News Release

Keeping doctors in the dark: Why women don't discuss using alternative treatments for breast cancer

Peer-Reviewed Publication

University of California - San Francisco

An increasing number of people are taking a dual approach to curing their ills by testing the waters of alternative medicine while simultaneously collaborating with their MDs. Although recent findings indicate that patients frequently don't tell their medical physicians what kinds of alternative therapies they're using, the reasons for remaining silent have been unclear. Now, a UCSF researcher offers insight into why many women with breast cancer choose to keep their forays into alternative therapies, such as traditional Chinese medicine and nutritional supplements, to themselves.

Data from an ongoing five-year UCSF study indicate that only a third of women with breast cancer disclosed using alternative treatment to their medical doctors while almost all women discussed their biomedical treatment with their alternative practitioners.

The findings will be presented as part of a symposium on women's self care at the 11th International Congress on Women's Health Issues held in San Francisco on Thursday, January 27, 2000. The Congress is sponsored by the University of California, San Francisco's School of Nursing in affiliation with the International Council on Women's Health Issues and other co-sponsoring institutions.

"Understanding why women are hesitant to talk to doctors about their alternative forms of medicine is critical to improving communication and patient care," said Shelley Adler, PhD, UCSF professor of medical anthropology and principal investigator of the study. "Some alternative therapies are beneficial, some can be harmful, and others may interact with pharmacologic therapies in significant ways. It's important for everyone involved to share information openly."

The three main reasons why women failed to discuss their alternative therapies revolved around their attitudes toward physicians. Impressions of physician disinterest, anticipation of a negative response, and the belief that their physician had inadequate training in or a bias toward alternative medicine deterred women from discussing their use of alternative medicine. Other reasons included the perception that disclosing complementary and alternative medicine use to physicians was not relevant or within the realm of the doctor-patient relationship.

"Patients are very cautious about revealing their alternative medicine practices to their doctors," said Adler. "Women seem to discuss their alternative therapies when they perceive their physician to be respectful, open-minded, and willing to listen."

The study included 86 English-, Spanish-, or Chinese-speaking women diagnosed with breast cancer who lived in San Francisco. The women were divided into two groups (between the ages of 35 and 49 or 60 and 74) in order to test for any differences in age.

During a 30-month period, which began two to four months after an initial diagnosis of cancer, the investigators conducted four, in-depth interviews designed to encourage women to articulate their beliefs and practices regarding health and illness. The open-ended questions touched upon the patients' experiences with and attitudes toward physicians and alternative practitioners as well as any interactions regarding alternative medicine and biomedical treatment. The most common forms of alternative therapies used to treat breast cancer were traditional Chinese medicine (such as acupuncture or herbs), mind/body healing methods (such as prayer or meditation), and nutritional supplements.

The most frequently cited reason for lack of disclosure was the feeling that the physician was not interested in the patient's use of alternative medicine. Even in instances where patients attempted to initiate discussion, their efforts were often not reciprocated, and unresponsiveness was taken as a sign that the physician did not want to hear more about the patient's practices, said Adler.

The second most cited reason for lack of disclosure was an anticipation of a negative physician response. "Patients are aware of the persistent ambivalence and occasional hostility of some biomedical practitioners toward alternative medicine," said Adler.

The study also dispelled two stereotypes surrounding alternative medicine. The researchers found that the use of alternative medicine is substantially higher than what is reported in the biomedical literature -- nearly 70 percent of the study participants had used at least one type of alternative medicine before the diagnosis of breast cancer. The study also found that women between 35 and 49 consistently used alternative therapies more often than women between 60 and 74, both before and after their diagnosis.

"Our findings challenge the persistent stereotype that women who use alternative therapies are desperate, older patients who are willing to try anything," said Adler. "It is critical not to make judgments about who uses alternative therapies on the basis of assumptions regarding age, socioeconomic status, or ethnicity. All patients have the potential to be interested in or to use a variety of alternative treatments."

The symposium on women's self care will also include research on self care actions of Myanmar domestic workers in Thailand, health beliefs and self care in Appalachian women, and the influence of perceived workplace support in a woman's ability to resume employment following breast cancer surgery.

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NOTE TO MEDIA: Shelley Adler will be available for interviews during the 11th International Congress on Women's Health Issues. Please call Rebecca Sladek Nowlis at (415) 476-2557 to arrange an interview or to attend the Congress.


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