CAM Use Common in Cancer Patients, Survivors

Pam Harrison

April 15, 2019

At least one third of patients who have a history of cancer report using some form of complementary and alternative medicine (CAM), a US national health survey suggests.

Moreover, roughly 30% of CAM users didn't tell their physician about it, report the authors, led by Nina Sanford, MD, a radiation oncologist at the University of Texas Southwestern, Dallas.

Results from the survey were published online April 11 in JAMA Oncology.

The data come from the the National Health Interview Survey. Since 2012, the survey has included a segment on the use of CAMs, which are defined as therapies used in addition to or instead of conventional therapies.

Among 3118 patients with a history of cancer who responded to the most recent survey, 33.3% reported that they had used CAMs in the past 12 months, the researchers report.

Most commonly, respondents indicated that they were taking herbal supplements (35.8%).

A fairly large percentage of respondents also reported engaging in other forms of CAM use, the investigators note.

Table. CAM Use in the Past 12 Months Among Cancer Patients/Survivors

Chiropractic/osteopathic manipulation 25.4%
Massage 13.1%
Yoga/tai chi/qigong 7.6%
Mantra/mindfulness/spiritual meditation 6.9%
Acupuncture 2%
Traditional healers 0.4%
Energy healing therapy 0.6%
Biofeedback 0.4%
Hypnosis 0.5%
Craniosacral therapy 0.2%


Certain factors appeared to make it more likely that patients with a history of cancer would use CAMs, according to survey results.

White patients, for example, were 82% more likely to use CAMs than others, at an adjusted odds ratio (AOR) of 1.82 (P = .001), the survey shows.

Women were 55% more likely to use CAMs than others, at an AOR of 1.55 (P < .001).

Patients who were younger than the median age of 66 years were also more likely to use CAMs than others, at an AOR of 1.02 per year (P < .001), the researchers note.

Nondisclosure of CAM Use

Among those who used CAMs, 29.3% did not disclose such use to their physician, the researchers report.

"The most frequently reported reasons for nondisclosure were because the physician did not ask (57.4%) or participants did not think their physicians needed to know (47.4%)," Sanford and colleagues note.

Among respondents, 8.5% of CAM users indicated that they did not feel that their physician knew as much about the therapy as they did; 5.7% indicated that they were not given enough time to tell their practitioner about their use of CAMs.

Others, at 3.9%, did not reveal their use of CAMs because they were afraid that their practitioner would react in a negative way or that their physician would overtly discourage CAM use altogether (3.6%), the investigators note.

Cause for Concern?

"There are several reasons why CAM use could be concerning," lead author Sanford told Medscape Medical News in an email.

Herbal supplements could interfere with the efficacy of conventional treatments, she noted.

Further, patients might choose to use CAMs rather than proceed directly to conventional cancer therapy, or at least delay its use by trying out CAMs first, Sanford added.

Even if patients only practice mindfulness and other meditation techniques, "if they are doing this instead of conventional cancer therapy, that would be concerning," she said.

In addition, for patients who have survived cancer, CAM use could be troublesome, Sanford elaborated.

For example, some advocates of CAM recommend special dietary practices, such as cutting out all sources of sugar, which might not be recommended by physicians.

Depending on the extent of the patient's disease and potential side effects from therapy, certain exercises may also be contraindicated for cancer survivors, she noted.

Backers of some CAM products or practices claim that their product or practice can prevent cancer recurrence, despite their being no evidence to support these claims.

"Taking these forms of CAM could lead patients to forgo recommended follow-up or forgo taking other medications," Sanford warned.

Cancer patients may be motivated to try CAMs to alleviate persistent symptoms or psychological distress, the researchers suggest.

They may also resort to use of CAMs to give them a sense that they have some control over their own care, they add.

The investigators stress that it is important for healthcare providers to ask their patients about CAM use in such a way that patients will not feel uncomfortable disclosing the information.

Having patients fill out a questionnaire that asks about CAM use before they see their practitioner might work as an alternative strategy, Sanford suggested.

Sanford also noted that it would be "particularly helpful" if physicians underwent some training about the basics of CAM modalities.

Alternatively, some centers for integrative medicine have CAM experts who could be consulted as to the safety of CAM use, Sanford also suggested.

"I think CAM modalities that are frankly unsafe — extreme diets, dangerous supplements — are usually pretty obvious," Sanford noted.

"But for other things, such as using a combination substance with unknown ingredients, I would err on the side of caution and recommend patients not use them," she concluded.

Sanford has disclosed no relevant financial relationships.

JAMA Oncol. Published online April 11, 2019. Abstract

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