Use of Chinese medicine by women with breast cancer: A nationwide cross-sectional study in Taiwan

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Summary

Objectives

The National Health Insurance (NHI) provided Western medicine (WM) and Chinese medicine (CM) in Taiwan. This study aims to explore CM use by women with breast cancer under NHI.

Methods

Using NHI Research Database, a retrospective cross-sectional study was conducted. Women with breast cancer were identified by diagnosis codes. Their claims of CM and WM outpatient services of 2007 were analyzed.

Results

Among 70,012 female breast cancer patients, the prevalence of insurance covered CM was 35.6%. Among all CM users, 4379 (17.5%) patients visited CM for breast cancer. More than half CM users (67.6%) had less than 6 visits and 16.3% users had more than 12 visits. The majority of CM users (87.6%) also used WM ambulatory services. Private clinics (76.7%) provided the most CM services, followed by private hospitals (16.9%). The most frequently used CM therapies were Chinese herbal medicine (80.5%), followed by acupuncture/traumatology manipulative therapies (22.3%). The average cost of CM was US$17.6 per visit and US$119.7 per user annually. CM users were more likely to be younger than 60 years old, employees, with higher income, and not living in Northern Taiwan.

Conclusions

A significant portion of breast cancer patients used insurance covered CM. Most CM users also used WM. The potential of drug–herb interactions should be concerned.

Introduction

Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females worldwide, accounting for 23% of the total cancer cases and 14% of the cancer deaths in 2008.1 Incidence rates of breast cancer are high in most of the developed areas. Although the incidence rates are low in the most part of Asia, breast cancer is currently the most common cancer among women in Asia and is increasing in incidence.2 In Taiwan, breast cancer is also the most common female cancer.3

Use of complementary and alternative medicine (CAM) is increasing among oncology patients in recent decades.4, 5 Previous studies showed that breast cancer patients were more likely to be CAM users compared with other tumor sites.6, 7, 8, 9 The prevalence of CAM among breast cancer patients varies widely, with estimates ranging from 28% to 97%.7, 8, 10, 11, 12, 13, 14, 15, 16, 17, 18 CAM comprises a diverse set of healing philosophies, therapies, and products. Chinese medicine (CM) is one of the most popular types of CAM worldwide. CM continues to play a significant role in the health care systems of many East Asian countries.19, 20, 21, 22, 23, 24, 25, 26 Acupuncture and Chinese herbal medicine are well known and practiced in the West.27, 28, 29, 30 Therefore, a large-scale study to explore the utilization of CM among breast cancer patients is necessary.

Taiwan launched a National Health Insurance (NHI) program since 1995. More than 99% of the 23 million Taiwan citizens and legal residents were enrolled. The range of care covered by NHI includes inpatient and ambulatory care, dental services, traditional Chinese medicine, child delivery services, physical rehabilitation, home care, and chronic mental illness care. More than 92% of providers contracted with NHI. Beneficiaries are free to choose Western medicine (WM) and CM services. The National Health Insurance Research Database (NHIRD) was released for research. In this study, we use NHIRD to explore the prevalence, patterns and costs of CM among breast cancer patients.

Section snippets

Data sources

This retrospective cross-sectional study used registration and claim datasets of NHIRD, including outpatient claims (CN2007 and CM2007), inpatient claims (DD2007) and registry for catastrophic illness patients (HV2007) of the year 2007. Before database construction at the National Health Research Institutes, data that could be used to identify patients or care providers has been scrambled by NHI. The data is then further scrambled before being released to each researcher. Since this study used

Results

A total of 70,012 female breast cancer patients were identified (Fig. 1). Among them, 24,955 (35.6%) patients used CM outpatient services at least once in 2007. Among all CM non-users, 37,737 patients used WM ambulatory services, 232 used inpatient care only and 7088 have no clinical visit.

Discussion

This is the first study to provide precise estimates for the prevalence of CM use among breast cancer patient in an entire population. The principal findings are that a significant portion of breast cancer patients used CM and most CM users also used Western medicine. Chinese herbal medicine was used most frequently. The potential of drug–herb interactions should be concerned. Besides, our results demonstrated that breast cancer patients used CM for non-cancer diseases more than for breast

Conflict of interest

The authors declare no conflict of interest.

Acknowledgments

This study is based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health and managed by National Health Research Institutes. The interpretations and conclusions contained herein do not represent those of Bureau of National Health Insurance, Department of Health or National Health Research Institutes.

This work was supported by National Yang-Ming University and Cheng Hsin General Hospital (grant number 100-31

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