J. Glaspy, M. Cole, et al. Use of complementary/alternative therapies by women with advanced-stage breast cancer. BMC Compl Altern Med, 2 (2002), p. 8.

[5]   L. VandeCreek, E. Rogers, J. Lester. Use of alternative therapies among breast cancer outpatients compared with the general population. Altern Ther Health Med, 5 (1998), pp. 71–76.

[6]   H.J. Burstein, S. Gelber, E. Guadagnoli, J.C. Weeks. Use of alternative medicine by women with early-stage breast cancer. N Engl J Med, 340 (1999), pp. 1733–1739.

[7]   T. Ashikaga, K. Bosompra, P. O’Brien, L. Nelson. Use of complimentary and alternative medicine in breast cancer patients: prevalence: patterns and communication with physicians. Support Care Cancer, 10 (2002), pp. 542–548.

[8]   C.A. Lengacher, M.P. Bennett, K.E. Kip, R. Keller, M.S. LaVance, L.S. Smith, et al. Frequency of use of complementary and alternative medicine in women with breast cancer. Oncol Nurs Forum, 29 (2002), pp. 1445–1452.

[9]   J.W. Henderson, R.J. Donatelle. Complementary and alternative medicine use by women after completion of allopathic treatment for breast cancer. Altern Ther Health Med, 10 (2004), pp. 52–57.

[10]P. Harris, I.G. Finlay, A. Cook, K.J. Thomas, K. Hood. Complementary and alternative medicine use by patients with cancer in Wales: a cross sectional survey. Compl Ther Med, 11 (2003), pp. 249–253.

[11] E. Ernst, B.R. Cassileth. The prevalence of complementary/alternative medicine in cancer: a systematic review. Cancer, 83 (1998), pp. 777–782.

[12] T. Risberg, E. Lund, E. Wist, S. Kaasa, T. Wilsgaard. Cancer patients use of nonproven therapy: a 5-year follow-up study. J Clin Oncol, 16 (1998), pp. 6–12.

[13] G.K. Wyatt, L.L. Friendman, B.A. Given, K.C. Beckrow. Complementary therapy use among older cancer patients. Cancer Pract, 7 (1999), pp. 136–144.

[14] M.A. Richardson, T. Sanders, J.L. Palmer, A. Greisinger, S.E. Singletary Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology. J Clin Oncol, 18 (2000), pp. 2505–2514.

[15]Hussain Z, Quigley EM. Systematic review: Complementary and alternative medicine in the irritable bowel syndrome. Ailment Pharmacol Ther, 15 (2006), pp. 465-71.