Abstract P4-14-03: Stage-specific survival of breast cancer patients receiving alternative medicine for treatment of cancer
Authors: Li Huaqi , Yu James B , Gross Cary P , Park Henry S , Johnson Skyler B 
Published: March 2020

Abstract
Background: We previously reported on the decreased survival in cancer patients associated with alternative medicine (AM). There is limited information on incidence and stage-specific survival outcomes of breast cancer patients who receive AM compared to those who receive conventional cancer treatment (CCT). Methods: Patients diagnosed with breast cancer in 2004-2016 were identified using the National Cancer Database. Patients were excluded if they had multiple malignant primaries, had radiation to a site other than breast, had unknown treatment status, received palliative care, or had missing death, estrogen receptor (ER), progesterone receptor (PR), and/or clinical stage information. Those who received an unproven cancer treatment and did not receive any CCT, defined as surgery, radiotherapy, chemotherapy, and/or hormone therapy, were classified within the AM group. Annual cumulative incidence of AM was assessed and differences by year were analyzed by the Cochran-Armitage test. Treatment selection was evaluated by the chi-square test, t-test, and logistic regression. Following 2:1 matching on age, clinical group stage, Charlson-Deyo comorbidity score (CDCS), insurance type, race, and year of diagnosis, overall and stage-specific survival were analyzed using the Kaplan-Meier method, log-rank test, and Cox proportional hazards regression for early stage (clinical stages I and II), locally advanced stage (clinical stage III), and metastatic disease (clinical stage IV).Variables with a p-value of ≤ 0.1 on univariate analyses were selected for entry into multivariable Cox proportional hazards survival modeling. Results: We identified 139 patients with breast cancer who received AM. The annual cumulative incidence of AM varied widely by year with increasing use from 10.8/100,000 in 2012 to 20.5/100,000 in 2015. Use of AM from 2004 to 2015 did not significantly increase. On multivariable analysis, when controlling for demographic and clinical factors, those residing in a non-metropolitan county compared to a metropolitan country (Odds Ratio [OR] = .42, 95% Confidence Interval [CI]  = .17 to .99) and those with a CDCS of 1 compared to 0 (OR = .33, 95% CI = .12 to .91) were less likely to receive AM; those receiving care in a Pacific location compared to a Northeast location (OR = 5.57, 95% CI = 2.61 to 11.88) and those with a clinical stage of 4 compared to 1 (OR = 6.53, 95% CI = 3.30 to 12.94) were more likely to receive AM. Following matching, there were no significant differences between matched characteristics (all p&gt;0.9). On matched univariate survival analysis, AM was associated with worse 5-year survival compared to CCT in the overall group (54% vs 82%, p&lt;0.001; Hazard Ratio [HR]: 2.97, 95% CI 2.01-4.38), as well as in patients with stage I or II (67% vs 91%, p&lt;0.001; HR: 3.88, 95% CI 2.15-6.98), stage III (50% vs 83%, p=0.002; HR: 3.99, 95% CI 1.55-10.30), and stage IV (0% vs 34%, p&lt;0.001; HR: 3.21, 95% CI 1.56-6.59) disease.When controlling for factors associated with survival on univariate analysis, AM remained independently associated with greater risk of death in the overall group (HR: 4.03, 95% CI 2.64-6.15), as well as in patients with stage I or II (HR: 4.03, 95% CI 2.23-7.30), stage III (HR: 5.23, 95% CI 1.83-14.93), and stage IV (HR: 3.27, 95% CI 1.04-10.30) disease. Conclusions: Compared to CCT, AM utilization is rare and is associated with greater risk of death in all breast cancer stages. These results may provide patients and providers with data to assist in informed decision-making and provide novel insights into the contemporary natural history of breast cancer.
Citation Format: Huaqi Li, James B Yu, Cary P Gross, Henry S Park, Skyler B Johnson. Stage-specific survival of breast cancer patients receiving alternative medicine for treatment of cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-14-03.