Blackwell Publishing LtdOxford, UKECCEuropean Journal of Cancer Care0961-5423© 2007 The Authors.

Journal compilation © 2007 Blackwell Publishing Ltd.? 2007166517525Original ArticleUse of CAM and cancer care provisionEVANS
et al.

Original article

Men with cancer: is their use of complementary and

alternative medicine a response to needs unmet by
conventional care?
M.A. EVANS, ma, Research Fellow, Academic Unit of Primary Care, A.R.G. SHAW, msc, phd, Non-clinical
Lecturer, Academic Unit of Primary Care, D.J. SHARP, ma, frcgp, phd, Head of Academic Unit, Academic Unit
of Primary Care, University of Bristol, E.A. THOMPSON, ba, mbbs, mrcp, mfhom, Consultant Homeopathic
Physician and Hon. Senior Lecturer in Palliative Medicine, Bristol Homeopathic Hospital, United Bristol Health-
care Trust, S. FALK, mb, chb, mrcp(uk), frcr, md, Consultant Clinical Oncologist, Bristol Haematology and
Oncology Centre, P. TURTON, msc, srn, Principal Lecturer in Cancer Care, Faculty of Health and Social Care,
University of the West of England & T. THOMPSON, phd, Senior Lecturer, Academic Unit of Primary Care,
University of Bristol, Bristol, UK

EVANS M.A., SHAW A.R.G., SHARP D.J., THOMPSON E.A., FALK S., TURTON P. & THOMPSON T. (2007)
European Journal of Cancer Care 16, 517–525
Men with cancer: is their use of complementary and alternative medicine a response to needs unmet by
conventional care?

This qualitative study aims to investigate why men with cancer choose to use complementary and alternative
medicine (CAM), and whether CAM is used to fill ‘gaps’ in conventional cancer care or as an ‘alternative’ to
conventional treatment. Interviews were carried out with 34 CAM users recruited from a National Health
Service (NHS) oncology department, an NHS homeopathic hospital and a private cancer charity offering CAM.
Participants used therapies to improve quality of life, to actively ‘fight’ the disease and possibly prolong life,
but rarely as an alternative to conventional treatment. Many were initially sceptical about CAM, but took a
‘pragmatic’ and ‘consumerist’ approach to getting their needs met. Gaps in conventional care included: lack
of empathy and support during and after treatment, poor continuity of care, and lack of advice on self-help,
diet and lifestyle. The skills of CAM therapists may enable them to tap into the underlying needs of men in
a way that health professionals do not always have the time or the skills to achieve.

Keywords: psycho-social factors, complementary and alternative medicine, men, quality of life, psycho-
social support.

INT RO D U C TIO N well documented (Ernst & Cassileth 1998; Molatossiotis

et al. 2005). Studies show that patients use these thera-
The increasing popularity of complementary and alterna-
pies to help with side effects of treatment, for psycholog-
tive medicine (CAM) among cancer patients has been
ical support, to feel more ‘in control’ of their situation, to
maintain a positive hopeful attitude and to adopt an
active coping style (Astin 1998; Sollner et al. 2000; Spar-
Correspondence address: Ms Maggie A. Evans, Academic Unit of Primary
Care, University of Bristol, Cotham House, Cotham Hill, Bristol BS6 6JL, ber et al. 2000). Previous research has suggested that
UK (e-mail: m.a.evans@bristol.ac.uk). patients turn to CAM partly as a result of dissatisfactions
Accepted 11 January 2007 with conventional care (Furnham & Vincent 2003), par-
DOI: 10.1111/j.1365-2354.2007.00786.x ticularly in the treatment of chronic diseases (Thomas &
European Journal of Cancer Care, 2007, 16, 517–525 Coleman 2004), but it is not clear whether this is the

© 2007 The Authors

Journal compilation © 2007 Blackwell Publishing Ltd
EVANS et al.
case for patients facing a life-threatening disease such as
cancer.
‘CAM’ is an umbrella term that covers a range of
complementary therapies and alternative treatments.
The role of some complementary therapies such as mas-
sage, reflexology and meditation in supportive cancer
care has been recognized in cancer policy (National
Institute for Clinical Excellence 2004), but the wider use
of ‘alternative’ treatments and cures remains a cause for
concern among healthcare professionals owing to their
potential for harm (Ernst & Cassileth 1999). Therefore,
it is important that health professionals and patients
develop a dialogue about CAM decision making and
potential side effects (Singh et al. 2005). In this paper,
the term ‘CAM’ is used to cover all non-conventional
treatments, and the focus of the study is men with can-
cer, since they have been the subject of less qualitative
research than women (Balneaves et al. 1999; Canales &
Geller 2003).
Men are generally reported to be lower users of CAM
than women (Sparber et al. 2000; Smith 2004), although
surveys suggest that 30–65% of prostate cancer patients
adopt some form of CAM (Diefenbach et al. 2003).
According to a recent American survey, use of CAM to
have a sense of control over recovery was more evident in
prostate cancer patients than in women with breast cancer
(Hann et al. 2005). Other studies reveal a limited under-
standing of the motivations of men, suggesting that ‘com-
plex psycho-social dynamics’ (Wilkinson et al. 2002) lead
men to use CAM.
Men have been reported to adjust less well than women
to a cancer diagnosis (Fife et al. 1994), and this may be due
to a reported tendency of men to be more reticent and less
willing to discuss emotional and psychological issues
(Moynihan 2002). As a result, their psycho-social needs
may be overlooked in clinical consultations (Moynihan
2002). By using CAM, men are effectively taking their
needs outside the conventional system, and an under-
standing of why they do so may give some insight into the
nature of their unmet needs. The different ways in which
men and women use CAM may be important information
for clinicians, since they ‘may reflect differences in their
psychological needs as they cope with their cancer diag-
nosis and treatment’ (Hedderson et al. 2004).
Few studies of CAM use have involved men with types
of cancer other than prostate, and little work has been
done outside North America. The present study aims to
address these gaps by using in-depth qualitative inter-
views to investigate CAM use among a sample of men
with a range of types of cancer in one part of the UK. We
aim to investigate why men choose to use CAM, and the
518
extent to which CAM is used to fill ‘gaps’ in conventional
care provision.
PAT I ENT S AND MET HODS
A qualitative research design was used in order to explore
the processes shaping men’s decision making about CAM,
and the rationales they provide for their views and
behaviour. The research focused in depth on a purposeful
sample of men with a recruitment strategy aimed at
maximum variation (Patton 2002). Men were recruited
from contrasting settings: a National Health Service (NHS)
oncology unit (n = 11), an NHS homeopathic outpatient
clinic (n = 12), and a private cancer charity specializing in
CAM therapies (n = 11). Men were included with a range of
cancer types, at varying stages of illness and treatment,
and who potentially held a range of views on CAM. At the
oncology outpatients’ clinic, the participating oncologist
invited patients with an interest in CAM to meet the
researcher after their appointment. The researcher used a
short face-to-face screening questionnaire to confirm their
CAM use and gained informed consent for the study. The
definition of ‘CAM’ included special diets and also the use
of counselling, psycho-therapy or exercise if received
within the context of cancer care. At the homeopathic
clinic and cancer charity, all male patients currently
attending were invited by their clinician or therapist to
participate in the project, and they subsequently met the
researcher who gained informed consent.
Semi-structured interviews were carried out in partici-
pants’ homes. A brief follow-up interview was conducted
6 months later, either face-to-face or over the telephone,
at the participant’s preference. Core topics were covered
in all interviews, to ensure comparability, but participants
were also able to pursue areas of interest to them. The core
topics included: the history of their current illness, expe-
riences of conventional cancer treatment, views and expe-
riences of CAM use before and during cancer. Interviews
were recorded and fully transcribed.
Data collection and analysis took place alongside each
other in an iterative fashion, with preliminary analysis of
earlier interview data informing the questioning in subse-
quent interviews (Pope et al. 2000). The analysis was ini-
tially shaped and informed by ‘sensitising topics’ derived
from the literature and the study objectives (Charmaz
2002), but new emergent themes were also explored,
ensuring that the analysis was grounded in the data. The
data were analysed thematically, drawing on the princi-
ples of ‘constant comparison’ (Strauss & Corbin 1998),
where data elements are continually compared to generate
core categories and themes. Attention was given to both
© 2007 The Authors
Journal compilation © 2007 Blackwell Publishing Ltd
 Use of CAM and cancer care provision

confirming and disconfirming perspectives across all the
transcripts, giving attention to minority as well as major-
ity views (Pope et al. 2000).
The project researcher (M.A.E.) took the lead in coding
and analysing the data, but a subsection of the transcripts
was independently coded by another member of the team
(A.R.G.S.), and the coding framework discussed and
agreed. Members of the steering group also read sections of
some transcripts and commented on the emerging coding
strategy. The researcher used the qualitative data manage-
ment software ‘Atlas.ti’ (Atlas.ti Scientific Software
Development GmbH, Berlin, Germany) to aid the organi-
zation and coding of the interview data. Recruitment of
subjects continued until ‘data saturation’ was reached
with no new themes emerging in the analysis.
treatments with individual therapists and attendance at
group sessions. Some participants chose to use only those
therapies available via the NHS, which gave them a
‘stamp of approval’, for example the homeopathic clinic.
The majority, however, looked outside the NHS. When
more invasive CAM treatments were used, such as ‘alter-
native cures’, herbal remedies or dietary programmes,
men seemed to be aware of the potential safety concerns
regarding such treatments in parallel with conventional
treatment, and they recognized the importance of disclos-
ing CAM use to clinicians.
Our understanding of the factors influencing use of
CAM by men in this study can be summarized under two
themes: Why CAM? and Why now? These themes are sup-
ported by illustrative quotes, reflecting the full range of
views expressed by participants.

RESU LTS
Thirty-four CAM users were recruited and interviewed.
Thirty-one received a follow-up interview 6 months later;
of the remaining three, one was too ill, one had died, and
one could not be contacted. Details of the sample are
given in Table 1.
One study participant had refused conventional cura-
tive treatment in favour of alternative approaches; the rest
had all used CAM alongside conventional treatment.
Complementary and alternative medicine (CAM) thera-
pies used are listed in Table 2. They included supplements
and remedies available over the counter or via mail order,
Why CAM? – reasons for CAM use after a diagnosis
of cancer
Men gave a range of reasons for turning to CAM, which
fell into six categories as detailed below. Some of the rea-
sons reflected dissatisfaction with their conventional can-
cer care, but related to the process of care rather than the
treatment itself. The majority of participants accepted and
valued their conventional clinical treatment, using CAM
alongside rather than instead of their conventional care,
but turned to CAM for additional support in the following
areas.

Table 1. Description of sample by referral centre

Centre Cancer charity NHS homeopathic NHS oncology
No. of participants 11 12 11
Mean age in years (range) 56 (42–74) 51 (31–74) 65 (43–83)
Occupation Professional/self-employed Professional/clerical Professional/clerical
Cancer type
Prostate 3 2 5
Lung 1 1 1
Colorectal 3 3 4
Other 4 6 1
Stage of disease
Localized 2 5 3
Remission 4 2 4
Metastatic 4 3 1
Palliative care 1 2 3
Types of CAM used by participants (at setting or elsewhere)
Nutrition/supplements √ √ √
Mind–body √ √ √
Homeopathy √
Psychological support √ √ √
Physical therapies √ √ √
Herbal remedies √ √ √
Unusual/alternative therapies √ √ √
CAM, complementary and alternative medicine; NHS, National Health Service.
√, usage.

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EVANS et al.

Table 2. Glossary of ‘complementary and alternative’ treatments used in this study

Nutrition: Most popular approach, with the majority of men making some dietary changes since diagnosis of cancer. Some participants
took advice from a nutritionist, others from books or, occasionally, the Internet. Many followed a wheat-free, dairy-free, organic,
vegan programme with nutritional supplements including vitamins, fish oils and selenium. Following advice, some supplements
were withheld during chemotherapy. A minority had experimented with a range of extreme ‘anticancer’ diets such as the Gerson
Institute programme.
‘Mind–body therapies’: Healing, hypno-therapy, visualization, relaxation, reiki, t’ai chi, qi gong and movement therapy.
Homeopathy: remedies prescribed by the consultant at the homeopathic clinic.
Psychological therapies: Individual and group counselling, positive affirmations, ‘journeying’ (exploring your soul journey using shamanic
techniques), on-line peer support and the ‘Health Creation Kit’ (a self-help programme developed by an Integrated Cancer
Consultant).
Physical and ‘hands-on’ therapies: Acupuncture, massage, shiatsu, reflexology, aromatherapy, cranio-sacral therapy, kinesiology and
exercise therapy.
Iscador: fermented extract of mistletoe, sometimes combined with silver, copper or mercury. Boosts immune system plus antitumour
properties. Originally proposed by Rudolph Steiner in the 1920s.
Herbal remedies:
Bach Flower remedies: diluted essences of flowers that aim to rebalance the body’s energy.
Gingko biloba: extract of the green leaves of the Gingko tree, used in Asia for at least 5000 years. Main purported effect – improve
blood circulation.
Saw palmetto: extract of the berries of a palm tree that grows in the USA. Used to decrease prostate size and improve urinary symptoms.
Essiac: a herbal tea attributed to a Canadian nurse Rene Caisse, who named it by spelling her surname backwards. It contains burdock
root, sheep sorrel, slippery elm, Turkish or Indian rhubarb: used to treat cancer.
Green tea: used in China for 4000 years to inhibit cancer cell growth.
Apricot kernels: a natural source of vitamin B17 used as an anticancer agent.
Carctol: an Indian ayurvedic compound used to treat cancer.
Pycnogenol: extract of the bark of the French maritime pine tree. An antioxidant.
Noni juice: originally from India as a component of ayurvedic medicine, now more commonly from the Pacific islands. Supports the
immune system.
Other ‘alternative’ therapies:
Cyto-luminescent therapy: whole-body irradiation with light of a specific wave length to selectively damage and eliminate tumour
cells.
Vitamin B17: often given as an infusion and claimed to be antineoplastic.
Psychic surgery: an operation is performed with no scalpels or instruments. Body parts and masses and removed and no scar is left.
Rife: a treatment invented by Royal Rife in the 1930s to cure cancer using electronic frequencies.
Parasite cleansing: a variety of herbs used to cleanse the body of parasites.
Colloidal silver: manufactured from silver, using electro-current controlled technology and a 9-stage water purification process to give
uniformity of particle size, shape and dispersion. The product claims to be antiviral, antifungal, and antibacterial.

1) Desire for active participation in treatment
To counter a sense of passivity sometimes experienced in
the acceptance of conventional treatment, men wanted to
make active choices. Using CAM provided an avenue for
self-help and enabled them to regain a sense of control in
the face of an uncertain future. One man (age 49 with met-
astatic colorectal cancer) put it like this: ‘I just wanted
more, I thought there’s got to be more to this than just
medical treatment actually . . . they’ll stop my chemo-
therapy after twelve treatments so then they’re going to
give my body a rest and that’ll be interesting, and I’m kind
of looking forward to that actually, . . . to see without the
treatment what I can do, and if the cancer comes back, all
I can say at the moment is that I am giving my best to try
and do something’. This desire to take control was not
exclusive to decisions about CAM use. Some younger
men, especially with rare tumours or with a poor progno-
sis, also took a pro-active role in conventional treatment
decisions, by investigating treatment options and clinical
success rates in the UK and overseas before deciding on a
course of treatment.
2) Desire for good communication
Patients reported experiences of poor communication
with oncologists, revolving around lack of time to talk
in depth, difficulty in ‘making a connection’ with clini-
cians and finding it hard to formulate and ask ques-
tions. This 47-year-old man with leukaemia recounts his
frustration: ‘If I managed to make the effort to commu-
nicate and ask questions and be compassionate it gets
reciprocated but YOU have to make the effort totally it
has to come from me not from them [oncology consult-
ant] because I’m the sixty seventh person they’ve seen
that day and they’re tired’. Such experiences left many
men feeling unsupported in consultations. In contrast,
the more probing questioning style and lengthier
appointments typical of CAM enabled them to open up,
offering opportunities to talk, to be listened to, and to

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Journal compilation © 2007 Blackwell Publishing Ltd

be understood and ‘cared for’, all of which helped them
deal more positively with their illness. While specialist
nurses were sometimes able to fulfil a supportive role in
the conventional setting, they were not routinely avail-
able to all.
3) To relieve side effects of cancer treatment or
symptoms of cancer
Many of the men reported an improvement in their sub-
jective state of health after using CAM therapies, experi-
encing an increase in energy, better sleep quality, and a
reduction in fatigue. One man (age 74 with colorectal can-
cer) noticed the difference between using and stopping his
dietary programme: ‘I think I’m more lively I’m a bit more
fit, pretty alert aren’t I, I think it [diet] helps, I’ve stopped
it about two or three times, stood back after three weeks
and do you think I’m better with it and I thought well,
probably I am’. Men also gave specific examples of how
CAM therapies had provided relief from side effects, for
example acupuncture or homeopathy for pain, hot flushes
and nausea. This 49-year-old patient who was receiving
palliative care for a brain tumour recounted how cranial
osteopathy provided better pain relief than conventional
pain-killers: ‘I had horrendous headaches after the radio-
therapy, I was on maximum dose of painkillers until I had
the cranial osteopathy and there was a noticeable step dif-
ference. I told one doctor but whether they sit down and
talk to each other I don’t know’.
4) Desire for a more holistic approach
Clinical treatment was often perceived as rather narrow
and not particularly geared to individual needs. Patients
were also troubled by the lack of continuity of care, often
seeing a different doctor every time, sometimes without
notes or test results being available, as highlighted by this
man (age 43 with bone cancer): ‘I’ve rarely had continuity
of care. This consultant once again hadn’t read my notes
and he wouldn’t let me see the scans, the whole thing was
very dismissive . . . he was very unsupportive, his mobile
phone went off in the middle of the session and he
answered it, I was very angry and I wrote and asked for my
previous consultant – I took it into my own hands which
was a good thing for me to do, it was good for me to take
charge of the situation’.
Many participants hoped for psychological, emotional
or spiritual support, and they valued the more individual-
ized ‘whole-person’ approach with an emphasis on self-
healing that typifies many CAM therapies. They reported
a reduction in stress, anxiety and panic attacks, felt more
© 2007 The Authors
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Use of CAM and cancer care provision
able to relax, and experienced ‘peace of mind’ and greater
mental clarity through using CAM. These therapies
helped some to deal with the trauma of diagnosis, to
recover from or avert the onset of depression, like this 54-
year-old patient with prostate cancer: ‘I was getting
depressed I was getting really down in the dumps and I
needed to be brought out of it . . . it was becoming a chore
to get out of bed and they’ve [CAM provider] given me a
lot of support . . . I think within a month I was feeling
fifty, sixty times better, I wasn’t so TIRED, I wasn’t so
depressed’.
As part of a more holistic approach, participants also
wanted advice on diet and lifestyle, so that they could
keep themselves as fit as possible and reduce the chance of
disease recurrence, topics rarely discussed in their con-
ventional consultations.
5) To reduce the spread of the disease and prolong life
While improving quality of life was the major rationale for
CAM use, there was a definite undercurrent of hope, par-
ticularly among the younger patients, that some therapies
might have an anticancer effect and slow tumour growth,
or boost the immune system, making it easier to ‘fight’
the disease. For some, CAM was a ‘last resort’ when con-
ventional treatment had no more to offer, as described by
this man (age 53 with end-stage colorectal cancer): ‘Well it
wasn’t until I found out basically that I was terminally
ill with cancer and basically I was chemo-therapy non-
receptive so the only other sort of alternative really was to
try this . . . “alternative” treatment’. There were few
explicit references to ‘cure’ by men in the study, but many
of them believed that CAM use might prolong their life,
illustrating these beliefs with reports of good prostate spe-
cific antigen (PSA) results, stable scans or outliving their
prognosis by months or, in some cases, years. They did,
however, acknowledge the difficulty in measuring the
effectiveness of CAM when used in parallel with conven-
tional treatment. This 79-year-old patient with metastatic
prostate cancer admitted: ‘I honestly don’t know whether
it did me any good or not. The only thing I can say is that
I’m still here and I’m supposed to have been dead what,
seven years ago or something’.
Why now? – pathways into CAM, timing and triggers
to CAM use
Men reflected on their use of CAM since they had cancer
and more broadly during their lives. The data suggest that
the categories of ‘CAM user’ or ‘non-user’ are dynamic
rather than fixed, with men moving in and out of CAM
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EVANS et al.
use at different points of time in their life, depending on
their health needs, their openness to looking outside con-
ventional medicine, and the influence of significant others
around them. Often the men themselves had not been the
main initiator of CAM use. There were many instances
where CAM was initially investigated by family and
friends, and participants’ wives and daughters often took a
key role in encouraging men to use CAM. This was par-
ticularly true since the cancer diagnosis, as described by
this 43-year-old man with lung cancer: ‘My wife found the
cancer centre and she DRAGGED me along, me being the
eternal cynic thinking that everybody is going to be very
luvvy-duvvy and alternative and walk around in kaftans
all this sort of thing’. Men described how they, them-
selves, had also became much more aware, since diagno-
sis, of hearing and seeking stories or information about
CAM and cancer in books, the media or their network of
social contacts.
Participants fell into two broad groups: just over half
had already used CAM before their cancer diagnosis, some
describing a history of use within their family: ‘We were
brought up you know to take different sort of herbal rem-
edies anyway for your sickness . . . yes when I was
younger but then I sort of faded away from all that sort of
stuff because I wasn’t ill basically so I didn’t really need to
bother you know . . . I mean that was just something my
parents and my grand parents used to give me’ (43 years
old with metastatic colorectal cancer). For the rest, cancer
was the trigger to CAM use, as in the case of this 63-year-
old patient with oesophageal cancer: ‘Well it would appear
one needs to be threatened, seriously, to actually take
advantage and avail oneself with some of the let’s say
holistic medicine things’. Prior to cancer, men had used
CAM in response to a range of health needs: physical (such
as migraine, musculoskeletal problems) or psychological
(support and personal growth). In some cases, conditions
had not been resolved by conventional medicine, or con-
ventional treatment had resulted in unpleasant side
effects; in others, CAM was used for preventive health
care.
For many men, their cancer diagnosis marked their first
serious illness, and this served as the trigger to use CAM
for the first time. Having a life-threatening illness gave
rise to many new and different needs, and led many men
to re-evaluate their priorities and attitudes, including
their willingness to look outside conventional health care
for support. Some of these ‘new users’ had previously been
sympathetic to CAM, but had perceived no need to use it,
whereas many described themselves as previously ‘cyni-
cal’ or ‘sceptical’ about CAM before their diagnosis and
had been surprised by the benefits they derived.
522
The majority of men in this study took a ‘pragmatic’ or
‘consumerist’ approach to CAM, both before and after
their cancer diagnosis, trying out different therapies in
response to specific needs until they found one that
‘worked’ for them, such as this 43-year-old patient with
colorectal cancer, who had never used CAM before his
recent illness: ‘After the operation I woke up and they
must have damaged a nerve during the operation some-
where and it was, I’ve got a numbness on my right hand
along like down the side of the thumb and across the back
and they’ve tried a lot of things for that and I ended up
having acupuncture to try and see if that would help’.
Even when a therapy offered little benefit, participants did
not reject CAM per se, but ‘shopped around’ for a different
CAM therapy in the hope that this might be able to help
them. Neither did they accept CAM wholesale: partici-
pants were often highly sceptical of therapies other than
the ones they had chosen. A minority of the men were
committed to the philosophies underlying many CAM
therapies and adopted CAM as part of a broader holistic
approach to health, lifestyle and personal development,
such as the 63-year-old patient with oesophageal cancer: ‘I
was fortunate to start with in the sense that um I’ve
always had a strong spirituality, and I think that’s an
aspect of connecting you to the holistic range of
possibilities . . . a belief in the possibility I guess that ah
one can make a difference, with suitable tools, to one’s
own existence’.
Men had used CAM at key points through their illness,
first of all to deal with the impact of diagnosis, as
described vividly by this 61-year-old patient with prostate
cancer: ‘When you’re first diagnosed, the mental trauma is
extensive not only for you but to the people around you as
well because no-one knows what to do . . . I mean if
there’s a fire you chuck something on it and put it out but
this you can’t see and they can’t feel it, they can only see
it affects me and it affects them and so the mental stress
of actually facing up and trying to organise a plan to do
something about it eventually gets to you’. Complemen-
tary and alternative medicine was used for support
through treatment and when active treatment was at an
end. This 41-year-old patient with metastatic lung cancer
described how he experienced a lack of follow-up care: ‘I
think looking back it was a pity that I think the hospital
it was just “cut it out and off you go Mr Smith you’re bet-
ter” and I had to organise really I organized the physio. and
this reflexology myself’. This latter stage, post-treatment,
was a particular trigger point for anxiety, whether the
individual prognosis was good or poor. Conventional care
may have little to offer at this time and support was often
sought via CAM for a range of issues: to deal with a sense
© 2007 The Authors
Journal compilation © 2007 Blackwell Publishing Ltd

of loss and abandonment after discharge, to seek advice
about health maintenance, to prolong life if possible, or to
come to terms with their impending death.
DI SC U SSIO N
Men in this study were using CAM as a response to psy-
cho-social needs as well as a need to actively ‘fight’ the
disease and prolong life. The influence of psychological
response on cancer survival and the importance of psycho-
logical intervention has recently been highlighted by a
longitudinal UK cohort study (Watson et al. 2005). A
hopeless/helpless response to diagnosis exerted a signifi-
cant negative effect on disease-free survival for up to
10 years among a cohort of breast cancer patients.
Although it was a study of women, it is another indicator
of the importance of positive psychological input such as
that experienced by the men in our sample through their
use of CAM therapies.
The evidence base for the effectiveness of CAM for psy-
chological support and symptom control in cancer is
beginning to develop. For example, the Cochrane review of
the evidence of aromatherapy/massage for cancer patients
concluded that ‘Massage and aromatherapy massage con-
fer short term benefits on psychological wellbeing, with
the effect on anxiety supported by limited evidence.
Effects on physical symptoms may also occur’ (Fellowes
et al. 2004). Cochrane reviews are currently underway for
homeopathy, acupuncture, reflexology and mistletoe for
cancer patients. In addition, the results of some smaller
studies suggest that psychological support such as group
psychotherapy (Blake-Mortimer et al. 1999), or mind–body
techniques such as relaxation and hypnotherapy (Walker
et al. 2000), may prolong survival in some patients.
Decisions by the men in this study to use CAM were
multifactorial, and resulted from ‘pragmatic’ choices in
order to fulfil emerging health needs arising out of their
cancer and its treatment. Wholesale dissatisfaction with
conventional treatment was not a primary driver for CAM
use, as the men continued to engage with the conven-
tional treatments on offer. However, our study points to
the need to distinguish between conventional cancer
treatments and the care process since it is in the latter
area where men’s needs remain unfulfilled, and these
contribute to their use of CAM. Complementary and
alternative medicine may provide a vehicle for men to
communicate their need for comfort, emotional and psy-
chological support. Previous research suggests that men
who are not encouraged to do so may become depressed or
anxious, conditions which may persist long after treat-
ment ends, with a subsequent reduction in their quality of
© 2007 The Authors
Journal compilation © 2007 Blackwell Publishing Ltd
Use of CAM and cancer care provision
life. Some men in our study had experienced a lack of
empathy and support during treatment, as well as a feeling
of loss and abandonment when discharged from follow-up.
The skills of CAM therapists may enable them to tap into
the underlying needs of men in a way that health profes-
sionals do not have either the time or the skills to achieve,
and in this way men may enjoy better supportive care and
quality of life through accessing CAM. It has also been
suggested that men respond well to ‘instrumental’ support
(Gordon 1995), whereby they can make external changes,
adopt a self-help approach or have something practical to
do which might enhance their sense of control. This was
evidenced in this study by the popularity of dietary
changes, use of food supplements and herbal remedies, as
well as visualization techniques.
To what extent could patients’ needs that underpin
their CAM use be effectively addressed within conven-
tional health care? A more holistic approach to care that
embraces patients’ psychological, emotional and spiritual
needs, with an emphasis on supportive listening, advice
on lifestyle and self-help may not require the specialized
attention of a CAM practitioner. However, wherever the
boundaries of conventional care are drawn, there may
always be some patients who seek added value by going
outside the orthodox system. Some men in the study
described using CAM in addition to conventional medi-
cine as giving them a ‘double chance’ of getting better.
The younger men in our study tended to take a more pro-
active role with regards to both their conventional and
CAM treatment choices, and this culture of patient choice
and participation in decision making is likely to increase
as it is actively promoted by recent health policy (Depart-
ment of Health 2003, 2005).
If a comparison is made with studies of women with can-
cer, some of our findings mirror those from studies of
women, such as the use of CAM as a way of taking per-
sonal responsibility for health and of participating more
actively in treatment. However, there are some differ-
ences. Qualitative data from this and other studies suggest
that the use of ‘anti-cancer’ or ‘health maintenance’ rem-
edies in the form of ingested tablets or preparations may be
more prevalent among men, with ‘touch’ therapies such as
massage and shiatsu being more popular among women.
The plethora of CAM remedies available over the counter,
by mail order or through the Internet may offer a partic-
ularly attractive self-help resource to men who, compared
with women, may be less confident about expressing their
needs to health professionals, and may even experience
‘guilt at using resources’ (George & Fleming 2004).
There may also be differences between men and women
in their attitudes towards CAM. Some studies suggest that
523
EVANS et al.
women have a greater orientation towards a holistic
approach to health and illness (Boon et al. 2000), while
men take a more ‘mechanical’ view of the body and illness
and are less likely to be drawn to CAM because of their
beliefs (Boon et al. 2003). Many men in this study were
responding to specific health needs, taking a ‘pragmatic’ or
‘consumerist’ approach to CAM use, without necessarily
embracing the underlying holistic philosophy. This find-
ing concords with a recent Australian study suggesting
that the decision to use CAM is essentially ‘pragmatic’, an
attempt to boost immunity and enhance overall quality of
life, and, as such, should be treated in a ‘non-judgemental
way by clinicians’ (Correa-Velez et al. 2003).
Male cancer patients, their use of CAM and their psy-
cho-social needs remain an under-researched area, and
studies that take a longitudinal perspective are particu-
larly needed. Cancer has recently overtaken heart disease
as the number one cause of death among men in the UK
(Cancer Research UK 2004), so there will be an increasing
pool of men with cancer, potentially seeking CAM.
Patients are also living longer with cancer and needing
support over longer periods of remission, issues that must
be addressed by providers of conventional cancer care.
Limitations to the study
The types of CAM used by men in this study were to some
extent determined by the therapies offered by the partic-
ular providers, and findings must be interpreted in this
light. However, to provide as varied a sample as possible,
men were recruited from three contrasting healthcare
settings, including the local NHS oncology unit, where
the patients could be considered to be ‘typical’ cancer
patients. Table 1 shows that types of CAM use were sim-
ilar across the recruitment settings and men were using
many CAM types beyond those offered by the specific pro-
vider. The one exception to this is homeopathy, which
was only used by patients attending the NHS homeo-
pathic hospital.
ACKN O W L E D G E M E NT
This study was supported by a grant from the Department
of Health. The views expressed do not necessarily reflect
those of the funders.
REFE RE N C E S
Astin J.A. (1998) Why patients use alternative medicine: results
of a national study. Journal of the American Medical Associa-
tion 279, 1548–1552.
524
Balneaves L.G., Kristjanson L.J. & Tataryn D. (1999) Beyond con-
vention: describing complementary therapy use by women liv-
ing with breast cancer. Patient Education and Counselling 38,
143–153.
Blake-Mortimer J., Gore-Felton C., Kimerling R., Turner-Cobb
J.M. & Spiegel D. (1999) Improving the quality and quantity of
life among patients with cancer: a review of the effectiveness
of group psychotherapy. European Journal of Cancer 35, 1581–
1586.
Boon H., Brown J.B., Gavin A.A., Kennard M.A. & Stewart M.
(2000) Breast cancer survivors’ perceptions of complementary/
alternative medicine (CAM): making the decision to use or not
to use. Qualitative Health Research 9, 639–653.
Boon H., Brown J.B., Gavin A.A. & Westlake K. (2003) Men with
prostate cancer: making decisions about CAM. Medical Deci-
sion Making 2, 471–479.
Canales M.K. & Geller B.M. (2003) Surviving breast cancer: the
role of complementary therapies. Family and Community
Health 26, 11–24.
Cancer Research UK (2004) Cancer Stats Monograph. Cancer
Research UK, London, UK.
Charmaz K. (2002) Qualitative interviewing and grounded theory
analysis. In: Handbook of Interview Research, Context and
Methods (eds Gubrium J.F. & Holstein J.A.), pp. 675–696. Sage,
London, UK.
Correa-Velez I., Clavarino A., Barnett A.G. & Eastwood H. (2003)
Use of CAM and quality of life: changes at the end of life.
Palliative Medicine 17, 695–703.
Department of Health (2003) Building on the Best: Choice,
Responsiveness and Equity in the NHS. Department of Health,
London, UK.
Department of Health (2005) Creating a Patient-Led NHS: Deliv-
ering the NHS Improvement Plan. Department of Health, Lon-
don, UK.
Diefenbach M.A., Hamrick N., Uzzo R., Pollack A., Horwitz E.,
Greenberg R. & Engstrom P.F. (2003) Clinical, demographic and
psycho-social correlates of CAM use by men diagnosed with
localised prostate cancer. Journal of Urology 170, 166–169.
Ernst E. & Cassileth B.R. (1998) The prevalence of complemen-
tary medicine in cancer: a systematic review. Cancer 83, 777–
782.
Ernst E. & Cassileth B.R. (1999) How useful are unconventional
cancer treatments. European Journal of Cancer 35, 1608–1613.
Fellowes D., Barnes K. & Wilkinson S. (2004) Aromatherapy and
massage for symptom relief in patients with cancer (Cochrane
Review). The Cochrane Library, Issue 3. John Wiley & Sons,
Chichester, UK.
Fife B.L., Kennedy V.N. & Robinson L. (1994) Gender and adjust-
ment to cancer: clinical implications. Journal of Psychosocial
Oncology 12, pp. 1–21.
Furnham A. & Vincent C. (2003) Reasons for using CAM. In:
Complementary and Alternative Medicine: Challenge and
Change (eds Kelner M., Wellman B., Pescosolido B. & Saks M.),
pp. 61–78. Routledge, London, UK.
George A. & Fleming P. (2004) Factors affecting men’s help-
seeking in the early detection of prostate cancer: implications
for health promotion. Journal of Men’s Health and Cancer 1,
345–352.
Gordon D.F. (1995) Testicular cancer and masculinity. In: Men’s
Health and Illness: Gender, Power and the Body (eds Sabo D.
& Gordon D.), pp. 246–265. Sage, Thousand Oaks, CA, USA.
Hann D.M., Baker F., Roberts C.S., Witt C., McDonald J., Living-
ston M., Ruiterman J., Ampela R. & Crammer C. (2005) Use of
complementary therapies among breast and prostate cancer
patient during treatment: a multisite study. Integrative Cancer
Therapies 4, 294–300.
© 2007 The Authors
Journal compilation © 2007 Blackwell Publishing Ltd

Hedderson M.M., Patterson R.E., Neuhouser M.L., Schwartz
S.M., Bowen D.J., Standish J.L. & Marshall L.M. (2004) Sex
differences in motives for use of CAM amongst cancer patients.
Alternative Therapies in Health and Medicine 10, 58–64.
Molatossiotis A., Fernadez-Ortega P., Pud D., Ozden G., Scott
J.A., Panteli V., Margulies A., Browall M., Magri M., Selveker-
ova S., Madsen E., Milovics L., Bruyns I., Gudmunsdottir G.,
Hummerston S., Ahmad A.M.-A., Platin N., Kearney N. &
Patiriki E. (2005) Use of CAM in cancer patients: a European
survey. Annals of Oncology 16, 655–663.
Moynihan C. (2002) The psychosocial aspects of men with can-
cer. Cancer Topics 11, 8–11.
National Institute for Clinical Excellence (2004) Improving Sup-
portive and Palliative Care for Adults with Cancer: The Man-
ual. NHS, London, UK.
Patton M.Q. (2002) Qualitative Research and Evaluation Meth-
ods, 3rd edn. Sage, London, UK.
Pope C., Ziebland S. & Mays N. (2000) Qualitative research in
health care: analysing qualitative data. British Medical Journal
320, 114–116.
Singh H., Maskarinec G. & Shumay D.M. (2005) Understanding
the motivation for conventional and CAM use among men
with prostate cancer. Integrative Cancer Therapies 4, 187–194.
Smith S.S. (2004) Who uses complementary therapies? Holistic
Nursing Practice 18, 176.
Sollner W., Maislinger S., DeVries A., Steixner E., Rumpold G. &
© 2007 The Authors
Journal compilation © 2007 Blackwell Publishing Ltd
Use of CAM and cancer care provision
Lukas P. (2000) Use of complementary and alternative medi-
cine by cancer patients is not associated with perceived distress
or poor compliance with standard treatment but with active
coping behaviour: a survey. Cancer 89, 873–880.
Sparber A., Bauer L., Curt G., Eisenberg D., Levin T., Parks S.,
Steinberg S.M. & Wooten J. (2000) Use of complementary med-
icine by adult patients participants in cancer clinical trials.
Oncology Nursing Forum 27, 623–630.
Strauss A.L. & Corbin J. (1998) Basics of Qualitative Research:
Grounded Theory Procedures and Techniques, 2nd edn. Sage,
London, UK.
Thomas K. & Coleman P. (2004) Use of complementary or alter-
native medicine in a general population in Great Britain.
Results from the National Omnibus survey. Journal of Public
Health 26, 152–157.
Walker L.G., Ratcliffe M.A. & Dawson A.A. (2000) Relaxation
and hypnotherapy: long term effects on the survival of patients
with lymphoma. Psycho-Oncology 9, 355–356.
Watson M., Homewood J., Haviland J. & Bliss J.M. (2005) Influ-
ence of psychological response on breast cancer survival: 10-
year follow-up of a population-based cohort. European Journal
of Cancer 41, 1710–1714.
Wilkinson S., Gomella L.G., Smith J.A., Brawer M.K., Dawson
N.A., Wajsman Z., Dai L.T. & Chodak W. (2002) Attitudes and
use of complementary medicine in men with prostate cancer.
Journal of Urology 168, 2505–2509.
525