title: Cancer patients use unconventional medical therapies far more frequently than standard history and physical examination suggest.
abstract: BACKGROUND
  Studies with questionnaires have suggested that many cancer patients utilize unconventional medical therapies (UMT). There are few data evaluating directed questions about the use of UMT. This study was performed to determine if careful directed questioning about UMT reveals a higher rate of utilization compared to standard history and physical examination.
  
  
  METHODS
  A prospective evaluation of 196 consecutive patients presenting for initial consultation at the University of Pennsylvania was performed. Each patient underwent standard history and physical examination, including questions regarding prescription and over-the-counter medications. At the completion of standard questioning, patients were asked an explicit set of directed questions regarding the utilization of UMT. The median age of the patient population was 61 years (range = 28-80 years). Cancer diagnoses included breast (19%), lung (28%), prostate (26%), and other (27%). Females constituted 32% of the patient population.
  
  
  RESULTS
  Initially, only 13 patients (7%) revealed they were using UMT during a standard history and physical. Evaluation of the remaining 183 patients with directed questioning revealed an additional 66 patients (36%) were utilizing these therapies. Of the 79 patients taking UMT, 84% were identified by directed questioning and 16% by standard history and physical examination (P < 0.0005). Forty-one patients (52%) were using > or = 2 of these therapies (mean = 2.5; range 1-17 therapies). A total of 48 different UMT were used by this patient population. Patients utilizing multivitamin supplementation were significantly more likely to be using an UMT than those who were not (68% vs. 31%; P < 0.0001). Females were more likely to use UMT than males (49% vs. 35%; P = 0.08).
  
  
  CONCLUSIONS
  The addition of explicitly directed questioning to the standard history and physical examination significantly increases the oncologist's ability to identify cancer patients who utilize UMT. Some of these therapies may interact with conventional cancer treatments and/or cause significant side effects; consequently, it is important for oncologists to detect those patients utilizing these therapies.
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Metz
authors.forename: H
authors.initials: H
authors.lastname: Jones
authors.forename: P
authors.initials: P
authors.lastname: Devine
authors.forename: S
authors.initials: S
authors.lastname: Hahn
authors.forename: E
authors.initials: E
authors.lastname: Glatstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000529:Complementary Therapies; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010349:Patient Compliance; D017060:Patient Satisfaction; D010808:Physical Examination; D011446:Prospective Studies; D011795:Surveys and Questionnaires