i DAVAO MEDICAL SCHOOL FOUNDATION, INC Medical School Drive, Bajada, Davao City College of Nursing

VIEWS AND REASONS OF ADULT CANCER PATIENTS ON THE USE OF COMPLEMENTARY AND ALTERNATIVE MEDICINES

A Research Paper Presented to the Faculty of College of Nursing in Davao Medical School Foundation

In Partial Fulfillment of the Requirements in Bachelor of Science in Nursing

By Norman B. Juruena, BSN Principal Researcher Jean Leslie C. Bughao, BSN Reyveen John B. Geli, BSN Kathlyn Janine S. Mones, BSN Co-Researchers Mary Laureen M. Santarin, BSN Rosthy John L. Soria, BSN Rinnah Grace Q. Talatagod, BSN

March 2012

ii APPROVAL SHEET

iii ACKNOWLEDGEMENT

The researchers would like to express their deepest gratitude and indebtedness to the following people who gave their full support and invaluable help to make this study possible:

To Ms. Elsie S. Callueng, RN, MAN, the researchers mentor, for her support and untiring guidance, as well as valuable suggestions and inspiring words of encouragement to finish this study;

To Mr. Ruperto Hector A. Lindo, MAEd, the research coordinator who facilitated this thesis, endowing the researchers with valuable suggestions and for his patience in guiding us in completing this study;

To the members of the panel at Southern Philippines Medical Center, Ms. Vilma Comoda, RN, MAN, Ms. Elizabeth Barriga, RN, MAN, Mr. Rueben Gaoaen, RN, MAN, Ms. Madel Dapit and Ms. Angie Revilla for their availability and for their suggestions and positive approaches in the improvement of this thesis;

To Ms. Elizabeth R. Soriano, RN, MAN, the Dean of College of Nursing, for allowing the research team to conduct this study;

iv To our beloved parents, for providing us the moral, financial support and commitment to help sustain the researchers in their field of endeavour, and for the faith and inspiration to finish this study;

And most of all, to Almighty God, who is the researchers ultimate source of knowledge, strength, wisdom, inspiration, guiding consciousness and strength during the difficult moments of writing this thesis.

The Researchers

v DEDICATION

The researchers dedicate this research work to God Almighty, the source of wisdom and inner strength; and also, to the future health care professionals.

The researchers also dedicate this research work to their loved ones, whose assistance and understanding transcended everything until the completion of this research work.

vi ABSTRACT Complementary and Alternative Medicines are healthcare systems, practices, and products not considered a part of conventional medicine. The use of CAM has increased steadily over the past 15 years or so, and undoubtedly it has gained medical, economic and sociological importance (National Center of Complementary and Alternative Medicine, 2009). This study used qualitative interviews specifically in-depth interview approach as the method of data collection. This study had provided a qualitative account of the adult cancer patients views and reasons on the use of complementary and alternative medicines and the rationales behind their perspectives. The researchers sought out five (5) possible respondents for this study who were currently admitted in a local tertiary hospital. Three (3) respondents came from Internal Medicine Ward while the two (2) remaining respondents came from Gynecology Ward. The researchers named the following patients as Respondent A, Respondent B, Respondent C, Respondent D and Respondent E. In conclusion, the five (5) respondents showed varied views and reasons on the use of complementary and alternative medicines. Most of them viewed these treatment modalities were partially effective in treating cancer due to several factors such as age and absence of underlying illness. Furthermore, majority of the respondents had shared common reasons on the use of complementary and alternative medicines such as financial constraint, hope to cure cancer, reduced side-effects of chemo drugs and by the influenced of others. With these views and reasons, it only showed that the use of complementary and alternative medicines needs further research and progressive investigation on its proper applications especially on its role as adjunctive therapy for cancer.

vii TABLE OF CONTENTS

Title Page .... i Approval Sheet ... ii Acknowledgement . iii Dedication .. v Abstract . vi Table of Contents .. vii List of Figures .. x List of Tables x

I. CHAPTER I Introduction Background of the Study .... 1 Conceptual Framework ... 3 Theoretical Framework ... 4 Statement of the Problem .... 8 Significance of the Study ..... 9 Scope and Delimitations ...... 9 Definition of Terms .... 10

II. CHAPTER II Review of the Related Literature Related Readings .... 12 Demographic and Clinical Profile ..... 15

viii Views and Reasons of Cancer Patients . 18 Related Studies .. 22

III. CHAPTER III Methodology Research Design .... 25 Locale of the Study ... 25 Unit of Analysis ........ 25 Sampling Design ... 26 Data Collection Procedure .... 26 Treatment of Data ..... 27 Data Analysis .... 28 Ethical Consideration .... 28

IV. CHAPTER 1V Results and Discussions Results ... 36 Discussions ... 36 Selected Demographic Profile . 37 Selected Clinical Profile .. 38 Respondents Views 39 Respondents Reasons . 42

V. CHAPTER V Summary, Conclusion and Recommendation Summary .. 50

ix Conclusion ... 52 Recommendation . 52

BIBLIOGRAPHY . 54 APPENDICES Appendix 1 . 62 Appendix 2 . 64 Appendix 3 . 66 Appendix 4 . 69 Appendix 5 . 72 Appendix 6 . 74 Appendix 7 . 77 Appendix 8 . 80 Appendix 9 . 83

x LIST OF FIGURES

Figure 1. Schematic Diagram showing the Independent and Dependent Variable of the Study .... 3 Figure 2. Revised Health Promotion Model by Nola J. Pender, 1996 ... 6

LIST OF TABLES

Table 1. Manner of Data Analysis 28 Table 2. Authorship and Contributorship . 33

1 CHAPTER I INTRODUCTION

Background of the Study Complementary and Alternative Medicines are healthcare systems, practices, and products not considered a part of conventional medicine. Complementary therapies are used concurrently with conventional medicine, alternative therapies are used in place of conventional medicine, and integrative therapies combine mainstream medical therapies with complementary or alternative therapies for which some high-quality scientific evidence of safety and efficacy exists (National Center for Complementary and Alternative Medicine, 2009).

In the United States, about four (4) in ten (10) adults and one (1) in nine (9) children are using some form complementary and alternative therapy according to the National Health Interview Survey (Barnes, Bloom & Nahim, 2008). These therapies have been broadly categorized as alternative medical systems, energy therapies, exercise therapies, manipulative and body-based methods, mind-body interventions, nutritional therapeutics, pharmacological and biologic treatments, and spiritual therapies (Office of Cancer Complementary and Alternative Medicine, 2009). Non-vitamin, non-mineral natural products are the most commonly used complementary, alternative, or integrative therapies among adults. Use has increased for many therapies, including meditation; massage therapy, deep breathing exercises, and yoga (Barnes, Bloom & Nahim, 2008).

2 The list of therapies will likely to continue to evolve as novel approaches are proven to be safe and effective, accepted as mainstream medicine, and integrated into cancer care.

Researchers report that patients with cancer and survivors are more likely to use these therapies than those without cancer (Basch & Ulbricht, 2004; Fouladbakhsh & Stommel, 2008). The most common reason for using them is a strong belief in their efficacy (Verhoef, Balneaves, Boon, & Vroegindewey, 2005). Methodologically rigorous preclinical and clinical research continues in the effort to establish safety and efficacy of these therapies through government and nongovernment funding sources. A clinical challenge is that 40 to 70 percent of use remains undisclosed because of patients beliefs that these therapies are natural and safe to use, concern that providers may react negatively, or simply, providers do not ask about their use (Robinson & McGrail, 2004).

In the Philippines, cancer ranks third in leading causes of mortality with 39,634 out of 100,000 populations in the year 2001 to 2005 according to Philippine Health Statistics (Department of Health, 2011).

According to World Health Organization (2001), there are 250,000 practitioners of traditional medicines in the Philippines. Approximately five (5) to eight (8) chiropractors are practicing. There are no privately owned hospitals providing formal traditional or complementary/alternative medical services. Natural medicines are marketed over the counter in dozens of health food stores and in a limited number of pharmacies (World Health Organization, 2001).

3 The use of CAM has increased steadily over the past 15 years or so, and undoubtedly it has gained medical, economic and sociological importance. However, little is known about the use of CAM in cancer patients here in the Philippines. Thus, the researchers become interested and choose this topic since there are an increased percentage of those people who use CAM based on the facts we gathered. It is estimated that 30 to 50 percent of cancer patients in all stages of the disease will experience pain and 70 to 95 percent with advanced disease will have significant pain, but only a fraction of these patients receive adequate treatment. Hence, the researchers will find out the reasons and views of adult cancer patients on the use of Complementary and Alternative Medicine.

Conceptual Framework Independent Variable Demographic Profile of the Respondents: Age Sex Religion Educational Attainment Civil Status Occupation Income Figure 1. Schematic Diagram showing the Independent and Dependent Variable of the Study Clinical Profile of the Respondents: Medical Diagnosis Treatment Options Views and reasons of adult cancer patients on the use of Complementary and Alternative Medicines Dependent Variable

4 A variable is a characteristic that has two or more mutually exclusive values or properties. The independent variable is the presumed cause of the dependent variable, which is the presumed effect in a relational.

The independent variables are divided into two (2) properties: the demographic profile of the respondents and the clinical profile of the respondents. Under the demographic profile, the researchers would like to find out the age, sex, religion, educational attainment, civil status, occupation and income of the respondents. On the other hand, the researchers would also like to find out the clinical profile of the respondents containing the medical diagnosis and treatment options. The independent variable is made to determine the views and reasons of adult cancer patients on the use of Complementary and Alternative Medicine which acts as a dependent variable.

Theoretical Framework The prevalence of Complementary and Alternative Medicine (CAM) is increasing worldwide because of the growing public interest and the predominance of cancer worldwide. The incidence of cancer has grown dramatically around the world in recent decades. A new American Cancer Society report estimates that there will be over 12 million new cancer cases and 7.6 million cancer deaths (about 20,000 cancer deaths a day) worldwide in 2007 (American Cancer Society, 2007).

According to the theory of Nola Pender, Health Promotion Model (HPM), the assumptions of the HPM reflect the behavioral science perspective and emphasize the

5 active role of the patient for managing health behaviors by modifying the environmental context. The major assumptions of the HPM: (1) Persons seek to create conditions of living through which they can express their unique human health potential; (2) Persons have the capacity for reflective self-awareness, including assessment of their own competencies; (3) Persons value growths in directions viewed as positive and attempt to achieve a personally acceptable balance change and stability; (4) Individuals seek to actively regulate their own behavior; (5) Individuals in all their biopsychosocial complexity interact with the environment, progressively transforming the environment and being transformed over time; (6) Health professionals constitute a part of the interpersonal environment, which exerts influence on persons throughout their life span; and (7) Self-initiated reconfiguration of person-environment interactive patterns is essential to behavior change (Tomey & Alligood, 2002).

The HPM (see Figure 2) is an attempt to depict the multifaceted nature of persons interacting with the environment as they pursue health. It is motivated by the desire to increase well being and actualize human potential. Nola Pender asserts that there are complex biophysical processes that motivate individuals to engage in behaviors directed toward the enhancement of health (Tomey & Alligood, 2002).

Figure 2. Revised Health Promotion Model by Nola J. Pender, 1996. A.M. Tomey & M.R. Alligood, 2002. Nursing Theorists and Their Work 5th edition, p.628.

Theoretical statements derived from the model provide a basis for investigate work on health behaviors. The HPM is based on the following theoretical assertions: (1) Prior behavior and inherited and acquired characteristics influence beliefs, affect, and

7 enactment of health-promoting behavior; (2) Persons commit to engaging in behaviors from which they anticipate deriving personally valued benefits; (3) Perceived barriers can constrain commitment to action, a mediator of behavior as well as actual behavior; (4) Perceived competence or self-efficacy to execute a given behavior increases the likelihood of commitment to action and actual performance of the behavior; (5) Greater perceived self-efficacy results in fewer perceived barriers to a specific health behavior; (6) Positive affect toward a behavior results in greater perceived self-efficacy, which can in turn, result in increased positive affect; (7) When positive emotions or affect are associated with a behavior, the probability of commitment and action is increased; (8) Persons are more likely to commit to and engage in health-promoting behaviors when significant others model the behavior, expect the behavior to occur, and provide assistance and support to enable the behavior; (9) Families, peers, and health care providers are important sources of interpersonal influence that can increase or decrease commitment to and engagement in health-promoting behavior; (10) Situational influences in the external environment can increase or decrease commitment to or participation in health-promoting behavior; (11) The greater the commitments to a specific plan of action, the more likely health-promoting behaviors are to be maintained over time; (12) Commitment to a plan of action is less likely to result in the desired behavior when competing demands over which persons have little control require immediate attention; (13) Commitment to a plan of action is less likely to result in the desired behavior when other actions are more attractive and thus preferred over the target behavior; and (14) Persons can modify cognitions, affect, and the interpersonal and physical environment to create incentives for health actions (Tomey & Alligood, 2002).

8 Statement of the Problem This study aims to determine the views and reasons of adult cancer patients on the use of Complementary and Alternative Medicine.

Specifically, this study seeks to answer the following questions: 1. What is the demographic profile of the patients in terms of: 1.1. 1.2. 1.3. 1.4. 1.5. 1.6. 1.7. Age Sex Religion Educational attainment Civil status Occupation Income

2. What is the clinical profile of the patients in terms of: 2.1. Medical Diagnosis 2.2. Treatment Options 3. What are the views of the patients on the use of Complementary and Alternative Medicine? 4. What are the reasons why did the patients use Complementary and Alternative Medicine?

9 Significance of the Study The result of this study will benefit the following: The Respondents. They may benefit from the result of the study because the information will serve as vital information to determine the views and reasons of adult cancer patients on the use of Complementary and Alternative Medicine. The Student Nurses. This study may serve as reference and learning materials for classroom discussions and other school related research works on determining the views and reasons of adult cancer patients on the use of Complementary and Alternative Medicine. The Health Care Providers. This study may aid health institutions and medical practitioners to acquire current trends on CAM which may help them to render better services and effective health teachings. The Future Researchers. This study may enhance the knowledge and skills for future purposes for the improvement of the nursing practice for cancer care in the hospital and even in the community.

Scope and Delimitations The study focuses on determining the views and reasons of adult cancer patients on the use of Complementary and Alternative Medicines. The participants will be those aged 18 years old onwards, who are willing to take part of the study, are awake, conscious and coherent and as well as able to communicate effectively. Only those cancer patients who have known their conditions and have been diagnosed for malignancy for the past three (3) months or more will be included in the study. The data on views and

10 reasons of adult cancer patients on the use of Complementary and Alternative Medicine will be obtained through conduct of in-depth interview with at least five (5) participants.

During our data collection last September 23, 2011 at the certain local tertiary hospital in Davao City, the total census was seven (7). Four (4) out of seven (7) came from Internal Medicine Ward and the remaining three (3) came from Gynecology Ward.

Definition of Terms The following terms in this study are defined operationally for clarity and common frame of references.

Views refer to the cancer patients views on the use of Complementary and Alternative Medicine. Reasons refer to the capacity for rational thought of a cancer patient regarding on the use of Complementary and Alternative Medicine. Complementary and Alternative Medicines (CAM) refers to medical products and practices that are not part of standard care or that which has not been shown consistently to be effective. Cancer refers to a class of diseases characterized by out-of-control cell growth. There are over 100 different types of cancer, and each is classified by the type of cell that is initially affected. Cancer staging describes the severity of a persons cancer based on the extent of the original (primary) tumor and whether or not cancer has spread in the body.

11 In-depth interview offers the opportunity to express their self in a way ordinary life rarely affords them. Age refers to the length of time that one has existed; duration of life. Sex refers to the property or quality by which organisms are classified as female or male on the basis of their reproductive organs and functions. Religion refers to the belief in and reverence for a supernatural power or powers regarded as creator and governor of the universe. Educational Attainment refers to a term commonly used by statisticians to refer to the highest degree of education an individual has completed. Civil Status refers to the legal standing of a person in regard to his or her marriage state. Occupation refers to an activity that serves as ones regular source of livelihood; a vocation. Income refers to amount of money or its equivalent received during a period of time in exchange for labor or services, from the sale of goods or property, or as profit from financial investments. Medical Diagnosis refers to the process of attempting to determine and/or identify a possible disease or disorder and the opinion reached by this process. Treatment options refer to the management and care of a patient or the combating of disease or disorder.

12 CHAPTER II Review of the Related Literature

Related Readings The use of Complementary and Alternative Medicine (CAM) by cancer patients is reported to increase. CAM are defined as methods that are not part of standard medical treatment (as described by evidence-based clinical practice guidelines, consensus statements or common medical practice) and are either used instead of (alternatively) or in addition (complementary) to a standard cancer treatment. These methods represent a great variety ranging from chemically well-defined molecules or other substances and mixtures from plant or animal origin to non-material methods like mind-body therapies, spiritual healing or psychosocial procedures (National Center for Complementary and Alternative Medicine, 2009).

Cancer is a word that none of us wants to hear, especially if it involves a diagnoses of ones self or loved ones. It can be a very long battle and the treatment options (especially chemotherapy regimens) can be brutal. During the battle with cancer, most patients seek ways to cope with the emotional and physical hardships they must deal with. In fact, according to a study in the Journal Oncologist, approximately 80 percent of cancer patients use Complimentary and Alternative Medicine (CAM) (Cassileth et al, 2004).

13 The goal for most patients that use CAM therapies is not to cure their cancer but rather help to alleviate the anxiety, stress, pain and side effects of treatment. The use of CAM therapies, including music therapy, has gained acceptance with the medical community as an effective tool in assisting patients deal with cancer and treatments. In fact, the American Cancer Society has a fantastic reference for CAM therapies called the Complete Guide to Complementary and Alternative Cancer Therapies. Hundreds of alternative therapies, to include music therapy, are listed and the evidence (or lack of it) as well as possible side effects are discussed. Most therapies listed are safe but the reference also lists and discusses some therapies that are used by some patients but can be dangerous (Cassileth et al, 2004).

The National Center for Complementary and Alternative Medicine (NCCAM) classification was found pragmatically useful. It all classifies Complementary and Alternative Medicine (CAM) into five (5) categories of therapy which include the Alternative Medical Systems; Mind-Body-Spirit therapies; Biologically-based therapies; Energy and biofield therapies; Manipulative and Body-based therapies; and (National Center for Complementary and Alternative Medicine, 2009).

Alternative medical systems are built upon complete systems of theory and practice. Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States. Examples of alternative medical systems that have developed in Western cultures include homeopathic medicine and naturopathic medicine. Examples of systems that have developed in non-Western cultures include

14 traditional Chinese medicine and Ayurveda (National Center for Complementary and Alternative Medicine, 2009).

Mind-body medicine uses a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms. Some techniques that were considered CAM in the past have become the mainstream (for example, patient support groups and cognitive-behavioral therapy). Other mind-body techniques are still considered CAM, including meditation, prayer, mental healing, and therapies that use creative outlets such as art, music, or dance (National Center for Complementary and Alternative Medicine, 2009).

Biologically-based therapies in CAM use substances found in nature, such as herbs, foods, and vitamins. Some examples include dietary supplements, herbal products, and the use of other so-called natural but as yet scientifically unproven therapies (for example, using shark cartilage to treat cancer) (National Center for Complementary and Alternative Medicine, 2009).

Manipulative and body-based methods in CAM are based on manipulation and/or movement of one or more parts of the body. Some examples include chiropractic or osteopathic manipulation, and massage (National Center for Complementary and Alternative Medicine, 2009).

15 Energy therapies involve the use of energy fields. They are of two types: (1) biofield therapies are intended to affect energy fields that purportedly surround and penetrate the human body. The existence of such fields has not yet been scientifically proven. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in, or through, these fields. Examples include qi gong, reiki, and therapeutic touch; and (2) bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternating current or direct current fields (National Center for Complementary and Alternative Medicine, 2009).

Demographic and Clinical Profile In particular, CAM use appears to be more common among those with higher income, higher educational level, younger age, female gender, or history of CAM use (Cauffield JS, 2000; Eisenberg DM, Davis RB & Ettner SL et al, 1998; Hyodo I, Amano N & Eguchi K et al, 2005; Paltiel O, Avitzour M & Peretz T et al, 2001). Also, cancer patients resort to CAM more frequently than patients with acute or chronic diseases, which are not malignant (Kappauf H, Leykauf-Ammon D & Bruntsch U et al, 2000). In addition, use of chemotherapy and advanced disease are correlated with more frequent CAM use use (Cauffield JS, 2000; Eisenberg DM, Davis RB & Ettner SL et al, 1998; Hyodo I, Amano N & Eguchi K et al, 2005; Paltiel O, Avitzour M & Peretz T et al, 2001). A study describing the prevalence of CAM use in patients enrolled in early-phase chemotherapy trials at the Mayo Clinic Comprehensive Cancer Center showed a high use of such products (Dy GK, Bekele L & Hanson LJ et al, 2004). More than 80 percent of

16 patients simultaneously used pharmacologic CAM (like vitamins, herbs, and minerals) in addition to their experimental chemotherapeutic agents (Dy GK, Bekele L & Hanson LJ et al, 2004), which is (currently) often an exclusion criterion and/or formally not allowed during this type of treatment. Additionally, a study in nearly 500 cancer patients revealed that 65 percent of the 131 patients being treated with chemotherapy alone said they used CAM in conjunction with their chemotherapy, whereas only 35 percent of the 142 patients receiving radiotherapy reported CAM use (Vapiwala N, Mick R & DeNittis A et al, 2005).

Colorectal and breast cancer patients, in particular, seem to be likely to use dietary supplements, compared with lung cancer patients (Gupta D, Lis CG & Birdsall TC et al, 2005; Rakovitch E, Pignol JP & Chartier C et al, 2005). An increased perception of the risk of cancer recurrence and cancer-related death are associated with CAM use by breast cancer patients, as concluded in a study by Rakovitch et al. (Rakovitch E, Pignol JP & Chartier C et al, 2005). In contrast, in another recent study, it was concluded that CAM users are less likely to believe they will die from breast cancer (Helyer LK, Chin S & Chui BK et al, 2006). In both studies, no relationship between CAM use and anxiety and/or depression could be found. This is noteworthy because both anxiety and depression are frequently mentioned as an important explanation for the more frequent use of CAM, in particular CAM influencing mood like St. Johns wort or medicinal cannabis (De Smet PA, 2002; Stevinson C & Ernst E, 1999; De Jong FA, Engels FK & Mathijssen RH et al, 2005; Radbruch L & Nauck F, 2003).

17 Most cancer patients combine, rather than replace, conventional therapy with CAM (Cauffield JS, 2000; Lafferty WE, Bellas A & Corage Baden A et al, 2004; Burstein HJ, Gelber S & Guadagnoli E et al, 1999; Cassileth BR, Lusk EJ & Strouse TB et al, 1984; Lerner IJ & Kennedy BJ, 1992). This is clearly demonstrated in a survey by Cassileth et al. (Cassileth BR, Lusk EJ & Strouse TB et al, 1984), in which 304 inpatients of a cancer center and 356 patients under the care of unorthodox practitioners were interviewed. Of all patients studied, 8 percent never received any conventional therapy, and 54 percent of patients on conventional treatment also used unorthodox treatments.

The use of Complementary and Alternative Medicine in cancer survivors is underreported (Gansler, Chiewkwei, Crammer, & Smith, 2008; Saxe et al., 2008), with as many as 81 percent of survivors having used vitamin or mineral supplements. Although use of the more common CAMs by cancer survivors was comparable to the general population, Gansler et al. (2008) noted an increase in other forms of CAM. Deng, Cassileth, and Yeung (2004) suggested that CAM users are seeking a holistic approach to their care and see CAM as a natural way to take responsibility and control of their health and promote an increased quality of life (Frenkel, Ben-Arye, Baldwin, & Sierpina, 2005; Saxe et al., 2008).

Increased CAM use was reported in short and long-term survivors (Gansler et al., 2008). Use and types of therapies differ according to cancer sites (Velicer & Ulrich, 2008). Survivors of melanoma and kidney cancers were reported as least likely to use

18 CAM, whereas survivors of breast, ovarian, non-Hodgkin lymphoma, and brain or central nervous system cancers were reportedly most likely to use CAM (Gansler et al., 2008; Richardson, Sanders, Palmer, Greisinger, & Singletary, 2000). Stage of disease also influenced CAM use, with increases noted in advanced-stage disease (Gansler et al., 2008). In addition, CAM use can be affected by geography, with higher use reported in California (Goldstein et al., 2005). Goldstein et al. (2005) hypothesized that the reason for this may be the "social milieu" that exists in California, where the population leads a culturally creative lifestyle (Goldstein et al., 2005). Additional commonalities identified in the survivors who use CAM included better education, a focus on health, and a general use of more mainstream medical services (Deng et al., 2004,).

Views and Reasons of Cancer Patients There are specific cancer-related reasons for using CAM. A Canadian survey of more than 900 cancer patients demonstrated that 94 percent experienced disease-related symptoms such as fatigue and anxiety that were not addressed by their conventional treatment (Ashbury FD, Findlay H & Reynolds B et al, 1998). Most cancer patients, in general, were satisfied with the conventional treatment they received for their cancer. Nonetheless, they were more likely dissatisfied with the attention paid to their symptoms and side effects. A second reason for CAM use is the presumed action as an anticancer agent (Kosty MP, 2004; Straus SE, 2002). Several CAM products are under investigation in clinical trials for this reason; however, they have not been under appropriate trial development so far (Vickers AJ, Kuo J & Cassileth BR, 2006).

19 CAM is used for its cancer preventive properties as well. An ideal preventive agent has little or no toxicity, high efficacy in multiple sites, capability of oral consumption, a known mechanism of action, low cost, and above all, general acceptance (Siddiqui IA, Adhami VM & Saleem M et al, 2006). For example, more or less conscious use of green tea by men has gained its place in society. Indeed, in a case-control study a protective effect of green tea against prostate cancer was suggested (Jian L, Xie LP & Lee AH et al, 2004), which is supported by in vitro research (Siddiqui IA, Adhami VM, Saleem M et al, 2006; Gupta S, Ahmad N & Mohan RR et al, 1999). The risk was thought to decline with increasing frequency, duration, and quantity of green tea consumption. However, it should be noted that conflicting results are reported by epidemiological studies on the use of green tea as a protective substance in relation to prostate cancer (Jian L, Xie LP & Lee AH et al, 2004).

In addition to these reasons, cancer patients, in general, have the same reasons as other people for using CAM (Cassileth BR, 2000; Cassileth BR, Lusk EJ & Strouse TB et al, 1984; Kronenberg F, Mindes J & Jacobson JS, 2005). Disease-related symptoms not easily addressed by conventional treatment and concerns about the adverse effects of chemical/pharmaceutical medicines are some of them (Cauffield JS, 2000). Also, an increased need for more personalized health and a greater public access to health information (i.e., the Internet) and popular media attention to CAM fuel its increasing use in many industrialized countries (Eisenberg DM, Davis RB & Ettner SL et al, 1998; Ernst E & Cassileth BR, 1998; Hyodo I, Amano N & Eguchi K et al, 2005). In addition, quality of life may also be a reason for CAM use (Lis CG, Cambron JA & Grutsch JF et al,

20 2006). However, results are conflicting regarding the self-reported quality of life among CAM users versus nonusers. In a recent report, a study performed at a community hospital comprehensive cancer center was described, which found a better quality of life among dietary supplement users compared with nonusers (Lis CG, Cambron JA & Grutsch JF et al, 2006). In contrast, earlier data showed opposite results (Burstein HJ, Gelber S & Guadagnoli E et al, 1999; Cassileth BR, Lusk EJ & Guerry D et al, 1991; Paltiel O, Avitzour M & Peretz T et al, 2001). It should be mentioned that these findings are not completely comparable because the latter studies used a broader definition for CAM.

Survivors identified many reasons for using CAM, and indicated that locus of control may be one important factor (Gansler et al., 2008). Survivors responses positively correlated with the use of CAM as a means of stress and recurrence reduction and enhancement of wellness and quality of life (Buettner et al., 2006; Greenlee, White, Patterson, & Kristal, 2004; Saxe et al., 2008), with the belief that CAM therapies are nontoxic (Richardson et al., 2000). Additionally, for those with advanced disease, CAM use was believed to be associated with prolongation of life (Richardson et al., 2000), the desire to remain hopeful (Richardson et al., 2000; Verhoef, Balneaves, Boon, & Vroegindewey, 2005), or to provide cure (Richardson et al., 2000).

In cancer survivors, CAM was reportedly used primarily for treatment for ailments such as diabetes mellitus, hypertension and other than the cancer diagnosis (Goldstein, Lee, Ballard-Barbash, & Brown, 2008). The National Center for Health

21 Statistics reported that cancer survivors were more likely to die from noncancer causes, and that they are more likely to have at least one functional limitation. As a result, the negative impact on quality of life or function from chronic health issues (Goldstein et al., 2008; Saxe et al., 2008), as well as the short- and long-term cancer-related medical issues or symptoms (Carpenter, Ganz, & Bernstein, 2008; Greenlee et al., 2004; Miller et al., 2008; Wesa, Gubili & Cassileth, 2008), were identified as initiating factors for using CAM by cancer survivors. The use of chemotherapy during treatment also was associated with an increased CAM prevalence (Mao et al., 2008).

The rising costs of health care (Saxe et al., 2008), coupled with multiple unmet needs, equates to multiple CAM uses (Mao et al., 2008). These unmet needs were identified by Mao et al. (2008) as emotional, physical, nutritional, financial, informational, treatment- and employment-related, and daily living activities. Other reasons included an identified dissatisfaction with conventional care (Richardson et al., 2000; Saxe et al., 2008), fragmentation of care into survivorship, lack of empathy and support, or if a survivor's subsequent needs were unfulfilled (Mao et al., 2008). In addition, Carpenter et al. (2008) identified decreased emotional function and multiple medical issues in very long-term breast cancer survivors who used CAM. The potential for recurrence and high levels of worry (Mao et al., 2008) and distress (Lawsin et al., 2007) also were reported with increased use. Finally, the use of herbal supplements were reportedly used to reduce the side effects of treatment and to boost immune function (Buettner et al., 2006; Deng et al., 2004; Lawsin et al., 2007; Richardson et al., 2000; Saxe et al., 2008).

22 Related Studies People who used CAM before a diagnosis are more likely to use CAM after their diagnosis (Miller M, Boyer MJ, Butow PN, Gattelari M, Dunn SM & Childs A, 1998; Harris P, Finlay I, Cook A, Thomas KJ & Hood K, 2003), but the biggest predictors of use are being female, younger and tertiary educated (Harris P, Finlay I, Cook A, Thomas KJ & Hood K, 2003; OCallaghan FV & Jordan N, 2003; Shorofi SA & Arbon P, 2010; Girgis, A, Adams J & Sibbritt D, 2005; Hedderson M, Patterson R, Neuhouser ML, Schwartz SM, Bowen DJ & Standish LJ, 2004).

Shorofi and Arbon (2010) claim women are more likely than men to have a positive attitude towards CAM (Shorofi SA & Arbon P, 2010). Other studies conclude women are 1.9 times more likely than men to use CAM (Girgis, A, Adams J & Sibbritt D, 2005; Hedderson M, Patterson R, Neuhouser ML, Schwartz SM, Bowen D &, Standish LJ, 2004). Hedderson et al (2004) found that about 80 percent of women and 60 percent of men used at least one CAM, and suggested it may be considered more socially acceptable for women to seek help (Hedderson M, Patterson R, Neuhouser ML, Schwartz SM, Bowen DJ & Standish LJ, 2004). But men were more likely to use CAM when their symptom distress scores were higher.

In a review of public attitudes to natural medicine, Leach reported that regular CAM users were more likely to be dissatisfied with conventional practitioners than nonusers (Leach MJ, 2004), and that over 40 percent of users turn to natural therapies because of a perceived failure of orthodox medicine to treat their health problems.

23 OCallaghan and Jordan (2003), in their survey of postmodern predictors of CAM use, quote one study with a contrary finding: that although dissatisfaction with the doctorpatient relationship and having postmodern values of health are significant predictors, dissatisfaction with medical outcomes is not. OCallaghan and Jordan (2003) conclude that holding postmodern values such as rejection of authority, and feeling responsible for ones own health predicts a positive attitude to CAM use (OCallaghan FV & Jordan N, 2003).

In Shorofi and Arbons (2010) comprehensive study of CAM attitudes, 46 percent of respondents had a positive attitude towards CAM, while only 10 percent had a negative attitude. In this study, patients rated their level of agreement to 18 statements about attitudes towards CAM and allopathic medicine. Examples include: CAM is an important aspect of my own familys health care (36 percent agree, 25 percent disagree, 35 percent unsure) and conventional health care services are too impersonal (27 percent agree, 44 percent disagree, 26 percent unsure) (Shorofi SA & Arbon P, 2010).

Miller et al (1998) found that 63 percent of patients felt CAM gave them psychological benefits and 41 percent physiological benefits. A majority would recommend the treatment they had and use the same therapy again themselves. However, 29 percent thought CAM provided no benefit (Miller M, Boyer MJ, Butow PN, Gattelari M, Dunn SM & Childs A, 1998).

24 Salminem et al found that 25 percent of women reported no improvement from a change in diet (Miller M, Boyer MJ, Butow PN, Gattelari M, Dunn SM & Childs A, 2004). However, 50 percent felt their condition had improved, while 25 percent were unsure. Harris et als survey (2003) of 1034 people with cancer determined that 72 percent were satisfied with their CAM use, 25 percent were uncertain and 4 percent were dissatisfied (Harris P, Finlay I, Cook A, Thomas KJ & Hood K, 2003). A similar result was reported by Chrystal et al (2003), where 71 percent of patients thought CAM beneficial and six (6) percent found CAM unhelpful (Chrystal K, Allan S, Forgeson G & Isaacs R, 2003).

A participant in Verhoef et als study (2005) reported an improvement in physical wellbeing, with massage or a natural health product most likely to cause these positive outcomes. Some participants cited emotional improvements, including feelings of greater control, more optimism, reduced anxiety and greater resilience. Others believed that CAM helped them remain cancer free (Verhoef M, Mulkins A & Boon H, 2005).

25 CHAPTER III METHODOLOGY

Research Design This study used qualitative research as the method of data collection. In this context, interviews were viewed as situations where various meanings of feelings and experiences were constructed and negotiated by the participants.

The researchers used the phenomenological type of qualitative research in which it studies the feelings and lived experiences of a person. Moreover, the meanings of feelings and experiences are placed in particular social and cultural contexts. In this context, participants accounts during an interview were viewed as products of an interrelationship between the interviewers and the interviewees. During an interview situation, both the researchers and the participants had strived to arrive at meanings together that both can understand.

Locale of the Study The study was conducted in a certain local tertiary hospital in Davao City. The involved departments were Gynecology ward, and Internal Medicine ward.

Unit of Analysis The unit of analysis was the adult cancer patients who were awake, conscious and coherent whose age were from 18 years old up to 65 years old and who were currently

26 admitted in a certain local tertiary hospital in Davao City and who were willing to participate in the study. This study obtained five (5) participants who were currently using Complementary and Alternative Medicines.

Sampling Design The non-probability purposive sampling technique was used in this study. This is a sampling technique in which the researchers were allowed to pick respondents based on the criteria. The criteria used for choosing the respondents were as follows: (1) must be an adult cancer patient who is awake, conscious and coherent; (2) must be at least 18 years old; (3) must be currently admitted in a local tertiary hospital; and (4) must be a Complementary and Alternative Medicines (CAM) user.

Data Collection Procedure To be able to fully determine the important details and information, the researchers devised a systematic approach to fully compensate the time involved therein.

Step 1: Preparation Phase The researchers of this study deliberated with the necessary information. Then a careful analysis and assessment of the data at hand and facilitated the proponents in conceptualizing the framework for this study.

Before the researchers carry out this study, a letter of consent addressed to the Dean of College of Nursing of Davao Medical School Foundation, Inc., the Hospital

27 Administrator of the Local tertiary Hospital and as well as the consent for the respondents were considered, seeking approval to conduct the study. Furthermore, the researchers sought for permission to the respondents to allow us to see his/her chart regarding on his/her clinical profile.

Step 2: Interview Phase The researchers of this study were using the open-ended question to a patient regarding on his/her views and reasons on the use of Complementary and Alternative Medicine. Furthermore, the researchers were using an interview guide in gathering data in order to have sufficient information.

Step 3: Transcription of Data Interviews were transcribed verbatim. Transcription rules regarding on how to handle pauses, false starts, emotional expressions and etc. were agreed upon to assure conformity between different interview transcriptions as well as different transcribers.

Step 4: Analysis and Interpretation The researchers of this study analyzed and interpret the patients statements.

Treatment of Data The data were encoded into the computer using the Microsoft Word. The qualitative data analysis approach was used to analyze the views and reasons of the adult cancer patients on the use of Complementary and Alternative Medicines.

28 Data Analysis Objective 1. Age 2. Sex 3. Religion To describe the patients 4. Educational Attainment demographic profile 5. Civil Status 6. Occupation 7. Income To determine the clinical 1. Medical Diagnosis profile of the patient To determine the views of using the CAM To determine the reasons of using the CAM Table 1. Manner of Data Analysis 2. Treatment options Qualitative Data Analysis Qualitative Data Analysis Qualitative Data Analysis Variable Statistical Treatment Qualitative Data Analysis

Ethical Consideration 1. Ethics Review A. Office of the Dean, College of Nursing, DMSF Permission was asked from the Office of the Dean to conduct study. (See Sample Letter, Appendix 1)

B. Office of the Hospital Administrator and/or Hospital Research Committee

29 A letter was sent to the Office of the Hospital Administrator and/or Hospital Research Committee to allow us to conduct study in the area. (See Sample Letter, Appendix 2)

2. Informed Consent (Form) As soon as permission from the Hospital Administrator and/or Hospital Research Committee is granted, permission from the participating individuals was been sought. A written informed consent was been used in different languages (English and Filipino Version Tagalog and Cebuano). (See Informed Consent, Appendix 3 English Version, Appendix 4 Tagalog Version and Appendix 5 Cebuano Version)

3. Informed Consent (Signatory) The researchers had been giving two copies of informed consent form (one for the researchers copy and the other one is the participants copy) and had been requiring a signature to formalize the consent.

4. Informed Consent (Witness) The researchers had been seeking for somebody (especially the significant others) to witness the signing of informed consent form.

5. Informed Consent (Proxy Consent)

30 The researchers allowed proxy consent if the respondent is not able to read or write. The only person who will sign for the consent is the one who is the nearest kin of the respondent.

6. Informed Assent The researchers did not obtain informed assent since the unit of analysis for this research study were adult respondents whose aged were from 18 years and onwards.

7. Informed Consent (Process) The potential respondents were been invited to listen to a short

explanation/discussion of the study objectives. Potential respondents queries will be entertained anytime during the explanation/discussion.

8. Informed Consent (Timing) The researchers obtained the informed consent right after the study objectives discussed and explained very well.

9. Informed Consent (Venue) The researchers obtained the informed consent at the respondents bed and in what department he/she confines.

10. Study Objectives, Risks, Benefits and Procedures

31 The researchers formulated study objectives and this served as the basis for the data collection. The researchers were asking personal question to our participants and they were free not to answer any of those questions. There may have benefits for taking part for this study and it may help others to understand how the Complementary and Alternative Medicines affects their life.

11. Remuneration, reimbursement and other benefits The participants did not spend anything during our interview. But, the researchers were giving free snacks as sign of gratitude for their active participation in this study.

12. Confidentiality The records from this study were kept as confidential as possible. The researchers did not reveal information about the participants to a third party without their consent or a clear legal reason. All transcripts and summaries were given codes and stored separately from any names or other direct identification of participants. Research information was kept in locked files at all times. Only research personnel had accessed to the files and only those with an essential need to see names had accessed to that particular file.

13. Investigators responsibility during adverse events The researchers did not provide for any payment if the participants will be harmed as a result of taking part in this study. If such harm occurs, treatment will be provided. However, this treatment will not be provided free of charge.

32 14. Specimen Handling The researchers had not performed any tissue sampling in the study.

15. Voluntariness of participation The researchers did not force anybody to participate in this study researcher. If the participant will not decide to participate in this research, there will be no further consequence be made. If the participant decides to participate, the participant may stop participating at any time and the participant may decide not to answer any specific question.

16. Alternative Options The researchers respected the participants decision if they decided to withdraw or refuse to participate in our study, and they will not be penalized or given charges for that matter.

17. Privacy The researchers did no longer contact the participants nor to have home visitations after the scheduled interview.

18. Information of Study Results The researchers decided not to inform the respondents involved in the study regarding the result of the research conducted. This decision will help the researchers maintain confidentiality and privacy of the participants.

33 19. Authorship and Contributorship Name Jean Leslie Bughao Authorship and Contributorship Methodology (Research Design, Locale of the Study, Unit of Analysis and Sampling Design) Reyveen John Geli Norman Juruena Appendix 9 Introduction (Background of the Study) Methodology (Data Collection Procedure, Treatment of Data and Data Analysis) Introduction (Conceptual Framework, Theoretical Framework and Statement of the Problem) Kathlyn Janine Mones Review of the Related Literature Results and Discussions Appendices 3 and 6 Introduction (Significance of the Study) Methodology (Ethical Consideration) Introduction (Scope and Limitation) Appendices 5 and 8 Acknowledgement and Dedication Bibliography and Appendices 1 and 2 Introduction (Definition of Terms)

Mary Laureen Santarin

Rosthy John Soria

Rinnah Grace Talatagod

Appendices 4 and 7 Table 2. Authorship and Contributorship

20. Extent of use of study data The data were encoded in the computer. There was no identifying information encoded to the computer so that the information cannot be traced back to the person

34 concerned. Only the group members had accessed to the data and the interview schedule. The interview schedules were kept at the data storage area at the Nursing Department of the Davao Medical School Foundation (DMSF). The interview

schedule shall be kept for a period of five (5) years. After five (5) years, the interview schedule shall be disposed of by shredding.

21. Conflict of interest Each of the researchers was appointed to do certain part of the research study and was guided by the group leader and with the help of the adviser/mentor. The researchers had shared common interest with regards in formulating the research study.

22. Publication The researchers will publish the research study at the end of November year 2011. It will be placed at the Nursing Library of Davao Medical School Foundation, Inc. This study will be use as a reference for future researchers.

23. Funding All the expenses were coming from the researchers pocket.

24. Duplicate copy of informed consent The researchers secured two (2) copies of an informed consent form, one for the researchers copy and the other one is the participants copy.

35

25. Questions and concerns regarding the study The researchers allowed the participants to raise questions and voice out their concerns about the study.

26. Contact details The participants will contact, Mr. Norman Juruena with the contact number of 09322151358 or 302-8089, if they have any questions, concerns or complaints about the research.

CHAPTER IV RESULTS AND DISCUSSIONS

36 Results Five (5) adult cancer patients were interviewed for this study and who were currently admitted in a certain local tertiary hospital. All of them were using different complementary and alternative medicines. This study was conducted in order to find out the selected demographic profile, selected clinical profile, and views and reasons of the adult cancer patients on the use of complementary and alternative medicines.

Discussions This study had provided a qualitative account of the adult cancer patients views and reasons on the use of complementary and alternative medicines and the rationales behind their perspectives. The findings indicated a spectrum of views and reasons on complementary and alternative medicines. The researchers sought out five (5) possible respondents for this study who were currently admitted in a local tertiary hospital. Three (3) respondents came from Internal Medicine Ward while the two (2) remaining respondents came from Gynecology Ward. The researchers obtained consent and fortunately, the patients agreed upon on what they had read in the consent. The researchers named the following patients as Respondent A, Respondent B, Respondent C, Respondent D and Respondent E.

Selected Demographic Profile This section presents the selected demographic profile of the respondents. It includes age, sex, religion, educational attainment, civil status, occupation and income.

37 Age. The age of the respondents ranged from 46 to 61 years old. First respondent is 58 years old, second respondent is 59 years old, third respondent is 54 years old, fourth respondent is 46 years old and the fifth respondent is 61 years old. They have a mean age of 55.6 years old. Sex. All of the respondents were females. Religion. Almost all of the respondents are Roman Catholic, four (4) out of five (5), while the remaining one (1) respondent is a Protestant (Church of Christ). Educational Attainment. There were three (3) respondents who were college graduates and the remaining two (2) respondents were elementary undergraduates, one of them reached only grade one (1) and the other one (1) reached only grade two (2). Civil Status. Almost all of the respondents were married, three (3) out of five (5), while the remaining two (2) respondents were a single and a widower respectively. Occupation. Only one (1) respondent is currently employed, an office clerk, to a private company. Two (2) respondents are unemployed and the remaining two (2) respondents are self-employed, a puto maker and a binangkal seller respectively. Income. The monthly income of the respondents ranged from Php 1,200 to Php 4,000 with a mean average of Php 2,233.33. First respondent has an estimated monthly income of Php 1,200 to Php 1,500. Second respondent has monthly income of Php 3,000 to Php 4,000. Third respondent has an estimated monthly income of Php 3,000. The unemployed respondents are currently supported by their children and nearest kin. Selected Clinical Profile This section presents the selected clinical profile of the respondents. It includes medical diagnosis and treatment options.

38 Medical Diagnosis. There were three (3) breast cancer respondents, two (2) of which were diagnosed with stage four (4) and the other one (1) was diagnosed with stage three (3). The two (2) remaining respondents were diagnosed with ovarian cancer stage one (1). Treatment Options. All of the respondents had undergone diagnostic procedures such as CBC, urinalysis, CT scan, chest x-ray, ultrasound and biopsy. Two (2) respondents had undergone operations. One (1) who has breast cancer stage four (4) had undergone Modified Radical Mastectomy (MRM) last June 2010. The other one (1) with ovarian cancer stage one (1) had two (2) operations, Total Abdominal Hysterectomy Bilateral Salphingo Oophorectomy (TAHBSO) and appendectomy last April 2011. Four (4) out of five (5) respondents are currently on chemotherapy. The remaining one (1) respondent was diagnosed to have breast cancer stage four (4) a year ago but refused to undergo chemotherapy by that time. During the interview, she was about to start of the said treatment. Almost all of the respondents, four (4) out of five (5), were receiving chemotherapeutic drugs and some were given antibiotics, diuretics, pain reliever, antiemetic and beta adrenergic drugs.

Respondents Views

39 This section presents the different views of the respondents regarding on the use of complementary and alternative medicines. The data were collated and the respondents views were classified as effective, partially effective and not effective. Effective. Only one (1) respondent said that using the complementary and alternative medicines, specifically acupuncture, is more effective than the conventional therapy in terms of alleviating the side effects of chemotherapeutic drugs such as pain, nausea and vomiting.

Ang gusto dyud nako kay doctors order lang gyud kung pwede, pero kung sa acupuncture ko mag basi maayo gyud kaayo siya, narelieved ko sa akong ginabati. Makawala og sakit. Makaingon ko nga epektibo siya kung acupuncture lang ang atong basehon pero sa uban dili kaayo ko kaingon nga epektibo jud. (All I want is the Doctors Order but when you base on the Acupuncture all I can say that it is more effective because it relieves me from pain and can ease my pain but for others I cannot say that it is more effective). Respondent D, 46 years old

However, she believed that herbal medicines were not effective in treating cancer. Furthermore, she added that the effectiveness of complementary and alternative medicines depend on the age of a person based on her observation.

40 Partially Effective. Three (3) respondents believed that complementary and alternative medicines were partially effective. One (1) respondent believed that it will only be more effective to those women in their pre-menopausal year (ages 12 to 45 years old). Pero sa akong nabantayan, mu-epekto lang man siguro ni sa mga naga-regla pa. (As what I have observed, it is more effective when you are still having menstruations.) Respondent B, 59 years old.

On the other hand, the other one (1) respondent believed that these alternative medicines alleviated her pain and other effects of the conventional therapy. Moreover, she strongly considered that it will only help in preventing the occurrence of cancer.

Nindot siya gamiton kung wala pa kay sakit. (It is better to use when you are not yet sick.) Respondent C, 54 years old.

While the last one (1) respondent said that the complementary and alternative medicines had little effects in reducing the side effects of the drugs that she was taking. She believed that only those patients diagnosed at a younger age and at the same time using the complementary and alternative medicines will have a chance of survival.

41 Makatabang pud gamay og maka-ingon ko naay epekto gamay sa akoa. (It helps me a little and I can say that it is somehow effective.) Respondent E, 61 years old.

The three (3) respondents all believed that the use of complementary and alternative medicines added another year of their life.

Not Effective. The remaining one (1) respondent believed that it was not effective. At first, she strongly believed on the effectiveness of the complementary and alternative medicines based on the experiences of others. At the long run of using the complementary and alternative medicines, she was really expecting that she will be cured and the conventional therapy was no longer necessary. Unfortunately, her condition worsens.

Pag tuo nako sa una maka ayo ni sa mga sakit-sakit, pero mali di-ay ko, dili tanan sakit kaya niya ma tambalan og mas maayo pa mo kunsulta sa doktor mismo aron di na mu lala ang imong sakit (Before, I thought this will cure any kind of illnesses, but I was wrong, not all illnessess cured by this and it is better to consult a doctor to hinder further worsening of the illness) Respondent A, 58 years old

42 She decided to stop using the complementary and alternative medicines and abided on the conventional therapy instead.

Wala siya makatabang sa akoa, gi-undangan na gani nako. Mas epektibo pa ang sa hospital kaysa sa una nakong gina pang himo (It didnt help me, so I stop using it. It is more effective to be hospitalized than on what I had used before) Respondent A, 58 years old

Respondents Reasons This section presents the different reasons of the respondents on the use of complementary and alternative medicines. The data were collated and the respondents reasons were the following: Financial Constraint. All of the respondents said that their income is not enough to sustain their treatment regimen. In order to maintain their conventional therapy, they borrowed money from their friends, neighbors and significant others for them to afford the treatments that were being prescribed by their physicians. However, complementary and alternative medicines were their first choice before they underwent the conventional therapy.

Naga hiram lang ko ug kwarta sa akong mga amigo ug amiga kay kulang akong kwarta pang palit ug tambal. Estimate nako, mga 3,500 pesos siguro ang akong mga na

43 gastos tapos Php 1,200 to Php 1,500 lang akong makuha sa pag baligya nako ug puto taga bulan. (Im just borrowing money from my friends so that I can afford to buy my own medicines for my illness. My estimated expenses was already 3,500 while I only have Php 1,200 to Php 1,500 earnings from my puto business) Respondent A, 58 years old female.

Kulang gihapon akong gina sweldo pang palit ug tambal para sa akong sakit Php 3,000 to Php 4,000 lang akong sweldo taga bulan (My salary is not enough for me to buy all my medicines monthly. My salary is only Php 3,000 to Php 4,000 ) Respondent B 59 years old female.

Isa ko ka government employee sauna, nag resign na ko karon tungod sa akong sakit. Akong duha ka anak ang naga tabang sa ako karon. (I was a government employee before but I resigned from my job because of my illness. My two children were the one who are supporting me now.) Respondent C, 54 years old female

Maski naa mi negosyo kulang man gihapon among kwarta pang maintain sa akong mga tambal kay sige lang

44 ko pa lab test. (Even though we have business, our money is not enough to buy all my maintenance medicines because I underwent several types of diagnostic tests.) Respondent D, 46 years old female

Gamay lang kaayo ang among makuna na kwarta sa among negosyo na binangkal, naga hiram na lng mi ug kwarta sa akong mga igsoon pampalit ug tambal na ko. (We only earned a little from our binangkal business, sometimes we used to borrow money from my brother and sister to buy my medicines.) Respondent E, 61 years old female.

Hope to cure cancer. Four (4) out of five (5) respondents had strongly believed that they will be cured by the complementary and alternative medicines while the remaining one (1) respondent had partially lost her belief on the said therapy since her condition was getting much worse. However, all of them were hoping to be cured by the complementary and alternative medicines.

Wala siya makatabang sa akoa, gi-undangan na gani nako. (No it doesnt help me, I stop using it) Respondent A, 58 years old

45 Nakatabang man gamay kay hangtod karon buhi gihapon ko. (It helps me a little because until now I live). Respondent B, 59 years old

Okey lang man. Hopeless na hopeful gihapon. Ambot kung makaayo gani siya. Pero nindot siya gamiton kung wala pa kay sakit. (It is okay. Hopeless but hopefull still. I dont know if it cures me. But its nice to use when you dont have illness yet). Respondent C, 54 years old

Maayo

dyud

para

sa

akoa

ang

acupuncture.

(Acupuncture is good on me). Respondent D, 49 years old

Dili man epektibo, wala man ko maayo sa akong sakit sa pag gamit anang mga herbal pero murag naka-ingon ko nga murag naa siya naitabang pod gamay sa akong kinabuhi. (Not effective, I am not being cured on my sickness when I used herbal but I can say that it helps me a little bit in my life). Respondent E, 61 years old

Reduce side-effects of treatment. The most devastating part of the treatment regimen is the side effects of the conventional therapy. Almost all of the respondents,

46 four (4) out of five (5), were given chemotherapeutic drugs. They were all experiencing side effects of the said drugs such as pain, nausea, vomiting, hair fall, loss of appetite and weight loss. Three (3) respondents were only using complementary and alternative medicines for them to relieve from the unpleasant effects of the drugs that they were taking.

Naka bati ko ug pag ka lipong ug suka suka pag ka human sa akong chemotherapy (I felt so dizzy and I vomited after my chemotherapy.) Respondent A, 58 years old female

Naka sulay ko ug walay gana sa pagkaon ug suka suka pag kahuman sa akong chemotherapy(I experienced loss of appetite and vomiting after my chemotherapy.) Respondent C, 54 years old female.

Nag sige nako suka kay malasahan nako ang tambal, tapos wala nako gana mukaon. (I always vomit because I can already taste the medication, then I also experienced loss appetite.) Respondent D, 46 years old female.

47 Mangurog ko, magsuka tapos wala gana kaon. (I experienced tremors, vomiting and loss of appetite.) Respondent E, 61 years old female.

Influenced by the friends, neighbors and others. All of the respondents were first heard about complementary and alternative medicines through their friends, neighbors and the significant others. They were influenced to use the complementary and alternative medicines because of their friends experiences. Moreover, complementary and alternative medicines have become more popular because of the advertisements in the television, radio and newsprints. The respondents had become more interested on complementary and alternative medicines based on the experiences to those who had used the said therapy.

Na dunggan lang nako siya sa mga silingan nako, makatabang man siya pero dili jud kaayo. (I heard it from my neighbors; it helps me but not that much). Respondent A, 59 years old

Nakabalo lang man ko sa akong amiga lang pod. Ana siya nga iyahang amiga nga naa pod kanser sa susu kay naga-inom og mga herbal nga tambal sama na lang sa capsicum, grapeseed, saluyot, ampalaya, termerick,

kumintang, lagundi, mangosteen, quantum, silver cure og

48 bifnor liquid. Ingon siya nga naayo jud siya masking ang iyahang doktor dili makatuo sa iyahang nakit-an nga pagbabago. (I only knew it from my friend. She told me that her friend, who had a cancer in her breast, used herbal medicines such as capsicum, grapeseed, saluyot, ampalaya, termerick, kumintang, lagundi, mangosteen, quantum, silver cure and bifnor liquid. She told me that she was cured by she herbal medicines and her doctor could not even believe that there is something changed on her). Respondent B, 59 years old

Usahay sa commercial sa T.V. na naga-ingon na maayo gyud daw sila, ug ang uban sa ka trabaho sa akong anak kay naka-sinati na man daw sila sa kaayo ani. (Sometimes in the commercial on T.V. that said it can cure, and according to my daughters coworkers said that they have tried using it and experienced little

effectiveness.). Respondent C, 54 years old

Sa akong silingan nakadungog ani, nakagamit man pud siya sa acupuncture og ana siya maayo daw. Mao gisulay pud nako basi maulian ko. (I heard it from my neighbor, and said that they were using acupuncture and said its

49 good. Thats why I also tried to use it). Respondent D, 46 years old

Sa mga lain tao rapud, mga silingan namo og sa seminar na gi-conduct sa among baranggay. (I knew it from others especially to my neighbors and on the seminar that was conducted in our Barangay). Respondent E, 61 years old

50 CHAPTER V SUMMARY, CONCLUSION AND RECOMMENDATION

Summary The study was conducted in a local tertiary hospital in Davao City. The involved departments were Gynecology ward, and Internal Medicine ward. This study aimed to collect data regarding on the participants demographic and clinical profile, views and reasons on the use of Complementary and Alternative Medicine. The data collection was conducted through an in-depth interview with the use of interview guide. Five (5) adult cancer patients who were awake, conscious and coherent were interviewed for this study.

The age of the respondents was ranging from 46 to 61 years old and all were females. Almost of the respondents were Roman Catholic and the remaining was a Protestant. Majority of them, three (3) out of five (5), were college graduates and some of which were elementary undergraduates. Three (3) respondents were married, one (1) was a single and the other one (1) was a widower. Only one (1) respondent is employed and two (2) are unemployed. The remaining two (2) respondents are self-employed. The monthly income of the respondents ranged from Php 1,200 to Php 4,000 with a mean average of Php 2,233.33.

There were three (3) breast cancer respondents, two (2) of which were diagnosed with stage four (4) and the other one (1) was diagnosed with stage three (3). The two (2) remaining respondents were diagnosed with ovarian cancer stage one (1). All of the

51 respondents had undergone diagnostic procedures such as CBC, urinalysis, CT scan, chest x-ray, ultrasound and biopsy. Two (2) respondents had undergone operations. One (1) who has breast cancer stage four (4) had undergone Modified Radical Mastectomy (MRM) last June 2010. The other one (1) with ovarian cancer stage one (1) had two (2) operations, Total Abdominal Hysterectomy Bilateral Salphingo Oophorectomy (TAHBSO) and appendectomy last April 2011. Four (4) out of five (5) respondents are currently on chemotherapy. The remaining one (1) respondent was diagnosed to have breast cancer stage four (4) a year ago but refused chemotherapy by that time. Currently, she was about to start of the said treatment. Almost all of the respondents, four (4) out of five (5), were receiving chemotherapeutic drugs and some were given antibiotics, diuretics, pain reliever, anti-emetic and beta adrenergic drugs.

Only one (1) respondent said that using the complementary and alternative medicines, specifically acupuncture, is more effective than the conventional therapy in terms of alleviating the side effects of chemotherapeutic drugs such as pain, nausea and vomiting. However, she believed that herbal medicines were not effective in treating cancer. Three (3) respondents believed that complementary and alternative medicines were partially effective and also, they were all believed that their use of complementary and alternative medicines added another year of their life. The remaining one (1) respondent believed that it was not effective.

52 Conclusion The five (5) respondents showed varied views and reasons on the use of complementary and alternative medicines. Most of them viewed these treatment modalities were partially effective in treating cancer due to several factors such as age and absence of underlying illness. Furthermore, majority of the respondents had shared common reasons on the use of complementary and alternative medicines such as financial constraint, hope to cure cancer, reduced side-effects of chemo drugs and by the influenced of others. With these views and reasons, it only showed that the use of complementary and alternative medicines needs further research and progressive investigation on its proper applications especially on its role as adjunctive therapy for cancer.

Recommendation Based on the findings of this study, the researchers would like to recommend to the following departments and institutions:

Department of Science and Technology (DOST) and other research institutes 1. To conduct concrete researches on effectivity of herbal medicines on the treatment of cancer. 2. To disseminate research results related to complementary and alternative medicines to avoid myths and misconceptions.

53 Philippine Medical Association (PMA) and other medical societies 1. To help in educating the public on the role of complementary and alternative medicines in treatment of the cancer. 2. To strengthen preventive campaign against cancer. 3. To give updates on the recent technologies related to the treatment of cancer.

Department of Health (DOH) and Local Government Unit (LGU) 1. To educate members of baranggay health units on proper use of the complementary and alternative medicines. 2. To establish community support group of cancer patients.

Hospitals 1. To help document patients with cancer who use complementary and alternative medicines to monitor disease progression related to its use. 2. To help educate patients on other well-studied treatment modalities for cancer.

54 BIBLIOGRAPHY

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55 Cassileth BR, Lusk EJ, Guerry D et al. Survival and quality of life among patients receiving unproven as compared with conventional cancer therapy. N Engl J Med 1991; 324:11801185. Cassileth BR, Lusk EJ, Strouse TB et al. Contemporary unorthodox treatments in cancer medicine. A study of patients, treatments, and practitioners. Ann Intern Med 1984; 101:105112. Cauffield JS. The psychosocial aspects of complementary and alternative medicine. Pharmacotherapy 2000; 20:12891294. Chrystal K, Allan S, Forgeson G, Isaacs R. The use of complementary/alternative medicine by cancer patients in a New Zealand regional cancer treatment centre. New Zealand Medical Journal. 2003; 116:1168. Department of Health, 2011. www.doh.gov.ph/node/198 De Jong FA, Engels FK, Mathijssen RH et al. Medicinal cannabis in oncology practice: still a bridge too far? J Clin Oncol 2005; 23:28862891. De Smet PA. Herbal remedies. N Engl J Med 2002; 347:20462056. Deng G., Cassileth B.R., & Yeung K.S. (2004). Complementary therapies for cancer-related symptoms. Supportive Oncology, 2, 419429. Dy GK, Bekele L, Hanson LJ et al. Complementary and alternative medicine use by patients enrolled onto phase I clinical trials. J Clin Oncol 2004; 22:48104815. Eisenberg DM, Davis RB, Ettner SL et al. Trends in alternative medicine use in the United States, 19901997: results of a follow-up national survey. JAMA 1998; 280:15691575.

56 Ernst E, Cassileth BR. The prevalence of complementary/alternative medicine in cancer: a systematic review. Cancer 1998; 83:777782. Frenkel M., Ben-Arye E., Baldwin C.D., & Sierpina V. (2005). Approach to communicating with patients about the use of nutritional supplements in cancer care. Southern Medical Journal, 98, 289294. Gansler T., Chiewkwei K., Crammer C., & Smith T. (2008). A population-based study of prevalence of complementary methods use by cancer survivors. Cancer, 113, 1048 1057. Girgis A, Adams J, Sibbritt D. The use of complementary and alternative therapies by patients with cancer. Oncology Research. 2005; 15:281-89. Goldstein M.S., Brown E.R., Ballard-Barbash R., Morgenstern H., Bastani R., Lee J., Ambs A. (2005). The use of complementary and alternative medicine among California adults with and without cancer. eCAM, 2, 557565. Goldstein M.S., Lee J.H., Ballard-Barbash R., & Brown E.R. (2008). The use and perceived benefit of complementary and alternative medicine among Californians with cancer. Psycho-Oncology, 17, 1925. Greenlee, H., White, E., Patterson, R.E., & Kristal, A.R. (2004). Supplement use among cancer survivors in the Vitamins and Lifestyle (VITAL) study cohort. Journal of Alternative and Complementary Medicine, 10, 660666. Gupta S, Ahmad N, Mohan RR et al. Prostate cancer chemoprevention by green tea: in vitro and in vivo inhibition of testosterone-mediated induction of ornithine decarboxylase. Cancer Res 1999; 59:21152120.

57 Gupta D, Lis CG, Birdsall TC et al. The use of dietary supplements in a community hospital comprehensive cancer center: implications for conventional cancer care. Support Care Cancer 2005; 13:912919. Harris P, Finlay I, Cook A, Thomas KJ, Hood K. Complementary and alternative medicine use by patients with cancer in Wales: a cross-sectional survey. Complementary Therapies in Medicine. 2003; 11:249-53. Hedderson M, Patterson R, Neuhouser ML, Schwartz SM, Bowen DJ, Standish LJ, et al. Sex differences in motives for use of complementary and alternative medicine among cancer patients. Alternative Therapies. 2004; 10(5):58-64. Helyer LK, Chin S, Chui BK et al. The use of complementary and alternative medicines among patients with locally advanced breast cancer - a descriptive study. BMC Cancer 2006; 6:39. Hyodo I, Amano N, Eguchi K et al. Nationwide survey on complementary and alternative medicine in cancer patients in Japan. J Clin Oncol 2005; 23:26452654. Jian L, Xie LP, Lee AH et al. Protective effect of green tea against prostate cancer: a case-control study in southeast China. Int J Cancer 2004; 108:130135. Kappauf H, Leykauf-Ammon D, Bruntsch U et al. Use of and attitudes held towards unconventional medicine by patients in a department of internal medicine/oncology and haematology. Support Care Cancer 2000; 8:314322 Kosty MP. PC-SPES: hope or hype? J Clin Oncol 2004; 22:36573659. Kronenberg F, Mindes J, Jacobson JS. The future of complementary and alternative medicine for cancer. Cancer Invest 2005; 23:420426.

58 Lafferty WE, Bellas A, Corage Baden A et al. The use of complementary and alternative medical providers by insured cancer patients in Washington State. Cancer 2004; 100:15221530. Lawsin C., DuHamel K., Itzkowitz S.H., Brown K., Lim H., Thelemaque L., & Jandorf L. (2007). Demographic, medical, and psychosocial correlates to CAM use among survivors of colorectal cancer. Supportive Care in Cancer, 15, 557564. Leach MJ. Public, nurse and medical practitioner attitude and practice of natural medicine. Complementary Therapies in Nursing and Midwifery. 2004; 10:13-21. Lerner IJ, Kennedy BJ. The prevalence of questionable methods of cancer treatment in the United States. CA Cancer J Clin 1992; 42:181191. Lis CG, Cambron JA, Grutsch JF et al. Self-reported quality of life in users and nonusers of dietary supplements in cancer. Support Care Cancer 2006; 14:193199. Mao J., Palmer S., Straton J., Cronholm P., Keddem S., Knott K., Barg F. (2008). Cancer survivors with unmet needs were more likely to use complementary and alternative medicine. Journal of Cancer Survivorship, 2, 116124. Markovic M, Manderson L, Wray N, Quinn M. Complementary medicine use by Australian women with gynaecological cancer. Psychooncology. 2006; 15:209-20. Miller M., Bellizzi K.M., Sufian M., Ambs A.H., Goldstein M.S., & Ballard-Barbash R. (2008). Dietary supplement use in individuals living with cancer and other chronic conditions: A population-based study. Journal of the American Dietetic Association, 108, 483494.

59 Miller M, Boyer MJ, Butow PN, Gattelari M, Dunn SM, Childs A. The use of unproven methods and treatment by cancer patients: frequency, expectations and cost. Support Care Cancer.1998; 6:337-47. National Center for Complementary and Alternative Medicine, 2009. www.nccam.nih.gov Ngelangel CA, Dantes LD, Sy-Ortin T, Falcis CM, Esteban DB, Lapuz FGM, et al. Profile of cancer pain among a series of Filipino patients. Philipp J Intern Med 1992; 30:2916. OCallaghan FV, Jordan N. Postmodern values, attitudes and the use of complementary medicine. Complementary Therapies in Medicine. 2003; 11:28-32. Office of Cancer Complementary and Alternative Medicine, 2009. www.cancer.gov/cam Paltiel O, Avitzour M, Peretz T et al. Determinants of the use of complementary therapies by patients with cancer. J Clin Oncol 2001; 19:24392448. Patterson RE, Neuhouser ML, Hedderson MM, Schwartz SM, Standish LJ, Bowen DJ, et al. Types of alternative medicine used by patients with breast, colon, or prostate cancer: predictors, motives and costs. Journal of Alternative and Complementary Medicine. 2002; 8:477-85. Radbruch L, Nauck F. A review of side effects and complications with cannabinoid treatment. Schmerz 2003; 17:274279. Rakovitch E, Pignol JP, Chartier C et al. Complementary and alternative medicine use is associated with an increased perception of breast cancer risk and death. Breast Cancer Res Treat 2005; 90:139148.

60 Robinson A., & McGrail M.R. (2004). Disclosure of CAM use to medical practitioners: A review of qualitative and quantitative studies. Complementary Therapies in Medicine, 12(23), 9098. Richardson M.A., Sanders T., Palmer J.L., Greisinger A., & Singletary S.E. (2000). Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology. Journal of Clinical Oncology, 18, 25052514. Salminen E, Bishop M, Drummond R, Salminen S, Dietary attitudes and changes as well as use of supplements and complementary therapies by Australian and Finnish women following the diagnosis of breast cancer. Eur J Clin Nutr. 2004; 58:137-44. Saxe G.A., Madlensky L., Kealey S., Wu D.P.H., Freeman K.L., & Pierce J.P. (2008). Disclosure to physicians of CAM use by breast cancer patients: Findings from the Women's Healthy Eating and Living Study. Integrative Cancer Therapies, 7(22), 122129. Shorofi SA, Arbon P. Complementary and alternative medicine (CAM) among hospitalised patients: an Australian study. Complementary Therapies in Clinical Practice. 2010; 16:86-91. Siddiqui IA, Adhami VM & Saleem M et al. Beneficial effects of tea and its polyphenols against prostate cancer. Mol Nutr Food Res 2006; 50: 130143. Stevinson C, Ernst E. Hypericum for depression. An update of the clinical evidence. Eur Neuropsychopharmacol 1999; 9:501505. Straus SE. Herbal medicines--whats in the bottle? N Engl J Med 2002; 347:19971998. Tomey AM & Alligood MR. Nursing Theorists and their work Fifth Edition 2002; 628631.

61 Vapiwala N, Mick R & DeNittis A et al. Initiation of complementary and alternative medical therapies (CAM) by cancer patients (pts) during radiation therapy (RT). Proc Am Soc Ther Radiat Oncol 2005; 63 (suppl 1):S451. Velicer C.M., & Ulrich C.M. (2008). Vitamin and mineral supplement use among U.S. adults after cancer diagnosis: A systematic review. Journal of Clinical Oncology, 26, 665673. Verhoef M., Balneaves L.G., Boon H.S., & Vroegindewey A. (2005). Reasons for and characteristics associated with complementary and alternative medicine use among adult cancer patients: A systematic review. Integrative Cancer Therapies, 4(4), 274 286. Verhoef M, Mulkins A, Boon H. Integrative health care: how can we determine whether patients benefit? Journal of Alternative and Complementary Medicine. 2005; 11(Suppl 1):S57-S65. Vickers AJ, Kuo J, Cassileth BR. Unconventional anticancer agents: a systematic review of clinical trials. J Clin Oncol 2006; 24:136140. Wesa K., Gubili J., & Cassileth B. (2008). Integrative oncology: Complementary therapies for cancer survivors. Hematology Oncology Clinical Journal of North America, 22, 343353. World Health Organization, 2001. www.apps.who.int/medicinedocs/en/d/Jh2943e/9.13

62 APPENDIX 1 DAVAO MEDICAL SCHOOL FOUNDATION, INC. Medical School Drive, Bajada, Davao City College of Nursing

Date: _____________

MRS. ELIZABETH R. SORIANO, R.N., M.A.N. Dean, College of Nursing Davao Medical School Foundation, Inc. Medical School Drive, Bajada, Davao City

Dear Mrs. Soriano,

Greetings!

This is to inform your good office that our group will be conducting a research entitled Views and Reasons of Adult Cancer Patients on the use of Complementary and Alternative Medicine. This is in relation with our Thesis Writing subject in Bachelor of Science in Nursing Course.

With this regard, we would like to seek your approval on this particular undertaking. Thank you and we fervently hope that our group would merit your utmost approval.

63 Very truly yours,

MR. NORMAN B. JURUENA Principal Researcher/Group Leader

Noted by:

MRS. MA. ELSIE S. CALLUENG, R.N., M.A.N. Adviser

MR. RUPERTO HECTOR A. LINDO, M.A.Ed. Research Coordinator

Approved by:

MRS. ELIZABETH R. SORIANO, R.N., M.A.N. Dean, College of Nursing

64 APPENDIX 2 DAVAO MEDICAL SCHOOL FOUNDATION, INC. Medical School Drive, Bajada, Davao City College of Nursing

Date: _____________

LEOPOLDO J. VEGA, M.D., F.P.C.S., F.P.A.T.A.C.S.I., M.B.A. H. Chief of Hospital III Southern Philippines Medical Center J.P. Laurel Avenue, Bajada, Davao City

Dear Dr. Vega,

Greetings!

We are the students of the College of Nursing of Davao Medical School Foundation, Inc. decided to conduct a research for the completion of our thesis entitled Views and Reasons of Adult Cancer Patients on the use of Complementary and Alternative Medicine which is one of the requirements for us to complete the course that we are presently taking.

65 In lieu with this, we would like to seek your approval so that we may be able to conduct interviews and surveys to the adult cancer patients, which is vital in conducting our research. We can assure you the confidentiality of the respondents involved.

Thank you and we anticipate your favorable response. More power!

Very truly yours,

MR. NORMAN B. JURUENA Principal Researcher/Group Leader

Noted by:

MRS. MA. ELSIE S. CALLUENG, R.N., M.A.N. Adviser

MR. RUPERTO HECTOR A. LINDO, M.A.Ed. Research Coordinator

Approved by:

LEOPOLDO J. VEGA, M.D., F.P.C.S., F.P.A.T.A.C.S.I., M.B.A. H. Chief of Hospital III

66 APPENDIX 3 Respondents Information and Informed Consent English Version

Thesis Title: Views and Reasons of Adult Cancer Patients on the use of Complementary and Alternative Medicine

Investigators: Jean Leslie Bughao, Reyveen John Geli, Norman Juruena, Kathlyn Janine Mones, Mary Laureen Santarin, Rosthy John Soria, and Rinnah Grace Talatagod

We are asking you to take part in our research study. We will explain to you the project in detail. However, you must be at least 18 years of age to be part in our research study. You will be asked questions of a personal nature and you might feel uncomfortable talking about some things. You are free to decline to answer any questions that you do not wish to answer, or you may stop your participation in the discussion at any time without penalty.

You may benefit from taking part in this study. This study may help us better understand how the Complementary and Alternative Medicine affects or improves your quality of life. There will be no procedure to be done to you in this study. There will be no compensation or reimbursement of any expenses you may have during in our interview. But, we will be giving you free snacks as our sign of gratitude for your active participation in this study.

67 The records from this study will be kept as confidential as possible. No individual identities will be used in any reports or publications resulting from the study. All transcripts and summaries will be given codes and stored separately from any names or other direct identification of participants. Research information will be kept in locked files at all times. Only research personnel will have access to the files and the audio tapes and only those with an essential need to see names will have access to that particular file. After the study is completed and all data has been transcribed from the tapes, the tapes will be held for one year and then destroyed. We will not contact you anymore and there will be no home visitations to be made after you take part of our research study.

The researchers will not provide you for any payment if you are harmed as a result of taking part in this study. If such harm occurs, treatment will be provided. However, this treatment will not be provided free of charge. Participation in this study is completely voluntary. If you decide not to participate there will not be any negative consequences. Please be aware that if you decide to participate, you may stop participating at any time and you may decide not to answer any specific question. If you decided to withdraw and discontinue your participation, you will not be charged or penalized. After our research study, you will not be informed on what will be the study results in order to keep you in safe and we will guarantee you that the results will be remained confidential. The study data will be stored in the Nursing library of Davao Medical School Foundation, Inc. and will make the data available for future researchers.

68 If you have any questions, concerns, or complaints about the research, you may discuss with Mr. Norman Juruena with the contact number of 09322151358 or 302-8089.

CONSENT FORM I have read and understood the above information and had been given the opportunity to consider and ask questions on the information regarding the involvement in this study. I have received a copy of this Patient Information and Informed Consent Form. I voluntarily agree to participate.

Respondents Signature: _______________________________ ________________________ Signature over Printed Name of Respondent Date

Witness or Legal Guardians Signature: (Only when patient cannot read or sign this informed Consent) _____________________________________ ________________________ Signature over Printed Name of Witness/Legal Guardian Date

69

APPENDIX 4 Impormasyon at Kaalamang Pahintulot ng Respondents Tagalog Version

Pamagat ng Sanaysay:

Views and Reasons of Adult Cancer Patients on the use of

Complementary and Alternative Medicine

Mga Imbestigador: Jean Leslie Bughao, Reyveen John Geli, Norman Juruena, Kathlyn Mones, Mary Laureen Santarin, Rosthy John Soria, and Rinnah Grace Talatagod

Humihingi kami ng iyong basbas na sanay pumayag kayong maging bahagi ng aming pananaliksik. Ikaw ay tatanungin ng personal at maaari mong hindi sagutin ang anumang mga katanungan na hindi mo nais, o maaari mong itigil ang iyong pagsali sa mga talakayan sa anumang oras nang walang parusa. Hindi mo mapapakinabangan ng direkta ang pagsali sa pag-aaral na ito. Gayunpaman, ang pag-aaral na ito maaaring makatulong sa amin na maunawaan kung paano nakakaapekto ang Complementary at Alternatibong Medisina o mapabuti ang iyong kalidad ng buhay. Walang pamamaraan na gagawin sa pag-aaral na ito. Walang kabayaran o pagbabayad na mangyayari sa panahon ng aming interbyu. Subalit, kami ay magbibigay sa iyo ng libreng meryenda bilang pasasalamat sa iyong aktibong pakikilahok sa pag-aaral na ito.

70 Ang mga talaan mula sa pag-aaral na ito ay panananatilihing kumpidensyal hangga't maaari. Walang indibidwal na pagkakakilanlan ang gagamitin sa anumang mga ulat o mga publication na nagreresulta mula sa pag-aaral. Lahat ng mga transcript at buod ay bibigyan ng code at naka-imbak sa hiwalay na pangalan o iba pang direktang pagkakakilanlan ng kalahok. Lahat ng impormasyon sa pananaliksik ay pananatilihing naka-lock file sa lahat ng oras. Hindi na kami makikipag-ugnayan sa iyo at walang mga bisitasyon sa bahay na gagawin pagkatapos mong makibahagi sa aming pananaliksik. Ang mga mananaliksik ay hindi magbibigay ng anumang bayad sa iyo kapag ikaw ay napinsala sa pakikibahagi sa pag aaral na ito. Kung may pinsalang nangyari, ipagkakaloob ang pagpapagamot. Gayunman, ang pagpapagamot ay hindi ibibigay ng libre.

Ang paglahok sa pag-aaral na ito ay lubos na boluntaryo. Kung nagpasya kang hindi na sasali walang anumang negatibong kahihinatnan. Mangyaring magkaroon ng kamalayan na kung ikaw ay nagpasyang lumahok, maaari mong itigil ang pagsali ng anumang oras at maaari kang magpasyang hindi sagutin ang anumang mga tiyak na katanungan. Kung nagpasya ka mag-withdraw at itigil ang iyong paglahok, hindi ka namin sisingilin o ipenalized. Pagkatapos ng aming pananaliksik, hindi namin sasabihan ang mga resulta ng pag-aaral upang panatilihing ligtas at magagarantiya namin na ang mga resulta ay mananatiling kumpidensyal.

71 Kung mayroon kang anumang mga katanungan, mga alalahanin, o mga reklamo tungkol sa pananaliksik, maaari mong talakayin kay Ginoong Norman Juruena sa numerong ibinigay 09322151358 or 302-8089.

PAHINTULOT FORM Nabasa ko na at naiintindihan ang nasa itaas na impormasyon at nabigyan ng pagkakataon na isaalang-alang at magtanong sa impormasyon tungkol sa paglahok sa pag-aaral na ito. Nakatanggap ako ng kopya ng Patient Information and Informed Consent Form. kusang-loob akong sumang-ayon na lalahok.

Pirma ng Tumutugon: ____________________________________ ________________________ Pirmi at pangalan ng Tumutugon Petsa

Saksi o Pirma ng Legal Tagapag-alaga: (Kapag ang pasyente ay hindi marunong bumasa o mag-sign ang kaalamang pahintulot) ____________________________________ ________________________ Pirma at pangalan ng Saksi/Legal na Tagapag-alaga Petsa

72

APPENDIX 5 Inpormasyon sa mga responde ug Inpormasyon sa Pagpabalo Cebuano Version

Title sa Research: Views and Reasons of Adult Cancer Patients on the use of Complementary and Alternative Medicine

Imbestigador: Jean Leslie Bughao, Reyveen John Geli, Norman Juruena, Kathlyn Mones, Mary Laureen Santarin, Rosthy John Soria, and Rinnah Grace Talatagod

Kami naga pangayo sa inyong cooperation sa pag buhat sa among research study. Among ipa sabot sa inyo ang mga detalye. Kami mangutana sa inyo bahin sa personal na butang og pwede nimo nga dili tubagon ang mga pangutana kung di ninyo gusto or buot tubagon og pwede sab nimong undangan ang diskusyon kung gusto nimo.Walay mga procedure na paga buhaton sa among research study. Walay mga gastohan sa among paga buhaton na pag interview pero kami maga hatag ug libreng pamainit isig pasalamat sa inyong kooperasyon sa among research study. Ang mga nakuha na impormasyon gikan

73 sa among pag interview kay confidential. Walay lain maka gamit sa inyong mga inpormasyon sa pag report o pag published. Ang mga research personnel lang ang naay karapatan na mo abri niining payl. Pag kahuman sa pag conduct sa among research.

Ang mga imbestigador kay dili mu hatag ug bayad sa inyo kung naay mahitabo sa imo bahin sa among pag panginterview. Ang pag salmot sa among study kay voluntaryo. Kung ikaw di gusto mu salmot sa amo walay negatibo na mahitabo sa inyo. Kung ikaw nag desisyon na mo salmot pwede ka mo undang sa pag salmot kung gustohon ninyo. Kung kamu buot mu undang sa inyong pag salmot kamu dili paga hatagan ug salot.

Kung naa kamuy mga pangutana kabahin sa among study pwede nimong tawagan si Norman Juruena sa mga numerong 09322151358 or 302-8089.

KATUGOTAN NA GITAHO Ako nakasabot sa mga inpormayon na gihatag, oportunidad ug sa pag pangutana sa among concern kabahin sa maong study. Ako nakadawat ug kopya sa Katugotan na gitaho. Ako voluntaryong mo sugot sa pag salmot.

Ngalan sa Manunubag: _____________________________________ ________________________ Pirma ug ngalan sa Manunubag Petsa

74

Ngalan sa Saksi o sa Magbalantay: (Para sa mga di makabasa) _____________________________________ ________________________ Pirma ug ngalan sa saksi Petsa

APPENDIX 6 INTERVIEW GUIDE English Version

Pseudo Name: ______________________ 1. Demographic Profile 1.1 Age 1.2 Sex 1.3 Religious Affiliation 1.4 Educational Attainment

Date: ____________________ Please Specify: ______ Male ______ Female Please Specify: ______ None ______ Elementary ______ High School ______ College ______ Vocational ______ Post Graduate ______ Single ______ Married ______ Separated ______ Widow/Widower ______ Employed

1.5 Civil Status

1.6 Occupation

75 ______ Unemployed ______ Selfemployed 1.7 Monthly Income 2. Clinical Profile 2.1 Medical Diagnosis 2.2 Treatment Options ______ Retired Please Specify: Please Specify: Please Specify:

3. What do you know about your current condition? ________________________________________________________________________ ________________________________________________________________________ 4. What are the treatments that you have undergone after being diagnosed with cancer? ________________________________________________________________________ ________________________________________________________________________ 5. What medications are you taking? ________________________________________________________________________ ________________________________________________________________________ 6. What are the effects after you have taken the medications? ________________________________________________________________________ ________________________________________________________________________ 7. What have you felt on the treatments that have been done unto you? ________________________________________________________________________ ________________________________________________________________________ 8. How long do you spend on this/these treatment/s? ________________________________________________________________________ ________________________________________________________________________ 9. How much do you spend on this/these treatment/s? ________________________________________________________________________ ________________________________________________________________________ 10. How often do you comply on this treatment regimen? ________________________________________________________________________ ________________________________________________________________________

76 11. What do you know about CAM? ________________________________________________________________________ ________________________________________________________________________ 12. What are your views about CAM? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 13. Where did you hear about the use of CAM and what are their experiences? ________________________________________________________________________ ________________________________________________________________________ 14. Do you use CAM as your mode of treatment? ________________________________________________________________________ ________________________________________________________________________ 15. What type of CAM do you use? ________________________________________________________________________ ________________________________________________________________________ 16. When did you start using CAM? ________________________________________________________________________ ________________________________________________________________________ 17. How often do you use CAM? ________________________________________________________________________ ________________________________________________________________________ 18. What are your reasons in using CAM? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 19. What are your experiences of using the following: 19.1 CAM _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________

77 19.2 Treatment Options _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________

APPENDIX 7 INTERVIEW GUIDE Tagalog Version

Alyas: _____________________________ 1. Demographic Profile 1.1 Edad 1.2 Kasarian 1.3 Relihiyon 1.4 Educational Attainment

Petsa: __________________ Mangyaring tukuyin: ______ Lalaki ______ Babae Mangyaring tukuyin: ______ Wala ______ Elementary ______ High School ______ College ______ Vocational ______ Post Graduate ______ Single ______ Married ______ Separated ______ Widow/Widower ______ May Trabaho ______ Walang Trabaho ______ Selfemployed ______ Retired Mangyaring tukuyin:

1.5 Civil Status

1.6 Trabaho

1.7 Kabuwanang Sahod 2. Klinikal Profile

78 2.1 Medikal na Pagsusuri 2.2 Pagpipiliang Gamot Mangyaring tukuyin: Mangyaring tukuyin:

3. Ano ang iyong pagkaka-alam tungkol sa iyong kasalukuyang karamdaman? ________________________________________________________________________ ________________________________________________________________________ 4. Anu-ano ang mga paraan sa paglunas na iyong nasubukan pagkatapos mong nalaman ang iyong karamdaman? ________________________________________________________________________ ________________________________________________________________________ 5. Anu-ano ang mga gamot na iyong iniinom? ________________________________________________________________________ ________________________________________________________________________ 6. Anu-ano ang mga epekto nito sa iyo? ________________________________________________________________________ ________________________________________________________________________ 7. Ano ang iyong naramdaman sa mga paggamot na ginawa sa inyo? ________________________________________________________________________ ________________________________________________________________________ 8. Gaano na katagal kang nag-papagamot? ________________________________________________________________________ ________________________________________________________________________ 9. Magkano na ang iyong ginastos sa iyong paggamot? ________________________________________________________________________ ________________________________________________________________________ 10. Gaano ka kadalas mong sinusunod ang pagpapagamot? ________________________________________________________________________ ________________________________________________________________________ 11. Ano ang alam mo tungkol sa CAM? ________________________________________________________________________ ________________________________________________________________________

79 12. Ano ang iyong mga pananaw tungkol sa CAM? ________________________________________________________________________ ________________________________________________________________________ 13. Saan mo narinig ang tungkol sa CAM at ano ang kanilang mga naranasan? ________________________________________________________________________ ________________________________________________________________________ 14. Gumagamit ka ba ng CAM bilang iyong paraan ng paggamot? ________________________________________________________________________ ________________________________________________________________________ 15. Anong uri ng CAM ang ginagamit mo? ________________________________________________________________________ ________________________________________________________________________ 16. Kailan mo sinimulan ang paggamit ng CAM? ________________________________________________________________________ ________________________________________________________________________ 17. Gaano ka kadalas gumagamit ng CAM? ________________________________________________________________________ ________________________________________________________________________ 18. Ano-ano ang iyong mga dahilan sa paggamit ng CAM? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 19. Ano ang iyong mga naranasan sa pag gamit sa mga sumusunod na: 19.1 CAM _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 19.2 Pagpipiliang pang-gagamot _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________

80

APPENDIX 8 INTERVIEW GUIDE Cebuano Version

Alyas: ________________________ 1. Demographic Profile 1.1 Edad 1.2 Kasarian 1.3 Relihiyon 1.4 Educational Attainment

Petsa: __________________ Palihog iingon: ______ Lalaki ______ Babae Palihog iingon: ______ Wala ______ Elementary ______ High School ______ College ______ Vocational ______ Post Graduate ______ Single ______ Married ______ Separated ______ Widow/Widower ______ May Trabaho ______ Walang Trabaho ______ Selfemployed ______ Retired Palihog iingon: Palihog iingon: Palihog iingon:

1.5 Civil Status

1.6 Trabaho

1.7 Kabuwanang Sahod 2. Clinical Profile 2.1 Medical diagnosis 2.2 Treatment Options

3. Unsa imong nahibaw-an mahitungod sa imung kondisyon?

81 ________________________________________________________________________ ________________________________________________________________________ 4. Unsa ang imong mga naagi-an na pamaagi na pagtambal sa imong sakit? ________________________________________________________________________ ________________________________________________________________________ 5. Unsa na mga tambal ang imong ginainom? ________________________________________________________________________ ________________________________________________________________________ 6. Unsa ang mga epekto sa tambal pagkahuman nimu og inum ato? ________________________________________________________________________ ________________________________________________________________________ 7. Unsa imung gibati sa pamaagi sa pagtambal sa imu? ________________________________________________________________________ ________________________________________________________________________ 8. Unsa ka dugay na ka naga gamit ani na mga pamaagi? ________________________________________________________________________ ________________________________________________________________________ 9. Pila ang imung nagastos mahitungod sa ani na mga pamaagi sa pag tambal? ________________________________________________________________________ ________________________________________________________________________ 10. Unsa kadugay ang imung pagsubay niining mga pamaagi? ________________________________________________________________________ ________________________________________________________________________ 11. Unsa imong nahil-an sa CAM? ________________________________________________________________________ ________________________________________________________________________ 12. Unsa imong opinyon mahitungod sa CAM? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 13. Ginagamit ba nimu ang CAM bahin isa sa pamagi sa imung pagtambal?

82 ________________________________________________________________________ ________________________________________________________________________ 14. Unsa klase sa CAM ang imung ginagamit? ________________________________________________________________________ ________________________________________________________________________ 15. Asa ka nakadungog matod sa CAM ug unsa pud ang ilang nasinati? ________________________________________________________________________ ________________________________________________________________________ 16. Kanus-a ka nagsugod og gamit aning CAM? ________________________________________________________________________ ________________________________________________________________________ 17. Unsa kadugay ang imung pagsubay niining CAM? ________________________________________________________________________ ________________________________________________________________________ 18. Unsa imung rason ngano ka nigamit aning CAM? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 19. Unsa ang imong nasinati matud ating mga misunod? 19.1 CAM _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 19.2 Treatment Options _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________

APPENDIX 9

83 CURRICULUM VITAE

Name: Jean Leslie C. Bughao Age/Sex: 19/Female Birth date: August 13, 1991 Birthplace: Davao City Civil Status: Single Nationality: Filipino Religion: Roman Catholic Address: #91 BPI Comp. Park Ave., Bajada, Davao City

EDUCATIONAL ATTAINMENT: Primary: Magallanes Elementary School Secondary: Assumption College of Davao College: Davao Medical School Foundation, Inc

FAMILY BACKGROUND: Fathers Name: Edwin Fuentesfina (Step-father) Mothers Maiden Name: Luzminda Bughao Siblings: Name: Edwin B. Fuentesfina Name: Edward B. Fuentesfina Occupation: Student Occupation: Student Occupation: Businessman Occupation: Businesswoman

CURRICULUM VITAE

84

Name: Reyveen John B. Geli Age/Sex: 19/Male Birth date: August 23, 1991 Birthplace: Tandag, Surigao del Sur Civil Status: Single Nationality: Filipino Religion: Roman Catholic Address: Tandag, Surigao del Sur

EDUCATIONAL ATTAINMENT: Elementary: Tandag Pilot Elementary School High School: Jacinto P. Elpa National High School- Special Science Curriculum College: Davao Medical School Foundation, Inc

FAMILY BACKGROUND: Father: Rey Vic Montenegro Geli Mother: Minerva Cabrera Balansag Sibling: Name: Jayvan B. Geli Occupation: Call Center Agent Occupation: Government Employee Occupation: Former Brgy. Councilor

CURRICULUM VITAE

85

Name: Norman B. Juruena Age/Sex: 19/Male Date of Birth: December 25, 1991 Place of Birth: Davao City Civil Status: Single Nationality: Filipino Religion: Roman Catholic Address: 180 Dao Street Nova Tierra Village, Lanang, Davao City

EDUCATIONAL ATTAINMENT: Primary: Assumption College of Davao Secondary: Holy Cross Academy of Sasa Tertiary: Davao Medical School Foundation, Inc

FAMILY BACKGROUND: Fathers Name: Antonio Juruena Mothers Maiden Name: Florenda Batalla Siblings: Name: Genelynne B. Juruena-Beley Name: May Flor B. Juruena-Cambongga Name: Gene May Ann B. Juruena CURRICULUM VITAE Occupation: Medical Doctor Occupation: Medical Doctor Occupation: Student Occupation: Retired Occupation: Nurse

86

Name: Kathlyn Janine S. Mones Age/Sex: 19/Female Birth date: June 3, 1992 Birthplace: General Santos City Civil Status: Single Nationality: Filipino Religion: Protestant Address: 502 Oak. Street GSIS Subdivision, Matina, Davao City

EDUCATIONAL ATTAINMENT: Primary: GSIS Heights Elemenetary School Secondary: Davao City National Highschool College: Davao Medical School Foundation, Inc

FAMILY BACKGROUND: Fathers Name: Venerando Mones Mothers Maiden Name: Janet Serrano Siblings: Name: Kahrene S. Mones Name: Verna Jeane S. Mones Occupation: Teacher Occupation: Nurse Occupation: Construction Occupation: House Wife

CURRICULUM VITAE

87

Name: Mary Laureen M. Santarin Age/Sex: 20/Female Birthdate: July 18, 1991 Birthplace: Davao City Civil Status: Single Nationality: Filipino Religion: Roman Catholic Address: Blk. 1 Lot 28 Hope Street Pag-Ibig Home, Buhangin, Davao City

EDUCATIONAL ATTAINMENT: Primary: Ford Academy of the Arts Secondary: Davao City National Highschool Tertiary: Davao Medical School Foundation, Inc

FAMILY BACKGROUND: Fathers Name: Samuel Santarin Mothers Maiden Name: Mary Jane Magon Siblings: Name: Jessa Mae M. Santarin Name: Shaine Jam M. Santarin Name: Sean Manuel M. Santarin Occupation: Student Occupation: Student Occupation: Student Occupation: Government Employee Occupation: Housewife

CURRICULUM VITAE

88

Name: Rosthy John L. Soria Age/Sex: 20/Male Date of Birth: December 21, 1990 Place of Birth: Davao City Civil Status: Single Nationality: Filipino Religion: Roman Catholic Address: Phase 3 Purok12 Dona Asuncion Village, Pampanga, Davao City

EDUCATIONAL ATTAINMENT: Primary: Dona Pilar Learning Center Secondary: Holy Cross Academy of Sasa Tertiary: Davao Medical School Foundation

FAMILY BACKGROUND: Fathers Name: Ronald T. Soria Mothers Maiden Name: Josephine Lipumano Worker Sibling: Name: Rosemare L. Soria Occupation: Student Occupation: Farmer Occupation: Banana Company

CURRICULUM VITAE

89

Name: Rinnah Grace Q. Talatagod Age/Sex: 19/Female Date of Birth: September 18, 1991 Place of Birth: Mangagoy, Bislig City Civil Status: Single Nationality: Filipino Religion: Roman Catholic Address: #50 Mahogany Street Hillside Subdivision, Bajada, Davao City

EDUCATIONAL ATTAINMENT: Primary: De la Salle John Bosco College Secondary: De la Salle John Bosco College Tertiary: Davao Medical School Foundation, Inc.

FAMILY BACKGROUND: Fathers Name: Rogelio Villar Talatagod Sr. Mothers Maiden Name: Genoveva Quiamjot Siblings Name: Rogelio Q. Talatagod Jr. Name: Geneveive Anne Q. Talatagod Name: Gen Rose Q. Talatagod Occupation: Unemployed Occupation: Student Occupation: Student Occupation: Businessman Occupation: Businesswoman