title: An unconventional cancer treatment lacking clinical efficacy remains available to Italian cancer patients.
abstract: OBJECTIVE
  An unconventional cancer treatment known as "Di Bella multitherapy" gained popularity among Italian cancer patients during the 90's. In 1999, it was shown to lack any detectable antitumor activity. Access to the multitherapy was investigated three years later within the post-bereavement Italian Survey of the Dying of Cancer (ISDOC), whose broader aim was to investigate the end-of-life care experiences of terminal cancer patients.
  
  
  METHODS
  ISDOC was carried out in a two-stage probability sample of 2,000 out of 160,000 Italian cancer patients deceased between March 2002 and June 2003. For each cancer patient, a non-professional caregiver, i.e., the closest and the best-informed person about her/his last three months of life, was identified. A specific question concerning the "Di Bella multitherapy" was included in a semi-structured questionnaire that was administered face-to-face to the caregivers by trained interviewers. Weighted estimates of the frequency of patients receiving the multitherapy in the target population and their 95% confidence intervals were computed by taking into account stratification and clustering of observations.
  
  
  RESULTS
  During their last three months of life, 0.7% (95% CI, 0.3-1.6) of terminal cancer patients, corresponding to some 1,100 subjects (range, 480-2,560), received the multitherapy. No statistically significant difference was observed for age at death, cancer type, gender, education, marital status, or residence.
  
  
  CONCLUSIONS
  The finding indicates that an unconventional cancer treatment proven to lack clinical efficacy remained accessible to Italian cancer patients. Ethical, deontologic, and economic implications call for a routine monitoring of provision of and access to unproven cancer treatments.
authors.affiliation: Epidemiology and Biostatistics and Clinical Trials and Bioethics, National Cancer Research Institute, Genoa, Italy. franco.merlo@istge.it
authors.forename: Domenico Franco
authors.initials: DF
authors.lastname: Merlo
authors.forename: Monica
authors.initials: M
authors.lastname: Beccaro
authors.forename: Massimo
authors.initials: M
authors.lastname: Costantini
mesh_terms: D000368:Aged; D001293:Attitude to Death; D017028:Caregivers / Q000523:psychology; D000529:Complementary Therapies; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D010166:Palliative Care; D011795:Surveys and Questionnaires; D015996:Survival Rate; D013727:Terminal Care; D016896:Treatment Outcome