Background This large population-based prospective study explored the associations between use of complementary and alternative medicine (CAM) and prevalence and changes in depressive symptoms from 3 to 15 months after surgery for primary breast cancer. Methods In an ongoing nationwide cohort study, depressive symptoms and the use of ten different types of CAM since time of diagnosis were assessed by questionnaire at 3 (N = 3233) and 15 months post-surgery (N = 2833). Clinical and socio-demopraphic variables were obtained from the Danish Breast Cancer Cooperative Group (DBCG) and national longitudinal registries. Results At 3 months post-surgery, 40.2 % reported having used CAM since the diagnosis, and in the time from 3 to 15 months after surgery, 49.9 % had used CAM. Compared with non-users, CAM users experienced more depressive symptoms at both 3 and 15 months follow-up when adjusting for several possible confounders. In a fully adjusted model, including all CAM variables and adjusting for depressive symptoms at 3 months, use of dietary/vitamin supplements was the only independent, statistically significant risk factor for experiencing more depressive symptoms at 15 months (RM = 1.10; 95 % CI 1.02–1.19, P = 0.014). Conclusion Cross-sectionally, CAM use was associated with higher levels of depressive symptoms at both time-points. Prospectively, users of dietary or vitamin supplements at 3 months after surgery reported higher levels of depressive symptoms than non-users 1 year later. Possible explanations could be an increased vulnerability for depressive symptoms among women using CAM or adverse effects of dietary or vitamin supplements.
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Christensen S, Zachariae R, Jensen A et al (2009) Prevalence and risk of depressive symptoms 3–4 months post-surgery in a nationwide cohort study of Danish women treated for early stage breast-cancer. Breast Cancer Res Treat 113(2):339–355
Fisch M (2004) Treatment of depression in cancer. J Natl Cancer Inst Monogr 32:105–111
Kang E, Yang EJ, Kim S et al (2012) Complementary and alternative medicine use and assessment of quality of life in Korean breast cancer patients: a descriptive study. Support Care Cancer 20:461–473
Sollner W, Maislinger S, DeVries A et al (2000) Use of complementary and alternative medicine by cancer patients is not associated with perceived distress or poor compliance with standard treatment but with active coping behavior: a survey. Cancer 89(4):873–880
Saquib J, Madlensky L, Kealey S et al (2011) Classification of CAM use and its correlates in patients with early-stage breast cancer. Integr Cancer Ther 10(2):138–147
Henderson JW, Donatelle RJ (2003) The relationship between cancer locus of control and complementary and alternative medicine use by women diagnosed with breast cancer. Psychooncology 12(1):59–67
Adams M, Jewell AP (2007) The use of complementary and alternative medicine by cancer patients. Int Semin Surg Oncol 4:10
de Jong FA, Sparreboom A, Verweij J et al (2008) Lifestyle habits as a contributor to anti-cancer treatment failure. Eur J Cancer 44(3):374–382
Burstein HJ, Gelber S, Guadagnoli E et al (1999) Use of alternative medicine by women with early-stage breast cancer. N Engl J Med 340(22):1733–1739
Gilbar O, Iron G, Goren A (2001) Adjustment to illness of cancer patients treated by complementary therapy along with conventional therapy. Patient Educ Couns 44(3):243–249
Popiela T, Kulig J, Hanisch J et al (2001) Influence of a complementary treatment with oral enzymes on patients with colorectal cancers: an epidemiological retrolective cohort study. Cancer Chemother Pharmacol 47(Suppl):55–63
Carlsson M, Arman M, Backman M et al (2005) Coping in women with breast cancer in complementary and conventional care over 5 years measured by the Mental Adjustment to Cancer Scale. J Altern Complem Med 11(3):441–447
Han E, Johnson N, DelaMelena T et al (2011) Alternative therapy used as primary treatment for breast cancer negatively impacts outcomes. Ann Surg Oncol 18:912–916
O’Connor M, Christensen S, Jensen AB, Moller S, Zachariae R (2011) How traumatic is breast cancer? Post-traumatic stress symptoms (PTSS) and risk factors for severe PTSS at 3 and 15 months after surgery in a nationwide cohort of Danish women treated for primary breast cancer. Br J Cancer 104(3):419–426
Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383
Singletary SE, Allred C, Ashley P et al (2002) Revision of the American Joint Committee on Cancer staging system for breast cancer. J Clin Oncol 20(17):3628–3636
Rostgaard K, Holst H, Mouridsen HT et al (2000) Do clinical databases render population-based cancer registers obsolete? The example of breast cancer in Denmark. Cancer Causes Control 11(7):669–674
Statistics Denmark (2005) http://www.dst.dk/HomeUK/About/introSD.aspx
American Psychiatric Association (1994) Diagnostic and statistical manual of mental health disorders (4th ed). American Psychiatric Association, Washington DC
Beck AT, Steer RA, Brown GK (1996) Manual: Beck depression inventory, 2nd edn. The Psychological Corporation, San Antonio
Ekholm O, Kjøller M, Davidsen M, Hesse U, Eriksen L, Christensen A et al (2006) Health and morbidity in Denmark 2005 & development since 1987. National Institute of Public Health, Copenhagen
Extermann M (2000) Measuring comorbidity in older cancer patients. Eur J Cancer 36(4):453–471
Washburn RA, Smith KW, Jette AM et al (1993) The physical activity scale for the elderly (PASE): development and evaluation. J Clin Epidemiol 46:153–162
Ware JE, Sherbourne CD (1992) The Mos 36-Item short-form health survey (Sf-36): conceptual-framework and item selection. Med Care 30(6):473–483
World Health Organization (2000). Obesity: preventing and managing the global endemic. Geneva, WHO. Technical Report Series no 894
Schafer JL, Graham JW (2002) Missing data: our view of the state of the art. Psychol Methods 7(2):147–177
Carlsson M, Arman M, Backman M et al (2006) A five-year follow-up of quality of life in women with breast cancer in anthroposophic and conventional care. Evid Based Complement Alternat Med 3(4):523–531
Correa-Velez I, Clavarino A, Barnett AG et al (2003) Use of complementary and alternative medicine and quality of life: changes at the end of life. Palliat Med 17(8):695–703
Pedersen CG, Christensen S, Jensen AB et al (2009) Prevalence, socio-demographic and clinical predictors of post-diagnostic utilisation of different types of complementary and alternative medicine (CAM) in a nationwide cohort of Danish women treated for primary breast cancer. Eur J Cancer 45(18):3172–3181
Sered S, Agigian A (2008) Holistic sickening: breast cancer and the discursive worlds of complementary and alternative practitioners. Sociol Health Illn 30(4):616–631
Long SJ, Benton D (2013) Effects of vitamin and mineral supplementation on stress, mild psychiatric symptoms, and mood in non-clinical samples: a meta analysis. Psychosom Med 75(2):144–153
We thank the participating women, the staff at the participating surgical departments, Susanne Møller, the Danish Breast Cancer Cooperative Group (DBCG), Rigshospitalet, Copenhagen University Hospital and Michael Væth, Department of Biostatistics, Aarhus University. We also thank the Danish Cancer Society and the Knowledge and Research Centre for Complementary and Alternative Medicine (ViFAB) for funding the study.
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Pedersen, C.G., Christensen, S., Jensen, A.B. et al. Use of complementary and alternative medicine (CAM) and changes in depressive symptoms from 3 to 15 months after surgery for primary breast cancer: results from a nationwide cohort study. Breast Cancer Res Treat 141, 277–285 (2013). https://doi.org/10.1007/s10549-013-2680-1
- Breast cancer
- Depressive symptoms
- Complementary and alternative medicine (CAM)
- Cohort studies
- Health behavior