Purpose U.S. cancer survivors commonly use vitamins/minerals and complementary and alternative medicine (CAM). We compare use of vitamins/minerals and CAM by adult cancer survivors and cancer-free adults, and estimate annual out-of-pocket expenses. Methods Data on self-reported vitamin/mineral and CAM use in the past 12 months from the cross-sectional 2012 U.S. National Health Interview Survey were used to estimate prevalence of use and out-of-pocket expenditures. The cohort included adults with (n=2,977) and without (n=30,551) a self-reported cancer diagnosis. Results Approximately 79% of cancer survivors and 68% of cancer-free adults reported using ≥1 vitamins/minerals and/or CAM modality in the past year. Compared to cancer-free adults, cancer survivors were more likely to report use of vitamin/minerals (75% vs. 61%, P<0.001), herbal/non-vitamin supplements (24% vs. 19%, P<0.001), manipulative and body-based therapies (19% vs. 17%, P=0.03), and alternative medical systems (5% vs. 4%, P=0.04). Adult cancer survivors and cancer-free adults spent an annual estimated $6.7 billion and $52 billion out-of-pocket, respectively, on vitamins/minerals and CAM. Survivors spent 60% of the total on vitamins/minerals ($4 billion), 18% ($1.2 billion) on herbal/non-vitamin supplements, and 7% ($0.5 billion) on massage. Conclusions Compared with cancer-free adults, a higher proportion of cancer survivors report vitamin/mineral and CAM use. Cancer survivors, who accounted for 6.9% of the total population, accrued more than 11.4% of the annual out-of-pocket costs on vitamins/minerals and CAM spent by U.S. adults. Implications for Cancer Survivors Given the high use of vitamins/minerals and CAM in cancer survivors, studies are needed to analyze health outcomes and the cost:benefit ratio of such use.

IntroductionMore than 25% of American adults report having 2 or more chronic conditions. People with chronic conditions often use complementary and alternative medicine (CAM) for self-care and disease management, despite a limited evidence base.MethodsData from the 2012 National Health Interview Survey (NHIS) (n = 33,557) were analyzed to assess associations between presence of multiple chronic conditions (n = 13) and CAM use, using multivariable relative risk and linear regressions weighted for complex NHIS sampling. CAM use was defined as self-reported use of one or more of 16 therapies in the previous 12 months.ResultsChronic conditions were common. US adults reported one (22.3%) or 2 or more (33.8%) conditions. Many used at least one form of CAM. Multivitamins, multiminerals, or both (52.7%); vitamins (34.8%); and minerals (28.4%) were the most common. Compared with adults with no conditions, adults with 2 or more conditions were more likely to use multivitamins or multiminerals or both, vitamins, minerals, nonvitamins or herbs, mind–body therapies, chiropractic or osteopathic manipulation, massage, movement therapies, special diets, acupuncture, naturopathy, or some combination of these therapies (P <.003).ConclusionPeople with multiple chronic conditions have a high prevalence of CAM use. Longitudinal studies are needed to understand the association between CAM use and chronic disease prevention and treatment.

Our hypothesis-generating results suggest that lifestyle modifications may be associated with changes in global DNA methylation detectable at 6 and 12 mo. These biomarkers may be useful intermediate biomarkers to use in future intervention trials. This trial was registered at clinicaltrials.gov as NCT00811824.

IMPORTANCE Not all women initiate clinically indicated breast cancer adjuvant treatment. It is important for clinicians to identify women at risk for noninitiation. OBJECTIVE To determine whether complementary and alternative medicine (CAM) use is associated with decreased breast cancer chemotherapy initiation. DESIGN, SETTING, AND PARTICIPANTS In this multisite prospective cohort study (the Breast Cancer Quality of Care [BQUAL] study) designed to examine predictors of breast cancer treatment initiation and adherence, 685 women younger than 70 years with nonmetastatic invasive breast cancer were recruited from Columbia University Medical Center, Kaiser Permanente Northern California, and Henry Ford Health System and enrolled between May 2006 and July 31, 2010. Overall, 306 patients (45%) were clinically indicated to receive chemotherapy per National Comprehensive Cancer Network guidelines. Participants were followed for up to 12 months. EXPOSURES Baseline interviews assessed current use of 5 CAM modalities (vitamins and/or minerals, herbs and/or botanicals, other natural products, mind-body self-practice, mind-body practitioner-based practice). CAM use definitions included any use, dietary supplement use, mind-body use, and a CAM index summing the 5 modalities. MAIN OUTCOMES AND MEASURES Chemotherapy initiation was assessed via self-report up to 12 months after baseline. Multivariable logistic regression models examined a priori hypotheses testing whether CAM use was associated with chemotherapy initiation, adjusting for demographic and clinical covariates, and delineating groups by age and chemotherapy indication. RESULTS A cohort of 685 women younger than 70 years (mean age, 59 years; median age, 59 years) with nonmetastatic invasive breast cancer were recruited and followed for up to 12 months to examine predictors of breast cancer treatment initiation. Baseline CAM use was reported by 598 women (87%). Chemotherapy was initiated by 272 women (89%) for whom chemotherapy was indicated, compared with 135 women (36%) for whom chemotherapy was discretionary. Among women for whom chemotherapy was indicated, dietary supplement users and women with high CAM index scores were less likely than nonusers to initiate chemotherapy (odds ratio [OR], 0.16; 95% CI, 0.03–0.51; and OR per unit, 0.64; 95% CI, 0.46–0.87, respectively). Use of mind-body practices was not related to chemotherapy initiation (OR, 1.45; 95% CI, 0.57–3.59). There was no association between CAM use and chemotherapy initiation among women for whom chemotherapy was discretionary. CONCLUSIONS AND RELEVANCE CAM use was high among patients with early-stage breast cancer enrolled in a multisite prospective cohort study. Current dietary supplement use and higher number of CAM modalities used but not mind-body practices were associated with decreased initiation of clinically indicated chemotherapy. Oncologists should consider discussing CAM with their patients during the chemotherapy decision-making process.

PURPOSE: Adjuvant therapy is associated with improved survival for women with breast cancer, but not all women who could benefit initiate treatment. Women's belief systems are related to treatment initiation. It has been hypothesized that complementary and alternative (CAM) use is associated with decreased initiation of standard oncology treatments because patients may be exploring alternative treatment approaches. However, there are limited data on the association between CAM use and cancer treatment initiation. We examined the association between CAM use and initiation of adjuvant breast cancer chemotherapy in a prospective cohort of early stage breast cancer patients. PATIENTS AND METHODS: Subjects participated in a multi-center prospective cohort study of women with early stage invasive breast cancer (n=1,156). National Comprehensive Cancer Network guidelines were used to define groups based on whether chemotherapy was indicated. Three subgroups were created: chemotherapy indicated for subjects &lt;70 years, chemotherapy discretionary for subjects &lt;70 years, and chemotherapy discretionary for subjects ≥70 years. CAM use was assessed based upon self-reported use of 5 CAM modalities, including vitamin/mineral supplements, herbal supplements, other over-the-counter natural products, mind-body based approaches, and body/energy-based treatments. Psychosocial factors potentially related to chemotherapy initiation were assessed. Multivariable logistic regression models evaluated the associations between CAM use and chemotherapy initiation, adjusted for demographic, clinical and psychosocial factors. RESULTS: Current CAM use was reported by 87% of women and 38% reporting current use of ≥3 modalities. The most commonly used CAM modalities were mind body therapies (63%) and other natural products (41%). In bivariate analyses, among women &lt;70 years where chemotherapy was indicated, women who reported current use of vitamins/minerals or current use of all 5 CAM modalities were less likely to initiate chemotherapy compared to non-users (P&lt;.0001), but this was not observed among women for whom chemotherapy was discretionary. Psychosocial factors were also associated with high levels of current CAM use in this group, including higher expectations of adverse effects from chemotherapy, more concerns about the physical effects of chemotherapy, lower beliefs in the benefits of chemotherapy, and lower positive decision balance while making chemotherapy decisions (all P&lt;.05). Among women age &lt;70 years for whom chemotherapy was indicated, 89% initiated treatment, and current use of all 5 CAM modalities was inversely associated with initiation in multivariable analyses adjusted for demographic and clinical factors (OR=0.08, CI: 0.02-0.32). The association remained after separately adjusting for psychosocial factors (all P&lt;.05), except for positive decision balance, which was no longer statistically significant. CONCLUSIONS: High use of CAM was associated with decreased chemotherapy initiation among women with breast cancer for whom chemotherapy was indicated. It is important for oncologists to discuss CAM use with their patients, especially since high CAM use is associated with negative expectations and beliefs about chemotherapy. Citation Format: Greenlee H, Neugut AI, Falci L, Hillyer GC, Buono D, Roh JM, Ergas IJ, Kwan ML, Lee M, Tsai WY, Shi Z, Lamerato L, Mandelblatt JS, Kushi LH, Hershman DL. Complementary and alternative medicine use and breast cancer chemotherapy initiation: The BQUAL study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD4-05.