Association between Complementary and Alternative Medicine Use and Breast Cancer Chemotherapy Initiation the Breast Cancer Quality of Care (BQUAL) Study

Heather Greenlee, Alfred I. Neugut, Laura Falci, Grace Clarke Hillyer, Donna Buono, Jeanne S. Mandelblatt, M. Janise, Isaac J. Ergas, Marilyn L. Kwan, Marion Lee, Wei Yann Tsai, Zaixing Shi, Lois Lamerato, Lawrence H. Kushi, Dawn L. Hershman

Research output: Contribution to journalArticle

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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 initiationwas 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.

Original languageEnglish (US)
Pages (from-to)1170-1176
Number of pages7
JournalJAMA oncology
Volume2
Issue number9
DOIs
StatePublished - Sep 1 2016
Externally publishedYes

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Quality of Health Care
Complementary Therapies
Breast Neoplasms
Drug Therapy
Dietary Supplements
Odds Ratio
Cohort Studies
Logistic Models
Prospective Studies

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Association between Complementary and Alternative Medicine Use and Breast Cancer Chemotherapy Initiation the Breast Cancer Quality of Care (BQUAL) Study. / Greenlee, Heather; Neugut, Alfred I.; Falci, Laura; Hillyer, Grace Clarke; Buono, Donna; Mandelblatt, Jeanne S.; Janise, M.; Ergas, Isaac J.; Kwan, Marilyn L.; Lee, Marion; Tsai, Wei Yann; Shi, Zaixing; Lamerato, Lois; Kushi, Lawrence H.; Hershman, Dawn L.

In: JAMA oncology, Vol. 2, No. 9, 01.09.2016, p. 1170-1176.

Research output: Contribution to journalArticle

Greenlee, H, Neugut, AI, Falci, L, Hillyer, GC, Buono, D, Mandelblatt, JS, Janise, M, Ergas, IJ, Kwan, ML, Lee, M, Tsai, WY, Shi, Z, Lamerato, L, Kushi, LH & Hershman, DL 2016, 'Association between Complementary and Alternative Medicine Use and Breast Cancer Chemotherapy Initiation the Breast Cancer Quality of Care (BQUAL) Study', JAMA oncology, vol. 2, no. 9, pp. 1170-1176. https://doi.org/10.1001/jamaoncol.2016.0685
Greenlee, Heather ; Neugut, Alfred I. ; Falci, Laura ; Hillyer, Grace Clarke ; Buono, Donna ; Mandelblatt, Jeanne S. ; Janise, M. ; Ergas, Isaac J. ; Kwan, Marilyn L. ; Lee, Marion ; Tsai, Wei Yann ; Shi, Zaixing ; Lamerato, Lois ; Kushi, Lawrence H. ; Hershman, Dawn L. / Association between Complementary and Alternative Medicine Use and Breast Cancer Chemotherapy Initiation the Breast Cancer Quality of Care (BQUAL) Study. In: JAMA oncology. 2016 ; Vol. 2, No. 9. pp. 1170-1176.
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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 initiationwas 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.",
author = "Heather Greenlee and Neugut, {Alfred I.} and Laura Falci and Hillyer, {Grace Clarke} and Donna Buono and Mandelblatt, {Jeanne S.} and M. Janise and Ergas, {Isaac J.} and Kwan, {Marilyn L.} and Marion Lee and Tsai, {Wei Yann} and Zaixing Shi and Lois Lamerato and Kushi, {Lawrence H.} and Hershman, {Dawn L.}",
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T1 - Association between Complementary and Alternative Medicine Use and Breast Cancer Chemotherapy Initiation the Breast Cancer Quality of Care (BQUAL) Study

AU - Greenlee, Heather

AU - Neugut, Alfred I.

AU - Falci, Laura

AU - Hillyer, Grace Clarke

AU - Buono, Donna

AU - Mandelblatt, Jeanne S.

AU - Janise, M.

AU - Ergas, Isaac J.

AU - Kwan, Marilyn L.

AU - Lee, Marion

AU - Tsai, Wei Yann

AU - Shi, Zaixing

AU - Lamerato, Lois

AU - Kushi, Lawrence H.

AU - Hershman, Dawn L.

PY - 2016/9/1

Y1 - 2016/9/1

N2 - 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 initiationwas 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.

AB - 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 initiationwas 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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