Characteristics of prostate cancer patients seeking integrative medicine

Prostate cancer is the most common cancer in older men, with a median diagnosis age of 67 years and a five-year survival rate of 98%.1 Patients often live with long-term physical and psychological sequelae, including genitourinary dysfunction, fatigue, pain, depression, and anxiety.2 Integrative oncology (IO) is a patient-centered, evidence-informed approach to cancer care that combines mind–body practices, natural products, and lifestyle modifications with conventional treatments to manage symptoms and enhance quality of life.3 Similar to geriatric oncology and palliative care, IO emphasizes evaluation of the whole person to improve clinical outcomes. Availability of IO has steadily increased in the past decade,4 and recent estimates indicate over 80% of NCI-designated cancer centers and community hospitals offer IO services.5 However, no previous research has explored the factors that drive prostate cancer patients to seek IO. This study examines the demographics, visit reasons, and symptom burden of prostate cancer patients seeking IO services at an academic cancer center. Established in 1999, the IO program at Memorial Sloan Kettering (MSK) Cancer Center accepts self-referrals or referrals from other MSK providers. We conducted a retrospective outpatient program evaluation of English-speaking prostate cancer patients who received IO consultation at MSK from July 2022 to August 2023. Before initial IO consultation, patients were asked to complete optional electronic questionnaires regarding their symptoms and visit reasons. This study was approved by the institutional review board (IRB#18–445). Demographic data and diagnosis date were extracted from the electronic medical record. In the questionnaire, patients identified the top three reasons for seeking IO consultation and reported their symptom burden using question items informed by validated instruments including the Edmonton Symptom Assessment System and Patient-Reported Outcomes Measurement Information System. Statistical analyses were conducted using STATA (Windows version 12.0, StataCorp LLC, College Station, TX). Among 260 survey respondents, mean age was 69.3 years (SD 9.8), 88.7% were 60 or older, 80.4% were White, and 92.7% were non-Hispanic. Patients sought IO consultation an average of 7.0 years (SD 6.7) after their initial prostate cancer diagnosis. Top visit reasons were guidance with diet and nutrition (53.1%), counseling on herbs and supplements (52.3%), and interest in specific integrative therapies, like acupuncture (31.2%) (Figure 1). The most frequently reported symptoms included fatigue (54.6%), hot flashes (37.7%), and trouble sleeping (34.2%) (Figure 2). 11.9% of patients scored ≥3 points on the PHQ-2, and 10.4% scored ≥3 points on the GAD-2. Over half of participants sought information on herbs, supplements, diet, and nutrition, and approximately one-third reported interest in a specific integrative therapy. Several IO therapies have a strong evidence base for common symptoms reported in this study. For example, the recent Society for Integrative Oncology–American Society of Clinical Oncology joint guidelines recommend acupuncture and massage for pain6 and mindfulness-based interventions for fatigue, anxiety, and depression.7, 8 However, IO therapies lack strong evidence for other commonly reported symptoms, such as hot flashes, highlighting a potential area for future research.9 Given that prostate cancer care typically involves multidisciplinary teams, future research could also explore how to best coordinate IO services with oncologists, geriatricians, primary care providers, and palliative care specialists to address symptoms and needs of this population. The substantial 7-year delay from the cancer diagnosis date to the initial IO consultation date warrants further investigation. Prior research has documented patient-, provider-, and system-level barriers to IO, all of which may contribute to delays in access.10 The time-intensive nature of cancer treatments may also cause patients to wait until the posttreatment period to seek additional services. The late effects of prostate cancer treatments may also influence when patients decide to seek help for their symptoms. Researching these possible reasons may shed light on how and when IO services should be incorporated into multidisciplinary, comprehensive cancer care. This study has several limitations. The survey was optional and limited to English-speaking patients at a single academic center, which may hinder generalizability. This study also lacked follow-up surveys or data on actual IO services received; this information could be helpful to collect in future studies. Additionally, referral information was not included, so provider-effect clustering may have affected the findings. Despite these limitations, this is the first study to describe the characteristics and visit reasons of prostate cancer patients seeking IO services at a single academic cancer center. These preliminary findings may help inform future research to identify and address the needs of a growing patient population. Jared Silberlust contributed to investigation, data curation, writing—original draft, writing—review and editing. Kaitlin Lampson contributed to data curation, writing—original draft, writing—review and editing. Katherine Han contributed to data curation, writing—original draft, writing—review and editing. Q. Susan Li contributed to formal analysis, writing—review and editing. Jun J. Mao: Resources, methodology, writing—review and editing. Kevin T. Liou contributed to conceptualization, project administration, investigation, supervision, writing—review and editing. The authors thank the patients and clinicians for their contributions to this study. This work was supported in part by the National Institutes of Health/National Cancer Institute Cancer Center grant (P30 CA008748, K08CA266927). The authors have no competing interests to declare. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.