Complementary and alternative medicine (CAM) use in cancer patients of immigration background.
Authors: Wu Alex , Wu Yunhong , SINGH PRABHSIMRANJOT , Natarajan Vijaya , Cheema Waseem , Hossain Rukhsana , Liu Christine , Mejia Yocasta , Oo Myoe Htet Htet , Valenzano Bina , Xu Yiqing 
Published: June 2021

12019 Background: Cancer patients are more likely to use complementary and alternative medicine (CAM) than non-cancer patients for immune enhancement and symptom relief. Cancer patients with immigration background may seek out CAM use more readily due to the influence from their cultural background. Methods: We carried out a prospective questionnaire study surveying the use of 21 CAM types to cancer patients between 10/23/2015 and 10/31/2020, to evaluate the association of CAM use with patients’ age, sex, cancer types, stages, race/ethnicity, birthplace, immigration duration, first language, marital status, levels of poverty, education and anxiety. Results: 658 patients were included in this analysis. The median age was 62 years old. The prevalence of CAM use was 66.11%. CAM use was higher in females (71.98%) than the males (54.34%) (p = 1.13x10-5), and higher in patients ≥ 38 years old (67.09%) than < 38 years old (46.88%) (p = 0.0215). Patients of African American descent (both US born and foreign born) (n = 198) had statistically higher CAM use (72.73%) than the Caucasians and Others (including Middle-Eastern, Multi-Racial and Others) (n = 266) (63.53%) (p = 0.0371). There was no difference of CAM use between the US born patients (n = 301, CAM use 68.77%) and the immigrants (n = 347, CAM use 63.98%) as a whole; however, Asian born immigrants (n = 106) had statistically less CAM use (53.77%) than the US born and other non-Latin American born (n = 397, CAM use 66.50%) (p = 0.0161), while the Latin-American born had a trend towards higher CAM use (74.83%, P = 0.0608). The number of years living in the US by the immigrants did not have an association with CAM use. Among psychosocial economic factors, married patients had a lower CAM use (61.23%) than the unmarried group (defined as divorced, separated, widowed, or single status, 70.85%) (p = 0.0102). The levels of education, poverty and anxiety did not show a statistical difference in relation to CAM use. Earlier stages of disease had numerically higher CAM use than stage 4 patients, and patients with breast and GYN cancers had higher CAM use (72.30%, p = 0.00252), consistent with the data on the higher CAM use in females. Prayer and spirituality and Dietary medicine were the 2 most common CAM types used (25.91% and 16.12%, respectively). African Americans of the combined US and Non-US origin showed the highest rate of using Prayer and spirituality (84.72%), versus Hispanics (71.19%), Caucasians (53.85%), and Asians (40.32%). Chiropractic therapy was exclusively used by Caucasian CAM users (9.38%). Conclusions: Among cancer patients of multi-ethnic groups with immigration background served in a community hospital in Brooklyn, New York, CAM use appeared to be higher in the African American patients, and lower in the patients born in Eastern Asia, as compared to the US born, or to Caucasians. Cultural roots appeared to be a strong influencing factor among all the medical and socioeconomic factors.