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Complementary and alternative medicine use linked to low chemotherapy initiation rates in breast cancer
Women with early-stage breast cancer who regularly used certain complementary and alternative medicines appeared less likely to initiate chemotherapy than those who did not, according to results of a prospective study led by researchers from Columbia University’s Herbert Irving Comprehensive Cancer Center and Mailman School of Public Health.
The Breast Cancer Quality of Life (BQUAL) trial included data from 685 women aged younger than 70 years (median age, 59 years) diagnosed with nonmetastatic invasive breast cancer between May 2006 and July 2010. Of this group, 306 (45%) were clinically indicated to receive chemotherapy per National Comprehensive Cancer Network guidelines.
Heather Greenlee
Researchers conducted baseline interviews with women to assess their current use of five forms of complementary and alternative medicine (CAM): vitamins and/or minerals; herbs and/or botanicals; other natural products; mind–body self-practice, and practitioner-based mind–body practice. Women self-reported chemotherapy initiation for up to 12 months after baseline assessment.
The majority of study participants (87%; n = 598) reported using some form of CAM at baseline.
Eighty-nine percent (n = 272) of women for whom chemotherapy was indicated initiated the treatment, as did 36% (n = 135) for whom chemotherapy was discretionary.
Among women recommended to initiate chemotherapy, nonadherence occurred most frequently among self-reported users of dietary supplements (OR = 0.16; 95% CI, 0.03-0.51) and high users of CAM (OR per unit = 0.64; 95% CI, 0.46-0.87).
The use of mind–body practices did not affect chemotherapy initiation (OR = 1.45; 95% CI, 0.57-3.59), and researchers observed no associations among women for whom chemotherapy was discretionary.
HemOnc Today spoke with study researcher Heather Greenlee, ND, MPH, PhD, assistant professor of epidemiology at Columbia University’s Mailman School of Public Health, about the findings and their potential impact.
Question: Nearly 90% of women enrolled in this trial reported using CAM at baseline. Why do you think use was so high?
Answer: The use that we observed in the study is not surprising. We have good population-based data that the use of CAM is high among cancer survivors. Our group recently published a paper using data from the CDC’s National Health Interview Survey. It showed that, in 2012, 79% of adult cancer survivors in the United States used one or more forms of CAM. We know that, among populations of patients with cancer, those with breast cancer are the highest users of CAM.
Q: Were you surprised that users of dietary supplements and heavy CAM users appeared less likely to initiate chemotherapy ?
A: Though we had hypothesized that CAM use would be associated with lower initiation of chemotherapy, we were surprised by the magnitude of the findings. Our findings were very robust, even after controlling for multiple potential confounders.
Q: Several studies have shown a recent rise in the use of CAM. What factors do you think might be driving this ?
A: Many of our studies have shown that patients and survivors are using CAM to promote health and wellness, and to manage conditions poorly controlled by conventional therapies. The question, though, is how well do CAM therapies achieve these goals? We need well-designed trials to test this.
Q: Women who performed mind – body practices — such as yoga, meditation and acupuncture — did not appear to delay or refuse chemotherapy. Why do you think that is?
A: In 2014, the Society for Integrative Oncology published clinical guidelines on the use of integrative therapies during breast cancer treatment. There is good evidence on the efficacy of many mind–body modalities to treat anxiety, depression and stress. Our current study illustrates the point that not all CAM modalities are the same. What motivates someone to take a dietary supplement is different from what motivates another person to engage in yoga or meditation.
Q: What are some approaches that practitioners can take when discussing chemotherapy with apprehensive patients?
A: The clinical practice guidelines published by the Society for Integrative Oncology provide a great framework for patients and their clinicians to engage in a discussion and shared decision-making about what evidence exists to support various CAM strategies.
Q: What are some potential focuses of future research in this area?
A: Acupuncture for pain management and mind–body therapies for stress, anxiety, depression and mood are very promising areas of future research. In addition, the majority of integrative oncology research to date has been in breast cancer. We need to conduct clinical trials in populations of patients with other cancers. – by Cameron Kelsall
For more information:
Heather Greenlee, ND, MPH, PhD, can be reached at hg2120@columbia.edu.
Disclosure: Greenlee reports no relevant financial disclosures. One study researcher reports a directorship position with the Kushi Foundation, a nonprofit organization that promotes educational activities regarding macrobiotics.