Complementary and alternative medicine use in patients before and after a cancer diagnosis.

Background: Cancer patients are increasingly seeking out complementary and alternative medicine (cam) and might be reluctant to disclose its use to their oncology treatment team. Often, cam agents are not well studied, and little is known about their potential interactions with chemotherapy, radiation therapy, or biologic therapies, and their correlations with outcomes. In the present study, we set out to determine the rate of cam use in patients receiving treatment at a Northern Ontario cancer centre. Methods: Patients reporting for treatment at the Northeast Cancer Centre (necc) in Sudbury, Ontario, were asked to complete an anonymous questionnaire to assess cam use. Changes in cam use before, compared with after, diagnosis were also assessed. Results: Patients in Northern Ontario reported significant cam use both before and after diagnosis. However, as a function of the cam type, cam use was greatly enhanced after cancer diagnosis. For example, the number of patients who reported use of biologic products increased to 51.8% after a cancer diagnosis from 15.6% before a cancer diagnosis. Patients reported much smaller changes in the use of alternative medical systems or spiritual therapy after diagnosis. Vitamin use was reported by 66% of respondents, and the number of different cams used correlated significantly with the reported number of vitamins used. Conclusions: Use of cam, particularly biologic products, increased significantly after a cancer diagnosis. Further studies are required to examine the effect of cam use on the efficacy and safety of cancer therapies.

Exploring spatial trends in Canadian incidence of hospitalization due to myocardial infarction with additional determinants of health.

OBJECTIVES: To explore the presence of spatial trends among rates of hospitalization due to myocardial infarction across health regions of Canada and the associated role of additional health determinants. STUDY DESIGN: An ecological study was conducted using aggregate data from the Canadian Institute for Health Information for age-standardized rates of myocardial infarction hospitalizations by health region in 2013. METHODS: Exploratory spatial data analyses were applied to myocardial infarction hospitalization rates including Moran's I for detecting global spatial autocorrelation. Local spatial dependence was examined using local indicators of spatial autocorrelation (LISA) to better identify the location of potential regional clusters. Linear and spatial regressions were applied to examine the role of additional health determinants. RESULTS: Significant spatial autocorrelation was observed for hospitalizations due to myocardial infarction for both sexes, independently and combined. This was largely present in the form of geographic disparities with cold spot clusters of low rates in the west, particularly British Columbia, and hot spot clusters of high rates moving east, especially in Ontario, Quebec, and New Brunswick. Additional disparities were observed with high rates clustered in Northern Ontario compared to clusters of low rates in Southern Ontario. Significant predictors included smoking, average income, education, and overweight or obesity and, after controlling for these, the central cold spot of low rates shifted east to Saskatchewan. CONCLUSIONS: The identification of spatial homogeneity suggests a necessity for better geographic-based preventive measures as determined by the varied needs of particular regions' communities. The demonstration that space matters in this context further indicates that spatial dependence should be included in additional investigations of myocardial infarction incidence and associated hospitalizations.