Complementary and Alternative Medicine Use in the Last Year of Life: The COMPASS Cancer Cohort Study

Context: There has been growing interest in the role of complementary and alternative medicine (CAM) as part of end-of-life care.

Objectives: This study prospectively examined the prevalence, predictors and outcomes of ingestible CAM use among cancer patients in their last year of life in Singapore.

Methods: This study (N=427) utilized data across 12 months (4 time points) prior to patient death. Utilizing mixed effects logistic regressions, we examined sociodemographic, clinical (symptom burden) and treatment-related factors associated with CAM use. Subsequently, the association between patient quality of life (i.e., physical, social, emotional, functional well-being) and CAM use were examined.

Results: Half of the patients (50%) reported using CAM at least once in the last year of life while 36% of patients in the last 3 months of life reported using CAM. Among CAM users, 67% reported using western herbal supplements while 56% reported using traditional Chinese medicine. Further, 27-28% of patients used CAM consistently (i.e., for six months or more). Most patients (73%) reported using CAM as a complementary treatment. Patients who were ethnically Chinese (OR: 5.59, 95% CI: 2.29 -13.69), reported less financial difficulties (OR: 0.82, 95% CI: 0.69 - 0.98), and believed in other curative treatments for cancer (OR: 2.39, 95% CI: 1.00 - 5.70) were more likely to use CAM. Controlling for time, CAM use (β: 0.60, CI: 0.01 - 1.19) was associated with higher social well-being.

Conclusions: A significant proportion of terminal cancer patients reported using CAM as a complementary treatment in the last year of life.