Complementary and alternative medicine use among breast cancer survivors.

OBJECTIVES: The use complementary and alternative medicine (CAM) by patients with breast cancer and survivors has been widely studied. However, scant research has focused on the degree to which CAM activity is related to the cancer experience, as opposed to use for other reasons. The study objective was to examine the use of CAM in a sample of patients with breast cancer. Additional objectives were to measure associations between psychosocial and medical factors and CAM use both related and unrelated to a breast cancer diagnosis. DESIGN: Breast cancer survivors (N=115) at least 1 year beyond active medical treatment were recruited during routine clinic visits. Survey data collected via structured telephone interview focused on CAM use, motivations for use, perceived risk of cancer recurrence, and breast cancer-specific and general measures of anxiety. RESULTS: Sixty-nine percent (69%) of participants reported use of CAM. Of CAM users, 73% reported initiating or changing CAM activity specifically because of their cancer diagnosis. Patients engaging in CAM for cancer-related reasons were younger (p<0.001) and had been diagnosed with cancer at a younger age (p<0.01). Although overall anxiety scores in this sample were not significantly elevated, higher trait anxiety was associated with CAM use related to one's cancer diagnosis. CONCLUSIONS: Rate of CAM use was high, with the majority of CAM users associating that activity with their breast cancer. Anxiety levels varied between nonusers, CAM users for cancer, and CAM users for other reasons, with highest trait anxiety among those who associate their CAM use with cancer. Assessing motivations for CAM use may be important in future examinations of the relationship between CAM use and quality of life among breast cancer survivors.

Physicians' observations and interpretations of the influence of religion and spirituality on health.

BACKGROUND: In spite of a substantial body of empirical data, professional disagreement persists regarding whether and how religion and spirituality (hereinafter "R/S" and treated as a single concept) influences health. This study examines the association between physicians' religious characteristics and their observations and interpretations of the influence of R/S on health. METHODS: A cross-sectional survey was mailed to a stratified, random sample of 2000 practicing US physicians from all specialties. Physicians were asked to estimate how often patients mention R/S issues, how much R/S influences health, and in what ways the influence is manifested. RESULTS: The response rate was 63%. Most physicians (56%) believed that R/S had much or very much influence on health, but few (6%) believed that R/S often changed "hard" medical outcomes. Rather, most physicians believed that R/S (1) often helps patients to cope (76%), (2) gives patients a positive state of mind (75%), and (3) provides emotional and practical support via the religious community (55%). Compared with those with low religiosity, physicians with high religiosity are substantially more likely to (1) report that patients often mention R/S issues (36% vs 11%)(P<.001); (2) believe that R/S strongly influences health (82% vs 16%) (P<.001); and (3) interpret the influence of R/S in positive rather than negative ways. CONCLUSION: Patients are likely to encounter quite different opinions about the relationship between their R/S and their health, depending on the religious characteristics of their physicians.

The association of physicians' religious characteristics with their attitudes and self-reported behaviors regarding religion and spirituality in the clinical encounter.

CONTEXT: Controversy exists regarding whether and how physicians should address religion/spirituality (R/S) with patients. OBJECTIVE: This study examines the relationship between physicians' religious characteristics and their attitudes and self-reported behaviors regarding R/S in the clinical encounter. METHODS: A cross-sectional mailed survey of a stratified random sample of 2000 practicing U.S. physicians from all specialties. Main criterion variables were self-reported practices of R/S inquiry, dialogue regarding R/S issues, and prayer with patients. Main predictor variables were intrinsic religiosity, spirituality, and religious affiliation. RESULTS: Response rate was 63%. Almost all physicians (91%) say it is appropriate to discuss R/S issues if the patient brings them up, and 73% say that when R/S issues comes up they often or always encourage patients' own R/S beliefs and practices. Doctors are more divided about when it is appropriate for physicians to inquire regarding R/S (45% believe it is usually or always inappropriate), talk about their own religious beliefs or experiences (14% say never, 43% say only when the patient asks), and pray with patients (17% say never, 53% say only when the patient asks). Physicians who identify themselves as more religious and more spiritual, particularly those who are Protestants, are significantly more likely to endorse and report each of the different ways of addressing R/S in the clinical encounter. CONCLUSIONS: Differences in physicians' religious and spiritual characteristics are associated with differing attitudes and behaviors regarding R/S in the clinical encounter. Discussions of the appropriateness of addressing R/S matters in the clinical encounter will need to grapple with these deeply rooted differences among physicians.

Religious characteristics of U.S. physicians: a national survey.

BACKGROUND: Patients' religious commitments and religious communities are known to influence their experiences of illness and their medical decisions. Physicians are also dynamic partners in the doctor-patient relationship, yet little is known about the religious characteristics of physicians or how physicians' religious commitments shape the clinical encounter. OBJECTIVE: To provide a baseline description of physicians' religious characteristics, and to compare physicians' characteristics with those of the general U.S. population. DESIGN/PARTICIPANTS: Mailed survey of a stratified random sample of 2,000 practicing U.S. physicians. Comparable U.S. population data are derived from the 1998 General Social Survey. MEASUREMENTS/RESULTS: The response rate was 63%. Fifty-five percent of physicians say their religious beliefs influence their practice of medicine. Compared with the general population, physicians are more likely to be affiliated with religions that are underrepresented in the United States, less likely to say they try to carry their religious beliefs over into all other dealings in life (58% vs 73%), twice as likely to consider themselves spiritual but not religious (20% vs 9%), and twice as likely to cope with major problems in life without relying on God (61% vs 29%). CONCLUSIONS: Physicians' religious characteristics are diverse and they differ in many ways from those of the general population. Researchers, medical educators, and policy makers should further examine the ways in which physicians' religious commitments shape their clinical engagements.

Social chemosignals from breastfeeding women increase sexual motivation.

Human pheromones, a type of social chemosignal, modulate endocrine function by regulating the timing of ovulation. In animals, pheromones not only regulate ovulation but also female reproductive motivation and behavior. There is no extant evidence that humans produce social chemosignals that affect human sexual motivation or reproductive behavior as occurs in other mammals. Here, we demonstrate that natural compounds collected from lactating women and their breastfeeding infants increased the sexual motivation of other women, measured as sexual desire and fantasies. Moreover, the manifestation of increased sexual motivation was different in women with a regular sexual partner. Those with a partner experienced enhanced sexual desire, whereas those without one had more sexual fantasies. These results are consistent with previous pheromonal effects on endocrine function, and warrant further study of these social chemosignals as candidates for pheromonal processes, including their effects on other aspects of motivation and behavior.

Women's sexual experience during the menstrual cycle: identification of the sexual phase by noninvasive measurement of luteinizing hormone.

Imprecise measures of ovulation obscure the relationship between women's sexuality and the menstrual cycle, as does studying women with different contraceptive goals in different social contexts. Here we present a novel noninvasive method to precisely pinpoint the preovulatory surge of Luteinizing Hormone (LH), demarcating hormonally distinct cycle phases with greater than 95% reliability. Women were more sexually active on days prior to and including the preovulatory (LH) surge. This pattern was evident only when women initiated sexual activity and not when their partners did, indicating an increase in women's sexual motivation rather than attractiveness. A second study replicated the 6-day increase in sexual activity beginning 3 days before the LH surge, accompanied by stronger sexual desire and more sexual fantasies. We propose the term 'sexual phase' of the cycle, since follicular phase is over inclusive and ovulatory phase is not sufficient. These findings are striking because the women were avoiding pregnancy and were kept blind to the hypotheses, preventing expectation bias. The sexual phase was more robust in women with regular sexual partners, although the increase in sexual desire was just as great in nonpartnered women, who also reported feeling less lonely at this time. We use these results to evaluate potential neuroendocrine mechanisms underlying women's sexual motivation and activity.

Effects of breastfeeding chemosignals on the human menstrual cycle.

BACKGROUND: To date, there has not been an investigation to determine whether lactating women and their infants influence the ovarian function of other women with whom they interact. METHODS: In a randomized, double-blind, placebo-controlled study of 47 nulliparous women, we utilized both within- and between-subjects controls to assess the effects of sustained exposure to breastfeeding compounds on menstrual cycle length, as well as characteristics of each phase of the ovarian cycle. RESULTS: Breastfeeding compounds modulated ovarian cycle length in comparison with the carrier control (0.01 < or = all P values < or = 0.05), disrupting the normal homeostatic regulation of cycle length and tripling its variance. Hence, women with long cycles stayed long and did not regress to the mode of 29 days and women with short cycles maintained short cycles. This effect was driven by changes in both the follicular and luteal phases of the cycle (0.01 < or = all P values < or = 0.04) and changed the timing of the pre-ovulatory surge of LH. CONCLUSIONS: Because compounds from lactating women and their infants modulated the ovarian cycles of women, as is seen in other mammals, they have the potential to function as pheromones, regulating fertility within groups of women.

Is patient travel distance associated with survival on phase II clinical trials in oncology?

BACKGROUND: Prior research has suggested that patients who travel out of their neighborhood for elective care from specialized medical centers may have better outcomes than local patients with the same illnesses who are treated at the same centers. We hypothesized that this phenomenon, often called "referral bias" or "distance bias," may also be evident in curative-intent cancer trials at specialized cancer centers. METHODS: We evaluated associations between overall survival and progression-free survival and the distance from the patient residence to the treating institution for 110 patients treated on one of four phase II curative-intent chemoradiotherapy protocols for locoregionally advanced squamous cell cancer of the head and neck conducted at the University of Chicago over 7 years. RESULTS: Using Cox regression that adjusted for standard patient-level disease and demographic factors and neighborhood-level economic factors, we found a positive association between the distance patients traveled from their residence to the treatment center and survival. Patients who lived more than 15 miles from the treating institution had only one-third the hazard of death of those living closer (hazard ratio [HR] = 0.32, 95% confidence interval [CI] = 0.12 to 0.84). Moreover, with every 10 miles that a patient traveled for care, the hazard of death decreased by 3.2% (HR = 0.97, 95% CI = 0.94 to 0.99). Similar results were obtained for progression-free survival. CONCLUSION: Results of phase II curative-intent clinical trials in oncology that are conducted at specialized cancer centers may be confounded by patient travel distance, which captures prognostic significance beyond cancer stage, performance status, and wealth. More work is needed to determine what unmeasured factors travel distance is mediating.

Factors influencing medical information seeking among African American cancer patients.

Qualitative research methods were used to explore factors that may affect medical information seeking, treatment engagement, and emotional adjustment among African American cancer patients. Focus group findings suggest that an array of cultural and socioeconomic factors plays important roles in the behavior of African American cancer patients. Participants described a number of important barriers and facilitators of medical information seeking and treatment participation. Factors linked to the health care-related behaviors and adjustment of African American cancer patients included limited knowledge and misinformation about cancer, mistrust of the medical community, concerns about privacy, lack of insurance, religious beliefs, and emotional issues such as fear and stigma associated with seeking emotional support. Recommendations are made that may assist mental and physical health providers in improving patient information and mental and physical health outcomes of African American cancer patients.