title: Complementary and alternative medicine use is associated with an increased perception of breast cancer risk and death.
abstract: OBJECTIVE
  Complementary and alternative medicines (CAMS) are frequently used by patients with breast cancer and their use may be related to the presence of psychosocial distress. The objective of this study is to assess the presence of anxiety and depression in breast cancer patients who use CAM and assess how they perceive their risks of recurrence and dying from breast cancer compared to non-users.
  
  
  METHODS
  Breast cancer patients attending ambulatory clinics at a single cancer center were approached by their oncologist. Participants completed a self-administered survey regarding CAM usage, beliefs associated with CAM, views of their risks of developing recurrent cancer, and of dying of breast cancer. The presence of anxiety and depression was scored using the Hospital Anxiety and Depression Scale (HADS). Responses were scored and compared between CAM users and non-users.
  
  
  RESULTS
  A total of 251 patients completed the survey. CAM usage was reported by 43% of patients. Individuals who used CAM were younger [53.1 versus 63.0 year (p < 0.001)], had higher education (p < 0.001), were more likely to have full time employment [25.7 versus 16.3% (p < 0.001)] and have private insurance for medications (76 versus 60%, p = 0.007) compared to non-users. CAM users perceived their risk of recurrence (p = 0.011) and death from breast cancer (p = 0.0001) as being significantly greater than non-users. There were no significant differences in anxiety or depression scores between CAM and non-users.
  
  
  CONCLUSIONS
  CAM use is associated with an increased perception of breast cancer recurrence and of breast cancer-related death. There was no association between the presence of anxiety or depression and CAM use. Improved patient understanding of actual risks of recurrence and death are required such that women will be able to make more informed decisions about using CAMs.
authors.affiliation: Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Avenue, Ontario, Toronto, Canada, M4N 3M5. eileen.rakovitch@sw.ca
authors.forename: Eileen
authors.initials: E
authors.lastname: Rakovitch
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Pignol
authors.forename: Carole
authors.initials: C
authors.lastname: Chartier
authors.forename: Michelle
authors.initials: M
authors.lastname: Ezer
authors.forename: Sunil
authors.initials: S
authors.lastname: Verma
authors.forename: George
authors.initials: G
authors.lastname: Dranitsaris
authors.forename: Mark
authors.initials: M
authors.lastname: Clemons
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology*; D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology*; D002170:Canada / Q000453:epidemiology; D000529:Complementary Therapies / Q000706:statistics & numerical data*; D003863:Depression / Q000453:epidemiology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D012306:Risk; D012959:Socioeconomic Factors