Integrative Cancer Therapies
XX(X) 1 –8
© The Author(s) 2010
Reprints and permission: http://www.
Integrative Medicine Consultation
Service in a Comprehensive
Cancer Center: Findings
Moshe Frenkel, MD1, Lorenzo Cohen, PhD1, Noemi Peterson, RN1,
J. Lynn Palmer, PhD1, Kay Swint, RN1, and Eduardo Bruera, MD1
Objectives. This study portrays the characteristics of patients who attended an integrative oncology clinic at a large
comprehensive cancer center and evaluated whether this service addressed patients’ concerns about complementary
and integrative medicine (CIM). Methods. Patient information was collected prior to an integrative consultation, including
demographics, previous use of CIM, and primary reason for requesting the consultation. Concerns and outcomes were
measured using the Measure Yourself Concerns and Well-being (MYCaW) Scale at the consultation and then again at
follow-up (6-12 weeks later). Patients met with a physician for an integrative consultation that included a discussion of
nutrition, supplements, physical activity, useful complementary therapies, and the mind–body–spirit connection. Results.
A total of 238 patients were referred for consultation regarding the integration of CIM into their care. The majority of
participants were female (60%, n = 143), and the mean age was 56 years (range, 21-90 years), with all major cancer types
represented. Patients’ leading concerns were related to “What else can I do?” and “How can I better cope?” Although
distressed over these concerns at the initial consultation, intense distress (5-6 out of 6 on the MYCaW scale) was reduced
to less than half (31%) by the follow-up visit. Additional qualitative data revealed that patients value the process of obtaining
reliable information that empowers them to be more involved in managing their care. Conclusions. Integrative medicine
consultations at a large comprehensive cancer center appear to provide some benefit in addressing patients’ concerns
about CIM use.
complementary medicine, alternative medicine, integrative medicine, cancer care, supportive care, quality of life, patient-
Complementary and integrative medicine (CIM) is becom-
ing very popular among patients. Health care professionals,
medical researchers, and educators are taking an increasing
interest in its application in cancer care. Data from the
National Health Statistics Report 2008 suggest that the use
of CIM has increased in the United States and that it is
being used for a variety of purposes.1
The report estimated that almost 4 of 10 adults (38.3%)
used some type of CIM in the previous 12 months, suggest-
ing a high demand for CIM therapies and the important role
these therapies have in our current and future health care
Most patients use CIM for common problems, such as
back pain, head cold, neck pain, anxiety, and depression.1
Many CIM modalities are most appropriate in the early
stages of disease or chronic illness.2 Recently, studies con-
firmed that a majority of patients undergoing cancer therapy
use self-selected forms of CIM.3,4 Previous reports esti-
mated that CIM was used by 20% to 55% of cancer
patients5,6; however, a survey administered at The Univer-
sity of Texas M D Anderson Cancer Center in 2000 revealed
1The University of Texas M D Anderson Cancer Center,
Houston, TX, USA
Moshe Frenkel, Integrative Medicine Program, Unit 145, The University
of Texas M D Anderson Cancer Center, 1515 Holcombe Blvd,
Houston, TX 77030, USA
Integrative Cancer Therapies XX(X)
that its use was much higher, exceeding 80%.3 Recent data
confirm the high rate of use among breast cancer patients.7
In the past few years, CIM has gradually entered the
conventional medical system through the doors of integra-
tive medicine clinics. Although the exact number of these
clinics in the United States is not known, data suggest that
the number is growing.8 The most recent membership of
The Consortium of Academic Health Centers for Integra-
tive Medicine now includes 45 highly esteemed US academic
medical centers, including Harvard, Yale, The University
of Texas, Georgetown University, Mayo Clinic, and others.9
Now, major comprehensive cancer centers around the coun-
try are joining this trend. The World Health Organization, a
White House commission, the Institute of Medicine, and
the National Center of Complementary and Alternative
Medicine of the National Institutes of Health have indepen-
dently concluded that integrating safe and effective CIM
interventions into traditional systems should be a high pri-
ority for research.10-14
With the current emphasis on patient-centered care,
evaluating the patient’s perspective is essential. Questions
that need to be addressed include the following: What do
patients really want? What are their main concerns when
they visit a CIM oncology clinic? What are the unmet needs
of these patients? Are their concerns being adequately
addressed? and How can the outcome be evaluated? Until
now, these questions remained unanswered. Most studies
have evaluated trends of CIM use in different geographic
locations15-20 and specific patient populations (such as
pediatrics, psychiatric patients, HIV/AIDS patients, atopic
dermatitis patients, etc).21-24 Other studies evaluated the
attitudes of physicians, medical students, and medical edu-
cators toward CIM use.25,26 Some studies described why
patients wanted CIM added to their care, and some exam-
ined barriers for disclosure of CIM to the medical team.27
How patients perceive the actual process of integration and
the practical implications of integrating complementary
therapies into their conventional care are not well docu-
mented. The purpose of this study is to fill in some of these
gaps by studying patients’ experiences with an integra-
tive medicine consultation service at a large comprehensive
The study was conducted at the University of Texas M D
Anderson Cancer Center’s Integrative Medicine Clinic
from January 2007 to December 2008; it was approved by
the internal review board at the institution. Data were col-
lected as part of a clinic registry protocol. All patients
older than 18 years who attended the clinic were asked to
participate in the study. Patients attended the clinic after a
request for consultation was initiated by their primary
oncologist or other physician involved in their active care at
the institution. Patients were approached about the study by
a clinic nurse during their first visit to the Integrative Medi-
cine Clinic. The study was explained to the patient, and
written consent was obtained. At that time, patients were
asked about their presenting symptoms and completed a
questionnaire regarding their concerns and well-being.
The consultation was physician led, and patients’ medical
records were examined and data extracted, including demo-
graphic information, diagnosis and treatment, comorbidities,
prior and current CIM use, previous integrative medicine
consultations, patients’ plans to incorporate complementary
medicine modalities, changes in symptoms, and any other
data relevant to the patients’ health and well-being. Some
of the patients were seen again at a follow-up visit 6 to
12 weeks later.
The questionnaire used to evaluate patients’ concerns and
well-being was the Measure Yourself Concerns and Well-
being (MYCaW), a tool developed to evaluate cancer
support services by a multidisciplinary research team in the
United Kingdom.28 The questionnaire requires participants
to identify 1 or 2 concerns and rate these concerns and their
general feeling of well-being on a 7-point scale. It takes
about 5 minutes to complete. The MYCaW is the standard
of care for all patients visiting the clinic, whether or not they
are study participants. For study participants, the MYCaW
was completed again when patients returned for follow-up
visits (usually 6-12 weeks later). At that time, the question-
naire included an open-ended question about what had been
the most important aspect of the clinic visit.
The consultation was meant to be a one-time educational
session, addressing patients’ main concerns about CIM use
prior to, during, and after their cancer treatments. During
the consultation, patients shared concerns and expectations
about CIM use, and clinic staff addressed these issues in a
way that empowered patients to be active in their care. The
main issues discussed were nutrition; physical activity;
supplement use, such as herbs, homeopathic remedies,
vitamins, or other type of supplements; complementary ther-
apies that can be integrated, such as acupuncture and massage;
and therapies that address the mind–body–spirit connec-
tion, such as meditation, yoga, and others. This consultation
involves a comprehensive history taking of both conven-
tional and CIM use, assessment, and integrative plan and is
described elsewhere in more detail.29,30
Frenkel et al.
After the initial consultation, patients usually discussed
nutritional issues with the staff nutritionist (RD) and used
the Place . . . of wellness, the facility at M D Anderson that
provides CIM classes and therapies (eg, massage, acupunc-
ture, music therapy, meditation, yoga, etc).
Descriptive statistics (such as means, standard deviations,
and frequencies) were used to summarize patient demo-
graphics, clinical characteristics, and MYCaW results. t Tests
or signed rank tests were used to determine whether changes
over time (difference scores) were significantly different
from zero (ie, no change) for the 2 MYCaW concerns and
well-being scores. SAS version 9.1 (SAS Institute Inc,
Cary, NC) was used for all analyses. Qualitative data were
categorized according to a process developed by Polley and
colleagues31 at the University of Westminster in the United
Kingdom, where a content analysis and framework of cat-
egories were produced.
Between 2007 and 2008, 280 new patients attended the
integrative medicine clinic for a total of 533 visits. Although
238 patients consented to participate in the study, only 229
actually completed the initial MYCaW questionnaire
(9 patients elected to avoid filling out the questionnaire).
Even though the consultation was meant to be a one-time
educational intervention, 85 (36%) patients elected to return
for additional advice about integrating CIM to their care
6 to 12 weeks after the initial consultation, and 73 (31%)
filled out the follow-up MYCaW.
The request for initial consultation was made by the
treating physician, but most of the visits were initiated by
the patient, with the physician agreeing to make the referral
(88% of referrals, 210/238). In only 4% (9/238) of patients
was the physician proactive in initiating the consultation
In all, 60% of the participants were female, and the mean
age was 56 years (range, 21-90 years). Patients’ diagnoses
varied and included breast cancer (23%), gastrointestinal
cancer (15%), genitourinary (13%), gynecological (12%),
lymphoma (8%), head and neck (8%), sarcoma (7%),
lung (6%), and others (Table 1). Most patients sought
CIM consultation when the disease was in an advanced
stage (63%; Table 1). The majority of patients used CIM prior
to consultation visit, usually incorporating a combination
of therapies. The most common CIM therapies were
nutritional supplements (91%); dietary changes (27%);
exercise (23%); acupuncture (20%); Asian movement
therapies, such as yoga, tai chi, or chi kung (16%); mas-
sage (10%); energy therapies (7%); prayer and spirituality
practices (6%); and others (Table 2). Prior to their clinic
visit, patients used multiple information sources to learn
about CIM therapies (Table 2), including other practitio-
ners and clinics that provide CIM (40%), independent
research (33%), the Place . . . of wellness (15%),
retail stores (13%), Internet (10.5%), family (8%), and
The concerns patients identified on the MYCaW were
analyzed by a framework that extracts data from patients’
comments.31 The leading concern was related to “What else
can I do?” These patients specifically looked for infor-
mation on CIM to integrate into their care (68%). Other
concerns were physical problems (37%), improving well-
being (34%), worries about the future (28%), healing (27%),
regaining balance (26%), adapting and coping (25%), and
others (Table 3).
MYCaW scores reflected patients’ progress in dealing
with the main concerns that originally led them to seek con-
sultation (Figure 1). Prior to the intervention, patients felt
very strongly about their concerns. On the MYCaW scale
of 0 to 6 (0 = does not bother me at all; 6 = bothers me
greatly), 75% and 76% of concerns were ranked in the 4 to 6
range for concern 1 and concern 2, respectively. On
Table 1. Patient Characteristics
Patients (N = 238)
Head and neck
Stage of disease
Integrative Cancer Therapies XX(X)
follow-up, the intense distress (5-6/6) was reduced to less
than half (31%, mean of concerns 1 and 2).
Table 4 shows the mean difference of MYCaW scores
before the consultation and then 6 to 12 weeks later (n = 73;
some patients elected to leave certain sections of the ques-
tionnaire blank). All mean changes in scores were highly
significant (P < .0001).
On the MYCaW at the follow-up visit, patients were also
asked what they thought were the most important aspects of
their time spent in the integrative medicine clinic. Most
patients made different remarks and comments. The common
recurrent statements are summarized in Table 5. The state-
ments showed that patients value being able to obtain
reliable information that empowers them to be involved in
their own care.
Our study found that an integrative medicine clinic con-
sultation helped patients with cancer identify their most
pressing health care concerns and provided them with reli-
able information on CIM therapies available to address
their concerns. This service provided a measurable benefit
to patients in that, on average, patients experienced almost
a 2-point drop (on a 7-point scale) in the severity of their
concerns between the time of their original visit to the time
of follow-up. A 2-point improvement in the MYCaW sever-
ity of problem score is deemed to be clinically significant.28
The decrease in severity was much more dramatic in patients
who originally rated their concerns as bothering them to the
highest degree (as suggested in Figure 1).
Our data indicate that patients are looking for reliable
information on CIM that can be integrated into their care,
which is consistent with what was found in previous
research.32-44 We found patients’ primary concerns to be
related to wanting more information on CIM and what else
they can do. As in other studies,45-49 patients wanted to
improve general well-being, reduce physical discomfort,
and improve their coping mechanisms; they value the sup-
port and guidance of “trusted individuals” in making
Table 2. Complementary and Integrative Medicine Use Prior to
Type of CIM Used
Prior to Consult
Patients (N = 238)
Yoga/Chi Kung/Tai Chi
Location of advice
Place of wellness
Abbreviations: CIM, complementary and integrative medicine.
Table 3. Patient Concerns
Patients (N = 238)
Information on CIM
Adapting and coping
Pains and aches
Poor energy level
Recurrence and spread
General cancer treatment
Chemotherapy side effects
Abbreviations: CIM, complementary and integrative medicine.
Figure 1. Addressing patient concerns: using Measure Yourself
Concerns and Well-being (MYCaW) as an evaluation tool
Frenkel et al.
choices about CIM. Patients in our study noted additional
benefits of the CIM consultation, including support for
daily life, obtaining a positive outlook, and the ability to
take a proactive role in their health care and well-being
The data that emerged from the MYCaW questionnaire
revealed high levels of distress with regard to patients’
cancer diagnosis and treatment. Addressing these concerns
by providing patients and their families reliable information
on beneficial CIM therapies seemed to empower them and
provided significant relief. In addition to providing informa-
tion, the CIM team attempted to relieve patients’ distress by
using a patient-centered communication style, active listen-
ing, empathic disclosure of concerns, and shared decision
making in choosing different CIM therapies to incorporate
into their care.30 These data are comparable to a report from
the United Kingdom that summarized a parallel experience
of providing a similar plan of CIM intervention.49
Patients with different cancers experience similar con-
cerns and express a need for reliable information, although
patients with breast cancer tend to be the most proactive
in obtaining that information as seen in this and other
studies.7,50 An interesting observation in our study was the
marked representation of patients with various types of cancer
with advanced disease (63%). This might be explained by
the fact that these patients came to a large reputable com-
prehensive cancer center with high expectations for cure in
the early stage of disease. When treatment failed and the
disease progressed, desperation became quite pronounced;
it was at this point that patients looked for additional
options, including CIM therapies. Correa-Velez et al51 and
Kristoffersen et al52 confirm our findings and have shown
that in the early stages of disease, patients trust that their
treatments will provide a cure and those using CIM thera-
pies do so to improve their quality of life. As the disease
progresses or patients have reduced sense of hope, there is
an increase in the use of CIM.52 Patients in the advanced
stage of disease use CIM to prolong their survival, palliate
their symptoms, alleviate the side effects of conventional
cancer treatments, detoxify their bodies, boost their immunity,
Table 4. Mean Difference in MYCaW Score for Patients With Initial and Follow-up Scores
MYCaW ScoresNumber of Patients Initial Visit Mean (SD) First Follow-up Mean (SD) Score Difference Mean
Abbreviations: MYCaW, Measure Yourself Concerns and Well-being; SD, standard deviation.
Table 5. Patients’ Statements
What Has Been Most Important to You?
Reflecting on Your Time With the Integrative Medicine Clinic, What Were the Most Important Aspects to You?
Support for life not just medical necessities
Knowledgeable people I can trust to know about complementary/integrative treatment for cancer
Gave me hope that I could still take a proactive role in maintaining health
It is so important for patients to know how they can proactively take charge of their health
Getting back to my daily life makes me think positive
It gave me tools to make lifestyle changes to maximize my health
It addresses me as a whole person not just my illness and symptoms
Talking with a doctor knowledgeable about alternative care
It definitely helped me focus on what I needed to do
It was a resource to answer questions about supplements and complementary medicine
Getting rid of cancer or living the best life I can with it
Help with foods to put in my diet
Encouragement to relieve stress
Good outcome with vitamin regimen to accommodate chemotherapy
The care and concern
Encouraged me to do the best I can for my well-being
Acquiring information to optimize my health
Do all I can do to support my body and mind to battle my cancer
Much needed support and advice on ways to strengthen body and mind
Someone really listening and hearing my concerns and needs of nutritional support
Integrative Cancer Therapies XX(X)
and enhance their overall quality of life.51 Although the
majority of the patients attending the integrative medicine
consultation clinic had advanced disease, most CIM-survey
studies indicate that, in general, CIM use is very high at all
stages of disease.3,4,6,7,34,36,39,46
Our data reveal that integrating CIM therapies into
cancer care is initiated primarily by patients, although phy-
sicians respond positively to their patients’ desire to obtain
reliable information on this topic. Physicians involved in
cancer care have limited time to adequately address this
need; thus, a consultation service that meets this need of
patients by providing information and addressing patients’
concerns is a very helpful resource to the practicing physi-
cian. At M D Anderson, the number of physicians who refer
their patients for integrative medicine consultations has
risen rapidly, from a few physicians in 2006 to more than
200 at the time of summarizing this study.
There are a number of limitations inherent in this type
of observational clinic study. It is likely that there is a
selection bias in people choosing to go to the Integrative
Medicine Clinic, and they may not be representative of the
M D Anderson cancer population as a whole. Moreover,
patients undergoing treatment at a major comprehensive
cancer center are not necessarily reflective of patients being
treated outside of major medical centers. Caution needs
to be taken in interpreting the pre-post consultation data
because only a minority of patients participated in the
follow-up visit. Although there was a dramatic improve-
ment in problem scores, there may clearly be a bias in who
returned for follow-up. More consistent follow-up with all
patients would need to take place to definitively determine
the benefits of the consultation service on the problem
scores. However, it is interesting to note that there were no
differences in baseline MYCaW scores between those who
did and did not return for a follow-up visit.
Given these limitations, future studies should examine
CIM use and consultation services in community-based
medical settings. With the changing landscape of health
care in the United States, even smaller medical settings are
starting to incorporate CIM into the standard care of their
practices. It is also important to try and consistently collect
follow-up data on patients to determine what CIM tech-
niques they used and if they benefited. The ideal would be
to conduct these using more conventional randomized trials
designs, but this is not always feasible because the majority
of cancer patients are using some form of complementary
medicine. Additional research is also needed to determine
how integrative medicine services benefit the physician and
the health care team as well as to examine cost-effectiveness
analyses. With health care reform starting to be imple-
mented, research needs to focus on the cost of care and
ways to provide third party coverage and public hospital
access to integrative medicine services. Improved quality of
life, adherence to cancer treatment, and overall survival
should be measured as it relates to the use of integrative
In summary, our findings suggest that a CIM consulta -
tion service provides some measurable benefit in addressing
patients’ concerns and reducing patients’ distress. This
consultation service appears to be a needed and valuable
resource for patients undergoing treatment for cancer and
afterward. Our findings reflect that CIM therapies can suc -
cessfully address the complex and challenging process of
responding to specific needs and concerns of cancer patients.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the authorship and/or publication of this article.
The author(s) received no financial support for the research and/or
authorship of this article.
1. Barnes PM, Bloom B, Nahin RL. Complementary and alterna-
tive medicine use among adults and children: United States,
2007. Natl Health Stat Report. 2008;(12):1-23.
2. Weiger W, Smith M, Boon H. Advising patients who seek
complementary and alternative medical therapies for cancer.
Ann Intern Med. 2002;137:889-903.
3. Richardson M, Sanders T, Palmer J, et al. Complementary alter-
native medicine use in a comprehensive cancer center and the
implications for oncology. J Clin Oncol. 2000;18:2505-2514.
4. Sparber A, Bauer L, Curt G, et al. Use of complementary med-
icine by adult patients participating in cancer clinical trials.
Oncol Nurs Forum. 2000;17:623-630.
5. Sandler RS, Halabi S, Kaplan EB, et al. Use of vitamins, min-
erals, and nutritional supplements by participants in a chemo-
prevention trial. Cancer. 2001;91:1040-1045.
6. Paltiel O, Avitzour M, Peretz T, et al. Determinants of the use
of complementary therapies by patients with cancer. J Clin
7. Greenlee H, Kwan ML, Ergas IJ, et al. Complementary and
alternative therapy use before and after breast cancer diag-
nosis: the Pathways Study. Breast Cancer Res Treat. 2009;
8. Sierpina V. Ethics Forum: Complementary Medicine and Can-
cer Care. American Medical News. October 4, 2004.
9. The Consortium of Academic Health Centers for Integrative
Medicine. http://www.imconsortium.org/. Accessed Septem-
ber 22, 2009.
10. World Health Organization. WHO Traditional Medicine Strat-
egy 2002-2005. Geneva, Switzerland: WHO; 2002.
11. White House Commission on Complementary and Alternative
Medicine Policy (WHCCAMP). Final Report. Washington,
DC: WHCCAMP; 2002.
Frenkel et al.
12. Institute of Medicine. Complementary and Alternative Medi-
cine in the United States. Washington, DC: National Acad-
emies Press; 2005.
13. National Center for Complementary and Alternative Medi-
cine. Expanding horizons of healthcare: five-year strategic
plan, 2005-2009. http://nccam.nih.gov/about/plans/2005/page4
.htm. Accessed September 5, 2009.
14. Institute of Medicine. Summit on integrative medicine and the
health of the public. http://www.iom.edu/?ID=52555. Accessed
September 5, 2009.
15. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR,
Delbanco TL. Unconventional Medicine in the United States:
prevalence, costs, and patterns of use. New Engl J Med. 1993;
16. Fisher P, Ward A. Complementary medicine in Europe. BMJ.
17. Kessler RC. Long-term trends in the use of complementary
and alternative medical therapies in the United States. Ann
Intern Med. 2001;136:262-268.
18. Eisenberg D, Davis R, Ettner S, et al. Trends in alternative
medicine use in the United States, 1990-1997: results of a
follow-up national survey. JAMA. 1998;280:1569-1575.
19. Harris P, Rees R. The prevalence of complementary and alter-
native medicine use among the general population: a system-
atic review of the literature. Complement Ther Med. 2004;
20. Shmueli A, Shuval J. Use of complementary and alternative
medicine in Israel: 2000 vs 1993. Isr Med Assoc J. 2004;6:
21. Davis MP, Darden PM. Use of complementary and alternative
medicine by children in the United States. Arch Pediatr Ado-
lesc Med. 2003;157:393-396.
22. Alderman C, Kiepfer B. Complementary medicine use by psy-
chiatry patients of an Australian hospital. Ann Pharmacother.
23. De Visser R, Grierson J. Use of alternative therapies by peo-
ple living with HIV/AIDS in Australia. AIDS Care. 2002;14:
24. Simpson E, Basco M, Hanifin J. A cross-sectional survey of
complementary and alternative medicine use in patients with
atopic dermatitis. Am J Contact Dermat. 2003;14:144-147.
25. Frenkel M, Ben Arye E. The growing need to teach about
complementary and alternative medicine: questions and chal-
lenges. Acad Med. 2001;76:251-254.
26. Derr S, Shaikh U, Rosen A, Guadagnino P. Medical students’
attitudes toward, knowledge of, and experience with comple-
mentary medicine therapies. Acad Med. 1998;73:1020.
27. Astin JA, Pelletier KR, Hansen E, Haskell WL. A review of the
incorporation of complementary and alternative medicine by
mainstream physicians. Arch Intern Med. 1998;58:2303-2310.
28. Paterson C, Thomas K, Manasse A, et al. Measure Yourself
Concerns and Wellbeing (MYCaW): an individualised ques-
tionnaire for evaluating outcome in cancer support care that
includes complementary therapies. Complement Ther Med.
29. Frenkel M, Cohen L. Incorporating complementary and inte-
grative medicine in a comprehensive cancer center. Hematol
Oncol Clin North Am. 2008;22:727-736.
30. Frenkel M. Clinical consultation, a personal perspective: com-
ponents of a successful integrative medicine clinical consulta-
tion. J Soc Integr Oncol. 2008;6:129-133.
31. Polley MJ, Seers HE, Cooke HJ, et al. How to summarise and
report written qualitative data from patients: a method for use in
cancer support care. Support Care Cancer. 2007;15:963-971.
32. Eisenberg DM, Kessler RC, Van Rompay MI, et al. Percep-
tions about complementary therapies relative to conventional
therapies among adults who use both: results from a national
survey. Ann Intern Med. 2001;135:344-351.
33. Richardson MA, Masse LC, Nanny K, Sanders C. Discrepant
views of oncologists and cancer patients on complementary/
alternative medicine. Support Care Cancer. 2004;12:797-804.
34. Crocetti E, Crotti N, Feltrin A, Ponton P, Geddes M, Buiatti E.
The use of complementary therapies by breast cancer patients
attending conventional treatment. Eur J Cancer. 1998;34:
35. Kappauf H, Leykauf-Ammon D, Bruntsch U, et al. Use of and
attitudes held towards unconventional medicine by patients in
a department of internal medicine/oncology and haematology.
Support Care Cancer. 2000;8:314-322.
36. Miller M, Boyer MJ, Butow PN, Gattellari M, Dunn SM,
Childs A. The use of unproven methods of treatment by can-
cer patients. Frequency, expectations and cost. Support Care
37. Morant R, Jungi WF, Koehli C, Senn HJ. Why do cancer
patients use alternative medicine? [in German]. Schweiz Med
38. Oneschuk D, Fennell L, Hanson J, Bruera E. The use of com-
plementary medications by cancer patients attending an outpa-
tient pain and symptom clinic. J Palliat Care. 1998;14:21-26.
39. Wyatt GK, Friedman LL, Given CW, Given BA, Beckrow
KC. Complementary therapy use among older cancer patients.
Cancer Pract. 1999;7:136-144.
40. Frenkel M, Ben-Arye E, Baldwin CD, Sierpina V. Approach
to communicating with patients about the use of nutritional
supplements in cancer care. South Med J. 2005;98:289-294.
41. Frenkel M, Ben-Arye E. Nutritional supplements and cancer.
Harefuah. 2002;141:893-897, 930.
42. Roberts CS, Baker F, Hann D, et al. Patient-physician com-
munication regarding use of complementary therapies during
cancer treatment. J Psychosoc Oncol. 2005;23:35-60.
43. Ben-Arye E, Frenkel M, Margalit RS. Approaching comple-
mentary and alternative medicine use in patients with cancer:
questions and challenges. J Ambul Care Manage. 2004;27:
44. Weiger WA, Smith M, Boon H, Richardson MA, Kaptchuk TJ,
Eisenberg DM. Advising patients who seek complementary
8 Download full-text
Integrative Cancer Therapies XX(X)
and alternative medical therapies for cancer. Ann Intern Med.
45. Bishop FL, Yardley L, Lewith GT. Treat or treatment: a qualita-
tive study analyzing patients’ use of complementary and alter-
native medicine. Am J Public Health. 2008;98:1700-1705.
46. Helyer LK, Chin S, Chui BK, et al. The use of complemen-
tary and alternative medicines among patients with locally
advanced breast cancer: a descriptive study. BMC Cancer.
47. Singh H, Maskarinec G, Shumay DM. Understanding the
motivation for conventional and complementary/alternative
medicine use among men with prostate cancer. Integr Cancer
48. Evans M, Shaw A, Thompson EA, et al. Decisions to use
complementary and alternative medicine (CAM) by male can-
cer patients: information- seeking roles and types of evidence
used. BMC Complement Altern Med. 2007;7:25.
49. Seers HE, Gale N, Paterson C, Cooke HJ, Tuffrey V, Polley MJ.
Individualised and complex experiences of integrative can-
cer support care: combining qualitative and quantitative data.
Support Care Cancer. 2009;17:1159-1167.
50. Boon HS, Olatunde F, Zick SM. Trends in complementary/
alternative medicine use by breast cancer survivors: compar-
ing survey data from 1998 and 2005. BMC Womens Health.
51. Correa-Velez I, Clavarino A, Eastwood H. Surviving,
relieving, repairing, and boosting up: reasons for using
complementary/alternative medicine among patients with
advanced cancer: a thematic analysis. J Palliat Med. 2005;8:
52. Kristoffersen AE, Fønnebø V, Norheim AJ. Do cancer patients
with a poor prognosis use complementary and alternative
medicine more often than others? J Altern Complement Med.