Complementary and Alternative Medicine (CAM) Use among Elderly Cancer Patients: A cross- sectional study in South Korea

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This study aimed to examined prevalence, patterns, reasons, and associated factors of CAM use among elderly cancer survivors. Materials and Methods A cross-sectional survey was conducted with 420 cancer patients aged ≥ 65 years attending outpatient clinics of the Veterans Hospital System, a 1,000-bed secondary hospital in Seoul, Korea. Data on CAM utilization, modalities, reasons for use, and information sources were collected through structured questionnaires. Multivariate logistic regression was used to identify demographic and clinical factors associated with CAM use. Results Among participants, 60.0% reported CAM use. The most common modalities were exercise (fast walking, 49.4%) and dietary interventions (42.9%). The primary reason was immune enhancement (61.6%), and family members or relatives were the main information source (42.1%). Multivariate analysis revealed that being married (OR 2.49, 95% CI 1.40–4.45), having prostate cancer (OR 2.14, 95% CI 1.36–3.35), and undergoing surgery (OR 1.62, 95% CI 1.07–2.45) were significantly associated with CAM use.. Conclusion CAM use is highly prevalent among elderly Korean cancer patients, particularly in married men, prostate cancer patients, and those who have undergone surgery. Oncologists should incorporate CAM-related discussions into survivorship care, and further studies are warranted to assess the impact of CAM modalities on quality of life and clinical outcomes. Complementary Therapies Neoplasms Aged Republic of Korea Introduction The global aging trend, accelerating at an unprecedented pace, presents formidable challenges to healthcare systems worldwide. According to the World Health Organization, the elderly population is projected to rise dramatically to 2.1 billion by 2050 [ 1 ]. This demographic shift is particularly pronounced in countries like Japan and Korea, where the elderly are expected to comprise 38% and 46.4% of the population, respectively, by 2070, which will have a profound impact on their healthcare systems [ 2 ]. Such shift significantly strains healthcare resources and amplify the burden of diseases like cancer, which show increasing prevalent among the elderly [ 3 ]. Elderly cancer patients, due to their heightened vulnerability to treatment-related side effects, face compounded challenges [ 4 ]. In Europe, the widespread use of dietary supplements among over half of cancer patients necessitates proactive intervention by healthcare providers [ 5 ]. In Korea, lifestyle factors such as smoking and poor dietary habits place elderly men at greater risk, underscoring the urgency for targeted self-management investigations [ 6 ]. Elderly cancer patients have complex needs, often intertwined with mental health problems, as assesses by the Hospital Anxiety and Depression Scale (HADS) [ 17 – 20 ]. Beyond physical symptom management, complementary and alternative medicine (CAM) offers potential relief for emotional and depressive symptoms commonly experienced by cancer patients [ 21 – 24 ]. CAM modalities, including vitamins, ginseng, green tea, and yoga are widely embraced for their perceived efficacy in enhancing immune response, alleviating stress, and managing a variety of health conditions as cancer, cholesterol reduction, and digestive symptoms [ 28 , 29 ]. Notably, ginseng and green tea have been used as therapeutic interventions for heart disease, anxiety, and depression [ 7 ]. Additionally, yoga is recognized for its ability to improve cellular function through by stress reduction, boosting immune function, and enhances physical attributes like flexibility, strength, and balance, thereby thus providing significant benefits to individuals undergoing cancer treatment [ 8 ]. Given these complexities, integrating CAM into supportive care for elderly cancer patients is imperative. Evidence suggests that those who engage in CAM practices, including spiritual practices such as personal prayer and meditation, report improved psychological well-being and quality of life [ 9 ]. Research indicates that personalized CAM interventions, aligned with patients’ cultural and individual preferences, led to better adherence to treatment plans and mitigate anxiety and depression [ 10 ]. This underscores the need for a holistic, patient-centered approach that respects the diverse practices and beliefs of elderly cancer patients. Despite the potential benefits, supportive care incorporating CAM for elderly cancer patients remains scare. The integration of complementary medicine into conventional cancer care remains limited, complicating medical decision-making. Geographic and cultural contexts significantly influence CAM utilization patterns among cancer patients [ 11 ]. While certain CAM practices are prevalent in specific regions, such as mushroom usage in Japan and Chinese medicine in China, and diet and acupuncture are commonly embraced in Taiwan [ 12 , 13 ], comprehensive studies focusing on CAM use among elderly cancer patients in major Asian nations remain limited. Therefore, the objectives of this study were (1) to investigate the patterns and characteristics of CAM use among elderly male cancer patients in Korea and (2) to identify factors associated with CAM utilization in this population. Materials and Methods 1. Setting and design This study was conducted at the Veterans Hospital System (VHS) in Seoul, South Korea, targeting outpatients aged 65 years and older. A convenience sampling method was used, and cancer patients receiving care in six outpatient departments were surveyed: hematology-oncology, surgery, day wards, radiation oncology, gastroenterology, and urology. During the recruitment period, 600 eligible patients were identified, and 450 were invited to participate through both an invitation letter and a follow-up phone call. Of these, 420 agreed to participate (participation rate: 93.3%), while 30 declined. After excluding 12 incomplete questionnaires, data from 408 participants were included in the final analysis (response rate: 97.1%). 2. Study population and survey administration Eligible participants were cancer patients aged 65 years or older who had been diagnosed within the past five years, were able to understand and respond to interview questions, and voluntarily agreed to participate. Patients with physical or cognitive impairments that hindered completion of the questionnaire were excluded. Using a convenience sampling strategy, participants were recruited consecutively in the outpatient setting until the target sample size was reached within the study timeframe. A total of 420 participants were enrolled, enabling the study to address the research questions effectively. While the sample may not be fully representative of the broader elderly cancer population, it was considered appropriate for hypothesis generation and exploratory analysis. 3. Dependent variables The final questionnaire comprised four sections with a total of 34 items. Prior to assessing CAM use, the definition of complementary and alternative medicine (CAM) provided by the World Health Organization was presented to all participants to ensure clarity and consistency. Respondents were asked about their CAM utilization and the specific types of CAM used, which were categorized into five major groups. Additional questions explored reasons for CAM use, consultation with a physician regarding CAM, methods of accessing CAM, and associated out-of-pocket costs. For non-users, reasons for not using CAM were recorded. Finally, participants’ CAM-related practices were evaluated [ 14 , 15 ]. 4. Independent variables The questionnaire assessed patients’ health status and disease characteristics, including relevant clinical features [ 23 ]. Depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS), following the guidelines of the National Comprehensive Cancer Network (NCCN). Stress and pain were evaluated using the Korean version of the distress thermometer and problem list, developed in alignment with the NCCN Guidelines (version 2.2021). Additional items captured information on the cancer treatment process, including diagnosis, stage, and treatment modalities, as well as participants’ experiences with healthcare services. 5. Covariates The first section of the questionnaire collected demographic and socioeconomic characteristics, including age, education level, marital status (married, divorced, widowed), and monthly household income [45, 46]. The data were collected from cancer patients attending six outpatient clinics between 25 August and 15 September 2021. Face-to-face interviews were conducted by trained interviewers, each lasting approximately 10–15 minutes. As a token of appreciation, participants who completed the survey received a $ 10 gift voucher. 6. Statistical analysis All analyses were conducted using the Statistical Package for the Social Sciences (SPSS) version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to summarize sociodemographic and clinical characteristics of the study population. Differences between CAM users and non-users were assessed using the chi-square test. Variables showing statistical significance in univariate analysis were further examined using logistic regression. Multiple logistic regression was performed to identify independent factors associated with CAM use. Statistical significance was set at p < 0.05. Results 1. Characteristics of the participants The sociodemographic and clinical characteristics of the 408 participants are presented in Table 1 . Nearly half of participants were 75 to 79 years of age (45.8%). Most participants had attained a high school level of education (39.9%) and were married or in a marital relationship (79.9%). A statistically significant association was identified between marital status and the utilization of complementary and alternative medicine (CAM), with CAM use being more common among those with a spouse (p = 0.002). Table 1 Sociodemographic and Clinical Characteristics of Participants (n = 408) Variables Total N (%) Users (N = 245) Non-user (N = 163) P- value Age Mean ± SD 75.85 ± 5.87 75.96 ± 5.40 75.74 ± 6.34 65–74 161 (39.4) 95 (38.8) 66 (40.4) 0.717 75–79 187 (45.8) 116 (47.3) 71 (43.6) ≥ 80 60 (14.8) 34 (13.9) 26 (16.0) Educational level Below middle school 155 (38.0) 92 (37.6) 63 (38.7) 0.752 High school 163 (39.9) 99 (40.4) 67 (41.1) College level and above 87 (22.1) 54 (22.0) 33 (20.2) Marital status Spouse 326 (79.9) 184 (75.1) 142 (87.1) 0.002 ** No spouse a 82 (20.1) 61 (24.9) 21 (12.9) Monthly Income ≤ 1,000,000 (KRW) 126 (30.8) 69 (28.1) 57 (35.0) 0.752 1,000,000–3,000,000 (KRW) 225 (55.1) 143 (58.3) 82 (50.3) ≥ 3,000,000 (KRW) 57 (14.1) 33 (13.6) 24 (14.7) Perceived health status Good 203 (49.7) 121 (49.4) 82 (50.3) 0.856 Bad 205 (50.3) 124 (50.6) 81 (49.7) Type of cancer b (N = 445) Prostate cancer 183 (41.1) 125 (51.0) 58 (35.6) 0.001 ** Lung cancer 69 (15.5) 35 (14.3) 34 (20.9) 0.056 Rectal, colon cancer 40 (8.9) 22 (9.0) 18 (11.0) 0.301 Stomach cancer 33 (7.4) 18 (7.3) 15 (9.2) 0.310 Liver cancer 24 (5.3) 15 (6.1) 9 (5.5) 0.490 Thyroid cancer 3 (1.0) 1 (0.4) 2 (1.2) 0.351 Others 93 (20.8) 53 (21.6) 40 (24.5) 0.285 Type of treatment c Surgery 214 (52.5) 139 (56.7) 75 (46.0) 0.043 * Chemotherapy 189 (46.3) 111 (45.3) 78 (47.9) 0.685 Radiotherapy 143 (35.0) 81 (33.1) 62 (38.0) 0.341 Hormone therapy 48 (11.8) 32 (13.1) 16 (9.8) 0.350 Others 44 (10.8) 30 (12.2) 14 (8.6) 0.259 Perceived anxiety level d 0–7 points 267 (65.4) 169 (68.9) 98 (60.1) 0.016* 8–21 points 141 (34.6) 76 (31.1) 65 (39.9) Perceived depression level d 0–7 points 105 (25.7) 73 (29.8) 32 (19.6) 0.014* 8–21 points 303 (74.3) 172 (70.2) 131 (80.4) Perceived distress level < 4 points 159 (39.0) 89 (36.3) 70 (42.9) 0.108 ≥ 4 points 249 (61.0) 156 (63.7) 93 (57.1) * P < 0.05, ** P < 0.001 a Unmarried variable included single/divorced/separated/widowed. b Type of cancer: multiple responses allowed. c Type of treatment: multiple responses allowed. d Normal: 0–7 points, Borderline: 8–10 points, Caseness: 11–21 points Prostate cancer was the most common diagnosis among participants (41.1%), followed by lung cancer (15.5%). Regarding treatment, 52.4% of participants had undergone surgical therapy and 46.3% had received chemotherapy. CAM utilization was significantly higher among patients diagnosed with prostate cancer (51.0%, p = 0.001) and among those who had undergone surgical treatment (56.7%, p = 0.043). An analysis of psychological status demonstrated that CAM users reported significantly lower levels of anxiety (p = 0.016), but higher levels of depression (p = 0.014) compared to non-users. Although CAM use was more frequent among those with a distress score ≥ 4 (63.7%) compared with those scoring < 4 (36.3%) (36.3%), this difference was not statistically significant. 2. The types of CAM used and reasons The distribution of CAM modalities among elderly cancer patients who reported CAM use is presented in Table 2 . Among CAM users, fast walking is the most prevalent CAM intervention, reported by 49.4% of the patients. This was followed by dietary modifications (42.9%) and the use of nutritional supplements such as vitamins (35.1%) and omega-3 fatty acids (28.2%). Table 2 Types of Complementary and Alternative Medicine (CAM) Used by Cancer Patients (n = 245) Used CAM modalities a N (%) Natural product Dietary (black beans, Mixed grains) 105 (42.9) Vitamins 86 (35.1) Omega3 69 (28.2) Ginseng, Red ginseng 55 (22.4) Mushrooms (Chaga, Phellinus linteus) 31 (12.7) Baked garlic 13 (5.3) Green tea or herbal 12 (4.9) Others 63 (25.7) Mind and body practices Fast walking 121 (49.4) Massage 6 (2.4) Hypogastric breathing 2 (0.8) Manual therapy 1 (0.4) Pray, Meditation 10 (4.1) Psychotherapy 5 (2.0) Other complementary health approaches Hand acupuncture 7 (2.9) Acupressure therapy 3 (1.2) Fenbendazole 1 (0.4) Canine meat soup 1 (0.4) a Multiple responses allowed. * Columns do not sum to 100% due to multiple responses. 3. Reasons for CAM Use and Sources of Information The reasons for CAM utilization among elderly cancer patients are summarized in Table 3 . The most frequently reported motivation was to strengthen immunity (61.6%), followed by improving quality of life (30.6%). Other reported reasons included the belief that CAM is natural and without side effects (26.1%), prevention of cancer recurrence (15.1%), treatment of cancer itself (12.7%), and prolonging life (8.6%). Table 3 Reasons for CAM Use and Sources of CAM Information Among Cancer Patients. Category* N (%) Reasons for using CAM (n = 393) a Strengthen immunity 151 (61.6) Improve the quality of life 75 (30.6) Belief that CAM is natural/ no side effect 64 (26.1) Prevent recurrent of cancer 37 (15.1) To treat cancer 31 (12.7) To live longer 21 (8.6) Others 14 (5.6) Sources of CAM information (n = 338) a Family or relatives 102 (42.1) TV (news or advertisement) / Newspaper 69 (28.5) Medical staffs (doctors, nurses) 43 (17.8) Internet (YouTube) 40 (16.5) Neighbors or Friends 39 (16.1) Other patients 11 (4.5) Pharmacist 5 (2.1) Literature 5 (2.1) Traditional Korean Medicine Hospitals 1 (0.4) Others 23 (9.5) a Multiple responses allowed; therefore, column percentages do not total 100%. Sources of CAM information (n = 338) varied considerably. Family or relatives were the most common source (42.1%), followed by media such as television (news or advertisements) and newspapers (28.5%). Medical staff (17.8%), internet sources such as YouTube (16.5%), and neighbors or friends (16.1%) also contributed notably. 4. Factors influencing participants' use of CAM The results of the multivariate logistic regression analysis are presented in Table 4 . Elderly cancer patients with a spouse were significantly more likely to use CAM than those without a spouse also positively associated with CAM utilization (OR = 2.493, p = 0.002). A diagnosis of prostate cancer (OR = 2.136, p = 0.001). Similarly, patients who had undergone surgical treatment were more likely to use CAM (OR = 1.615, 95% CI = 1.065–2.449, p = 0.024). Table 4 Multivariate Logistic Regression Analysis of CAM Use by Demographic and Clinical Factors Category OR 95% CI P -value Marital status No Spouse 1 Ref. Spouse 2.493 1.417–4.384 0.002 * Type of cancer Non-prostate cancer 1 Ref. Prostate cancer 2.136 1.394–3.273 0.001 * Surgery treatment No 1 Ref. Yes 1.615 1.065–2.449 0.024 * Perceived Anxiety 0–7 points 1 Ref. Above 8 points 0.839 0.530–1.328 0.454 Perceived Depression 0–7 points 1 Ref. Above 8 points 0.654 0.389–1.100 0.110 Perceived distress level ≥ 4 points 1 Ref. < 4 points 1.435 0.939–2.914 0.095 OR = Odds ratio; CI = Confidence interval; Ref. = reference category. *Statistically significant at P < 0.05. In contrast, perceived anxiety, depression, and distress levels were not significantly associated with CAM use in the adjusted model. Discussion This study provides novel evidence on the prevalence and determinants of CAM use among elderly cancer patients in Korea, a population often underrepresented in supportive care research. The overall CAM utilization rate was 64%, considerably higher than previously reported rates, such as 27% among U.S. veterans with cancer and 51% in a recent global systematic review [ 16 , 17 ]. Multivariate analysis identified marital status, surgical treatment, and prostate cancer diagnosis as significant predictors of CAM use. Notably, the high uptake of CAM among elderly Korean men contrasts with earlier findings that male patient generally less likely to engage in CAM [ 18 ]. This discrepancy may reflect sociocultural dynamics unique to Korea, including the influence of family caregiving patterns and strong cultural trust in traditional medicine. The importance of proactive clinician–patient dialogue regarding CAM, particularly with elderly male patients, and underscore the need to integrate culturally sensitive supportive strategies into cancer care [ 19 ]. Our study highlights important implications for supportive cancer care in elderly patients. Exercise and dietary interventions emerged as the most practiced CAM modalities, with fast walking reported most frequently. Lifestyle-based strategies such as exercise are not only feasible and safe but are also perceived positively by older patients, who report benefits including reduced stress, improved sleep, and enhanced quality of life [ 20 ]. Elderly cancer patients in particular perceive exercise positively, reporting improvements in physical health and emotional well-being, particularly in stress reduction and sleep quality [ 21 ]. These findings are consistent with prior evidence demonstrating improvements in physical function, disability reduction, chronic disease prevention, and psychological health [ 17 ]. In the Korean context, access to public exercise facilities and senior centers further facilitates participation, fostering social engagement and reducing isolation [ 22 ]. Collectively, these results underscore the need to integrate low-barrier, culturally appropriate lifestyle practices into survivorship care, reinforcing the holistic role of CAM in improving psychosocial well-being and clinical outcomes for elderly cancer patients. Depression and anxiety symptoms are highly prevalent among elderly cancer patients and significantly affect treatment adherence, clinical outcomes, and overall quality of life [ 23 ]. In our study, CAM utilization was more common among patients with depressive symptoms than in those with higher anxiety, suggesting that depression may serve as a stronger motivator for seeking CAM adoption. Approximately two-thirds of participants reported borderline depressive symptoms, underscoring the substantial emotional burden in this population. These findings align with previous research suggesting that psychological vulnerability, particularly depression, often drives engagement with CAM as a form of self-empowerment and emotional regulation. Given that cancer-related fatigue (CRF) often exacerbates mood disturbances—particularly depression—non-pharmacological strategies like structured physical activity may serve as both preventive and therapeutic tools [ 24 ]. Collectively, these results highlight the importance of integrating CAM into holistic, patient-centered cancer care, with tailored exercise and dietary approaches playing a critical role in improving psychosocial well-being and supporting favorable clinical outcomes among elderly patients. Participants in this study reported using CAM primarily to boost immunity and enhance quality of life, often perceiving this intervention as safer due to their natural origin. This perception aligns with previous research that elderly cancer patients frequently turn to CAM to manage symptoms, improve well-being, and assert greater control over treatment decisions [ 25 , 26 ]. However, our findings also revealed several concerns regarding the potential risks associated with unsupervised CAM use in this population, including adverse interactions with conventional medications, increased toxicity, and diminished therapeutic efficacy of standard cancer treatments [ 27 ]. For instance, ginseng - a commonly used CAM product- has demonstrated cytotoxic effects on certain cancer cells, yet its unregulated use may lead to unpredictable outcomes [ 28 ]. Similarly, excessive consumption of dietary supplements such as vitamins can lead to complications including nephrolithiasis and hypercalcemia, thereby interfering with standard cancer therapies [ 29 ]. These risks underscore the limitations of CAM in elderly cancer care, where unregulated production standards, drug-herb interactions, and inconsistent evidence regarding efficacy remain critical concerns [ 30 ]. To mitigate these risks, healthcare providers should play a proactive role by offering balanced, evidence-based guidance on CAM use. Open, non-judgmental communication is crucial in supporting elderly patients in making informed and safe treatment decisions [ 25 ]. Furthermore, establishing trustworthy and accessible sources of CAM information is vital to ensure that elderly cancer patients can navigate integrative care safely and effectively. The sources of CAM information among elderly cancer patients are diverse and shaped by interpersonal and media influences. Family members, spouses, and friends were the primary sources of CAM- related knowledge, aligning with prior studies highlighting the role of familial support in healthcare decisions. Traditional media, such as television programs and newspaper articles, continue to influence perceptions, while digital platforms, including YouTube, are emerging as modest but growing sources of information among older adults. Our findings highlight the significant role of family dynamics in facilitating CAM engagement, particularly in cases where a spouse is present, consistent with literature showing that families of cancer patients often express a heightened need for caregiving-related information and support. At the same time, the proliferation of CAM-related information through non-clinical sources presents a critical challenge, as healthcare providers currently lack robust mechanisms to evaluate the safety, effectiveness, and compatibility of such information with standard oncological treatment regimens. Emerging research calls for healthcare professionals to play a pivotal role by establishing clinical guidelines and rationales for CAM use, thereby helping patients navigate the growing influx of informal health advice. Although cancer management policies are currently increasingly accessible online, they often fall short of addressing the nuanced needs of elderly populations. To bridge this gap, primary medical institutions should integrate exercise therapy and structured CAM education as default components of elderly cancer care protocols. Such institutional embedding, coupled with open clinician-patient dialogue, can enhance decision-making, mitigate treatment risks, and support the safe and informed incorporation of CAM into conventional cancer care. This study has several limitations. Its cross-sectional design precludes causal inference, and the data were collected in 2021; patterns of CAM use may have changed since then due to evolving healthcare access, patient preferences, or the impact of the COVID-19 pandemic. Nevertheless, CAM utilization among elderly cancer patients remains highly relevant, and our findings provide timely evidence for supportive care planning. The single-institution, predominantly male veteran sample may limit generalizability, and reliance on self-reported questionnaires introduces recall bias. Moreover, details on dosage, duration, and frequency of CAM practices were not captured, and potential confounders such as socioeconomic status and comorbidities were not fully addressed. Future research should employ multicenter, longitudinal designs with updated datasets and incorporate clinical endpoints to clarify the impact of CAM on adherence, survivorship, and quality of life. Conclusion This study emphasizes that elderly cancer patients in Korea widely use CAM for supportive care, with exercise and dietary interventions being the most common methods. Immune enhancement is a primary motivation for CAM use, often influenced by family support. Factors such as marital status, prostate cancer diagnosis, and surgical therapy are linked to CAM utilization. However, further research is needed to understand how these factors affect treatment outcomes. Ultimately, this will help develop guidelines to integrate CAM with conventional cancer care and improve supportive care for elderly patients. Declarations Ethical statement The study was approved by the VHS Institutional Review Board (No: 2021-07-004-007). In accordance with ethical procedures, informed consent was obtained from all participants after a full explanation of the study. All procedures involving human participants in this study were conducted in accordance with the ethical standards of the institutional and/or national research committee and the principles of the Declaration of Helsinki. Author Contributions Conceived and designed the analysis: Chang HY, Choi SJ, Im HB, Choi DI, and Han DW Collected the data: Chang HY, Choi SJ and Han DW Contributed data or analysis tools: Chang HY and Han DW Performed the analysis: Choi DI, and Han DW Wrote the paper: Chang HY and Han DW Supervision: Han DW Acknowledgments The authors gratefully acknowledge the valuable participation of all study subjects and appreciate their cooperation and support. Competing interests The authors declare that they have no potential conflicts of interest relevant to this article. Funding source This work was supported by the Veterans Medical Research Institute under Research Project No: VHSMC21046. Data availability: The data supporting this study's findings are available from the corresponding author. Access to the data may be subject to privacy and ethical considerations. References World Health Organization . 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JAMA, 2022. 327 (23): p. 2326. https://www.aafp.org/pubs/afp/issues/2022/1100/ppip-supplementation-cardiovascular-disease-cancer.pdf River, J., et al., Convergent priorities and tensions: a qualitative study of the integration of complementary and alternative therapies with conventional cancer treatment. Supportive Care in Cancer, 2018. 26 (6): p. 1791-1797. https://link.springer.com/content/pdf/10.1007/s00520-017-4021-0.pdf Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7605426","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":515614476,"identity":"433404ba-1d6a-403a-b998-5db3a47b7e6b","order_by":0,"name":"Hyunyem Chang","email":"","orcid":"","institution":"Veterans Hospital System medical center","correspondingAuthor":false,"prefix":"","firstName":"Hyunyem","middleName":"","lastName":"Chang","suffix":""},{"id":515614477,"identity":"b582ed37-7b0c-4d3a-bd6f-250fec9fd945","order_by":1,"name":"Soo Jeung Choi","email":"","orcid":"","institution":"Hanyang University","correspondingAuthor":false,"prefix":"","firstName":"Soo","middleName":"Jeung","lastName":"Choi","suffix":""},{"id":515614479,"identity":"9d0efbb6-e5f4-4c08-8299-ae5a083e69ee","order_by":2,"name":"Hyea Bin Im","email":"","orcid":"","institution":"Hanyang University","correspondingAuthor":false,"prefix":"","firstName":"Hyea","middleName":"Bin","lastName":"Im","suffix":""},{"id":515614481,"identity":"23f73f27-6201-4904-9404-b685522bab50","order_by":3,"name":"Dain Choi","email":"","orcid":"","institution":"Hanyang University","correspondingAuthor":false,"prefix":"","firstName":"Dain","middleName":"","lastName":"Choi","suffix":""},{"id":515614482,"identity":"1148ef8d-77aa-4dcc-bce2-85aba4b8e2f6","order_by":4,"name":"Dongwoon Han","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYDCCAzxAouIAkggPUVrOkKyFsY0ULXw3cg9+Lpx3R95cIvnZwy8MdvIMPGcf4NUieSMvWXrmtmeGO2ekmRvLMCQbNvC2G+DVYnA7x0Cad9thxg03EsykJRiYExj42fA7DKjF+DfvnMP2G26kfwNqqSdKi5k0b8PhxA03cswkPzAcTmDgbcOvRfL+GzNrnmOHkzeceVMmzWBw3LCN5xh+LXxnzhjf5qk5bLvhePo2yR8V1fL8PGn4tSCAQAIDMw8wrAj4BBnwH2Bg/EG88lEwCkbBKBhBAAB8UEYHlDEt7QAAAABJRU5ErkJggg==","orcid":"","institution":"Hanyang University","correspondingAuthor":true,"prefix":"","firstName":"Dongwoon","middleName":"","lastName":"Han","suffix":""}],"badges":[],"createdAt":"2025-09-13 07:23:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7605426/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7605426/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91719864,"identity":"799cc328-dd65-4ff4-9aad-35170925afcf","added_by":"auto","created_at":"2025-09-19 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14:07:41","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":110254,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7605426/v1/d8d050b654eb80eee864ecfa.html"},{"id":92912333,"identity":"04e849cb-1c81-4411-bb22-86051d818d8a","added_by":"auto","created_at":"2025-10-07 04:16:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":916206,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7605426/v1/14049145-745e-4e83-ab5d-21280655f411.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Complementary and Alternative Medicine (CAM) Use among Elderly Cancer Patients: A cross- sectional study in South Korea","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe global aging trend, accelerating at an unprecedented pace, presents formidable challenges to healthcare systems worldwide. According to the World Health Organization, the elderly population is projected to rise dramatically to 2.1\u0026nbsp;billion by 2050 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This demographic shift is particularly pronounced in countries like Japan and Korea, where the elderly are expected to comprise 38% and 46.4% of the population, respectively, by 2070, which will have a profound impact on their healthcare systems [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Such shift significantly strains healthcare resources and amplify the burden of diseases like cancer, which show increasing prevalent among the elderly [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Elderly cancer patients, due to their heightened vulnerability to treatment-related side effects, face compounded challenges [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In Europe, the widespread use of dietary supplements among over half of cancer patients necessitates proactive intervention by healthcare providers [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In Korea, lifestyle factors such as smoking and poor dietary habits place elderly men at greater risk, underscoring the urgency for targeted self-management investigations [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eElderly cancer patients have complex needs, often intertwined with mental health problems, as assesses by the Hospital Anxiety and Depression Scale (HADS) [\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Beyond physical symptom management, complementary and alternative medicine (CAM) offers potential relief for emotional and depressive symptoms commonly experienced by cancer patients [\u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. CAM modalities, including vitamins, ginseng, green tea, and yoga are widely embraced for their perceived efficacy in enhancing immune response, alleviating stress, and managing a variety of health conditions as cancer, cholesterol reduction, and digestive symptoms [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Notably, ginseng and green tea have been used as therapeutic interventions for heart disease, anxiety, and depression [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Additionally, yoga is recognized for its ability to improve cellular function through by stress reduction, boosting immune function, and enhances physical attributes like flexibility, strength, and balance, thereby thus providing significant benefits to individuals undergoing cancer treatment [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGiven these complexities, integrating CAM into supportive care for elderly cancer patients is imperative. Evidence suggests that those who engage in CAM practices, including spiritual practices such as personal prayer and meditation, report improved psychological well-being and quality of life [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Research indicates that personalized CAM interventions, aligned with patients\u0026rsquo; cultural and individual preferences, led to better adherence to treatment plans and mitigate anxiety and depression [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This underscores the need for a holistic, patient-centered approach that respects the diverse practices and beliefs of elderly cancer patients.\u003c/p\u003e\u003cp\u003eDespite the potential benefits, supportive care incorporating CAM for elderly cancer patients remains scare. The integration of complementary medicine into conventional cancer care remains limited, complicating medical decision-making. Geographic and cultural contexts significantly influence CAM utilization patterns among cancer patients [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. While certain CAM practices are prevalent in specific regions, such as mushroom usage in Japan and Chinese medicine in China, and diet and acupuncture are commonly embraced in Taiwan [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], comprehensive studies focusing on CAM use among elderly cancer patients in major Asian nations remain limited. Therefore, the objectives of this study were (1) to investigate the patterns and characteristics of CAM use among elderly male cancer patients in Korea and (2) to identify factors associated with CAM utilization in this population.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\n\u003ch3\u003e1. Setting and design\u003c/h3\u003e\n\u003cp\u003eThis study was conducted at the Veterans Hospital System (VHS) in Seoul, South Korea, targeting outpatients aged 65 years and older. A convenience sampling method was used, and cancer patients receiving care in six outpatient departments were surveyed: hematology-oncology, surgery, day wards, radiation oncology, gastroenterology, and urology. During the recruitment period, 600 eligible patients were identified, and 450 were invited to participate through both an invitation letter and a follow-up phone call. Of these, 420 agreed to participate (participation rate: 93.3%), while 30 declined. After excluding 12 incomplete questionnaires, data from 408 participants were included in the final analysis (response rate: 97.1%).\u003c/p\u003e\n\u003ch3\u003e2. Study population and survey administration\u003c/h3\u003e\n\u003cp\u003eEligible participants were cancer patients aged 65 years or older who had been diagnosed within the past five years, were able to understand and respond to interview questions, and voluntarily agreed to participate. Patients with physical or cognitive impairments that hindered completion of the questionnaire were excluded. Using a convenience sampling strategy, participants were recruited consecutively in the outpatient setting until the target sample size was reached within the study timeframe. A total of 420 participants were enrolled, enabling the study to address the research questions effectively. While the sample may not be fully representative of the broader elderly cancer population, it was considered appropriate for hypothesis generation and exploratory analysis.\u003c/p\u003e\n\u003ch3\u003e3. Dependent variables\u003c/h3\u003e\n\u003cp\u003eThe final questionnaire comprised four sections with a total of 34 items. Prior to assessing CAM use, the definition of complementary and alternative medicine (CAM) provided by the World Health Organization was presented to all participants to ensure clarity and consistency. Respondents were asked about their CAM utilization and the specific types of CAM used, which were categorized into five major groups. Additional questions explored reasons for CAM use, consultation with a physician regarding CAM, methods of accessing CAM, and associated out-of-pocket costs. For non-users, reasons for not using CAM were recorded. Finally, participants\u0026rsquo; CAM-related practices were evaluated [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003e4. Independent variables\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe questionnaire assessed patients\u0026rsquo; health status and disease characteristics, including relevant clinical features [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS), following the guidelines of the National Comprehensive Cancer Network (NCCN). Stress and pain were evaluated using the Korean version of the distress thermometer and problem list, developed in alignment with the NCCN Guidelines (version 2.2021). Additional items captured information on the cancer treatment process, including diagnosis, stage, and treatment modalities, as well as participants\u0026rsquo; experiences with healthcare services.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003e5. Covariates\u003c/h3\u003e\n\u003cp\u003eThe first section of the questionnaire collected demographic and socioeconomic characteristics, including age, education level, marital status (married, divorced, widowed), and monthly household income [45, 46]. The data were collected from cancer patients attending six outpatient clinics between 25 August and 15 September 2021. Face-to-face interviews were conducted by trained interviewers, each lasting approximately 10\u0026ndash;15 minutes. As a token of appreciation, participants who completed the survey received a \u003cspan\u003e$\u003c/span\u003e10 gift voucher.\u003c/p\u003e\n\u003ch3\u003e6. Statistical analysis\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAll analyses were conducted using the Statistical Package for the Social Sciences (SPSS) version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to summarize sociodemographic and clinical characteristics of the study population. Differences between CAM users and non-users were assessed using the chi-square test. Variables showing statistical significance in univariate analysis were further examined using logistic regression. Multiple logistic regression was performed to identify independent factors associated with CAM use. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Results","content":"\n\u003ch3\u003e1. Characteristics of the participants\u003c/h3\u003e\n\u003cp\u003eThe sociodemographic and clinical characteristics of the 408 participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Nearly half of participants were 75 to 79 years of age (45.8%). Most participants had attained a high school level of education (39.9%) and were married or in a marital relationship (79.9%). A statistically significant association was identified between marital status and the utilization of complementary and alternative medicine (CAM), with CAM use being more common among those with a spouse (p\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSociodemographic and Clinical Characteristics of Participants (n\u0026thinsp;=\u0026thinsp;408)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal N (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUsers (N\u0026thinsp;=\u0026thinsp;245)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNon-user (N\u0026thinsp;=\u0026thinsp;163)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75.85\u0026thinsp;\u0026plusmn;\u0026thinsp;5.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e75.96\u0026thinsp;\u0026plusmn;\u0026thinsp;5.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75.74\u0026thinsp;\u0026plusmn;\u0026thinsp;6.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e65\u0026ndash;74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e161 (39.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95 (38.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66 (40.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.717\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e75\u0026ndash;79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e187 (45.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e116 (47.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71 (43.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60 (14.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34 (13.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26 (16.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eEducational level\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBelow middle school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e155 (38.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92 (37.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63 (38.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.752\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e163 (39.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e99 (40.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67 (41.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCollege level and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87 (22.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54 (22.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33 (20.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e326 (79.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e184 (75.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e142 (87.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo spouse \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82 (20.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61 (24.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21 (12.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eMonthly Income\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;1,000,000 (KRW)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e126 (30.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69 (28.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57 (35.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.752\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1,000,000\u0026ndash;3,000,000 (KRW)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e225 (55.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e143 (58.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e82 (50.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;3,000,000 (KRW)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57 (14.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33 (13.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24 (14.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003ePerceived health status\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e203 (49.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e121 (49.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e82 (50.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.856\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e205 (50.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e124 (50.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81 (49.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eType of cancer\u003csup\u003eb\u003c/sup\u003e (N\u0026thinsp;=\u0026thinsp;445)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProstate cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e183 (41.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e125 (51.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e58 (35.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLung cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69 (15.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35 (14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34 (20.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.056\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRectal, colon cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (8.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22 (9.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18 (11.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.301\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStomach cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33 (7.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (7.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 (9.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.310\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiver cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (5.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (6.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (5.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.490\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThyroid cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.351\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e93 (20.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53 (21.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40 (24.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.285\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eType of treatment \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e214 (52.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e139 (56.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75 (46.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.043\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChemotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e189 (46.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e111 (45.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78 (47.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.685\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRadiotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e143 (35.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81 (33.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62 (38.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.341\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHormone therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48 (11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32 (13.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (9.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.350\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44 (10.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (12.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14 (8.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.259\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003ePerceived anxiety level \u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u0026ndash;7 points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e267 (65.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e169 (68.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e98 (60.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.016*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u0026ndash;21 points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e141 (34.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76 (31.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65 (39.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003ePerceived depression level \u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u0026ndash;7 points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e105 (25.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73 (29.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32 (19.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.014*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u0026ndash;21 points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e303 (74.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e172 (70.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e131 (80.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003ePerceived distress level\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;4 points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e159 (39.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89 (36.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70 (42.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.108\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;4 points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e249 (61.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e156 (63.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e93 (57.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e* P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ** P\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Unmarried variable included single/divorced/separated/widowed.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e Type of cancer: multiple responses allowed.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003ec\u003c/sup\u003e Type of treatment: multiple responses allowed.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003ed\u003c/sup\u003e Normal: 0\u0026ndash;7 points, Borderline: 8\u0026ndash;10 points, Caseness: 11\u0026ndash;21 points\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eProstate cancer was the most common diagnosis among participants (41.1%), followed by lung cancer (15.5%). Regarding treatment, 52.4% of participants had undergone surgical therapy and 46.3% had received chemotherapy. CAM utilization was significantly higher among patients diagnosed with prostate cancer (51.0%, p\u0026thinsp;=\u0026thinsp;0.001) and among those who had undergone surgical treatment (56.7%, p\u0026thinsp;=\u0026thinsp;0.043).\u003c/p\u003e\u003cp\u003eAn analysis of psychological status demonstrated that CAM users reported significantly lower levels of anxiety (p\u0026thinsp;=\u0026thinsp;0.016), but higher levels of depression (p\u0026thinsp;=\u0026thinsp;0.014) compared to non-users. Although CAM use was more frequent among those with a distress score\u0026thinsp;\u0026ge;\u0026thinsp;4 (63.7%) compared with those scoring\u0026thinsp;\u0026lt;\u0026thinsp;4 (36.3%) (36.3%), this difference was not statistically significant.\u003c/p\u003e\n\u003ch3\u003e2. The types of CAM used and reasons\u003c/h3\u003e\n\u003cp\u003eThe distribution of CAM modalities among elderly cancer patients who reported CAM use is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Among CAM users, fast walking is the most prevalent CAM intervention, reported by 49.4% of the patients. This was followed by dietary modifications (42.9%) and the use of nutritional supplements such as vitamins (35.1%) and omega-3 fatty acids (28.2%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTypes of Complementary and Alternative Medicine (CAM) Used by Cancer Patients (n\u0026thinsp;=\u0026thinsp;245)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUsed CAM modalities \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNatural product\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDietary (black beans, Mixed grains)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e105 (42.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVitamins\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e86 (35.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOmega3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69 (28.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGinseng, Red ginseng\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55 (22.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMushrooms (Chaga, Phellinus linteus)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31 (12.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBaked garlic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (5.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGreen tea or herbal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (4.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63 (25.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eMind and body practices\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFast walking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e121 (49.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMassage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (2.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypogastric breathing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (0.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eManual therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePray, Meditation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (4.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (2.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eOther complementary health approaches\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHand acupuncture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcupressure therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (1.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFenbendazole\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCanine meat soup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Multiple responses allowed.\u003c/p\u003e\u003cp\u003e\u003csup\u003e*\u003c/sup\u003e Columns do not sum to 100% due to multiple responses.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003e3. Reasons for CAM Use and Sources of Information\u003c/h3\u003e\n\u003cp\u003eThe reasons for CAM utilization among elderly cancer patients are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The most frequently reported motivation was to strengthen immunity (61.6%), followed by improving quality of life (30.6%). Other reported reasons included the belief that CAM is natural and without side effects (26.1%), prevention of cancer recurrence (15.1%), treatment of cancer itself (12.7%), and prolonging life (8.6%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eReasons for CAM Use and Sources of CAM Information Among Cancer Patients.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategory*\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eReasons for using CAM (n\u0026thinsp;=\u0026thinsp;393) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStrengthen immunity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e151 (61.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImprove the quality of life\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75 (30.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBelief that CAM is natural/ no side effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64 (26.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrevent recurrent of cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37 (15.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTo treat cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31 (12.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTo live longer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (8.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (5.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSources of CAM information (n\u0026thinsp;=\u0026thinsp;338) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily or relatives\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e102 (42.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTV (news or advertisement) / Newspaper\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69 (28.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedical staffs (doctors, nurses)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43 (17.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInternet (YouTube)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (16.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeighbors or Friends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39 (16.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (4.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePharmacist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (2.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiterature\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (2.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTraditional Korean Medicine Hospitals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (9.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Multiple responses allowed; therefore, column percentages do not total 100%.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSources of CAM information (n\u0026thinsp;=\u0026thinsp;338) varied considerably. Family or relatives were the most common source (42.1%), followed by media such as television (news or advertisements) and newspapers (28.5%). Medical staff (17.8%), internet sources such as YouTube (16.5%), and neighbors or friends (16.1%) also contributed notably.\u003c/p\u003e\n\u003ch3\u003e4. Factors influencing participants' use of CAM\u003c/h3\u003e\n\u003cp\u003eThe results of the multivariate logistic regression analysis are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Elderly cancer patients with a spouse were significantly more likely to use CAM than those without a spouse also positively associated with CAM utilization (OR\u0026thinsp;=\u0026thinsp;2.493, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002). A diagnosis of prostate cancer (OR\u0026thinsp;=\u0026thinsp;2.136, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001). Similarly, patients who had undergone surgical treatment were more likely to use CAM (OR\u0026thinsp;=\u0026thinsp;1.615, 95% CI\u0026thinsp;=\u0026thinsp;1.065\u0026ndash;2.449, p\u0026thinsp;=\u0026thinsp;0.024).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eMultivariate Logistic Regression Analysis of CAM Use by Demographic and Clinical Factors\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo Spouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.493\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.417\u0026ndash;4.384\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eType of cancer\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-prostate cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProstate cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.394\u0026ndash;3.273\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eSurgery treatment\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.615\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.065\u0026ndash;2.449\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.024\u003c/b\u003e*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003ePerceived Anxiety\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u0026ndash;7 points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbove 8 points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.839\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.530\u0026ndash;1.328\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.454\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003ePerceived Depression\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u0026ndash;7 points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbove 8 points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.654\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.389\u0026ndash;1.100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.110\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003ePerceived distress level\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;4 points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;4 points\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.435\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.939\u0026ndash;2.914\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.095\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eOR\u0026thinsp;=\u0026thinsp;Odds ratio; CI\u0026thinsp;=\u0026thinsp;Confidence interval; Ref. = reference category.\u003c/p\u003e\u003cp\u003e*Statistically significant at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn contrast, perceived anxiety, depression, and distress levels were not significantly associated with CAM use in the adjusted model.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides novel evidence on the prevalence and determinants of CAM use among elderly cancer patients in Korea, a population often underrepresented in supportive care research. The overall CAM utilization rate was 64%, considerably higher than previously reported rates, such as 27% among U.S. veterans with cancer and 51% in a recent global systematic review [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Multivariate analysis identified marital status, surgical treatment, and prostate cancer diagnosis as significant predictors of CAM use. Notably, the high uptake of CAM among elderly Korean men contrasts with earlier findings that male patient generally less likely to engage in CAM [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This discrepancy may reflect sociocultural dynamics unique to Korea, including the influence of family caregiving patterns and strong cultural trust in traditional medicine. The importance of proactive clinician\u0026ndash;patient dialogue regarding CAM, particularly with elderly male patients, and underscore the need to integrate culturally sensitive supportive strategies into cancer care [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur study highlights important implications for supportive cancer care in elderly patients. Exercise and dietary interventions emerged as the most practiced CAM modalities, with fast walking reported most frequently. Lifestyle-based strategies such as exercise are not only feasible and safe but are also perceived positively by older patients, who report benefits including reduced stress, improved sleep, and enhanced quality of life [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Elderly cancer patients in particular perceive exercise positively, reporting improvements in physical health and emotional well-being, particularly in stress reduction and sleep quality [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. These findings are consistent with prior evidence demonstrating improvements in physical function, disability reduction, chronic disease prevention, and psychological health [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In the Korean context, access to public exercise facilities and senior centers further facilitates participation, fostering social engagement and reducing isolation [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Collectively, these results underscore the need to integrate low-barrier, culturally appropriate lifestyle practices into survivorship care, reinforcing the holistic role of CAM in improving psychosocial well-being and clinical outcomes for elderly cancer patients.\u003c/p\u003e\u003cp\u003eDepression and anxiety symptoms are highly prevalent among elderly cancer patients and significantly affect treatment adherence, clinical outcomes, and overall quality of life [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In our study, CAM utilization was more common among patients with depressive symptoms than in those with higher anxiety, suggesting that depression may serve as a stronger motivator for seeking CAM adoption. Approximately two-thirds of participants reported borderline depressive symptoms, underscoring the substantial emotional burden in this population. These findings align with previous research suggesting that psychological vulnerability, particularly depression, often drives engagement with CAM as a form of self-empowerment and emotional regulation. Given that cancer-related fatigue (CRF) often exacerbates mood disturbances\u0026mdash;particularly depression\u0026mdash;non-pharmacological strategies like structured physical activity may serve as both preventive and therapeutic tools [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Collectively, these results highlight the importance of integrating CAM into holistic, patient-centered cancer care, with tailored exercise and dietary approaches playing a critical role in improving psychosocial well-being and supporting favorable clinical outcomes among elderly patients.\u003c/p\u003e\u003cp\u003eParticipants in this study reported using CAM primarily to boost immunity and enhance quality of life, often perceiving this intervention as safer due to their natural origin. This perception aligns with previous research that elderly cancer patients frequently turn to CAM to manage symptoms, improve well-being, and assert greater control over treatment decisions [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. However, our findings also revealed several concerns regarding the potential risks associated with unsupervised CAM use in this population, including adverse interactions with conventional medications, increased toxicity, and diminished therapeutic efficacy of standard cancer treatments [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. For instance, ginseng - a commonly used CAM product- has demonstrated cytotoxic effects on certain cancer cells, yet its unregulated use may lead to unpredictable outcomes [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Similarly, excessive consumption of dietary supplements such as vitamins can lead to complications including nephrolithiasis and hypercalcemia, thereby interfering with standard cancer therapies [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. These risks underscore the limitations of CAM in elderly cancer care, where unregulated production standards, drug-herb interactions, and inconsistent evidence regarding efficacy remain critical concerns [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. To mitigate these risks, healthcare providers should play a proactive role by offering balanced, evidence-based guidance on CAM use. Open, non-judgmental communication is crucial in supporting elderly patients in making informed and safe treatment decisions [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Furthermore, establishing trustworthy and accessible sources of CAM information is vital to ensure that elderly cancer patients can navigate integrative care safely and effectively.\u003c/p\u003e\u003cp\u003eThe sources of CAM information among elderly cancer patients are diverse and shaped by interpersonal and media influences. Family members, spouses, and friends were the primary sources of CAM- related knowledge, aligning with prior studies highlighting the role of familial support in healthcare decisions. Traditional media, such as television programs and newspaper articles, continue to influence perceptions, while digital platforms, including YouTube, are emerging as modest but growing sources of information among older adults. Our findings highlight the significant role of family dynamics in facilitating CAM engagement, particularly in cases where a spouse is present, consistent with literature showing that families of cancer patients often express a heightened need for caregiving-related information and support.\u003c/p\u003e\u003cp\u003eAt the same time, the proliferation of CAM-related information through non-clinical sources presents a critical challenge, as healthcare providers currently lack robust mechanisms to evaluate the safety, effectiveness, and compatibility of such information with standard oncological treatment regimens. Emerging research calls for healthcare professionals to play a pivotal role by establishing clinical guidelines and rationales for CAM use, thereby helping patients navigate the growing influx of informal health advice. Although cancer management policies are currently increasingly accessible online, they often fall short of addressing the nuanced needs of elderly populations. To bridge this gap, primary medical institutions should integrate exercise therapy and structured CAM education as default components of elderly cancer care protocols. Such institutional embedding, coupled with open clinician-patient dialogue, can enhance decision-making, mitigate treatment risks, and support the safe and informed incorporation of CAM into conventional cancer care.\u003c/p\u003e\u003cp\u003eThis study has several limitations. Its cross-sectional design precludes causal inference, and the data were collected in 2021; patterns of CAM use may have changed since then due to evolving healthcare access, patient preferences, or the impact of the COVID-19 pandemic. Nevertheless, CAM utilization among elderly cancer patients remains highly relevant, and our findings provide timely evidence for supportive care planning. The single-institution, predominantly male veteran sample may limit generalizability, and reliance on self-reported questionnaires introduces recall bias. Moreover, details on dosage, duration, and frequency of CAM practices were not captured, and potential confounders such as socioeconomic status and comorbidities were not fully addressed. Future research should employ multicenter, longitudinal designs with updated datasets and incorporate clinical endpoints to clarify the impact of CAM on adherence, survivorship, and quality of life.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study emphasizes that elderly cancer patients in Korea widely use CAM for supportive care, with exercise and dietary interventions being the most common methods. Immune enhancement is a primary motivation for CAM use, often influenced by family support. Factors such as marital status, prostate cancer diagnosis, and surgical therapy are linked to CAM utilization. However, further research is needed to understand how these factors affect treatment outcomes. Ultimately, this will help develop guidelines to integrate CAM with conventional cancer care and improve supportive care for elderly patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the VHS Institutional Review Board (No: 2021-07-004-007). In accordance with ethical procedures, informed consent was obtained from all participants after a full explanation of the study. All procedures involving human participants in this study were conducted in accordance with the ethical standards of the institutional and/or national research committee and the principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceived and designed the analysis: Chang HY, Choi SJ, Im HB, Choi DI, and Han DW\u003c/p\u003e\n\u003cp\u003eCollected the data: Chang HY, Choi SJ and Han DW\u003c/p\u003e\n\u003cp\u003eContributed data or analysis tools: Chang HY and Han DW\u003c/p\u003e\n\u003cp\u003ePerformed the analysis: Choi DI, and Han DW\u003c/p\u003e\n\u003cp\u003eWrote the paper: Chang HY and Han DW\u003c/p\u003e\n\u003cp\u003eSupervision: Han DW\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge the valuable participation of all study subjects and appreciate their cooperation and support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no potential conflicts of interest relevant to this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding source\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Veterans Medical Research Institute under Research Project No: VHSMC21046.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e The data supporting this study\u0026apos;s findings are available from the corresponding author. Access to the data may be subject to privacy and ethical considerations.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cem\u003eWorld Health Organization\u003c/em\u003e. Ageing 2024 [cited 2024 (n.d)]; Available from: https://www.who.int/health-topics/ageing#tab=tab_1.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eKOSIS\u003c/em\u003e. Korea in the world 2024 [cited 2024 June 08]]; Available from: KOSIS KOrean Statistical Information Service.\u003c/li\u003e\n\u003cli\u003eTorres, A.C., P. Garc\u0026iacute;a-Vald\u0026eacute;s, and G. 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Hajjar, \u003cem\u003ePolypharmacy in the Geriatric Oncology Population.\u003c/em\u003e Current Oncology Reports, 2017. \u003cstrong\u003e19\u003c/strong\u003e(11).\u003c/li\u003e\n\u003cli\u003eMajeed, F., et al., \u003cem\u003eGinseng phytochemicals as therapeutics in oncology: Recent perspectives.\u003c/em\u003e Biomedicine \u0026amp; Pharmacotherapy, 2018. \u003cstrong\u003e100\u003c/strong\u003e: p. 52-63.\u003c/li\u003e\n\u003cli\u003eMangione, C.M., et al., \u003cem\u003eVitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer.\u003c/em\u003e JAMA, 2022. \u003cstrong\u003e327\u003c/strong\u003e(23): p. 2326. https://www.aafp.org/pubs/afp/issues/2022/1100/ppip-supplementation-cardiovascular-disease-cancer.pdf\u003c/li\u003e\n\u003cli\u003eRiver, J., et al., \u003cem\u003eConvergent priorities and tensions: a qualitative study of the integration of complementary and alternative therapies with conventional cancer treatment.\u003c/em\u003e Supportive Care in Cancer, 2018. \u003cstrong\u003e26\u003c/strong\u003e(6): p. 1791-1797. https://link.springer.com/content/pdf/10.1007/s00520-017-4021-0.pdf\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Complementary Therapies, Neoplasms, Aged, Republic of Korea","lastPublishedDoi":"10.21203/rs.3.rs-7605426/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7605426/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eComplementary and alternative medicine (CAM) use is common among elderly cancer patients, but evidence on its prevalence, characteristics, and determinants in Korea is limited. This study aimed to examined prevalence, patterns, reasons, and associated factors of CAM use among elderly cancer survivors.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e\u003cp\u003eA cross-sectional survey was conducted with 420 cancer patients aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years attending outpatient clinics of the Veterans Hospital System, a 1,000-bed secondary hospital in Seoul, Korea. Data on CAM utilization, modalities, reasons for use, and information sources were collected through structured questionnaires. Multivariate logistic regression was used to identify demographic and clinical factors associated with CAM use.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAmong participants, 60.0% reported CAM use. The most common modalities were exercise (fast walking, 49.4%) and dietary interventions (42.9%). The primary reason was immune enhancement (61.6%), and family members or relatives were the main information source (42.1%). Multivariate analysis revealed that being married (OR 2.49, 95% CI 1.40\u0026ndash;4.45), having prostate cancer (OR 2.14, 95% CI 1.36\u0026ndash;3.35), and undergoing surgery (OR 1.62, 95% CI 1.07\u0026ndash;2.45) were significantly associated with CAM use..\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eCAM use is highly prevalent among elderly Korean cancer patients, particularly in married men, prostate cancer patients, and those who have undergone surgery. Oncologists should incorporate CAM-related discussions into survivorship care, and further studies are warranted to assess the impact of CAM modalities on quality of life and clinical outcomes.\u003c/p\u003e","manuscriptTitle":"Complementary and Alternative Medicine (CAM) Use among Elderly Cancer Patients: A cross- sectional study in South Korea","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-19 13:59:36","doi":"10.21203/rs.3.rs-7605426/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"66a5a0d7-2297-4729-92af-c963948908d7","owner":[],"postedDate":"September 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-07T04:08:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-19 13:59:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7605426","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7605426","identity":"rs-7605426","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}