Survey of Oncology Patients’ Perceptions on Integrative Medicine and Awareness of Resources at an Academic Cancer Center

Abstract

Background:

More cancer centers are offering integrative medicine (IM) therapies. However, it is unclear how many patients are aware of, and are utilizing, these therapies to help manage their symptoms.

Objectives:

This survey study examines patients’ knowledge, satisfaction with, and perceptions of available IM resources at an academic cancer center.

Methods:

An online, anonymous survey was sent to 7,807 patients of the University of California Davis Health Comprehensive Cancer Center using the electronic health record. The survey consisted of 11 primary questions with follow-up questions.

Results:

One thousand and sixteen respondents initiated the survey (response rate of 13%). Eight hundred and fifty-five respondents (10.9%) completed the survey. Mean age was 65.4 years; 67.3% of respondents were female, 84.9% were Caucasian/White, and 86.8% reported being non-Hispanic. The largest group of responders were patients with breast cancer (25.7%). 78.7% reported no IM use, and 18.9% reported using IM. Although 53.7% of respondents were satisfied with the resources, 42.1% reported not being aware of any IM resources. Those who were unaware of resources were more likely to be female than male (47.8% vs. 30.5%) and non-Hispanic (42.3% vs. 31.2%). 48.7% wanted additional IM resources. Of those who wanted additional resources, 54.7% wanted nutritional counseling, 49.3% wanted manipulative and body-based methods, 44.4% wanted alternative medical systems, and 43.4% wanted counseling on herbs, dietary supplements, and cannabis.

Discussion:

Forty-two percent of participants were unaware of any IM resources at the institution and an even greater number, 48.7%, voiced a desire for additional IM resources.

Conclusion:

This is the first study in the United States at an academic comprehensive cancer center to examine patients’ perceptions of available IM resources. Although some cancer centers offer a variety of IM resources, many patients may be missing out on potential symptom or quality-of-life benefits due to a lack of awareness of these resources.

Introduction

Integrative medicine (IM) is the use of complementary health approaches (e.g., special diets, acupuncture, mind–body therapies) in conjunction with conventional therapies in a coordinated, evidence-based way.¹ It is estimated that up to 70% of patients with cancer and survivors have used IM during or after treatment.^2,3 In a survey of patients with gynecological cancer at the University of California Davis Health (UCDH) Comprehensive Cancer Center, 87% of patients reported using a form of IM.⁴ IM therapies are a multibillion-dollar industry and much of it is out-of-pocket for patients.⁵ IM use in patients with cancer is more prevalent among those who are younger, female, and have higher-education levels.⁶

With increasing numbers of patients using IM, there has also been a growth in IM offered by cancer centers allowing cancer centers to combine IM and standard-of-care cancer therapies in an evidence-based way.^3,7 A study evaluating services provided at 51 National Cancer Institute (NCI) designated comprehensive cancer centers, and 100 community hospitals found that a majority of cancer centers had some form of IM available. While community hospitals overall had fewer IM therapies than NCI-designated comprehensive cancer centers, over 50% of all cancer centers had services including acupuncture, massage therapy, meditation, music therapy, yoga, and exercise therapies.⁷ Furthermore, in a previous study of NCI-designated comprehensive cancer centers, a majority of them also offer herbs and dietary supplement counseling, nutrition, spiritual counseling, and consultation with an IM physician.⁸

While many cancer centers offer IM therapies, it is unclear how many patients are aware of and are utilizing these therapies effectively to help manage their symptoms. UCDH has an NCI-designated comprehensive cancer where IM therapies are available. The purpose of this study was to determine UCDH Comprehensive Cancer Center patients’ knowledge of and satisfaction with currently available IM resources. Our secondary objective was to determine if there are any associations between patient characteristics and their satisfaction with the IM resources at our institution. This study will inform the health system on how to improve patients’s experiences with IM and may have relevance for other cancer centers.

Materials and Methods

This is a cross-sectional study of patients of the UCDH Comprehensive Cancer Center. A voluntary, anonymous, online survey was sent to 7,807 cancer center patients. Eligible participants were identified via a query of the Epic electronic health record. Inclusion criteria were patients who were 18 years of age or older, had a clinic visit at the cancer center within the past year, with ICD-10 codes for cancer or precancer diagnoses, were English-speaking, and had activated MyChart status. Patients who did not have MyChart access and could not complete an online survey in English were excluded. Once eligible participants were identified, they were sent an invitation to participate through the Epic MyChart system in the electronic health record. The invitation contained a link that led participants to complete the survey, which was hosted online in the UC Davis Research Electronic Data Capture (REDCap) secure server. The invitation was sent in 16 batches of about 500 patients per batch, between October 14, 2021, and November 2, 2021. The survey was sent once to all participants and the survey link was kept open for 3 months, closing on February 3, 2022. The survey was sent to participants only one time to prevent multiple participation. There was no financial remuneration for participating, and therefore no additional incentive for multiple responses. All responses were anonymous and survey data were kept confidentially in the REDCap server, a secure web application for creating and managing online surveys and databases.⁹ This study was given exempt status by the UCDH institutional review board.

The survey consisted of 11 questions, with additional follow-up questions depending on participant answers. The survey consisted of two sections. The first section collected self-reported information including demographics, cancer type, satisfaction rating with IM resources, and desire for additional IM resources. The second section appeared if participants desired additional IM resources. Question 10 included a detailed list of which types of resources they may want. The survey took approximately 5–15 min to complete (Supplementary Data S1). To decrease nonresponse bias, the survey was designed to be short and easy to complete. Pretesting was conducted with the staff from the Division of Supportive Oncology of the UCDH Cancer Center who have experience working with cancer center patients. Pretesting with cancer center patients was not performed.

For this cross-sectional study, convenience sampling was used and no sample size calculations were performed. We considered that recruiting participants using MyChart would target a generalizable sample of the UCDH Comprehensive Cancer Center since 82.9% of patients have an activated MyChart account (Alyssa Davis, personal communication, December 21, 2023).

Secondary analyses were performed only for the participants who completed the survey in its entirety. The independent variables that were examined included age, sex, race, ethnicity, and current use of IM. The outcome variable was satisfaction with IM resources at the UCDH Comprehensive Cancer Center. Sex was classified into three categories: female, male, and other based on self-reported gender. The other category included responses such as “trans female/trans woman,” “Trans Male/Trans Man,” “Nonbinary,” and “Other.” The response “Prefer not to answer” was recoded as missing data. The current use of IM had response options including “Yes,” “No,” or “Not Sure.” The outcome variable satisfaction had responses of “Very Satisfied,” “Satisfied,” “Dissatisfied,” “Very Dissatisfied,” and “I am not aware of any integrative medicine resources at UC Davis Health.” For the analysis, “Very Satisfied” and “Satisfied” were analyzed together as “Satisfied,” and “Very Dissatisfied” and “Dissatisfied” were analyzed together as “Dissatisfied.”

Univariate analysis was performed for all variables. Age was analyzed and described using descriptive statistics (mean, standard deviation). Sex, race, current use of complementary and alternative medicine, and satisfaction with IM resources were analyzed using frequency tables. Statistical analysis between age and satisfaction was performed using one-way analysis of variance. Bivariate analyses of sex, race, and current use of IM compared with satisfaction were performed with Fisher’s exact or chi-square. An additional analysis with multivariate logistic regression was also performed. Missing data were reported but not included in the analyses. SAS version 9.4 was used to perform the analyses.

Results

Of the 7,807 patients invited to participate in the survey, 1,016 respondents initiated the survey, yielding a response rate of 13%. A total of 855 respondents completed the survey in its entirety, with a complete response rate of 10.9%.

The demographics of the respondents are displayed in Table 1. The mean age of respondents was 65.4 years. The range of ages was 18–95 years. The majority of respondents were female (67.3%). Most respondents were White/Caucasian (84.9%) and identified as not Hispanic/Latino (86.8%). For other races and ethnicities, 8.2% of respondents were Hispanic/Latino, 7.7% were mixed/race or other, 3.7% were Asian, and 2.1% were Black or African American. Although participants reported a wide variety of cancer types, the most common one was breast cancer (25.7%), followed by more than one cancer (11.3%).

Table 1.

Demographics of Survey Respondents (n = 1016)

Age^a,c	65.4 (11.8)
Sex^b,d
Male	322 (32.4%)
Female	668 (67.3%)
Other	3 (0.3%)
Race^b,e
American Indian or Alaska Native	12 (1.2%)
Black or African American	20 (2.1%)
Native Hawaiian or Other Pacific Islander	3 (0.3%)
Caucasian/White	818 (84.9%)
Asian	36 (3.7%)
Mixed race or other	74 (7.7%)
Ethnicity^b
Hispanic/Latino	83 (8.2%)
Not Hispanic/Latino	882 (86.8%)
Unknown	51 (5.0%)
Cancer type^b,f
Brain	9 (1.0%)
Breast	239 (25.7%)
Gastrointestinal	64 (6.9%)
Genitourinary	89 (9.6%)
Gynecological	70 (7.5%)
Head and neck	24 (2.6%)
Leukemia	49 (5.3%)
Lung	65 (7.0%)
Lymphoma	88 (9.5%)
Sarcoma	26 (2.8%)
Skin	12 (1.3%)
Thyroid	15 (1.6%)
Other	75 (8.1%)
More than one cancer	105 (11.3%)

Results reported as mean (standard deviation).

Results reported as number of responses (percent of total responses).

Fifty-five missing responses.

Twenty-three missing responses.

Fifty-three missing responses.

Eighty-six missing responses.

78.7% of respondents reported not using any IM, 18.9% reported using IM, and 2.4% were not sure if they were using any forms of IM. Of all respondents, 53.7% of respondents were satisfied with the IM resources at the UCDH Comprehensive Cancer Center, and only 4.2% were dissatisfied (Table 2). However, a large proportion of respondents (42.1%) reported being unaware of any IM resources within the health system. Of respondents who were current IM users (n = 176), 38.3% were satisfied with the IM resources, 8.6% were dissatisfied, and 53.1% were unaware of any IM resources in the health system. Although in the overall population, 53.7% of people were satisfied with the IM resources, 48.7% stated that they would want additional resources at UC Davis, and 46.7% were unsure. Of the respondents who identified as current IM users, 72.1% requested additional IM resources. Of all participants who requested additional IM resources (n = 452), 44.5% were unaware of any existing IM resources in the health system. In contrast, among those who did not request additional resources (n = 43), only 14.0% stated that they were unaware of any IM resources. Overall, the most common IM resources requested by participants included nutritional counseling (54.7%); manipulative and body-based methods (49.3%); alternative medical systems (44.4%); counseling on herbs, dietary supplements, and cannabis (43.4%); and exercise therapies (42.6%) (Fig. 1).

FIG. 1.

Types of integrative medicine resources requested by participants. Nutritional therapeutics (i.e., counseling on nutrition or vitamins); manipulative and body-based methods (i.e., chiropractic, therapeutic massage, and reflexology); alternative medical systems (i.e., acupuncture, Ayurveda, and traditional Chinese medicine); pharmacological and biological treatments (i.e., counseling on herbs, dietary supplements, and cannabis); exercise therapies (i.e., Tai Chi, yoga, and dance); mind–body interventions (i.e., meditation, art/music therapy, cognitive behavioral therapy); energy therapies (i.e., qigong, Reiki, and healing touch); and spiritual therapies (i.e., prayer, spiritual counseling).

Table 2.

Patient Perceptions of Integrative Medicine (n = 1016)

	Number of responses (% of total)
Current use of IM^a
Yes	176 (18.9%)
No	732 (78.7%)
Not sure	22 (2.4%)
Satisfaction with IM resources^b
Satisfied	499 (53.7%)
Dissatisfied	39 (4.2%)
Unaware of any resources	391 (42.1%)
Request for additional IM resources^c
Yes	452 (48.7%)
No	43 (4.6%)
Do not know	433 (46.7%)

Eighty-six missing responses.

Eighty-seven missing responses.

Eighty-eight missing responses.

IM, integrative medicine.

Secondary analyses were performed on the 855 complete survey responses to determine whether there was any association between participant demographic information and IM use, satisfaction, and the desire for additional resources. Current IM users were younger (63.3 ± 11.3 years) than nonusers (65.9 ± 11.8 years; p = 0.03). Participants with gastrointestinal (29.0%), thyroid (28.6%), gynecological (23.7%), sarcoma (22.7%), head and neck (21.7%), and breast (21.6%) cancers had the highest rates of IM use (p = 0.006, Table 3). In further evaluating the participants who were unaware of any IM resources, they were more likely to be female than male (47.8% vs. 30.5%) and non-Hispanic compared with Hispanic (42.3% vs. 31.2%, Table 4).

Table 3.

Current Use of Integrative Medicine Based on Demographic Variables of All Participants Who Completed Survey (n = 855)

	Yes (N = 161)	No (N = 675)	Not sure (N = 19)	p-Value
Age^a,e	63.3 (11.3)	65.9 (11.8)	68.10 (9.5)	0.03^c
Sex^b,f				0.1^d
Male	39 (13.9%)	235 (83.9%)	6 (2.1%)
Female	120 (21.1%)	436 (76.6%)	13 (2.3%)
Other	0 (0.0%)	2 (100.0%)	0 (0.0%)
Race^b,g				0.2^d
American Indian or Alaska Native	3 (30.0%)	7 (70.0%)	0 (0.0%)
Black or African American	1 (6.7%)	14 (93.3%)	0 (0.0%)
Native Hawaiian or other Pacific Islander	1 (33.3%)	2 (66.7%)	0 (0.0%)
Caucasian/White	125 (17.6%)	570 (80.4%)	14 (2.0%)
Asian	12 (36.4%)	21 (63.6%)	0 (0.0%)
Mixed race or other	11 (19.6%)	43 (76.8%)	2 (3.6%)
Ethnicity^b				0.002^d
Hispanic/Latino	10 (15.6%)	53 (82.8%)	1 (1.6%)
Not Hispanic/Latino	141 (18.4%)	610 (79.6%)	15 (2.0%)
Unknown	10 (40.0%)	12 (48.0%)	3 (12.0%)
Cancer type^b				0.006^d
Brain	0 (0.0%)	7 (100.0%)	0 (0.0%)
Breast	48 (21.6%)	169 (76.1%)	5 (2.3%)
Gastrointestinal	18 (29.0%)	44 (71.0%)	0 (0.0%)
Genitourinary	15 (17.9%)	69 (82.1%)	0 (0.0%)
Gynecological	14 (23.7%)	45 (76.3%)	0 (0.0%)
Head and neck	5 (21.7%)	17 (73.9%)	1 (4.3%)
Leukemia	3 (6.7%)	40 (88.9%)	2 (4.4%)
Lung	5 (8.3%)	52 (86.7%)	3 (5.0%)
Lymphoma	7 (9.0%)	71 (91.0%)	0 (0.0%)
Sarcoma	5 (22.7%)	16 (72.7%)	1 (4.5%)
Skin	2 (18.2%)	9 (81.8%)	0 (0.0%)
Thyroid	4 (28.6%)	8 (57.1%)	2 (14.3%)
Other	15 (21.1%)	54 (76.1%)	2 (2.8%)
More than one cancer	20 (20.6%)	74 (76.3%)	3 (3.1%)

Results reported as mean (standard deviation).

Results reported as number of responses (percent of total responses).

Linear model analysis of variance.

Fisher’s Exact test for count data with simulated p-value (based on 1e + 06 replicates).

Thirty-one missing responses.

Four missing responses.

Twenty-nine missing responses.

Table 4.

Satisfaction with Integrative Medicine Resources Based on Demographic Variables of All Participants Who Completed Survey (n = 855)

	Satisfied (n = 460)	Dissatisfied (n = 34)	Unaware of resources (n = 361)	p-Value
Age^a,e	66.1 (11.9)	64.4 (9.4)	64.9 (11.5)	0.3^c
Sex^b,f				<0.001^d
Male	181 (64.6%)	14 (5.0%)	85 (30.4%)
Female	277 (48.7%)	20 (3.5%)	272 (47.8%)
Other	1 (50.0%)	0 (0.0%)	1 (50.0%)
Race^b,g				0.2^d
American Indian or Alaska Native	7 (70.0%)	1 (10.0%)	2 (20.0%)
Black or African American	8 (53.3%)	1 (6.7%)	6 (40.0%)
Native Hawaiian or other Pacific Islander	0 (0.0%)	1 (33.3%)	2 (66.7%)
Caucasian/White	382 (53.9%)	29 (4.1%)	298 (42.0%)
Asian	15 (45.5%)	1 (3.0%)	17 (51.5%)
Mixed race or other	37 (66.1%)	1 (1.8%)	18 (32.1%)
Ethnicity^b				0.04^d
Hispanic/Latino	41 (64.1%)	3 (4.7%)	20 (31.2%)
Not Hispanic/Latino	411 (53.7%)	31 (4.0%)	324 (42.3%)
Unknown	8 (32.0%)	0 (0.0%)	17 (68.0%)
Cancer type^b				0.08^d
Brain	3 (42.9%)	1 (14.3%)	3 (42.9%)
Breast	108 (48.6%)	9 (4.1%)	105 (47.3%)
Gastrointestinal	35 (56.5%)	2 (3.2%)	25 (40.3%)
Genitourinary	59 (70.2%)	4 (4.8%)	21 (25.0%)
Gynecological	29 (49.2%)	3 (5.1%)	27 (45.8%)
Head and neck	14 (60.9%)	1 (4.3%)	8 (34.8%)
Leukemia	21 (46.7%)	0 (0.0%)	24 (53.3%)
Lung	37 (61.7%)	4 (6.7%)	19 (31.7%)
Lymphoma	45 (57.7%)	2 (2.6%)	31 (39.7%)
Sarcoma	11 (50.0%)	1 (4.5%)	10 (45.5%)
Skin	5 (45.5%)	2 (18.2%)	4 (36.4%)
Thyroid	7 (50.0%)	0 (0.0%)	7 (50.0%)
Other	38 (53.5%)	4 (5.6%)	29 (40.8%)
More than one cancer	48 (49.5%)	1 (1.0%)	48 (49.5%)

Results reported as mean (standard deviation).

Results reported as number of responses (percent of total responses).

Linear model analysis of variance.

Fisher’s exact test for count data with simulated p-value (based on 1e + 06 replicates).

Thirty-one missing responses.

Four missing responses.

Twenty-nine missing responses.

More male participants (64.6%) were satisfied with the current IM resources at our institution than female (48.7%) or other (50%) (p < 0.001). Also, those who identified as Hispanic (64.1%) were more likely to be satisfied than non-Hispanic (53.7%) or other (32.0%).

Finally, younger age was the only demographic variable associated with desiring more IM resources (p < 0.001). The average age of those who wanted additional resources was 63.9 ± 11.3 years old. The mean age of those who did not or were unsure of wanting additional resources were 65.9 ± 11.0 years and 67.2 ± 11.9, respectively.

Discussion

This study is the first to investigate the opinions of patients with cancer at an NCI-designated comprehensive cancer center regarding not only their use of IM but also their satisfaction with and knowledge of institutional IM resources. Among the over 1,000 patients who responded to the study most were in their mid-60s, female, Caucasian/White race, and were not currently using any forms of IM. IM users were more likely to be younger, and to have gastrointestinal, thyroid, gynecological, sarcoma, head and neck sarcoma, and breast cancers. Although there was considerable overlap in age between IM users and nonusers (the large standard deviation reflects the broad age range of survey respondents), we did detect a statistically significant difference in age between IM users and nonusers (p = 0.03), likely due to the large number of survey respondents. Compared with the general UCDH cancer center patient population at this time, survey respondents were more likely to be younger (average age 65.4 vs. 68), female (67.3% vs. 56.4%), and White/Caucasian race (84.9% vs. 76%). Similar proportions were identified as being non-Hispanic (86.8% vs. 88.6%) (Jenny Neeley, personal communication, February 27, 2024). The differences in demographics between the participants and the overall cancer center population could indicate a nonresponse bias.

At our institution, 18.9% of patients reported IM use. This rate is lower than the 33.3% reported by the 2012 National Health Interview Survey including patients with cancer and cancer survivors.¹⁰ However, the timing of their cancer diagnoses relative to the survey was not defined, and this number may be higher now given that their study was conducted over a decade ago. Our study population includes both patients undergoing active cancer treatment and surveillance. A study from the United States showed that IM use decreases during active cancer treatment, which may be a reason for the lower IM use seen in our study.¹¹ To limit the burden of answering too many questions, our study did not specify which therapies are included as IM, which may have led to lower reported rates of IM use. Certain forms, such as prayer, mind–body therapies, or lifestyle and diet are common modalities used by patients that may not always be recognized as IM.^11
–13 A cross-sectional study of gynecological oncology patients at our institution found a high discrepancy between self-identifying as an IM user and actually using IM.⁴ Although 63.2% of patients did not identify as being an IM user when asked to self-report specific types of IM use, 87% were actually using at least one form of IM. It is likely that many patients are actively using IM therapies without identifying them as such. The most common types of IM therapies used were spiritual therapies (77%) and nutrition therapeutics (70%).⁴

Most cross-sectional studies of IM use from the United States are focused on specific populations of patients with cancer.^{11,14

–18} There is one other study inclusive of patients with all types of cancer.¹⁹ Similar to our results, the mean age of respondents was 63 and 22.7% had breast cancer. However, our study had more female participants (67.3% vs. 47.7%) and had a more diverse population with greater numbers of non-Caucasian (15.1% vs. 5.2%) and Hispanic respondents (8.2% vs. 3.9%).¹⁹ A systematic review of studies of IM use among cancer patients internationally (from 2008 to 2018), showed that being female, having younger age, higher education, and higher income were independent predictors of IM use.² This is consistent with other reports of IM use in patients with cancer internationally.^20,21 Similarly in our study, IM users were younger than nonusers; however, we did not find any difference based on gender. We did not evaluate income or education as variables.

In our study, 53.7% of respondents were satisfied with the current IM resources, and only 4.2% were dissatisfied. In a similar study performed at an NCI-designated comprehensive cancer center, 37.9% of respondents were extremely satisfied, 43.5% were somewhat satisfied, and 4.3% were somewhat or extremely dissatisfied.¹⁹ Surprisingly, in our population, 42.1% could not appropriately respond regarding their satisfaction level because they were unaware of any IM resources (Table 2). The respondents who were unaware of available IM resources were more likely to be female and non-Hispanic (Table 4). The large number of people who were unaware of IM resources may be another reason why the self-reported rates of IM use in our study are lower compared with other studies. At our institution, we have an IM clinic associated with our community primary care practices. We also have a variety of clinics and individuals who are trained to provide other therapies such as acupuncture, music therapy, Reiki, and cannabis counseling although in somewhat limited settings. The lack of awareness of the already-available IM resources means that many patients may be missing out on potential benefits to their symptoms or quality of life.

Additionally, in our study, 48.7% requested more IM resources (Table 2). In a study of patients with breast and gynecological cancer in Germany, 54% of patients wished for more integrative approaches to their conventional cancer care.²⁰ The most common types of integrative therapies requested included relaxation therapies (44%) and dietary counseling (43%).²⁰ In our study, over half of participants wanted nutritional counseling (54.7%) followed by manipulative and body-based methods (49.3%). Despite the availability of IM resources in most U.S. cancer centers, our study is the first to show a continued high demand for additional resources.⁷

There is increasing evidence demonstrating that IM therapies can be helpful for cancer-related symptoms. Over the last decade, the Society of Integrative Oncology (SIO) has partnered with the American Society of Clinical Oncology (ASCO) to publish several joint guidelines for integrative management of cancer-related symptoms.^22,23 In 2022, SIO–ASCO published guidelines for pain management, which include modalities such as acupuncture and mind–body practices, both of which are present in our institution.²³ Many of our patients could benefit from access to these resources if they were aware of their availability.

To the authors’ knowledge, this is the first study in the United States, inclusive of patients with all cancer types, that demonstrated a lack of awareness of available IM resources and a demand for more resources. Our study illustrates that although IM resources are present at a comprehensive cancer center, a large proportion of patients are unaware of them. Therefore, although a majority of cancer centers offer IM services, a significant number of patients may not be benefiting from them due to a lack of awareness. The reasons why patients are unaware of available IM resources are not entirely clear from our survey. Compared with respondents who do not seek additional resources, those who do request more IM resources have a higher proportion of being unaware of current resources (14.0% vs. 44.5%). More effort could be made in publicizing and marketing the already-present resources on our campus. This may be helpful not only to patients but also to providers who may also be unaware of these resources. One potential explanation for why patients are unaware of IM resources is because providers may not be discussing them with their patients. Nondisclosure of IM use is seen often in patients with cancer. It is estimated that approximately 50%–60% of patients do not disclose their use of IM with their providers.²⁴ One of the most common reasons for nondisclosure included that the provider did not ask.^10,25 In future studies, it will be important to elicit the perceptions and knowledge of IM resources from providers at our institution.

Limitations

Limitations to this study include a low response rate and the potential for selection bias as is inherent to a voluntary, anonymous survey. Although the survey response rate was low at 13%, this study included a fairly large sample size of over 1,000 respondents and 855 complete responses. This response rate is within what is expected for our institution using a MyChart recruitment method. In 2021, the year this study was conducted, the response rate to MyChart recruitment messages for research studies was 22.9% with 11.2% stating that they were interested and 11.7% not interested (Alyssa Davis, personal communication, December 28, 2023). There may have been selection bias as patients who use IM are more likely to respond to a survey about this topic. However, the percentage of IM users in our study was lower than the nationally reported numbers of IM use among oncology patients. More female and Caucasian/White patients responded to the survey. This may be because more patients who are female and White are seeking to use IM therapies.¹⁰ If there is selection bias, it may limit the generalizability of our results. Also, the survey was distributed to patients who had Epic MyChart access. At the UCDH Comprehensive Cancer Center, 82.9% of patients have an activated MyChart account. Of those patients, 65.4% log in at least monthly to their account, and 79% of patients log in at least once every 3 months (Alyssa Davis, personal communication, December 21, 2023). Therefore, sending out this survey via MyChart should capture a large proportion of the patient population. Finally, this survey was sent in English, which limits the population responding to the survey. This may have led to a higher proportion of Caucasian/White respondents. In the future, we can try to be more inclusive of all patients by creating surveys that can be easily translated into other languages and accessible via multiple forms. Understanding the perspectives on IM use from non-English-speaking patients is also important. Since many IM practices arise from different cultures, it will be imperative to include patients from all backgrounds.

Conclusion

This is the first study in the United States to evaluate patient perceptions of IM resources at an NCI-designated comprehensive cancer center among patients with a broad range of cancer diagnoses. Our results of this study suggest that there is a high demand for more IM resources and more education is needed to inform patients about our already-available resources. The data from this study are important in building an Integrative Oncology program to improve the quality of life for our oncology patients. Future directions include understanding provider perceptions of IM use during cancer treatments and their awareness of IM resources on our campus. Furthermore, understanding the perspectives on IM use from non-English-speaking patients will allow building a diverse and inclusive Integrative Oncology program. There is still much work that is needed to truly integrate IM into our health system and cancer center.

Footnotes

Acknowledgments

Alyssa Davis—University of California MyChart Support. Jenny Neeley—University of California SlicerDicer Support. Carin Lao—the University of California REDCap support.

Authors’ Contributions

H.C.: Conceptualization (lead), methodology (lead), formal analysis, and writing original draft (lead). T.P.: Data curation, project administration, and writing (review and editing). M.P.: Formal analysis (lead-equal) and writing (original draft). M.W.: Formal analysis (lead-equal) and writing (original draft). B.S.: Conceptualization, methodology, and review and editing. S.M.: Conceptualization, methodology, project administration, and review and editing. M.D.: Supervision and review and editing (lead).

Author Disclosure Statement

M.D. has received royalties from UpToDate. None of the other authors have any disclosures.

Funding Information

The work described was supported by the National Institutes of Health, Building Interdisciplinary Research Careers in Women’s Health at UC Davis through grant number 5K12HD051958 as well as the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through grant UL1 TR001860.

Supplementary Material

Supplementary Data S1

Supplementary Data S2

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