The Use of Complementary and Alternative Therapies in Dogs and Cats With Cancer
The use of complementary and alternative medical therapies is becoming widespread. The objective of this study was to examine the use of complementary and alternative therapies in dogs and cats with cancer. The types of modalities used, the intended purpose for each modality, sources of information pet owners used, and the level of interest in these modalities were all evaluated. Information was obtained by written survey, and 254 owners agreed to participate. Complementary and alternative therapy use was commonplace, with 76% of surveyed owners reporting some use. When prayer for health reasons was excluded, the number of owners reporting use dropped to 65%. Nutritional supplements were the most commonly used therapy.
Introduction
The use of complementary and alternative medical therapies is becoming widespread. In a recent study done by the National Center for Complementary and Alternative Medicine and the National Center for Health Statistics, 31,044 adults in the United States were surveyed.1 This study found that 75% of respondents had used complementary and alternative medicines at some point in their lives, and 62% had used them in the past 12 months.1 When prayer for health reasons was excluded, 50% of respondents had used these therapies at some time, and 36% had used them in the last year.1 Richardson et al. reported that 83% of 453 human cancer patients surveyed had used at least one complementary or alternative approach.2 When spiritual approaches and psychotherapy were excluded, the percentage dropped to 63%.2 In a report assessing women treated for breast and gynecological cancers, it was found that 48% used some type of herbal or vitamin supplement, yet only 53% informed their physician about the usage.3
In animals, the use of complementary and alternative therapies has been reported in many species, and their use has been associated with a variety of disease states and conditions, including musculoskeletal, neurological, cardiovascular, dermatological, endocrine metabolic, and behavioral disorders.4–9 Because this area has undergone rapid change in recent years and its popularity has increased, concern has arisen over the possible interactions of complementary and alternative therapies with traditional treatments.10–13 Herbal products, in particular, may alter the activity of drug-metabolizing enzymes (e.g., cytochrome p450) or bind to drug transporter proteins (e.g., p-glycoprotein), potentially interfering with the pharmacokinetics of a chemotherapeutic drug and resulting in increased or decreased drug levels or alterations in rates of drug clearance.10 In some instances, an herb may cause direct toxicity or interfere with laboratory analysis of other compounds.11–13 To avoid unwanted interactions that negate treatment efficacy or increase unwanted side effects, it is important to know if these therapies are being used concurrently with traditional therapies. Although the true prevalence of use is unknown, it is often assumed that the use of complementary and alternative therapies in dogs and cats mirrors that of humans.
The purpose of this study was to examine the use of complementary and alternative therapies in a population of dogs and cats with cancer. Specifically, the types of modalities used, their intended purpose, the sources of information pet owners used to learn about these modalities, and the level of interest in such therapies were evaluated.
Materials and Methods
Study Subjects
Pet owners who presented their animal to a university oncology referral center between August 2004 and January 2005 were invited to participate in the study. The study was approved by the institutional review board for the use of human subjects (i.e., Regulatory Compliance Office, Human Research Committee). While clients waited for their pets’ appointment, they were asked by a designated research assistant if they were willing to participate in the survey. They were informed of the purpose of the study, told they would remain anonymous, and were given the option of declining participation. Owners were also informed that they could choose to stop and not complete the survey at any time. A cover letter stating the same information was also provided with each survey. If verbal consent was obtained, clients were given the survey to complete. The research assistant remained with the client, and the survey was returned to the assistant when completed. The individual who administered the survey was not involved with the pet’s veterinary care or treatment. Clients were given the survey only once and were instructed to provide information relating only to the pet they had brought with them on that day. Owners were surveyed at all types of visits (e.g., initial visit, follow-up visit), and owners of both dogs and cats were eligible to participate.
Survey Instrument
The survey instrument was five pages in length and was intended to take no more than 15 minutes to complete. It was divided into three sections, with 13 questions total. Space for comments was provided after each question. Information was obtained concerning demographic data of the owner (i.e., age, gender, level of education), types of complementary and alternative modalities used, length of use, sources of information about the modality, and intended purpose.
The therapies were classified into 11 major categories: herbs or botanicals, nutritional supplements, vitamins, special diets, acupuncture, massage, chiropractic, homeopathy, Reiki or healing touch, prayer, and flower essences. Participants were asked to select from the following sources of information about the modalities they were using: Internet, book or magazine, veterinarian, friend or family member, or other. Participants were also asked to select from the following intended purposes of the modalities chosen: improve general well-being, reduce pain, cure cancer, improve immune function, reduce treatment toxicity/detoxify, improve appetite, or other reasons. If other was the response chosen, participants were asked to give a specific answer in the comment field. More than one response could be given for each question. For example, more than one modality or reason for usage could be noted. Participants were asked if their regular veterinarian supported the use of complementary and alternative therapies and if they had talked to their veterinarian about the use of such therapies. A final question was designed to determine the level of interest each participant had in these therapies and included the following response options: no interest, average interest, or strong interest.
Statistical Analysis
Analysis was done with a statistical software package.a Frequencies for each variable were calculated. Statistically significant differences between owners who reported using complementary and alternative therapies and those who did not, based on gender and education level (e.g., high school or Graduate Equivalency Diploma; some college [i.e., <2 years]; 2-year technical schooling; 4-year college degree; advanced or postgraduate degree), were assessed through the use of chi-square. Differences based on age were assessed through the use of unpaired t-tests. Significance level was set at P<0.05.
Results
Two-hundred-fifty-four surveys were completed. Demographic data of the respondents are provided in the Table. There were more female than male respondents and more than half (n=163 or 64%) had a 4-year college or advanced degree. Complementary and alternative therapies were used by 199 (76%) owners. This number dropped to 164 (65%) when prayer was excluded. Based on the 11 categories of treatment modalities previously described, their usage is summarized in Figure 1. The most commonly used modality was nutritional supplements, with 102 (40%) of the respondents reporting their use. The length of time that owners used each modality ranged from one time or sporadic use to =60 months of continuous use.
The resources participants used for information on these modalities varied, with many (46%) owners listing their veterinarian as a resource. This was true for seven categories of modalities, with the exception of massage, healing touch, flower essences, and prayer. For these latter categories, family and friends were the predominant resources. Other resources listed by survey participants included school, breeder, training classes, dog shows, alternative health care provider, health food stores, and television [Figure 2].
The intended purpose of complementary and alternative therapies was varied [Figure 3]. The most common reasons for using these therapies were to improve general well-being (34%) and improve immune function (22%). When the specific modalities were considered separately, 10 modalities were most often selected in an effort to improve general well-being. Chiropractic procedures were usually chosen to reduce pain.
When asked if their regular veterinarian supported the use of complementary and alternative therapies, 163 (64%) owners believed they did, 23 (9%) respondents said no, and 50 (20%) respondents did not know their veterinarians’ views. Eighteen (7%) respondents did not provide an answer. When asked if they talked to their veterinarian about complementary and alternative therapy use, 89 (35%) owners said yes, 144 (57%) respondents said no, and 21 (8%) did not respond. When asked about level of interest, 141 (57%) owners indicated strong interest, 100 (40%) respondents indicated an average interest, and seven (3%) respondents reported no interest in complementary and alternative therapies.
When differences based on the age, gender, or education level of owners were compared to usage, no statistically significant differences were found. With respect to level of interest, gender of the owner had a significant influence (P=0.003), with female participants more likely to report a strong interest (n=161; 64%) than male participants (n=38; 44%). Additionally, even though 24% of those surveyed reported no use, an overwhelming number (97%) reported at least some interest in these modalities.
Discussion
The study reported here sought to determine the frequency of use of complementary and alternative therapies in a population of dogs and cats diagnosed with cancer and to further define the type and reasons such modalities were chosen. The high usage rate (76%) was similar to that reported in humans in the United States.1 Demographically, most human studies involving cancer patients or the general public have found that the individuals who most often seek complementary and alternative therapies are female, better educated, of a higher socioeconomic status, and of a younger age.14 In the survey population of the present study, no differences were found with respect to the age, gender, or education level of the respondents and frequency of use of these modalities. It is possible that the survey participants were skewed with regard to demographics, because no attempt was made to control the number or type of participants in each demographic category. Demographic data for nonsurveyed pet owners who visited the veterinary teaching hospital during the same time period were not maintained and were not available for comparison. The only difference based on demographic data that was found in the current study was the level of interest in complementary and alternative therapies. More female respondents reported a strong interest than male respondents. This finding mirrored the trend seen in humans.3
The most common modalities used included nutritional supplements, prayer, diet, and vitamins. When prayer was excluded, the rest of the above modalities accounted for 51% of the responses chosen. These modalities are commonly classified as biological interventions and were often chosen, administered, and controlled by the pet owner. In contrast, the least used modalities were acupuncture and chiropractic procedures. Only 5% of all owners used these modalities, and their low frequency may have been affected by their requirement for a third party or practitioner to provide the services.
Veterinarians were listed as the most common resource for information about complementary and alternative modalities. This finding emphasized the opportunity veterinarians have to appropriately educate pet owners concerning the potential pitfalls and benefits of these treatments. Simply providing owners with sources of reliable information would likely be beneficial. The reason for use or intended purpose of each modality was quite varied. It was interesting to note, however, that the most common reason was “to improve general well-being” and not as a treatment for a specific problem or as a cure for cancer.
When participants were asked about their regular veterinarians’ support of the use of complementary and alternative therapies, most (64%) respondents believed the veterinarians supported their use. However, when asked if they had talked to their veterinarian about the subject, the majority (58%) had not done so. This pattern was similar to reports in humans, where many complementary and alternative therapies have not been disclosed to the physician.3,16 In some cases, patients were not asked, or the information was not recorded in the medical record.9,16 In a survey of 165 primary care physicians, only 58% always or often asked their patients about complementary therapy use, and most physicians estimated that <15% of their patients used these modalities.17 It was concluded that physicians underestimated the rate of use by their patients, and it was suggested that many patients do not report such use to their physicians.17 These findings reiterate the importance of good communication with pet owners, because some owners may not think these therapies are medically important, and some may be concerned about potential veterinarian objections to their use.
This survey, which was intended to provide some general information concerning complementary and alternative therapies in dogs and cats with cancer, raised many additional questions. Additional socioeconomic information (e.g., ethnicity, income) regarding owners was not sought, in an attempt to increase survey participation. No detailed information was obtained concerning the type of supplements used or doses of any particular vitamin or herb. The definition of what constitutes a supplement or botanical was not specifically given, although survey participants were free to ask questions if they wished. Such information might prove useful, especially in animals that have cancer and are receiving more traditional medications. Reports have been published about certain herbs and botanicals and their possible interactions with chemotherapeutic agents and drug metabolism.10 Recently, the Clinical Center of the National Institutes of Health set new policies concerning supplement use in humans enrolled in clinical trials. All patients are to be screened, and all therapies are to be authorized by the attending physician.15 This policy does not recommend discontinuation in most cases, but instead stresses the importance of open communication and disclosure of what patients are taking, in order to avoid unwanted drug interactions.15
The survey reported here was limited to owners of pets seen by a clinical oncology service. To ensure anonymity, no attempt was made to link survey participant responses with animal information (e.g., type of cancer, stage of disease, visit type). It may be beneficial to further define the use of complementary and alternative therapies based on these parameters. Navo et al. reported that disease status can have a significant influence on the use of complementary and alternative therapies in women with gynecological cancer.3 In that study, newly diagnosed patients were less likely to use these modalities than those with relapses or those currently in remission.3
Conclusion
This study found that the use of complementary and alternative therapies in a group of dogs and cats with cancer was high and paralleled that previously reported for humans. Pet owners turned to their veterinarians most often for information about these modalities. Additional studies are necessary to better define what effect these modalities might have or what interactions there may be with traditional medicines. Expanded studies that include a variety of animal species, disease states, owner demographics, and geographic areas are warranted to further define the use of complementary and alternative therapies in the general animal population as a whole.
SPSS 13.0 for Windows; Apache Software Foundation, Chicago, IL 60606
Acknowledgment
The authors acknowledge Carrie Griesedieck, CVT, for her help with survey administration.
Citation: Journal of the American Animal Hospital Association 42, 5; 10.5326/0420361
Citation: Journal of the American Animal Hospital Association 42, 5; 10.5326/0420361
Citation: Journal of the American Animal Hospital Association 42, 5; 10.5326/0420361
Eleven categories of complementary and alternative treatment modalities used, in order of decreasing frequency (total respondents=199).
Most common sources of information about complementary and alternative therapies. See text for details on the “other” category (total respondents=199).
Intended purposes of complementary and alternative therapies. See text for details on the “other” category (total respondents=199).
