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I. Article’s Title, Source and Authors:

Title:
Gender, Symptom Experience, and Use of Complementary and Alternative Medicine
Practices among Cancer Survivors in the U.S. Cancer Population
Source and date of publication:
Oncology Nursing Forum • Vol. 37, No. 1,
January 2010
Authors:
Judith M. Fouladbakhsh, PhD, APRN, AHN-BC, CHTP, and Manfred Stommel, PhD

II. Summary:

The study entitled “Gender, Symptom Experience, and Use of Complementary

and Alternative Medicine Practices among Cancer Survivors in the U.S. Cancer
Population” is geared toward the identification of the relationships among gender,
physical and psychological symptoms particularly pain, insomnia, fatigue, and
depression, and use of specific complementary and alternative medicine (CAM) practices
among survivors in the U.S. cancer population. CAM therapies are the group of diverse
medical and healthcare treatments, products and practices not considered part of
conventional medicine but often use in relation to health. Previous studies reveal that
more than 39% of individuals in US diagnosed with cancer at some point in their lifetime
have used CAM. Some patients use CAM with the hope of improving their survival
chances or decreasing their risk of cancer recurrence. In relation to gender, women are
more likely than men to use CAM. The utilization of meditation, guided imagery, and
deep breathing for relaxation may reflect the tendency of women to be more actively
involved in self-care, as has been previously suggested in the healthcare literature.
Because of these rationales, the researchers decided to examine what triggers the use of
specific types of CAM practices as self-care strategies to manage symptoms and to
determine similarities and differences in their use among men and women in the cancer
population. They utilized CAM Healthcare Model which was a modification of
Andersen’s Behavioral Model in data gathering. About 2,262 adults, aged 18 years and
older diagnosed with cancer representing more than 14.3 million cancer survivors in the
United States were the participants. NHIS interview data on use of CAM practices (diet,
yoga, tai chi, qigong, meditation, guided imagery, relaxation, and deep breathing) were
examined in relationship to gender and symptoms. Analysis was conducted using Stata®
9.2 software for population estimation. Binary logistic regression, the primary statistical
model employed in the analysis, focused on between-subject differences in practice use.

The finding of the research revealed that CAM practice use was more prevalent
among female, middle-aged, Caucasian, and well-educated subjects. Pain, depression,
and insomnia were strong predictors of practice use, with differences noted by gender and
practice type.

Gender, Symptom Experience, and Use of Complementary and

Alternative Medicine Practices among Cancer Survivors in the
U.S. Cancer Population BY MEDINA, PATRICK LUIS F.
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The most used CAMs were the “no cost” or “low cost” practices, such as deep
breathing, meditation, and special diets. Diet requires purchase of foods while the
meditation and deep breathing exercises can be practiced with only the cost of a time
commitment. These practices also may be easier to adopt for self-care, with little need for
instruction. Practices such as yoga, guided imagery, and tai chi are used less frequently,
possibly because they may require expenses for class attendance or purchase of
instructional materials. It appears that apart from the strong predisposing factors of
gender, age, and education, the gender-specific experience of chronic symptoms such as
insomnia and depression affects the likelihood of engaging in specific CAM practices.

III. Relevance to the Nursing Practice:

Nursing is a healthcare profession focused on the care of individuals, families,

and communities so they may attain, maintain, or recover optimal health and quality of
life from birth to the end of life. (Lipincott, 2001). The study is very beneficial in the
nursing practice since the profession deals with the various treatments needed for the
management of patients with cancer especially when they were in pain. Cancer is not a
single disease with a single cause; rather, is it a group of distinct diseases with different
causes, manifestations, treatments and prognosis. (Brunner and Suddarth, 2005).
According to the book of Bruner and Suddarth (2005), cancer nursing practice covers all
age groups and nursing specialties and is carried out in variety of health care settings,
including the home, community, acute care institutions, outpatient centers, rehabilitation
and long term care facilities. The scope, responsibilities and goals of cancer nursing, also
called oncology, are complex as those of nursing specialty. This research is essential
since it provides knowledge of the most used and significance if alternative and
complementary medicine management in cancer patients. Through these self cares, we
are enhancing the emotional support of the patient especially when he is already dealing
with severe pain. Bruner (2005) said that cancer nurses must be prepared to support
patients and families through a wide range of physical, emotional, social, cultural and
spiritual crises.

. In nursing profession, nurses do not only deal with the curative aspect of health
care but also in promotive and preventive aspect of diseases to achieve a decreased in
morbidity and mortality rate. Through gaining additional insights and knowledge
regarding cancer the provision of holistic health care system will be facilitated to the
community. The nurses, which are of the profession of nursing, portray various qualities
and roles. As educators to the clients, nurses are rendered to provide a multidimensional
knowledge, awareness and understanding regarding cancer in order to provide promotive,
preventive, and curative perspectives to them. By gaining additional information
specifically on the effect of CAM in care of cancer patients, then nurses would be able to
deliver a comprehensive health teaching to their patients especially those who are
confined in the palliative ward. As social change agent, nurses are responsible in starting
the change to encourage the clients to practice activities of daily living which would

Gender, Symptom Experience, and Use of Complementary and

Alternative Medicine Practices among Cancer Survivors in the
U.S. Cancer Population BY MEDINA, PATRICK LUIS F.
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enable them to improve health through low but effective cost. As leader of the
community, nurses may serve as the instrument in the formulation and creation of various
health programs that would help the community decrease the incidence of cancer. The
findings of the research will serve as the guide of the health workers to create such
program. As a caregiver, nurses are rendered to provide comfort and therapeutic
treatment to the patient (Huber, 2007). The research reveals the most common self – care
treatment for cancer patients. A good quality of a nurse is being a caring individual. He
must be somebody who has concern and love to the patients. By portraying the various
roles and characteristics of nurses, a caring behavior is practiced thus facilitate the health
care delivery system to the patient for the purpose of health maintenance and
improvement. To sum up, the study mentioned plays vital role in the nursing practice
since this research will serve as the nurse’s guide in provision of health care and
completion of nursing process, particularly in the planning phase, to numerous patients
such as in palliative ward for them to live with improved and quality of life through the
correct nursing management and interventions that could be applied to them.

IV. Relevance to Nursing Education:

Through the information provided by the research mentioned, student nurses and
registered nurses will be able to acquire additional knowledge for them to achieve a
holistic learning regarding the most common complementary and alternative medicines
used in cancer patients in order to improve the planning phase of nursing process hence
enhancing the educative part of nursing interventions and SOAP. This knowledge can be
shared to other members of health team thus enhancing the provision of health care
education. By gaining knowledge from this research, readers will have new realization on
how to facilitate the nursing process especially when dealing with patients who are
diagnosed with cancer. Aside from those rationales, people should not only know one
aspect rather he must know the all of the information regarding a disease and by knowing
the most common CAM used and its relation to symptoms like pain, the health team
could perform the suggested CAM in dealing to the cancer patients. This is the reason
why nursing education is a holistic approach. Learning is dynamic and not static therefore
awareness regarding the latest development in medical and nursing field is necessary.
Nurses play the role of educator and in order to achieve such role, he must acquire first a
holistic knowledge in order to perform fittingly the nursing process. When the problem is
already determined, health teaching could be performed for the provision of health care to
the people so that mortality and morbidity incidences could be prevented and their
cooperation will be attained. Because of this research, the nurse could conduct health
teachings in relation to the suggested CAM through various learning strategies such as
return demonstration or utilization of pamphlet.

Gender, Symptom Experience, and Use of Complementary and

Alternative Medicine Practices among Cancer Survivors in the
U.S. Cancer Population BY MEDINA, PATRICK LUIS F.
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V. Relevance to Nursing Research:

Research is a systematic, empirical and controlled investigation of hypothetical

proposition regarding the natural phenomena. (Kerlinger, 1996). In relation to the nursing
research, the study emphasizing the impact of alternative and complementary medicines
such as diet, yoga, tai chi, qigong, meditation, guided imagery, relaxation, and deep
breathing is a big contribution to supplement the knowledge of the reader motivating and
encouraging him to conduct further research regarding the topic. By conducting similar
research, comparison can be done to validate the result of this study. As a student
researcher, I was motivated to conduct a qualitative research this time. Observations
informed me that cancer is common in the country, one of the cases in SLU-HSH and
often manifests intolerable symptoms like pain. Because of that, I want to determine the
effect of utilization of CAM in alleviating pain.

The study entitled “Gender, Symptom Experience, and Use of Complementary and
Alternative Medicine Practices among Cancer Survivors in the U.S. Cancer Population”
provides a big impact to professional readers like nursing researchers since it aids them to
gain relevant information that would be utilized to supplement and make one’s research
an evidence -based research. The future researchers can also used this to strengthen the
rigor, truthfulness and validity of their studies since this is a possible RRL. Through the
help of the study, researchers on same topic would acquire more perspectives and
references for their further studies.

VI. Relation to the Philippines setting:

According to the statistics given by Cureresearch (2002), the annual incidence of

cancer in the Philippines is 20,387 out of 86,241,697 population. Although cancer is not
in the top 10 indicators of morbidity and mortality in the Philippines, still there is
occurrence of the cancer disease. Some herbal treatments on the specific type of cancer
are already present in the country. For example, One Filipino research said that
“malunggay” is used to treat ovarian cancer. Study suggests M Oleifera can interfere with
hormone receptor-related and neoplastic growth-related cytokine pathways through
centrally acting mechanisms (http://www.stuartxchange.org/Malunggay.html). One
research from Saint Louis University said that bitter melon has potential to prevent
cancer such as of breast. (http://health.einnews.com/news/philippines-cancer)

Department of Health encourage everyone to lessen developing cancer by quitting

smoking, limiting drinking alcoholic beverages, watching your diet, consulting your
doctor Regularly and doing regular physical activity. They also emphasized that the risks
factors in cancer development are related to heredity, diet, physical inactivity and
prolonged, continuous exposure to certain chemicals and other substances. However
DOH doesn’t promote the utilization of complementary and alternative medicine in
dealing with cancer. Such method is effective and yet of low cost. This research may

Gender, Symptom Experience, and Use of Complementary and

Alternative Medicine Practices among Cancer Survivors in the
U.S. Cancer Population BY MEDINA, PATRICK LUIS F.
 5

serve as an instrument in order for the department to emphasize the application of CAM
in cancer.

This research will also benefit the Philippines Cancer Control Program handled
by DOH. The Philippine Cancer Control Program, begun in 1988, is an integrated
approach utilizing primary, secondary and tertiary prevention in different regions of the
country at both hospital and community levels. Dealing with the six lead cancers (lung,
breast, liver, cervix, oral cavity, colon and rectum), the knowledge provided from this
research can be utilized by the program in order to enhance and facilitate the management
of the diseases particularly in the symptoms in order to enhance the provision of care to
the cancer patients..

VII. Reaction:

The journal successfully informed me the relationship of complementary and

alternative medicine in dealing with cancer. Cancer occurs in the Philippines hence early
detection of the disease is necessary so that nursing interventions could be given
immediately thus preventing further complications. One priority in nursing process is the
management of pain. An affordable yet effective self care management is necessary
especially for those in low socio economic status or DOPE. This research benefits the
entire health team members and patients thus this will aid in the provision of health care
delivery system.

The method and tools used in the research is effective although the result may not
be accurate. One limitation of the research is that, the result may just be due to chance;
hence another research may support the result of this study to make it more
comprehensive and accurate. The researchers conducted a systematic process to come up
with their conclusion.

I suggest these complementary and alternative medicine management will be

applied in the nursing practice. The research informed us that this therapy is widely used
in the US. If it is applicable to the whites then why not to the browns also? For sure, this
will improve the patient’s condition since it is one way of alleviating the symptoms such
as pain, insomnia and depression. Aside from that, CAM is widely used and is acceptable
in the Philippine culture.

VIII. Relevance to patient’s case:

One case in the palliative ward is the case of Maria Alona Rivera TIbule. She is
42 years old, female, who was admitted last March 1m 1010 at 5:10om with chief
complaint for third cycle of chemotherapy. The diagnostic procedures done to her
included CBC, hematology, Serum K and Na test, Creatinine Test, ASAL, ALAT and

Gender, Symptom Experience, and Use of Complementary and

Alternative Medicine Practices among Cancer Survivors in the
U.S. Cancer Population BY MEDINA, PATRICK LUIS F.
 6

Urea Test. The medications given were dexamethasone, dipenhydramine, ranitidine, iron
multivitamins, and Nasea. The nursing diagnosis identified were risk for infection,
ineffective airway clearance, mild anxiety and altered tissue perfusion. Some of the
nursing interventions done were assessment of general status, monitoring of vital signs,
assessment of circulatory status, assessment of respiratory srarus, observation of verbal
and non-verbal cues, reviewing of laboratory results, conversing therapeutically to the
patient, promotion of rest, fixing of linens, positioning the patient, encouragement to
perform hand washing and emphasizing the importance of eating foods rich in iron.

The research is essential to the patient’s case because the complementary and
alternative medicine can be applied in the interventions of the patient. CAM is widely
used in US because it alleviates symptoms of cancer particularly pain, depression and
insomnia hence it gives nurses other applicable nursing interventions to make the nursing
process effective. The patient said that before there were times wherein she experienced
pain. Because of cancer, this pain may reoccur again. Complementary and alternative
medicine is nice to know and to be taught to the patient since this is a low cost and
effective self-care treatment.

IX. References:

Book sources:
a. Kozier, Fundamentals of Nursing
b. Oncology Nursing Forum • Vol. 37, No. 1, January 2010
c. Kerlinger, Introduction to Research
d. Lippincott’s foundation of nursing
e. Lippincott, Williams, and Wilkins’ Medical-Surgical Nursing
f. Diane Huber’s Leadership and nursing care management
g. Susan Bacorn Bastable’s Nurse as educator: principles of teaching and learning
for nursing practice

Internet sources:
a) www.doh.gov.ph
b) http://www.who.int/
c) http://www.doh.gov.ph/programs/dengue
d) http://www.arbovirus.health.nsw.gov.au
e) http://www.ebscohost.com
f) http://newsinfo.inquirer.net
g) Cureresearch.com

Gender, Symptom Experience, and Use of Complementary and

Alternative Medicine Practices among Cancer Survivors in the
U.S. Cancer Population BY MEDINA, PATRICK LUIS F.
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IX. Additional information:

>The different complementary and alternative medicine:
1. deep breathing - act of breathing deep into one's lungs by flexing one's diaphragm
rather than breathing shallowly by flexing one's rib cage. This deep breathing is marked
by expansion of the stomach (abdomen) rather than the chest when breathing. It is
generally considered a healthier and fuller way to ingest oxygen, and is often used as a
therapy for hyperventilation and anxiety disorders; Improper breathing causes oxygen
deficiency. Use the full capacity of your lungs by expanding both the chest and lower
abdomen. Practice deep breathing for a few minutes every day. If you feel depressed, try
breathing more deeply. Deep breathing also contributes to moving the lymph.

2. meditation- Meditation is a mind-body practice in complementary and alternative

medicine (CAM). There are many types of meditation, most of which originated in
ancient religious and spiritual traditions. Generally, a person who is meditating uses
certain techniques, such as a specific posture, focused attention, and an open attitude
toward distractions. Meditation may be practiced for many reasons, such as to increase
calmness and physical relaxation, to improve psychological balance, to cope with illness,
or to enhance overall wellness.

3. diet

4. Yoga- Yoga is a mind-body practice in complementary and alternative medicineA

group of diverse medical and health care systems, practices, and products that are not
presently considered to be part of conventional medicine. Complementary medicine is
used together with conventional medicine, and alternative medicine is used in place of
conventional medicine. (CAM) with origins in ancient Indian philosophy.

• People use yoga for a variety of health conditions and to achieve fitness and
relaxation.
• It is not fully known what changes occur in the body during yoga; whether they
influence health; and if so, how. There is, however, growing evidence to suggest
that yoga works to enhance stress-coping mechanisms and mind-body awareness.
Research is under way to find out more about yoga's effects, and the diseases and
conditions for which it may be most helpful.
• Tell your health care providers about any complementary and alternative practices
you use. Give them a full picture of what you do to manage your health. This will
help ensure coordinated and safe care.

Gender, Symptom Experience, and Use of Complementary and

Alternative Medicine Practices among Cancer Survivors in the
U.S. Cancer Population BY MEDINA, PATRICK LUIS F.
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5. Taichi - Tai chi, which originated in China as a martial art, is a mind-body practice in
complementary and alternative medicine (CAM). Tai chi is sometimes referred to as
"moving meditation"—practitioners move their bodies slowly, gently, and with
awareness, while breathing deeply. This Backgrounder provides a general overview of tai
chi and suggests sources for additional information.

Key Points

• Many people practice tai chi to improve their health and well-being.
• Scientific research is under way to learn more about how tai chi may work, its
possible effects on health, and chronic diseases and conditions for which it may
be helpful.
• Tell your health care providers about any complementary and alternative practices
you use. Give them a full picture of what you do to manage your health. This will
help ensure coordinated and safe care.

6. Qigong - Qigong (or ch'i kung) is an internal Chinese meditative practice which often
uses slow graceful movements and controlled breathing techniques to promote the
circulation of qi within the human body, and enhance a practitioner's overall health.
There are also many forms of qigong that are done with little or no movement at all, in
standing, sitting and supine positions; likewise, not all forms of qigong use breath control
techniques.

7. Guided imagery - Guided affective imagery (GAI; also known as katathym

imaginative psychotherapy) is a method of psychotherapy. It is a therapeutic technique in
which a facilitator uses descriptive language intended to psychologically benefit mental
imagery, often involving several or all senses, in the mind of the listener. In this method,
the imagination plays an important role together with discussions with the client. It was
developed by German psychiatrist Hanscarl Leuner, based on his research in guided
mental imagery, "catathymic influences" (the interaction of mental contents and
emotional processes), dreams and daydreams.

Gender, Symptom Experience, and Use of Complementary and

Alternative Medicine Practices among Cancer Survivors in the
U.S. Cancer Population BY MEDINA, PATRICK LUIS F.