Use of Integrative Oncology, Involvement in Decision-Making, and Breast Cancer Survivor Health-Related Quality of Life in the First 5 Years Postdiagnosis

Abstract

Objective: This study sought to describe changes in the health-related quality of life (HRQOL) of women who do and do not seek naturopathic oncology (NO) complementary and alternative medicine (CAM) care during and immediately after breast cancer treatment, and to explore the predictive role of NO CAM care, demographic characteristics, and involvement in decision-making on HRQOL in breast cancer survivors. Methods: Matched cohorts of breast cancer survivors who did and did not choose to supplement their breast cancer treatment with NO care within 2 years of diagnosis participated. NO users were identified through naturopathic doctors’ clinics and usual care (UC) controls with similar prognosis were identified through a cancer registry. The registry provided information about all participants’ age, race, ethnicity, marital status, stage of cancer at time of diagnosis, date of diagnosis, and use of conventional medical treatments (surgery, chemotherapy, radiation, and endocrine therapy). Data of participants’ self-reported involvement in decision-making and HRQOL were collected at study enrollment and at 6-month follow-up. Results: At 6-month follow-up, the NO patients reported significantly more involvement in decision-making about care and better general health than did UC patients (P < .05). Self-reported involvement in decision-making about cancer treatment was associated with better role-physical, role-emotional, and social-functional well-being (P < .05). Race, age, marital status, and congruence of preferred and achieved levels of involvement also predicted aspects of HRQOL in breast cancer survivors (P < .05). Conclusions: Both NO CAM care and involvement in decision-making about cancer treatment may be associated with better HRQOL in breast cancer survivors.

Effects of Vitamin D Use on Health-Related Quality of Life of Breast Cancer Patients in Early Survivorship

“…Additional information about study procedures is available in prior reports that describe the cost and content of NO care provided to the NO cohort and in reports that describe the pilot of these study methods and the enrollment characteristics of our cohorts. 23,24,26,27 This report supplements one describing the HRQOL of women in the 2 cohorts 26 that found women in the NO cohort versus the UC cohort to report reduced levels of HRQOL on study enrollment but slightly higher levels of HRQOL at the 6-month follow-up. This report describes use of vitamin D by women in both study cohorts and the results of laboratory assessments of 25(OH)D blood levels ordered by patients' personal physicians and described in medical records in an effort to understand the contribution of vitamin D recommendation and use to any effects of NO care.…”

“…This report is a secondary analysis following up on a report that found modest improvements in HRQOL associated with NO care use among these women. 26 The differences found here associated with vitamin D levels and supplement use are substantially stronger, suggesting that the extent to which NO providers encourage vitamin D supplement use or healthy practices that increase vitamin D blood levels may be one of the means by which NO providers improve the HRQOL of their patients. Naturopathic providers who see breast cancer patients in early survivorship should be aware that a substantial proportion of their patients may be potentially deficient for vitamin D and may benefit from recommendations to improve vitamin D levels.…”

“…These differences associated with vitamin D use and 25(OH)D blood levels are also larger and more consistent than differences in HRQOL associated with use of NO that we previously reported in this data set. 26…”

What Japanese Women with Breast Cancer Decide: A Mixed Methods Analysis of Web-Based Open-Ended Responses

“…The other possibility is that some participants may not have recognized that they had participated in choosing their BC treatments, as approximately 26-43% of these decisions have been found to be conducted collaboratively with doctors (Nakashima et al, 2012;Shimizu et al, 2019;Yamauchi et al, 2019). There is a positive association between involvement in treatment decision-making and quality of life (QOL) in cancer patients (Hack et al, 2006;Andersen et al, 2009;Atherton et al, 2013;Andersen et al, 2018), suggesting that the manner in which these psychosocial decisions are made, along with the decisions themselves, contribute to increasing a patients' QOL. Even though sociopsychological status after primary care significantly influences cancer patients' QOL (Kobayashi et al, 2008;Konieczny et al, 2020), to the best of our knowledge, no research has been conducted on how patients' involvement in sociopsychological decision-making or how the type of sociopsychological made by them affect their QOL afterward.…”

Barriers and Facilitators to Integrative Oncology Services in Australia: A Changed Mind Set Required

“…43 The additional cost of IO will therefore need to demonstrate financial savings in other ways, for example, by improving adherence to life-saving cancer treatment and reducing the overall burden of disease. [44][45][46] Finally, while a lack of evidence is commonly cited as a reason not to provide or fund IO, 47,48 the findings suggest that building the evidence-base is only one part of the solution. These findings are in line with other non-IO health services research that recognizes the complexities of cultural biases, pragmatic constraints, and the political and organizational realities of decision-makers that combined, often have a greater influence than scientific evidence in ''real-world'' health care priority setting and funding decisions.…”