title: Complementary and alternative medicine use and its association with quality of life among Lebanese breast cancer patients: a cross-sectional study.
abstract: BACKGROUND
  Breast cancer patients are increasingly seeking Complementary and Alternative Medicine (CAM) therapies with the hope of alleviating the burden of the disease and improving their quality of life (QOL). The objective of this study was to assess the prevalence, types, socio-demographic and disease-related correlates as well as characteristics of CAM use (including disclosure to treating physicians) among breast cancer patients in Beirut, Lebanon. A secondary objective was to evaluate the association between CAM use and QOL.
  
  
  METHODS
  A cross-sectional survey was conducted on breast cancer patients recruited from two major referral centers in Beirut: a philanthropic hospital and a private academic medical center. In face-to-face interviews, participants completed a questionnaire of three sections: socio-demographic and lifestyle characteristics, breast cancer condition, and CAM use. Three to four weeks following these interviews, the secondary QOL assessment was carried out via telephone using the Arabic version of the Functional Assessment of Cancer Therapy-Breast questionnaire. The main outcome in this study, CAM use, was defined as using CAM at least once after breast cancer diagnosis.
  
  
  RESULTS
  A total of 180 breast cancer patients completed the survey (response rate: 94.6 %). Prevalence of CAM use was 40 %. Using multivariate logistic regression, CAM use was negatively associated with age (OR: 0.96, CI: 0.92-0.99), treatment at the philanthropic hospital (OR: 0.13, CI: 0.05-0.35) and was positively associated with an advanced stage of the disease (OR: 4.20, CI: 1.65-10.69). Among study participants recruited from both sites, the most commonly used CAM was 'special food' followed by 'herbal teas', 'diet supplements' and 'Spiritual healing'. Only 4 % of CAM users cited health professionals as influencing their choice of CAM and only one in four patients disclosed CAM use to their treating physician. There was no significant association between CAM use and QOL.
  
  
  CONCLUSIONS
  The findings of this study revealed a prevalent CAM use among Lebanese breast cancer patients. Furthermore, physicians' role in orienting CAM use was found to be marginal as patients relied mainly on family and media for their choice of CAM and were less likely to disclose CAM use to their treating physicians.
authors.affiliation: Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. BOX 11-0.236, Riad El Solh, 11072020, Beirut, Lebanon. fn14@aub.edu.lb.
authors.forename: Farah
authors.initials: F
authors.lastname: Naja
authors.affiliation: Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. BOX 11-0.236, Riad El Solh, 11072020, Beirut, Lebanon. raa90@mail.aub.edu.
authors.forename: Romy Abi
authors.initials: RA
authors.lastname: Fadel
authors.affiliation: Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon. ma164@aub.edu.lb.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Alameddine
authors.affiliation: Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. BOX 11-0.236, Riad El Solh, 11072020, Beirut, Lebanon. ysa07@mail.aub.edu.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Aridi
authors.affiliation: Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. BOX 11-0.236, Riad El Solh, 11072020, Beirut, Lebanon. aze09@mail.aub.edu.
authors.forename: Aya
authors.initials: A
authors.lastname: Zarif
authors.affiliation: Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. BOX 11-0.236, Riad El Solh, 11072020, Beirut, Lebanon. Dania.b.hariri@gmail.com.
authors.forename: Dania
authors.initials: D
authors.lastname: Hariri
authors.affiliation: Medical Director Office, Makassed University Hospital, Beirut, Lebanon. msa@makassedhospital.org.
authors.forename: Anas
authors.initials: A
authors.lastname: Mugharbel
authors.affiliation: Department of Internal Medicine, Miami Miller Medical Center, Miami, USA. mayakk9@gmail.com.
authors.forename: Maya
authors.initials: M
authors.lastname: Khalil
authors.affiliation: Department of Internal Medicine, Texas Tech University, El Paso, USA. zeina.nahleh@ttuhsc.edu.
authors.forename: Zeina
authors.initials: Z
authors.lastname: Nahleh
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon. at35@aub.edu.lb.
authors.forename: Arafat
authors.initials: A
authors.lastname: Tfayli
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology / Q000628:therapy*; D000529:Complementary Therapies / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D011795:Surveys and Questionnaires