UUse of Traditional, se of Traditional, Complementary and Alternative Complementary and Alternative

Medicine (TCAM): Medicine (TCAM): A Case Study of Indian Cancer A Case Study of Indian Cancer

PatientsPatients

Prem Chhetri RMIT University & Prem Chhetri RMIT University &

Dr Alex BroomDr Alex Broom

the University of Newcastlethe University of Newcastle

ContentContent ► BackgroundBackground

► Concept of TCAMConcept of TCAM

► Research MethodologyResearch Methodology

► Data collection Data collection

► Results and InterpretationResults and Interpretation

► DiscussionDiscussion

BackgroundBackground ►In 2005 cancer killed In 2005 cancer killed

approximately 826,000 people in approximately 826,000 people in India; 519,000 under the age of 70 India; 519,000 under the age of 70 (WHO, 2005). (WHO, 2005).

►This is predicted to rise This is predicted to rise disproportionally compared with disproportionally compared with cardiovascular and communicable cardiovascular and communicable diseases by 2030 to nearly 1.5 diseases by 2030 to nearly 1.5 million deaths annually.million deaths annually.

BackgroundBackground ► The Indian subcontinent is home to 16.5 percent of The Indian subcontinent is home to 16.5 percent of

the world’s population and at any one time it is the world’s population and at any one time it is estimated that there are over 2 million people with estimated that there are over 2 million people with cancer (Kishore et al 2008). cancer (Kishore et al 2008).

► The majority of Indian cancer patients have late The majority of Indian cancer patients have late stage incurable disease (75% to 80%) when first stage incurable disease (75% to 80%) when first diagnosed (Jones, 1999; Kishore et al, 2008; Kumar diagnosed (Jones, 1999; Kishore et al, 2008; Kumar & Mittal, 2004; Pal, 2002).& Mittal, 2004; Pal, 2002).

► At present, out of one million newly diagnosed Indian cancer patients each year, more than 50 percent will die within 12 months of diagnosis and another one million cancer survivors (within 5 years of diagnosis) will show progressive disease (Pal & Mittal, 2004).

Background: TCAM and global health

(source: WHO, 2001)

► Global health policy emphasising the importance of promoting traditional medicines (TM) to help address the range of health concerns facing poorer countries

► Traditional medicines could (and do) play a role in reducing excess mortality and morbidity in poor and marginalised populations

► Recent policy trajectory has been toward a melding of traditional and biomedical systems

► But are there implications of the promotion of TM?

Many traditional, complementary and alternative practices

► Examples in South Asia: Ayurveda (Hindu) Unani medicine - Hakim (Islamic) Spiritual healers, Dam - Pirs (Islamic) Traditional Chinese Medicine (China and

used throughout Asia) Homeopathy (imported from Europe,

popular in India)

► Participants shifted between alternative and traditional, few used complementary.

Traditional MedicinesTraditional Medicines

► TCAM generally refers to health care practices TCAM generally refers to health care practices not offered within orthodox facilities (or by not offered within orthodox facilities (or by their practitioners). their practitioners).

► Traditional medicine (TM) refers to local Traditional medicine (TM) refers to local indigenous practices and belief systems that indigenous practices and belief systems that are used in developing countries for health-are used in developing countries for health-related purposes (Bodeker & Kronenberg, related purposes (Bodeker & Kronenberg, 2002). 2002).

► TMs have often been the dominant means of TMs have often been the dominant means of treatment for health problems for centuries treatment for health problems for centuries (e.g. Ayurveda and Unani in India), and in (e.g. Ayurveda and Unani in India), and in some cases, they continue to dominate health some cases, they continue to dominate health care beliefs and practices.care beliefs and practices.

Complementary and Complementary and Alternative MedicineAlternative Medicine

►Complementary and alternative medicine (CAM) is generally used to refer to a range of non-indigenous, unorthodox practices including homeopathy, naturopathy, herbalism and so on (Broom and Tovey, 2008).

PurposePurpose ►The aim of this project is two fold:The aim of this project is two fold:

i) first to identify socio-i) first to identify socio-demographic and disease status demographic and disease status differences between the TCAM differences between the TCAM and non-TCAM users among and non-TCAM users among cancer patients in India and cancer patients in India and

ii) second to assess whether ii) second to assess whether there is a difference in seeking there is a difference in seeking help from ‘orthodox medicine’ help from ‘orthodox medicine’ between the groups. between the groups.

Data CollectionData Collection ► Survey of 825 cancer patients in public and private Survey of 825 cancer patients in public and private

hospitals in Delhi. The survey was conducted over the hospitals in Delhi. The survey was conducted over the course of four months and the response rate was course of four months and the response rate was 80%. 80%.

► Recruitment sites: Recruitment sites: All India Institute of Medical SciencesAll India Institute of Medical Sciences Rajiv Ghandi Cancer Institute Rajiv Ghandi Cancer Institute

► Using four interviewers, we used list sampling to Using four interviewers, we used list sampling to interview every second patient over this four month interview every second patient over this four month period. period.

► 90 percent of the interviews were done in Hindi and 90 percent of the interviews were done in Hindi and 10 percent in English. 10 percent in English.

Data CollectionData Collection

ResultsResults ► Of the entire sample, 34.3% used TCAM

representing a significant proportion of the population.

► The most common types of practices used in this cohort of patients were Ayurveda, Homeopathy, Meditation, Acupuncture and Reiki.

► 22.8% had used local TM practices (e.g. Ayurveda) and 25.5% used CAM (e.g. Homeopathy).

► Of the 34.3% of TCAM users, 13.9% used both local TM and non-indigenous CAM.

TCAM User’s ProfileTCAM User’s Profile ► TCAM users are more likely to be relatively TCAM users are more likely to be relatively

older private patients, they are tended to be older private patients, they are tended to be married upper caste Hindu, generally married upper caste Hindu, generally residing in Delhi or its surrounding states. residing in Delhi or its surrounding states.

► Non-users of TCAM are more likely to be Non-users of TCAM are more likely to be male. Furthermore, non-users were more male. Furthermore, non-users were more likely to be single, public patients and non-likely to be single, public patients and non-Hindu in comparison to TCAM users. Hindu in comparison to TCAM users.

► Non-users also tend to travel longer Non-users also tend to travel longer distance for their treatment (14.8% for distance for their treatment (14.8% for TCAM users as compare to 21.6% for non-TCAM users as compare to 21.6% for non-users). users).

Delay in seeking help from Delay in seeking help from orthodox medicineorthodox medicine

►35.2% of respondents using TCAM sought help immediately after onset of symptoms whereas 50% of non-users immediately sought help from orthodox medicine.

►12.8% of TCAM users waited 3 months or more after noticing symptoms whereas only 4.3% of non-users waited this long.

delay in seeking help from delay in seeking help from orthodox medicineorthodox medicine

Delays in seeking help: TCAM Users

Non-Users

One week 35.2% 50.0% 0.000* *

One month 9.7% 6.8%

Three months 30.8% 36.8%

More than 3 months 12.8% 4.3%

►Are women more likely to be treated with TCAM?

Crosstab

137 302 439

31.2% 68.8% 100.0%

146 240 386

37.8% 62.2% 100.0%

283 542 825

34.3% 65.7% 100.0%

Count

% within Sex

Count

% within Sex

Count

% within Sex

Male

Female

Sex

Total

Yes No

Use of CAM or TM

Total

►Do women more likely to use public or private hospitals?

Crosstab

19 162 181

10.5% 89.5% 100.0%

11 128 139

7.9% 92.1% 100.0%

30 290 320

9.4% 90.6% 100.0%

118 140 258

45.7% 54.3% 100.0%

135 112 247

54.7% 45.3% 100.0%

253 252 505

50.1% 49.9% 100.0%

Count

% within Sex

Count

% within Sex

Count

% within Sex

Count

% within Sex

Count

% within Sex

Count

% within Sex

Male

Female

Sex

Total

Male

Female

Sex

Total

Public/PrivatePublic

Private

Yes No

Use of CAM or TM

Total

For TCAM Users For Non TCAM Users

►Is there a difference between the treatment received by non-upper caste women?

Crosstab

84 204 288

29.2% 70.8% 100.0%

94 181 275

34.2% 65.8% 100.0%

178 385 563

31.6% 68.4% 100.0%

28 76 104

26.9% 73.1% 100.0%

19 33 52

36.5% 63.5% 100.0%

47 109 156

30.1% 69.9% 100.0%

Count

% within Sex

Count

% within Sex

Count

% within Sex

Count

% within Sex

Count

% within Sex

Count

% within Sex

Male

Female

Sex

Total

Male

Female

Sex

Total

Caste recodeUpper caste

Others

Yes No

Use of CAM or TM

Total

For TCAM Users

ConclusionConclusion►We found that TCAM and Non-TCAM

users are different in terms of their socio-demographic characteristics

►We also found that TCAM users tend to delay in Orthodox medicinal treatment that might have strong implication in treatment.

►Female participants are more likely to be treated with TCAM, but they are more likely to be presented at private hospitals

What nextWhat next?► Requires more advanced statistical analysis

and modelling to ascertain the factors affecting the use of TCAM

► Combining the results of qualitative data analysis and cross validation.

► Comparing results from different parts of South Asia

► Establishing a broader theoretical framework of the analysis