title: What is an exceptional cancer trajectory?: Multiple stakeholder perspectives on cancer trajectories in relation to complementary and alternative medicine use.
abstract: BACKGROUND
  Although links between exceptional cancer trajectories (ECTs) and complementary and alternative medicines (CAMs) have been suggested, most research on ECT uses predefined criteria for ECTs without necessarily including CAM use. Little knowledge can be found about subjective perspectives of ECTs in relation to CAM.
  
  
  OBJECTIVE
  This Swedish study explores how patients, significant others, and CAM and biomedical health care (BHC) providers reason about ECT, including the role of CAM.
  
  
  METHODS
  Using a case study approach, open interviews were conducted with multiple stakeholders about cancer trajectories reported as exceptional.
  
  
  RESULTS
  In-depth analysis of 5 cases indicated that although all stakeholders agreed that the reported cases were positive, in no case was the same trajectory considered exceptional by all stakeholders. Different stakeholders shared neither conceptualizations of what constituted an ECT nor attributions for positive trajectories. Patients, significant others, and CAM providers emphasized unexpectedly long survival and well-being in ECTs, whereas BHC providers only referred to survival. CAM and BHC providers normalized reported trajectories, although the forms for this differed between provider groups. CONCLUDING DISCUSSION: Stakeholders' accounts are discussed relative to different health care domains, legitimization processes, and legal constraints, which have led to the lack of a public sphere for CAM use in cancer.
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Division of Nursing, Unit for Studies of Integrative Health Care, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Johanna
authors.initials: J
authors.lastname: Hök
authors.forename: Anette
authors.initials: A
authors.lastname: Forss
authors.forename: Torkel
authors.initials: T
authors.lastname: Falkenberg
authors.forename: Carol
authors.initials: C
authors.lastname: Tishelman
mesh_terms: D000529:Complementary Therapies / Q000191:economics / Q000331:legislation & jurisprudence / Q000523:psychology; D003657:Decision Making; D018572:Disease-Free Survival; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010358:Patient Participation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011788:Quality of Life / Q000523:psychology; D013548:Sweden; D016896:Treatment Outcome