Spirituality and use of complementary therapies for cure in advanced cancer.

OBJECTIVE: Complementary and alternative medicine (CAM) is frequently used by patients with advanced cancer, for a variety of reasons. We examined the use of CAM in this population, and associations of use for potential cure with spiritual faith and existential well-being. METHODS: Patients with advanced cancer on a palliative care unit completed a measure of spiritual well-being (existential well-being and faith), and a survey assessing complementary therapy use and reasons for such use. Information was also gathered on demographic data, previous cancer treatment, performance status, and symptom distress. Regression analyses assessed the association between the spirituality domains of existential well-being and faith, and the use of CAM for cure. RESULTS: Of 123 participants, 85% had used CAM, 42% with curative intent. More than 95% would consider future use of CAM, 48% for potential cure. Previous use for cure predicted current interest in using CAM for cure (p<0.0001). Spiritual faith was associated with previous (p<0.02) and interest in future use for cure (p<0.0001). Poor existential well-being was associated with interest in future use of CAM for cure (p=0.04). CONCLUSIONS: Interest in considering CAM for cure was relatively high in this group of inpatients on a palliative care unit, and was associated with increased spiritual faith and decreased existential well-being. Understanding factors associated with seeking CAM for cure may help health-care professionals to support and educate patients with advanced cancer.

The association of physical and psychological symptom burden with time to death among palliative cancer outpatients.

Previous studies have reported on the symptom burden of cancer inpatients, but outpatient studies have been few and have not examined the association of symptoms with time to death (TTD). Cancer patients seen in an oncology palliative care clinic from January 2005 to June 2006 and who subsequently died were identified from a palliative care database. Data from the last outpatient Edmonton Symptom Assessment Scale (ESAS) score completed in clinic were analyzed among patients who were followed during the last four months of life. Multiple linear regression analyses with Bonferroni adjustment were used to determine the association of ESAS total symptom distress score (TSDS), physical subscore (PHS), psychological subscore (PSS), and individual symptom scores with demographic parameters, disease characteristics, and TTD. Data from 198 patients were analyzed. All had stage IV cancer, the median age was 65, and 55% were men. There was no significant association between symptom burden and age, gender, or cancer site. TTD was significantly associated with TSDS (P=0.001) and PHS (P=0.001) but not with PSS (P=1.0). Individual symptoms most strongly associated with TTD were lack of appetite (P=0.001), drowsiness (P=0.006), dyspnea (P=0.009), and fatigue (P=0.01). There was no significant association between TTD and anxiety (P=1.0) or depression (P=1.0). Lack of appetite, drowsiness, dyspnea and fatigue represent a cluster of symptoms that tend to intensify at the end of life. The lack of intensification of psychological symptoms in relation to time to death is striking and needs to be further investigated using specific validated measures for depression and anxiety.