Health Services Research

PV QA 3 - Poster Viewing Q&A 3

TU_35_2936 - Complementary Medicine, Refusal of Conventional Cancer Therapy, and Survival Among Patients with Curable Cancers

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Complementary Medicine, Refusal of Conventional Cancer Therapy, and Survival Among Patients with Curable Cancers
S. B. Johnson1, H. S. M. Park1, C. P. Gross2, and J. B. Yu1; 1Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, 2Department of Medicine, Yale University School of Medicine, New Haven, CT

Purpose/Objective(s): There is limited information on the association among complementary medicine, conventional treatment adherence, and survival outcomes of patients with cancer who receive complementary medicine compared to those who do not receive complementary medicine.

Materials/Methods: Patients diagnosed with non-metastatic breast, prostate, lung, or colorectal cancer and received at least one conventional cancer therapy modality, defined as surgery, radiotherapy, chemotherapy and/or hormone therapy, were identified between 2004-2013 using the National Cancer Database. Patients were defined as undergoing complementary medicine if they received ‘Other-Unproven: Cancer treatments administered by nonmedical personnel’ in addition to any conventional cancer therapy. Factors associated with complementary medicine were evaluated by the chi-square test, t-test, and hierarchical mixed-effects logistic regression with clustering by reporting facility. Following 4:1 matching, treatment adherence and overall survival were analyzed using the Kaplan-Meier method, log-rank test, and Cox proportional hazards regression.

Results: We identified 258 patients who received complementary medicine. Patients who chose complementary medicine had longer delays to initial conventional cancer therapy compared to no complementary medicine (49.8 days interquartile range [IQR]: 14-50 days vs. 34.2 days IQR: 15-46 days, p<0.001) and higher refusal rates of surgery (7.0% vs. 0.1%), chemotherapy (34.1% vs. 3.2%), radiotherapy (53.0% vs. 2.3%) and hormone therapy (33.7% vs. 2.8%) (all p<0.001). Complementary medicine use was associated with worse 5-year overall survival compared to no complementary medicine (82.2% vs. 86.6%, p=0.001) and was independently associated with greater risk of death (HR:2.08, 95% confidence interval [CI]:1.50-2.90) in a multivariable model that did not include treatment delay or refusal. However, there was no significant association between complementary medicine and survival once treatment delay or refusal was included in the model (HR:1.39, 95%CI:0.83-2.33).

Conclusion: Patients who received complementary medicine were more likely to refuse or experience a delay in conventional cancer therapy receipt, and had a higher risk of death. The mortality risk associated with complementary medicine was mediated by the refusal of conventional cancer therapy. For patients with curable cancers inclined to pursue complementary methods, timely adherence to all recommended conventional therapies should be strongly advised.

Author Disclosure: S.B. Johnson: None. H.S. Park: Employee; Yale School of Medicine. C.P. Gross: Research Grant; 21st Century Oncology, Johnson & Johnson.

Skyler Johnson, MD

Yale University School of Medicine

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