Absent and Discordant Electronic Health Record Documentation of Complementary and Alternative Medicine in Cancer Care

Abstract

Objectives: Many patients with cancer use complementary and alternative medicine (CAM), but the quality of CAM documentation in their electronic health records (EHRs) is unknown. The authors aimed to describe (i) the prevalence and types of CAM used after cancer diagnosis and the influence of oncologists on CAM use, as per patients' self-report, and (ii) the prevalence of CAM documentation in the EHR and its consistency with self-reported usage. Design: Patient and provider surveys and chart review. Settings/Location: Medical oncology practices at one institution. Subjects: Patients with cancer at oncologist visits. Outcome measures: Patient self-reported rate of 3-month postvisit CAM use; provider EHR documentation of CAM use or discussion and its concordance with patient self-report. Results: Among 327 patients enrolled, 248 responded to the 3-month postvisit survey. Of these, 158 reported CAM use after diagnosis (63.7%). CAM users were younger (p < 0.001) and had a higher percentage of women (p = 0.03) than nonusers. Modalities most commonly used were supplements (62.6%), special diets (38.6%), chiropractor (28.4%), and massage (28.4%). CAM was used to improve well-being (68.7%), manage adverse effects (35.5%), and fight cancer (22.9%). Oncologists suggested CAM in 22.5% of instances of use. CAM use/discussion was documented for 58.2% of self-reported CAM users. Of the documented modalities, EHR and self-report were concordant for only 8.2%. CAM documentation was associated with physician provider (p = 0.03), older patients (p = 0.01), and treatment with radiation (p = 0.03) or surgery (p = 0.001). After adjusting for other factors, patients with breast cancer or ''other'' tumor category were four times more likely than patients with gastrointestinal cancer to have CAM use documentation (odds ratio [95% confidence interval]: 4.41 [1.48-13.10]; 3.76 [1.42-9.99], respectively). Conclusions: Most patients with cancer use CAM after diagnosis, yet EHR documentation is complete for very few. Oncologists should inquire about, document, and discuss CAM benefits and harm or refer patients to CAM specialists.

Use of Complementary and Alternative Medicine in Patients with Cancer and their Relationship with Health Behaviours: A Cross-Sectional Study

“…Most often, the patients chose vitamin C, green tea, vitamin D and curcuma. Similar results were obtained in the studies carried out by Stanisz et al [16], Stan et al [13], Kwon et al [20], Kessel et al [21], Sárváryi et al [22] and King et al [23].…”

“…It proves the lack of communication between the healthcare staff and patients with diagnosed cancer as well as the fear that oncologists will not accept CAM. Stan et al [13] from the USA report that as many as 96% of the patients informed their oncologists about the use of complementary and alternative medicine. Similar results, i.e.…”

Complementary and alternative medicine use in glioma patients in France

“…Future studies should prospectively address to what extent CAM use exerts intrinsic toxicity or alters tolerability and safety of standard cancer therapies or novel agents administered in the context of clinical trials [15]. As a prerequisite for that, it would be important to implement proper CAM use documentation in clinical patient records [36].…”

Complementary Medicine Provision in an Academic Hospital: Evaluation and Structuring Project

“…One way to ensure this continuity of care in a hospital is to guarantee a written record of CM treatments in the main electronic medical record (EMR). 7,29,33,41 The results of this project showed a need for better documentation of CM treatments because notes on CM were not systematically recorded in the patients' EMRs, as has also been the case in other settings, 42 despite the fact that sharing of patients' medical information in the EMR has been shown to be vital. 40 Action priorities to structure CM…”