New York—How does use of dietary supplements and multiple types of complementary and alternative medicine (CAM) affect willingness to initiate chemotherapy in women with early-stage breast cancer, even when the treatment is indicated?

That was the issue tackled recently by researchers. Their study, one of the first to evaluate how CAM use affects the decision to begin chemotherapy, was published recently in JAMA Oncology.

Columbia University’s Mailman School of Public Health–led researchers focused on 685 women with early-stage breast cancer—all younger than 70 with nonmetastatic invasive breast cancer—who were recruited from Columbia University Medical Center, Kaiser Permanente Northern California, and Henry Ford Health System, with enrollment from 2006 to 2010.

The large majority, 87%, of the women reported use of one of five types of complementary therapies—the dietary supplement use of vitamins/minerals, herbs/botanicals, and other natural products, as well as mind-body self-practice, and mind-body practitioner-based; dietary supplements and mind-body practices were most common. The median number of CAM modalities used was two, with 261 women (38%) reporting use of three or more types of CAM.

By 12 months, 89% of the 306 women for whom chemotherapy was indicated had begun treatment. The remaining group of women, for whom chemotherapy was discretionary, had a much lower rate of initiation, 36%, although almost half, 45%, were clinically indicated to receive chemotherapy in line with National Comprehensive Cancer Network guidelines.

The article points out that not all women initiate adjuvant treatment for breast cancer despite the survival benefits associated with it because the decision involves psychosocial factors and belief systems as well as clinical, demographic, and provider characteristics.

Results indicate that the use of mind-body practices was not related to chemotherapy initiation, but the use of dietary supplements and a higher CAM index score among women for whom chemotherapy was indicated both were associated with a lower likelihood to initiate chemotherapy than nonusers.

No association was identified between starting chemotherapy and CAM use among women for whom chemotherapy was discretionary, the report notes.

Suggesting it is important to consider possible alternative explanations for their findings, the authors point out that it is unclear whether the associations between CAM use and chemotherapy noninitiation reflects long-standing decision-making patterns among study participants.

“Though the majority of women with clinically indicated chemotherapy initiated treatment, 34 of 306 (11%) did not,” the authors conclude. “A cautious interpretation of results may suggest to oncologists that it is beneficial to ascertain CAM use among their patients, especially dietary supplement use, and to consider CAM use as a potential marker of patients at risk of not initiating clinically indicated chemotherapy.”

That CAM use might be associated with noninitiation of potentially life-saving adjuvant treatment highlights the urgent need for healthcare professionals to find better ways to urge patient disclosure of alternative therapies use, according to Robert Zachariae, DMSc, of Aarhus University Hospital in Aarhus, Denmark.

Zachariae adds in a related commentary, “This can best be done in a patient-centered manner by respectfully exploring patients’ preferences and beliefs about CAM and by providing the best evidence-based information about treatment options in a nonjudgmental fashion.”

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