Dallas, TX—About a third of patients with a history of cancer reported using complementary and alternative medicines (CAM), and 29.3% didn’t tell their physician. Potential reactions between medications and alternative therapies makes that an issue for pharmacists.

A research letter in JAMA Oncology points out that CAMs, defined as therapies used in addition to or instead of conventional therapies, respectively, are frequently used in the U.S. by patients with cancer and cancer survivors. But University of Texas Southwestern–led researchers suggest that physicians are concerned because they might never be told about that.

Background information notes that a study from the National Cancer Database found that a small subset of patients who reported CAM use, 0.01% of the study population, had worse survival than patients who did not use CAM, which appeared to be mediated by refusal of conventional cancer therapy.

“Given the potentially serious, adverse, and wide-reaching implications of CAM use (particularly use of alternative medicines) in patients with cancer, an accurate assessment of the prevalence of CAM use is needed,” the study team writes. “We used data from a comprehensive nationwide survey to conduct a cross-sectional study estimating the proportion of patients with cancer and cancer survivors using CAM and the associated rates of nondisclosure.”

The study recounts how, in 2012, the National Health Interview Survey included a supplement on CAM use, as defined by the National Center for Complementary and Alternative Medicine (renamed the National Center for Complementary and Integrative Health). Data on CAM use and on participant demographics among those reporting a cancer diagnosis were obtained for this study through the Integrated Health Interview Series, with analysis performed from October to December 2018.

Results indicate that, among 3,118 participants reporting a history of cancer—1,230 men and 1,888 women, median age 66 years—33.3% said they had used CAM in the past 12 months.

Reported CAM modalities included:
• Herbal supplements (363 of 1,023 participants, 35.8%)
• Chiropractic or osteopathic manipulation (256 of 1,023, 25.4%)
• Massage (129 of 1,023, 14.1%)
• Yoga/tai chi/qigong (85 of 1,023, 7.6%)
• Mantra/mindfulness/spiritual meditation (75 of 1,023, 6.9%)
• Special diets (29 of 1,023, 2.9%)
• Acupuncture (26 of 1,023, 2.0%)
• Homeopathy (15 of 1,023, 1.5%)
• Movement or exercise techniques (11 of 1,023, 1.3%)
• Naturopathy (7 of 1,023, 0.6%),
• Traditional healers (6 of 1,023, 0.4%),
• Energy healing therapy (5 of 1,023, 0.6%),
• Biofeedback (5 of 1,023, 0.4%),
• Hypnosis (4 of 1,023, 0.5%), and
• Craniosacral therapy (2 of 1,023, 0.2%).

Those more likely to report CAM use were white (AOR, 1.82; 95% CI, 1.28-2.58; P = .001), female (AOR, 1.55; 95% CI, 1.26-1.91; P <.001), non-Hispanic (AOR, 1.64; 95% CI, 1.05-2.56; P = .03), and younger (AOR, 1.02 per year; 95% CI, 1.01-1.02; P <.001).

Adjusted rates of nondisclosure to physicians for those using herbal supplements were 11.8% and 58.2% for those using mantra/mindfulness/spiritual meditation.

Asked why they didn’t disclose CAM use, 57.4% said the physicians didn’t ask; another 47.4% said they didn’t think their physicians needed to know.

A smaller proportion of CAM users felt that their physician did not know as much about the therapy, 8.5%; reported they were not given enough time to tell about therapy 5.7%; expressed concern about a negative reaction, 3.9%; were concerned that their physician would discourage use, 3.6%, or reported that physicians discouraged use in the past, 1.9%.

“Individuals diagnosed with cancer may have many motivations for seeking CAM, including persistent symptoms, psychological distress, or to gain a sense of control over their care,” study authors concluded. “Given the high proportion of patients with cancer and cancer survivors reporting use of CAM in this nationally representative sample, the potential implications of CAM use on oncologic outcomes merits further study. Policy and guidelines should be established to encourage discussion of CAM.”

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