Use Patterns and Perceptions of Non-Traditional Therapies in Radiotherapy Patients: Results from the Multi-Institutional Complementary and Alternative Medicine Exposure in Oncology (CAMEO) Study

Abstract

<h3>Purpose/Objective(s)</h3> The use of complementary and alternative medicine (CAM) has been associated with detrimental effects on survival outcomes in cancer patients compared to standard of care medical interventions. CAM has received a significant increase in public awareness and interest in recent years. We sought to understand use patterns and perceptions in radiotherapy patients. <h3>Materials/Methods</h3> Data was collected from a cross-sectional survey of prospectively enrolled adult cancer patients, conducted at an NCI-designated cancer center and a comprehensive cancer center between 2020 and 2021. Cancer patients who received or were recommended radiotherapy were selected for analysis and grouped by CAM use. CAM users analyzed were those reporting use of enteral and parental interventions, including alternative medicines, special diets and herbal, vitamin and mineral supplements, and excluding mind/body practices. Differences between CAM users and non-users were analyzed with χ² and two-sample t-tests. Predictors of CAM use were identified with multivariable logistic regression. <h3>Results</h3> Of the 749 respondents, 445 (59%) received or were recommended radiotherapy. Of those 445, 297 (67%) used enteral or parenteral CAM. Among CAM users, 81% were satisfied and 77% felt CAM was effective for intended use. The most common goal of CAM therapy was symptom management (44%), although CAM use as a curative-intent treatment (31%) was common. Compared to non-users, CAM users were more likely to be female (76% vs 62%, p<0.01), have self-reported incurable disease (73% vs 62%, p=0.04), to feel CAM is safe (45% vs 9%, p<0.01), effective at curing cancer (26% vs 11%, p<0.01), effective at managing symptoms (42% vs 20%, p<0.01), more likely to trust naturopaths (33% vs 22%, p=0.02) or chiropractors (26% vs 15%, p=0.01), more likely since COVID-19 to have a more favorable view of CAM (79% vs 42%, p=0.01) or use CAM (61% vs 40%, p=0.04), but less likely to decline recommended surgery (7% vs 19%, p<0.01) or recommended radiotherapy (5% vs 11%, p=0.03). No differences were noted between CAM users and non-users in trust of physicians or any media. Predictors of enteral or parenteral CAM use included female gender (OR 1.4, p=0.04), breast cancer (OR 2.1, p=0.03), colon cancer (OR 3.5, p=0.01), and metastatic cancer (OR 2.2, p<0.01). <h3>Conclusion</h3> The use of CAM is common among patients receiving or recommended radiotherapy, with nearly one-third of patients using CAM as a cancer cure. However, radiotherapy patients using CAM were less likely than non-users to decline other recommended therapies, dispelling the notion that CAM-users are more likely to eschew standard-of-care treatments, at least in this cohort. Understanding the patterns and perceptions of CAM use in radiotherapy patients is essential for improving patient-physician communication and treatment decision-making.