Temporal Trends of Alternative Therapy Use before, during and after Cancer Treatment: Results from the Multi-Institutional Complementary and Alternative Medicine Exposure in Oncology (CAMEO) Study

Abstract

<h3>Purpose/Objective(s)</h3> Complementary and alternative medicine (CAM) use has been well-documented among cancer patients, with increasing public awareness of non-traditional treatments in the era of COVID-19. However, the temporal trends in usage at the patient level have not been well defined. We sought to characterize trends in what CAM interventions patients used before, during and after cancer treatment. <h3>Materials/Methods</h3> An NCI-designated cancer center and a comprehensive cancer center prospectively enrolled adult cancer patients onto a cross-sectional survey assessing CAM use between 2020 and 2021. The survey evaluated perceptions and use of CAM, including vitamins/minerals, herbal supplements and alternative medicines, diets, and mind/body therapies. Types of CAM utilized were self-reported by use before, during and after primary cancer treatment. Differences in utilization were analyzed with two-proportion z-tests. <h3>Results</h3> Among 749 patients enrolled, 578 (77%) reported using CAM. Among CAM users, the most popular interventions used at some point included multivitamins (60%), vitamin D (58%), prayer (48%), vitamin C (35%), massage (33%), meditation (28%), fish oil (24%), probiotics (21%), turmeric (20%), CBD products (19%), chiropractic manipulation (17%), marijuana (16%) and vegetarian diet (12%). Vitamin use nearly universally declined over the before → during → after period, for example multivitamin (52% → 39% → 31%, p<0.01), vitamin D (37% → 42% → 30%, p<0.01), and calcium (21% → 24% → 15%), p<0.01). No vitamin consumption increased after treatment compared to before. Multiple herbal supplements increased during treatment but stayed higher than pre-treatment levels, including CBD (5.4% → 13% → 8.2%, p<0.01), marijuana (6.0% → 12% → 7.9%, p<0.01) and turmeric (9.1% → 13% → 9.3%). Many specialized diets were adopted during treatment but were not continued afterward, including vegetarian (5.4% → 8.3% → 5.5%), vegan (2.2% → 5.2% → 2.2%), ketogenic (3.3% → 4.3% → 2.6%), alkaline (1.2% → 3.6% → 1.9%) and raw food (0.9% → 1.4% → 0.3%). Mind/body intervention use also nearly universally decreased over the before to after period, such as chiropractic manipulation (16% → 7.4% → 5.9%, p<0.01), yoga (12% → 12% → 9.2%) or pilates (34.2% → 2.2% → 1.6%). Some increased during treatment but decreased after, like acupuncture (8.0% → 12% → 5.9%, p<0.01) or meditation (18% → 23% → 15%, p<0.01), with the largest decrease being in prayer (43% → 44% → 32%, p<0.01). <h3>Conclusion</h3> Although CAM use is known to be common, the patterns of use before, during and after treatment have not been well-defined. Herbal supplements were the most likely to continue to be used after cancer treatment. General health maintenance, wellness and mind/body interventions largely decreased below pre-treatment levels after treatment, regardless of utilization during treatment.