How can anyone be thankful in every circumstance? One principle I’m learning is that bad situations could often be worse. For example, my husband and I recently were involved in a fender bender. We were unhappy about it; however, the situation turned into a positive experience for us when we began to realize how much worse it could have been. We were counting our blessings and were appreciative of each other in the process, even though it was difficult.

When my cousin was diagnosed with metastatic head and neck cancer, the news was devastating, but we knew that the situation could have been worse. Now, he has been cancer free for many years!

Tim McGraw had a country hit, "Live Like You Were Dying," that musically illustrates a positive side to cancer. Clifford shared that given the opportunity; she would not change her cancer experience. Studies have reported positive changes in people’s lives following a cancer diagnosis. Survivors have described richer lives with more meaning, greater appreciation, and less fear of death. They described themselves as more optimistic, with new priorities and a stronger faith in God.

In Silver Linings: The Other Side of Cancer, one survivor described the cancer experience as going "from black and white to full color" (Gullo & Glass, 1997). Survivors shared the lessons learned through the cancer experience that make life precious and more valuable. To view more lessons shared by cancer survivors, click here.

We can encourage the attitude of gratitude by examining each day and recording the day’s blessings in a journal. Cancer survivors can make a list of significant people or events for which they are thankful. They can prioritize sharing gratitude with others in a note, phone call, or conversation, and encourage others to do the same. Don’t save thankfulness for Thanksgiving. Every day is a blessing, share thanks for it.

Editor's Message
The Complementary and Integrative Therapies SIG Is on the Cutting Edge 

The Complementary and Integrative Therapies SIG is in the right place (ONS) at the right time (right now)! I formulated that opinion after attending the one day ONS SIG Leadership Orientation Workshop and the subsequent SIG meeting at Congress 2007 in Las Vegas, NV.

• Charlene Hawley, BSN, RN-BC, OCN^® (coordinator)
• Colleen Lee, MS, APRN-BC, AOCN^® (coordinator–elect)
• Pamela Potter, APRN, BC, DNSc (editor)
• Mary Beth Revak, RN, OCN^® (web administrator)
• Jody Owen, BSN, RN (rejuvenation leader and former coordinator)

The team is here to support the SIG’s membership. Communicate with us. We want to hear your interests, ideas, and opinions!

This newsletter focuses on measuring Complementary Alternative Medicine (CAM) use by cancer survivors. Judith Fouladbakhsh, PHD, APRN, BC, AHN-BC, describes the CAM healthcare model based on a behavioral model of health services use as a means for identifying patterns that predict CAM use by cancer survivors. Her reference list leads the reader into deeper consideration of the topic. Later, we learn more about Judith through her elevator introduction. Gwen Wyatt, RN, PhD, shares an instrument for assessing complementary therapy use. Gwen also is featured in an annotated bibliography of her CAM and cancer-related research. Margaretta Page, RN, MS, describes her experience with ONS PEP Resources and asks us to share our exemplars from using these cards. We would like to hear from you.

On a personal note, I’ve recently completed data collection for a CAM use and access study at a regional cancer center in Seattle, WA. An analysis is forthcoming. Also, I am moving to Portland, OR, where I’ve taken a faculty position teaching in an integrative care curriculum at the University of Portland.

Predicting Complementary Therapy Use Can Improve Patient Care

During the past decade, the use of complementary and alternative medicine (CAM) therapies in the United States and worldwide has gained attention. Reports that more visits were made to CAM providers than to primary care providers and data that support higher prevalence of CAM use by patients with cancer have been a particular focus (Eisenberg et al., 1998; Ernst & Cassileth, 1998; Richardson & Straus, 2002). Although research in the area of CAM has increased dramatically, additional studies are needed to sort the factors that influence a patient’s decision to use CAM therapies and individual patterns of CAM use. Healthcare professionals then will be able to understand CAM healthcare behavior and how it influences health outcomes and the use of conventional health services.

CAM use by patients with cancer has been estimated to range from 7%–64%, with approximately 30% using a CAM therapy (Ernst & Cassileth, 1998; Salmenpera, 2002). National survey data reveals that having cancer increased the odds of seeing a CAM provider by a factor of three (Wolsko, Eisenberg, Davis, Ettner & Phillips, 2002). Many studies have reported higher prevalence of use by women and by those with higher levels of education (Barnes, Powell-Griner, McFann, & Nahin, 2004; Bausell, Lee, & Berman, 2001; Eisenberg et al., 1998; Lee, Charn, Chew & Ng, 2004; Lengacher, Bennett, Kip, Berarducci, & Cox, 2003). Significant predictors of CAM use among community-based patients with cancer have included gender, cancer stage, cancer treatment, and the number of severe symptoms (Fouladbakhsh, Stommel, Given & Given, 2005). Difficulty in comparisons across CAM studies is evident and is often because of the operational definition of CAM. Some studies may include certain CAM therapies and other studies do not. The mix or combination of studied therapies, whether they involve provider-directed care or self-care or widely varied patient populations, makes comparisons difficult. More than 4,000 therapies are estimated to be considered CAM. Given the nature of CAM, fully understanding every therapy and the practices and products that are not in the realm of conventional medicine is difficult. Healthcare professionals must consider the context of CAM use by defining whether a specific CAM therapy is used as a complementary therapy or an alternative therapy. With the vast array of traditional medicine practices across world cultures, accurately estimating the number of therapies that constitute CAM is a challenge. Further compounding CAM studies are the current movements toward integrative medicine, which redefines selected CAM provider services and therapies as a part of conventional medicine as they become increasingly available in hospitals and outpatient settings.

To fully understand the patterns, predictors, and purpose of CAM use among patients with cancer, a secondary analysis of the 2002 National Health Interview Survey (NHIS) was conducted. From a sample of more than 31,000 adults (age 18 years and older) interviewed using a multistage probability sampling design, individuals who were diagnosed with cancer were selected for study (N = 2262). The strong nature of the NHIS sampling design allowed for estimated findings for the United States’ cancer population. Using population estimation software (STATA 9.2), our findings showed that more than 14.3 million individuals have been diagnosed with cancer.

In order to study CAM use from a health service use perspective, the Behavioral Model of Health Services Use (Andersen, 1968, 1995) was modified for a research study. The CAM Healthcare Model (Fouladbakhsh, 2005) recognized that CAM includes more than provider services, CAM also includes practices and products. The revised model identifies potential predisposing and enables the need for care variables that may predict the specific categories of CAM use. The model also allowed us to examine concurrent use of CAM with conventional health care by cancer survivors. The CAM Healthcare Model effectively guided the research and will serve as a theoretical framework for future studies that will continue to illuminate CAM health behavior and its affect on healthcare outcomes among patients with cancer.

The results of the CAM study are extensive and informative. Prevalence of CAM use was higher among patients with cancer. An estimated 5.6 million cancer survivors (39%) reported the use of at least one CAM therapy in the year preceding NHIS interviews. No significant differences in CAM use were noted among recent and long-term survivors or by cancer site. Study results strongly suggest the need for nurses to assess CAM use by their patients who are undergoing cancer treatment and by recent and long-term cancer survivors living in the community.

Understanding what CAM therapies patients with cancer and survivors are using can help prevent untoward interactions, facilitate continued use of therapies and self-care practices that are beneficial, and promote use of CAM in an integrative framework. Nurses are in a key position to assess CAM use among their patients and provide important information for the nursing plan of care that will enhance patient outcomes. Assessment tools and complementary therapy information guides that focus on various CAM provider services, products, and practices can be used to direct the process in a variety of clinical patient care and community-based oncology support settings (Fouladbakhsh, 2005). The detailed results of the study were presented at the 32nd Annual ONS Congress in Las Vegas, NV, and at the International Congress on Complementary Medicine Research in Munich, Germany, in spring 2007. Funding for the research was provided by ONS and the ONS Foundation, Blue Cross and Blue Shield Foundation of Michigan, and Sigma Theta Tau International Honor Society, Lambda Chapter.

Measure Complementary Alternative Medicine Use

New instruments are available to measure complementary and alternative medicine use among patients with cancer. I first developed my instrument for use in a pilot study. We wanted to know more about the interest of chemotherapy patients in having various CAM therapies available in the clinic setting. We also wanted to know what the patients were using outside the clinic. As we all know, many of our patients are electing to engage in several different CAM therapies without telling healthcare providers that they are using them. As healthcare providers, this concern is our responsibility. We need to find ways of making CAM use a standard part of the health history data that is collected from patients.

Since my first use of the tool, I have used it in a major study where I provided a postsurgical intervention for women with breast cancer. The survey data showed that women with breast cancer are one of the highest CAM users, so I wanted to have a better idea of use among my sample. I found that a high percent were already using CAM. We know that CAM therapies were administered outside the various clinics the patients attended because none of our sites offered CAM during the time of the study.

I am currently using the instrument in my NCI–funded reflexology study with advanced stage breast cancer. In the study, we need to track other therapies that women are engaging in outside of the study. We have exclusion criteria that cover other foot therapies, but results may be skewed if patients are receiving any type of CAM in addition to what we are providing. Tracking other therapies will allow us to account for additional CAM therapy use in our data analysis.

Beyond simple use, I think that knowing the costs of CAM services, if insurance covers any costs, and what symptoms CAM is being sought for is important.

I am sharing my instrument with our SIG so that you might consider where the data is needed most; in practice or research. The data is fine to use wherever they are needed. However, I would appreciate being cited. You can view the instrument here.

Check Out These Articles Related to Complementary and Integrative Therapies

Note. This brief annotated list was generated from a Medline^® search.
Given, B., Wyatt, G., Given, C., Sherwood, P., Fift, A., DeVoss, D., et al. (2004). Burden and depression among caregivers of patients with cancer at the end of life. Oncology Nursing Forum, 31, 1105–1117.

The purpose was to examine the patient and family caregiver variables that predicted caregiver burden and depression for family caregivers of patients with cancer at the end of life. A prospective, longitudinal study was implemented with an inception cohort of patients and their family caregivers who were followed after the diagnosis and treatment of cancer.

Kozachik, S. L., Wyatt, G., Given, C.W., & Given, B.A. (2006). Patterns of use of complementary therapies among cancer patients and their family caregivers. Cancer Nursing, 29, 84–94.

The focus of this quasi-experimental study was to offer an 8-week, 5-contact, nurse-delivered intervention involving guided imagery, reflexology, and reminiscence therapy to cancer patients undergoing chemotherapy and their family caregivers.

Wyatt, G. (2003). Evidence-based practice and research methodologies: Challenges and implications for the nursing profession. Clinical Journal of Oncology Nursing, 7, 337–338.

Wyatt, G. & Friedman, L.L. (1996). Long-term female cancer survivors: Quality of life issues and clinical implications. Cancer Nursing, 19, 1–7.

The purpose of this research was to identify concerns and issues related to quality of life in long-term female cancer survivors and to discuss the implications of these issues for nursing. Data were collected by mailed questionnaire to 188 female long-term cancer survivors whose mean age was 61 years.

Wyatt, G., & Post-White, J. (2005). Future direction of complementary and alternative medicine (CAM) education and research. Seminars in Oncology Nursing, 21, 215–224.

The objectives were to identify key educational and scientific tasks for the incorporation of complementary and alternative medical therapies into conventional health care.

Wyatt, G.K., Donze, L.F., & Beckrow, K.C. (2004). Efficacy of an in-home nursing intervention following short-stay breast cancer surgery. Research in Nursing and Health, 27, 322–331.

This randomized controlled trial (N = 240) was designed to test the efficacy of a subacute home nursing intervention following short-stay surgery for breast cancer.

Wyatt, G.K. and Friedman, L.L. (1998). Physical and psychosocial outcomes of midlife and older women following surgery and adjuvant therapy for breast cancer. Oncology Nursing Forum, 25, 761–768.

The purpose was to investigate the patterns of functioning and psychosocial adjustment of midlife and older women following surgery for breast cancer. Differences between those who received follow-up adjuvant therapy and those who did not also were compared.

Current Research Project: Gwen Wyatt and her colleagues—Alla Sikorskii and Hossein Rahbar—have received NCI funding to study Reflexology: an Intervention for Advanced Breast Cancer. The abstract can be found on Gwen’s Michigan State University bio page at http://nursing.msu.edu/facultyprofile.aspx?ID=97.

Attend an Upcoming Conference

Advanced Practice Nursing Conference
Host: ONS
Date: November 8–10, 2007
Location: Chicago, IL
Information:www.ons.org/meetings/apn07/index.shtml

Alternative and Integrative Medicine for Pain Management
Host: University of California Davis Health System
Date: October 7–10, 2007
Location: Lana’i City, HI
Information:www.ucdmc.ucdavis.edu/cme/conferences/pdfs/alpain08_lo.pdf

Institutes of Learning
Host: ONS
Date: November 9–11, 2007
Location: Chicago, IL
Information: www.ons.org/meetings/iol07/index.shtml

• Basic descriptions of CAM modalities
• Guidance for evaluating CAM information
• A list of reliable CAM resources
• Tips for talking with traditional healthcare providers about CAM
• Suggestions for finding certified CAM providers.

Free copies of Thinking About Complementary and Alternative Medicine are available. To order the booklet, call NCI’s Cancer Information Service at 800-4-CANCER, or visit http://www.cancer.gov/publications.

To view Thinking About Complementary and Alternative Medicine online, visit www.cancer.gov/cancertopics/thinking-about-CAM.

Margaretta S. Page, MS, RN, primary author of the ONS Putting Evidence Into Practice (PEP) card on sleep-wake disturbances and its corresponding article in the Clinical Journal of Oncology Nursing, recounts her first-hand experience using the PEP resources. Click here for the article.

The SIGs Virtual Community was developed to improve communication among SIG leaders and members. Visiting your SIG’s Web page on the Virtual Community keeps you updated about SIG activities by providing you with important information and resources.

To navigate to your SIG’s page, visit the SIGs Virtual Community at http://sig.vc.ons.org and select "Find a SIG" from the top navigation.

Many features in the SIGs Virtual Community are useful to all members. Below is an outline of the information that can be found on your SIG’s page.

From your SIG’s main page, you can subscribe to SIG announcements, calendar events, and the discussion forum. Once you are subscribed to the areas, an e-mail will be sent to you every time an announcement, event, or discussion has been posted.

Announcements are added frequently with important information pertaining to your SIG, such as scholarship, leadership, and meeting information.

SIG events on the SIG calendar are showcased on the main page for your convenience. Simply click on an event for detailed information.

About Us
The About Us area features information about your SIG leaders.

News
The News section provides important information, such as minutes from past meetings and newsletters. Educational news and photos also can be found here.

Discussions
The Discussions area is very similar to the ONS List Serve, which can be found at http://listserv.vc.ons.org. Click the Discussions button at the top of your SIG’s page to access the area. You can post a message, thought, or questions and fellow SIG members can read your message and respond.

ONS National Announcements
Check this section every month for updated information from ONS such as continuing nursing education offerings, events, and important information.

If you have questions or problems navigating the SIGs Virtual Community, contact me at jshinsky@ons.org.

• "Feasibility of a Reflexology and Guided Imagery Intervention During Chemotherapy: Results of a Quasi-Experimental Study" by Gwen Wyatt, PhD, RN, Alla Sikorskii, PhD, Azfar Siddiqi, PhD, and Charles W. Given, PhD (ONF, Vol. 34, pp. 635–642)

Membership Information

• Network with colleagues in an identified subspecialty area around the country.
• Contribute articles for your SIG's newsletter.
• Participate in discussions with other SIG members.
• Contribute to the future path of the SIG.
• Share your expertise.
• Support and/or mentor a colleague.
• Receive information about the latest advancements in treatments, clinical trials, etc.
• Participate in ONS leadership by running for SIG coordinator-elect or join SIG work groups.
• Acquire information with a click of a mouse at http://sig.vc.ons.org/, including
• Educational opportunities for your subspecialty
• Education material on practice
• Calls to action
• News impacting or affecting your specific SIG
• Newsletters
• Communiqués
• Meeting minutes.

Join a Virtual Community
A great way to stay connected to your SIG is to join its Virtual Community. It's easy to do so. All you will need to do is

• Log on to the ONS Web site (www.ons.org).
• Select "Membership" from the tabs above.
• Then, click on "Chapters, SIGs & Virtual Communities."
• Scroll down to "Special Interest Groups (SIG) Virtual Community" and click.
• Now, select "Find a SIG."
• Locate and click on the name of your SIG from the list of all ONS SIGs displayed.
• Once the front page of your SIG's Virtual Community appears on screen, select "New User" from the top left. (This allows you to create log-in credentials.)
• Type the required information into the text fields as prompted.
• Click "Join Group" (at the bottom right of the text fields) when done.

Special Notices

• If you already have log-in credentials generated from the ONS Web site, use this information instead of attempting to generate new information.
• If you created log-in credentials for the ONS Web site and wish to have different log-in information, you will not be able to use the same e-mail address to generate your new credentials. Instead, use an alternate e-mail address.

Subscribe to Your SIG's Virtual Community Discussion Forum
All members are encouraged to participate in their SIG's discussion forum. This area affords the opportunity for exchange of information between members and nonmembers on topics specific to all oncology subspecialties. Once you have your log-in credentials, you are ready to subscribe to your SIG's Virtual Community discussion forum. To do so,

• Select "Log In," located next to "New User," and enter your information.
• Next, click on the "Discussion" tab on the top right of the title bar.
• Now, select "Featured Discussion" from the left drop-down menu.
• Locate and select "Subscribe to Discussion" inside the "Featured Discussion" section.
• Go to "Subscription Options" and select "Options."
• When you have selected and entered all required criteria, you will receive a confirmation message.
• Click "Finish."
• You are now ready to begin participating in your SIG's discussion forum.

• First, log in. (This allows others to identify you and enables you to receive notification [via e-mail] each time a response or new topic is posted.)
• Click on "Discussion" from the top title bar.
• Select "Featured Discussion" from the left drop-down menu.
• Click on any posted topic to view contents and post responses.

Sign Up to Receive Your SIG's Virtual Community Announcements
As an added feature, members also are able to register to receive their SIG's announcements by e-mail.

• From your SIG's Virtual Community page, locate the "Sign Up Here to Receive Your SIG's Announcements" section. This appears above the posted announcements section.
• Select the "Click Here" feature, which will take you to a link to subscribe.
• Once the "For Announcement Subscription Only" page appears on screen, select how you wish to receive your announcements.
• As individual e-mails each time a new announcement is posted
• One e-mail per day comprised of all new daily announcements posted
• Opt-out, indicating that you will frequently browse your SIG's Virtual Community page for new postings
• Enter your e-mail address.
• Click on "Next Page."
• Because you have already joined your SIG's Virtual Community, you will receive a security prompt with your registered user name already listed. Enter your password at this prompt and click "Finish."
• This will bring up a listing of your SIG's posted announcements. Click on "My SIG's Page" to view all postings in their entirety or to conclude the registration process and begin browsing.

Complementary and Integrative Therapies SIG Officers

To view past newsletters, click here.

ONS Membership/Leadership Team Contact Information

Angie Stengel, MS, CAE, Director of Membership/Leadership
astengel@ons.org
412-859-6244

Diane Scheuring, MBA, CMP, Manager of Member Services
dscheuring@ons.org
412-859-6256

Carol DeMarco, Membership/Leadership Administrative Assistant
cdemarco@ons.org
412-859-6230

The Oncology Nursing Society (ONS) does not assume responsibility for the opinions expressed and information provided by authors or by Special Interest Groups (SIGs). Acceptance of advertising or corporate support does not indicate or imply endorsement of the company or its products by ONS or the SIG. Web sites listed in the SIG newsletters are provided for information only. Hosts are responsible for their own content and availability.

Oncology Nursing Society
125 Enterprise Dr.
Pittsburgh, PA 15275-1214
866-257-4ONS
412-859-6100
www.ons.org