Who uses CAM? A narrative review of demographic characteristics and health factors associated with CAM use

Complementary and Alternative Medicines (CAM) are used by an extensive number of patients in the UK and elsewhere. In order to understand this pattern of behavior, it is helpful to examine the characteristics of people who use CAM. This narrative review collates and evaluates the evidence concerning the demographic characteristics and health status factors associated with CAM use in community-based non-clinical populations. A systematic literature search of computerized databases was conducted, and published research papers which present evidence concerning associations between CAM use and demographic and health characteristics are discussed and evaluated. The evidence suggests that people who use CAM tend to be female, of middle age and have more education. In terms of their health, CAM users tend to have more than one medical condition, but might not be more likely than non-users to have specific conditions such as cancer or to rate their own general health as poor. The multivariate studies that have been conducted suggest that both demographic and health characteristics contribute independently to CAM use. In conclusion, demographic characteristics and factors related to an individual's health status are associated with CAM use. Future research is needed to address methodological limitations in existing studies

The impact of positive and negative spiritual experiences on distress and the moderating role of mindfulness

Both spiritual experiences and mindfulness as a psychological variable have been identified as components of wellbeing and health. As there is uncertainty about their relationship, we have investigated the impact of spiritual experiences and mindfulness as well as their interaction on distress in chronically ill patients. The unidimensional Daily Spiritual Experiences Scale (DSES), the multidimensional Exceptional Experiences Questionnaire (EEQ), the Freiburg Mindfulness Inventory (FMI), and the Brief Symptom Inventory (BSI) were administered to 109 chronically ill patients. Fifty-eight patients (53%) reported regular and frequent spiritual or contemplative practice from different traditions over an average of 14.7 years (SD = 13.7). Patients with regular spiritual practice reported more positive spiritual experiences, were more mindful and less distressed (p < .001). A stepwise linear regression analysis revealed that the EEQ subscale “negative spiritual experiences” (NSE) was the most important single predictor for psychological distress (R2=.38; ?=.63). In contrast, both the EEQ subscale “positive spiritual experiences” as well as the DSES that also captures positives daily encounters with a transcendental realm or entity did not account for a significant amount of variance in distress. Further analysis of the regression model (R2=.57), confirmed that NSE was still the largest predictor for distress (?=.61) and that mindfulness (?=-.38) and the interaction between mindfulness and NSE (?=-.23) were the most important buffers protecting individuals from distress. Thus, mindfulness seems not only to be a clinically important protective factor for buffering generic distress, but particularly for distress derived from NSEs. This suggests that in addition to directly facilitating well-being and health by means of positive spiritual experiences, at least some form of regular spiritual or meditative techniques seem to endow an individual with a certain degree of resilience against negative spiritual experiences that is likely a consequence of increased mindfulness. If these findings are vindicated by further studies, spiritual experiences should not be conceived and measured as univariate but rather multivariate constructs

Abstract LB-73: Circulating tumor cells with the invasive phenotype predict progression free survival and overall survival in preoperative patients diagnosed with advanced epithelial ovarian cancer.

Abstract Purpose: Circulating tumor cells (CTCs) might function as prognostic markers for monitoring and assessing therapy efficacy ex vivo. This study aimed to measure overall population of CTCs based on expression of epithelial lineage (Epi) markers and the subpopulation of CTCs with the invasive phenotype (iCTCs) in preoperative patients for prognosis of advanced Epithelial Ovarian Cancer (EOC). Experimental Design: CTCs and iCTCs enriched by the Cell Adhesion Matrix (CAM)-coated devices from 122 preoperative patients were identified as Epi+ nucleic acid (NA)+ hematopoietic lineage (HL)- cells and CAM uptake (CAM+) Epi+ NA+ HL- cells, respectively. CTCs and iCTCs were enumerated using multiplex flow cytometry, validated by microscopy, and correlated with overall survival (OS) and progression-free survival (PFS). Results: iCTCs were detected in 0/39 (0%) benign patients, 5/11 (45.5%) Stage I, 2/4 (50%) Stage II, 41/43 (95.3%) Stage III and 16/16 (100%) stage IV patients (P-value &amp;lt;0.001). However, healthy (n=48) and benign women had noticeable CTCs (mean=10 and 3 CTCs/1.0-mL blood, respectively), and large variation (IQR=24.5 and 30 CTCs/1.0-mL blood, respectively), although CTCs were significantly different across different stage groups. Kaplan-Meier estimates of OS at 5 years in the iCTC positive and negative groups were 15.4% (95% CI, 7.2% to 26.3%) and 94% (95% CI, 82.5% to 98%), respectively. The PFS in the iCTC positive group was also significantly lower than that in the negative group (P-value &amp;lt;0.001). In multivariable Cox models, iCTCs were independently predictive of OS (P-value &amp;lt;0.001) and provided predictive power for disease recurrence independent of diagnostic disease stages, age, debulking status and platinum sensitivity. Conclusion: CTCs show the expression of heterogeneous epithelial antigens with potential biologic relevance. Co-expression of epithelial antigens and invasiveness of iCTCs in preoperative patients provides prognosis of advanced EOC that could help tailor appropriate therapy. Citation Format: Wen-Tien Chen, Qiang Zhao, Huan Dong, Jie Yang, Qiao Zhang, Tina Fan, Marc G. Golightly, Whitney C. Dessio, Stefan Madajewicz, Melissa Henretta, Michael L. Pearl. Circulating tumor cells with the invasive phenotype predict progression free survival and overall survival in preoperative patients diagnosed with advanced epithelial ovarian cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr LB-73. doi:10.1158/1538-7445.AM2013-LB-73</jats:p