Temporal Trends of Alternative Therapy Use before, during and after Cancer Treatment: Results from the Multi-Institutional Complementary and Alternative Medicine Exposure in Oncology (CAMEO) Study

Complementary and alternative medicine (CAM) use has been well-documented among cancer patients, with increasing public awareness of non-traditional treatments in the era of COVID-19. However, the temporal trends in usage at the patient level have not been well defined. We sought to characterize trends in what CAM interventions patients used before, during and after cancer treatment. An NCI-designated cancer center and a comprehensive cancer center prospectively enrolled adult cancer patients onto a cross-sectional survey assessing CAM use between 2020 and 2021. The survey evaluated perceptions and use of CAM, including vitamins/minerals, herbal supplements and alternative medicines, diets, and mind/body therapies. Types of CAM utilized were self-reported by use before, during and after primary cancer treatment. Differences in utilization were analyzed with two-proportion z-tests. Among 749 patients enrolled, 578 (77%) reported using CAM. Among CAM users, the most popular interventions used at some point included multivitamins (60%), vitamin D (58%), prayer (48%), vitamin C (35%), massage (33%), meditation (28%), fish oil (24%), probiotics (21%), turmeric (20%), CBD products (19%), chiropractic manipulation (17%), marijuana (16%) and vegetarian diet (12%). Vitamin use nearly universally declined over the before → during → after period, for example multivitamin (52% → 39% → 31%, p<0.01), vitamin D (37% → 42% → 30%, p<0.01), and calcium (21% → 24% → 15%), p<0.01). No vitamin consumption increased after treatment compared to before. Multiple herbal supplements increased during treatment but stayed higher than pre-treatment levels, including CBD (5.4% → 13% → 8.2%, p<0.01), marijuana (6.0% → 12% → 7.9%, p<0.01) and turmeric (9.1% → 13% → 9.3%). Many specialized diets were adopted during treatment but were not continued afterward, including vegetarian (5.4% → 8.3% → 5.5%), vegan (2.2% → 5.2% → 2.2%), ketogenic (3.3% → 4.3% → 2.6%), alkaline (1.2% → 3.6% → 1.9%) and raw food (0.9% → 1.4% → 0.3%). Mind/body intervention use also nearly universally decreased over the before to after period, such as chiropractic manipulation (16% → 7.4% → 5.9%, p<0.01), yoga (12% → 12% → 9.2%) or pilates (34.2% → 2.2% → 1.6%). Some increased during treatment but decreased after, like acupuncture (8.0% → 12% → 5.9%, p<0.01) or meditation (18% → 23% → 15%, p<0.01), with the largest decrease being in prayer (43% → 44% → 32%, p<0.01). Although CAM use is known to be common, the patterns of use before, during and after treatment have not been well-defined. Herbal supplements were the most likely to continue to be used after cancer treatment. General health maintenance, wellness and mind/body interventions largely decreased below pre-treatment levels after treatment, regardless of utilization during treatment. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Use Patterns and Perceptions of Non-Traditional Therapies in Radiotherapy Patients: Results from the Multi-Institutional Complementary and Alternative Medicine Exposure in Oncology (CAMEO) Study

The use of complementary and alternative medicine (CAM) has been associated with detrimental effects on survival outcomes in cancer patients compared to standard of care medical interventions. CAM has received a significant increase in public awareness and interest in recent years. We sought to understand use patterns and perceptions in radiotherapy patients. Data was collected from a cross-sectional survey of prospectively enrolled adult cancer patients, conducted at an NCI-designated cancer center and a comprehensive cancer center between 2020 and 2021. Cancer patients who received or were recommended radiotherapy were selected for analysis and grouped by CAM use. CAM users analyzed were those reporting use of enteral and parental interventions, including alternative medicines, special diets and herbal, vitamin and mineral supplements, and excluding mind/body practices. Differences between CAM users and non-users were analyzed with χ2 and two-sample t-tests. Predictors of CAM use were identified with multivariable logistic regression. Of the 749 respondents, 445 (59%) received or were recommended radiotherapy. Of those 445, 297 (67%) used enteral or parenteral CAM. Among CAM users, 81% were satisfied and 77% felt CAM was effective for intended use. The most common goal of CAM therapy was symptom management (44%), although CAM use as a curative-intent treatment (31%) was common. Compared to non-users, CAM users were more likely to be female (76% vs 62%, p<0.01), have self-reported incurable disease (73% vs 62%, p=0.04), to feel CAM is safe (45% vs 9%, p<0.01), effective at curing cancer (26% vs 11%, p<0.01), effective at managing symptoms (42% vs 20%, p<0.01), more likely to trust naturopaths (33% vs 22%, p=0.02) or chiropractors (26% vs 15%, p=0.01), more likely since COVID-19 to have a more favorable view of CAM (79% vs 42%, p=0.01) or use CAM (61% vs 40%, p=0.04), but less likely to decline recommended surgery (7% vs 19%, p<0.01) or recommended radiotherapy (5% vs 11%, p=0.03). No differences were noted between CAM users and non-users in trust of physicians or any media. Predictors of enteral or parenteral CAM use included female gender (OR 1.4, p=0.04), breast cancer (OR 2.1, p=0.03), colon cancer (OR 3.5, p=0.01), and metastatic cancer (OR 2.2, p<0.01). The use of CAM is common among patients receiving or recommended radiotherapy, with nearly one-third of patients using CAM as a cancer cure. However, radiotherapy patients using CAM were less likely than non-users to decline other recommended therapies, dispelling the notion that CAM-users are more likely to eschew standard-of-care treatments, at least in this cohort. Understanding the patterns and perceptions of CAM use in radiotherapy patients is essential for improving patient-physician communication and treatment decision-making. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Shifting perceptions of alternative therapies in cancer patients during the COVID-19 pandemic: Results from the Complementary and Alternative Medicine Exposure in Oncology (CAMEO) Study

Background: Complementary and alternative medicine (CAM) use has been associated with worse survival outcomes in cancer patients compared to standard of care therapies. CAM has received a significant increase in public awareness and interest in the COVID-19 pandemic era. We sought to understand how the COVID-19 pandemic affected CAM use and perceptions in cancer patients. Methods: Data was collected from adult cancer patients prospectively enrolled on a cross-sectional survey conducted at an NCI-designated cancer center and a comprehensive cancer center between 2020 and 2021. The survey included questions assessing changes in patient attitude towards CAM and likelihood of using CAM, both relative to prior to COVID-19. Analyzed CAM users included those taking vitamin, mineral and herbal supplements, alternative medicines and special diets, and excluded mindbody practices as the focus of this analysis was on enteral and parenteral CAM therapies. Differences in the impact of COVID-19 on CAM use beliefs and practices between CAM users and non-users were analyzed with χ2 and two-sample t-tests. Results: Out of 749 respondents, 578 (77%) used any CAM and 470 (63%) used enteral or parenteral CAM. Results shown in table. Compared to prior to COVID- 19, CAM users were more likely to view CAM more favorably (12% vs 5%, p < 0.01), while non-users were more likely to have an unchanged opinion (90% vs 84%, p = 0.03). Females had higher rates of viewing CAM more favorably than males (80% vs 58%, p = 0.04). Patients who viewed CAM more favorably had higher rates of self-reported incurable cancer (36% vs 11%, p = 0.04), declining recommended hormone therapy (22% vs 0%, p < 0.01), and higher trust of social media (19% vs 0%, p = 0.02) and websites (24% vs 0%, p < 0.01). Since the start of COVID-19, CAM users were more likely to report increased likelihood of using CAM (12% vs 6%, p = 0.01). Patients who were more likely to use CAM had higher rates of declining recommended chemotherapy (12% vs 0%, p = 0.02), and higher trust of social media (15% vs 2%, p = 0.01) and websites (28% vs 7%, p < 0.01). Conclusions: During the COVID-19 pandemic, attitudes on CAM use in oncology patients have become increasingly polarizing. Patients with favorable attitudes toward CAM were likely to decline recommended standard of care therapy and more like to use CAM since COVID-19. This data helps characterize shifting attitudes toward CAM and may help guide shared decision-making between physician and patient.

Ethical Reasoning During a Pandemic: Results of a Five Country European Study.

Introduction: There has been no work that identifies the hidden or implicit normative assumptions on which participants base their views during the COVID-19 pandemic, and their reasoning and how they reach moral or ethical judgements. Our analysis focused on participants' moral values, ethical reasoning and normative positions around the transmission of SARS-CoV-2.Methods: We analyzed data from 177 semi-structured interviews across five European countries (Germany, Ireland, Italy, Switzerland and the United Kingdom) conducted in April 2020.Results: Findings are structured in four themes: ethical contention in the context of normative uncertainty; patterns of ethical deliberation when contemplating restrictions and measures to reduce viral transmission; moral judgements regarding "good" and "bad" people; using existing structures of meaning for moral reasoning and ethical judgement.Discussion: Moral tools are an integral part of people's reaction to and experience of a pandemic. 'Moral preparedness' for the next phases of this pandemic and for future pandemics will require an understanding of the moral values and normative concepts citizens use in their own decision-making. Three important elements of this preparedness are: conceptual clarity over what responsibility or respect mean in practice; better understanding of collective mindsets and how to encourage them; and a situated, rather than universalist, approach to the development of normative standards.

COVID-19 contact tracing apps: UK public perceptions.

In order to combat the COVID-19 pandemic, policymakers around the globe have increasingly invested in digital health technologies to support the 'test, track and trace' approach of containing the spread of the novel coronavirus. These technologies include mobile 'contact tracing' applications (apps), which can trace individuals likely to have come into contact with those who have reported symptoms or tested positive for the virus and request that they self-isolate. This paper takes a critical public health perspective that advocates for 'genuine participation' in public health interventions and emphasises the need to take citizen's knowledge into account during public health decision-making. In doing so, it presents and discusses the findings of a UK interview study that explored public views on the possibility of using a COVID-19 contact-tracing app public health intervention at the time the United Kingdom (UK) Government announced their decision to develop such a technology. Findings illustrated interviewees' range and degree of understandings, misconceptions, and concerns about the possibility of using an app. In particular, concerns about privacy and surveillance predominated. Interviewees associated these concerns much more broadly than health by identifying with pre-existent British national narratives associated with individual liberty and autonomy. In extending and contributing to ongoing sociological research with public health, we argue that understanding and responding to these matters is vital, and that our findings demonstrate the need for a forward-looking, anticipatory strategy for public engagement as part of the responsible innovation of the COVID-19 contact-tracing app in the UK.

The implications of treatment delays in adjuvant therapy for cholangiocarcinoma patients

Background: To understand the factors associated with timing of adjuvant therapy in the management of intrahepatic and extrahepatic cholangiocarcinoma and the impact of delays on overall survival (OS). Methods: Data from the NCDB for patients with pathologically proven non-metastatic adenocarcinoma of the bile ducts from 2004 to 2014 were pooled and screened. Patients were included only if they underwent surgery and adjuvant chemotherapy (CMT) and/or radiotherapy (RT). Patients who underwent neoadjuvant therapy or received CMT or RT with palliative intent were excluded. Pearson's chisquared test and multivariate logistic regression analyses were used to assess the distribution of demographic, clinical, and treatment factors. After propensity-score matching with inverse probability of treatment weighting, OS was compared between patients who had initiation of adjuvant therapy past various time points using Kaplan Meier analyses and doubly-robust estimation with multivariate Cox proportional hazards modeling. Results: In total, 7,422 patients in our analysis underwent adjuvant treatment. This represented 43% of the study cohort of 17,123 patients. Of the patients who underwent adjuvant treatment, 3,956 (53%) initiated adjuvant therapy by two months, 6,234 (84%) by 3 months and 6,987 (94%) by four months. High-grade disease, macroscopically positive margins, tumors larger than five centimeters, and unknown LVSI status, were associated with earlier initiation of adjuvant treatment at two months or earlier. Patients who received early adjuvant therapy were also more likely to be treated with a combination of CMT and RT. Factors associated with delay of adjuvant therapy beyond three months postsurgery included Charlson scores of one or greater and Hispanic race. After propensity score weighting, there was no survival difference between groups when comparing initiation of adjuvant therapy before or after two, three or four month time pointsConclusions: We identified a number of patient characteristics related to the timing of initiating adjuvant therapy in patients with biliary cancers. There were no significant difference in OS associated with delaying adjuvant therapy beyond two, three or four month time-points. Our findings are relevant in the era of COVID-19 when minimizing patient exposure to healthcare settings during a pandemic may need to be considered when deciding on the timing of adjuvant therapy. If a delay is necessary, our results suggest that there is no survival detriment to initiating adjuvant therapy beyond three or four months after surgery for biliary cancers.