Use of dietary supplements and multiple modalities of complementary and alternative medicine (CAM) were both associated with reduced initiation of clinically indicated chemotherapy among patients with early-stage breast cancer, a study published in JAMA Oncology has shown.1

Not all women opt for clinically indicated adjuvant breast cancer therapy. Because it is important for clinicians to identify women less likely to initiate chemotherapy, researchers sought to investigate whether CAM use is associated with decreased chemotherapy initiation.

For the multicenter, prospective study, researchers enrolled 685 women younger than 70 years with nonmetastatic invasive breast cancer. Patients 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. Of those, 306 (45%) were clinically indicated to receive chemotherapy according to National Comprehensive Cancer Network (NCCN) guidelines.

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Current use of CAM modalities, including vitamins and/or minerals, herbs and/or botanicals, other natural products, mind-body self-practice, and mind-body practitioner-based practice, was assessed through baseline interviews. Researchers evaluated chemotherapy initiation via self-report up to 12 months after baseline.

Results showed that 598 women (87%) reported baseline CAM use and 272 of the 306 women (89%) who were clinically indicated for chemotherapy actually initiated chemotherapy. Among those for whom chemotherapy was discretionary, 135 women (36%) initiated chemotherapy.

Researchers found that among the 306 women for whom chemotherapy was indicated, those who used dietary supplements and women who used a higher number of CAM modalities were less likely to initiate chemotherapy compared with nonusers of CAM; however, use of mind-body practices was not associated with chemotherapy initiation.

The study further demonstrated that there was no association between CAM use and chemotherapy initiation among patients for whom chemotherapy was discretionary.

The findings suggest that clinicians should consider including CAM use in their discussion with patients during the chemotherapy decision-making process.


1. Greenlee H, Neuget AI, Falci L, et al. Association between complementary and alternative medicine use and breast cancer chemotherapy initiation: The Breast Cancer Quality of Care (BQUAL) study [published online ahead of print May 12, 2016]. JAMA Oncology. doi: 10.1001/jamaoncol.2016.0685.