Using the National Cancer Database (2010–2019), this study examined predictors of CAM use and its association with overall survival among 1,526,482 adults with GI cancers, comparing four groups: traditional therapy only, CAM alone, combination CAM plus traditional therapy, and no treatment.
CAM alone was associated with 86% higher mortality vs. traditional therapy (aHR 1.86; 95% CI 1.37–2.51), while combination CAM plus traditional therapy showed no survival difference (aHR 1.00; 95% CI 0.78–1.27). CAM use was most strongly linked to pancreatic (aOR 10.22) and liver cancer (aOR 10.09).
CAM users (alone or combined) represented <0.1% of the cohort, raising concerns about ascertainment bias and very small sample sizes in those groups (n=197 and n=193). The NCDB does not capture granular CAM type or patient intent, limiting causal inference. Residual confounding by performance status, patient preference, and disease severity is likely.
Patients with GI cancer who rely on CAM alone face significantly worse survival than those receiving standard treatment — counsel them proactively, especially those with pancreatic or liver cancer. Adding CAM to traditional therapy does not appear to worsen survival, so discussion should focus on replacing, not supplementing, standard care.
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