We undertook this study to ascertain the prevalence and characteristics of use of 6 common CAM treatments among a group of veterans who were receiving outpatient care for cancer or chronic pain within a VA Health Care System. Twenty seven percent of veterans reported use of these complementary and alternative medicine treatments in the prior 12 months. While this is a substantial number, it is lower than what has been reported for the general population. This may be due in part to methodological differences among CAM studies but is consistent with previous findings of lower prevalence of CAM use among males compared to women[1
] It should be noted however, that although the gender difference is clear, there are studies that have demonstrated a relatively high prevalence of CAM use (>40%) among older men with cancer[22
] and chronically painful conditions[24
Variations in prevalence of CAM use may also reflect differences in geographic location. As noted earlier, the only other study assessing veteran use of CAM was located in the southwest United States where use of CAM is more common [14
]. When compared to this group in Southern Arizona, with similar age and gender characteristics (mean age of CAM users = 61.9 years; mean age of non-CAM users = 62.7 years, CAM users = 90.5% men, non-CAM users = 93.4% men), reported CAM use in our group was in fact lower (27% vs. 49.6%).
Another potential reason for overall lower use of CAM in our study is the group's low income. Only 19% reported annual incomes above $30,000, similar to findings in other studies [2
]. CAM use in this population was associated with higher socioeconomic status and having insurance. A large majority of CAM non-users in this population (76%) did report that they would use these modalities if they were offered within the VA healthcare system. It is possible that increased health insurance coverage of well-studied CAM therapies may lead to increased use of these therapies.
The definition of CAM has not been uniform across the many studies assessing prevalence of CAM use. For example, in Eisenberg's landmark telephone survey [1
], the list of "unconventional therapies" used by 34% of Americans included spiritual healing, commercial weight-loss programs, lifestyle diets and self-help groups, although users of these constituted a small minority. A 2002 NHIS survey found that when excluding prayer, meditation and relaxation was the second most common CAM treatment [6
]. In the Southern Arizona study, subjects were asked whether they "currently use or have\ldotsever used complementary and alternative medicine." Only if subjects asked for clarification of CAM were they given examples from the categories outlined by NCCAM [4
]. In a follow-up qualitative study of 100 of those CAM users [14
], the researchers do report that those subjects were using a wide range of CAM modalities, not including alternative diets. In our study, we chose CAM modalities most likely to be familiar to the largest number of veterans [1
] and for the sake of clarity, excluded modalities such as vitamin therapy which may be prescribed as part of a conventional regime (examples: vitamins B12 and E). We also excluded prayer, and when compared to the most recent national, comprehensive survey [6
], the use of CAM in our more local study was slightly lower (27.3% versus 36%). In the national study, when prayer specifically for health reasons was included in the definition of CAM, use increased to 62%. Uniformity of CAM definition is likely to increase as researchers become more familiar with NCCAM categories.
There seems to be a lingering perception in the literature that individuals who use non-conventional treatments for their medical problems reject conventional care [25
]. This study supports the idea that most CAM users employ these modalities in conjunction with conventional medicine [2
] by affirming that there are CAM users among those who seek treatment in conventional medical settings. Because the study only sampled users of conventional medicine, it was unable to test the hypothesis that CAM users may reject conventional care. Unlike other studies, however, a very high percentage of CAM users in this study reported discussing their use of CAM with their VA providers [26
]. One explanation may be that users of veterans administration health services have a high level of satisfaction with their health care providers[30
]. Future studies might address the question of satisfaction in the provider and disclosure of CAM treatment. Another possible explanation for this finding might be the change in public opinion about CAM and presumption among patients that this is a legitimate aspect of treatment to discuss with their provider. In the 1998 survey conducted by Eisenberg et al, 70% of respondents reported they sought care from both conventional and alternative providers at the same time [31
]. The recent NCCAM/NCHS survey [6
] seems to support this view. In that study, 25.8% of adults who used CAM during the past 12 months did so because a conventional health care provider suggested it. Furthermore, these patients were all followed in specialty clinics in which the clinicians may be attuned to potential use of CAM among their patients. This would need to be reevaluated among veterans using non-specialty services.
One major limitation of this study is its cross-sectional design. Longitudinal studies could track changes in the use of CAM over time, especially if these therapies were introduced to the VA healthcare system. Another major limitation is the potential underestimation of CAM use by including only 6 therapies. However, these are the CAM modalities most likely to be known by the majority of veterans. Relationships between respondent characteristics and the CAM modalities in this study likely reflect those of all CAM modalities. Length of time since cancer diagnosis could influence use of CAM but this was not asked of respondents. However, the limited information about this in the medical literature suggests that this is not a strong predictor of CAM use [32
]. This has not been studied among veterans. Further studies on the topic should include all users of VA services.
Lastly, we do not know the characteristics of the survey non-respondents, but the demographic characteristics of our study subjects reflect those of the VA population served at the medical center [25