Patients’ perceptions of Complementary and Alternative Medicine in head and neck cancer: A qualitative, pilot study with clinical implications Kristopher A. Hendershot, Margie Dixon, Scott A. Kono, Dong M. Shin, Rebecca D. Pentz * 1365 Clifton Road NE, Building B, Emory School of Medicine, Winship Cancer Institute, Atlanta, GA 30322, USA Keywords: Complementary and Alternative Medicine Head and neck cancer Natural compounds Ethics abstract Purpose: To describe head and neck cancer (HNC) patients’ perceptions of Complementary and Alter- native Medicine (CAM) and their attitudes towards a discussion regarding CAM. Methods: We interviewed a convenience sample of HNC patients, using a structured interview tool. Results: The participants’ perceptions of CAM can be grouped into three categories: positive; open- minded: needing more input; and negative. Almost all of the 14 participants (93%) report that they would be comfortable having a CAM discussion with their physician, although only 43% of the partici- pants had such a conversation. Conclusions: Participants’ willingness to discuss CAM suggests that HNC patients might be open to learning about their options for participating in needed CAM-related research. The reported lack of CAM discussions, despite participants expressed comfort with them, and potential harms of interactions be- tween CAM and conventional therapy, support our recommendation that physicians routinely initiate discussion with HNC patients regarding CAM usage. Ó 2013 Elsevier Ltd. All rights reserved. 1. Background Complementary and Alternative Medicine (CAM) is gaining popularity among cancer patients. The National Institutes of Health’s National Center for Complementary and Alternative Medicine (NCCAM) defines CAM as “a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine” [1]. These therapies are classified as: natural products, manipulative and body-based practices, mind and body medicine, and other CAM practices [1]. Head and neck cancer (HNC) affects more than half a million people globally annually and is treated with chemotherapy, radia- tion therapy, and surgery, which can result in both short- and long- term complications [2]. Smokers and heavy drinkers are at a higher risk of developing HNC [2]. Additionally, with the current advances in the treatment options available to patients, more survivors will need assistance with managing the long-term effects of the ther- apies [2], which could open a niche for natural compounds and other CAM. It is important to study CAM usage in patients with specific tumor types, as patients’ perceptions of, and rationale for, CAM use may vary by their disease site. Furthermore, under- standing CAM usage by HNC patients is necessary due to the nature of the disease and treatment, which can cause patients to have debilitating symptoms, such as difficulty chewing, swallowing, speaking, and breathing [3e5]; these factors may serve as both a reason for and a barrier to the usage of CAM. Although patients may benefit from CAM, its potential for harm includes significant side effects that are not always recog- nized by patients. Only 19.6% of HNC patients know about the potential for interactions between CAM and conventional ther- apy [6]. Patients often believe that CAM is inherently safe [6e9], though natural compounds have been found to have negative effects on radiation therapy [6], chemotherapy [6], and surgery [7,9e11]. The use of alternative medicine may result in the delay of effective cancer therapy, as HNC patients who used alternative medicine experienced a significant postponement of treatment by 22 days compared to patients who did not use alternative medicine [3]. We found eight quantitative studies reporting the prevalence of CAM usage by HNC patients [4e7,9,10,12,13]. These studies, con- ducted in different countries, used different definitions of CAM and different criteria for determining users, thus producing varying * Corresponding author. 1365 Clifton Road NE, B4300, Atlanta, GA 30322, USA. Tel.: þ1 404 831 1758 (mobile); fax: þ1 404 778 3366. E-mail addresses: kristopher.a.hendershot@emory.edu (K.A. Hendershot), mddixon@emory.edu (M. Dixon), scott.kono@gmail.com (S.A. Kono), dmshin@ emory.edu (D.M. Shin), rpentz@emory.edu (R.D. Pentz). Contents lists available at ScienceDirect Complementary Therapies in Clinical Practice journal homepage: www.elsevier.com/locate/ctcp 1744-3881/$ e see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ctcp.2013.10.005 Complementary Therapies in Clinical Practice xxx (2013) 1e6 Please cite this article in press as: Hendershot KA, et al., Patients’ perceptions of Complementary and Alternative Medicine in head and neck cancer: A qualitative, pilot study with clinical implications, Complementary Therapies in Clinical Practice (2013), http://dx.doi.org/10.1016/ j.ctcp.2013.10.005