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Original Investigation
September 2016

Association Between Complementary and Alternative Medicine Use and Breast Cancer Chemotherapy InitiationThe Breast Cancer Quality of Care (BQUAL) Study

Author Affiliations
  • 1Mailman School of Public Health, Columbia University, New York, New York
  • 2Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
  • 3College of Physicians and Surgeons, Columbia University, New York, New York
  • 4Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Washington, DC
  • 5Division of Research, Kaiser Permanente Northern California, Oakland
  • 6Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco
  • 7Henry Ford Health System, Detroit, Michigan
JAMA Oncol. 2016;2(9):1170-1176. doi:10.1001/jamaoncol.2016.0685
Abstract

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.

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