Unapproved and unproven cancer treatments in patients admitted to palliative care units

Unapproved and unproven cancer treatments in patients admitted to palliative care units | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Unapproved and unproven cancer treatments in patients admitted to palliative care units Hideko Akagi, Noriyuki Katsumata, Kozue Suzuki, Kento Masukawa, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4553487/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Dec, 2024 Read the published version in Supportive Care in Cancer → Version 1 posted 11 You are reading this latest preprint version Abstract Purpose To clarify the current use of unapproved and unproven cancer treatment (UUCT) among the bereaved families of patients with cancer who died in palliative care units, the financial burden and psychological experiences of the families, and the relationship between patients in palliative care who used UUCT and communication with their physicians’. Methods This study was conducted as part of a cross-sectional, anonymous nationwide survey of the bereaved family members of patients with cancer in Japan. Results Questionnaires were sent to 1,039 bereaved family members, and responses were received from 661 (64%). Of these, 558 were included in the study after excluding the 103 who did not complete the questionnaire. A total of 7.3% (41 of 558) of patients received UUCT. Of these, 34% (14 of 41) of patients were formed that the treatment was in the research phase, and 49% (20 of 41) were informed that the efficacy of the treatment was unknown. Regarding expectations for UUCT, 61% (25/41) expected to be cured, and 80% (33/41) expected it to slow disease progression. In multivariate logistic regression analysis, more patients received complementary and alternative medicine (CAM) than UUCT ( p = 0.024), and patients who could discuss CAM with their doctors tended to receive UUCT ( p = 0.054). Conclusion Patients with cancer want to be cured and improve their condition, no matter what it takes. These results highlight the challenge of telling patients that UUCT is ineffective and informing them of their prognosis and severe medical conditions. unapproved and unproven cancer treatment (UUCT) Complementary and Alternative Medicine (CAM) Cancer Palliative care Introduction Complementary and Alternative Medicine (CAM) is a broad set of non-mainstream practices, including the use of natural products, mind-body therapies, and entire medical systems [ 1 ]. Its use among patients with cancer has increased in the last decades [ 2 ]. CAM therapies are used by an estimated 60–80% of patients with a history of cancer [3.4]. CAM therapies may be used to promote overall health and wellness, mitigate cancer-related symptoms, provide supportive care during cancer treatment to mitigate side effects, address the late effects of cancer treatment during survivorship care, and improve the overall quality of life during the continuum of cancer care, including end-of-life care. Unapproved and unproven cancer treatment (UUCT), administered by doctors as an alternative medicine for treating cancer, is expensive and not covered by insurance. UUCT refers to treatments for various conditions and diseases for which standard treatments have failed and for which the efficacy is unclear and unproven in clinical trials. For example, the use of untested cellular therapies presents a worldwide problem [ 5 ]. However, patients are unaware of the risks associated with such therapies. Therefore, focusing on the potential limitations and adverse effects of these therapies is critical to preventing misinformation. Given the high frequency of CAM use and the various reasons for its use in patients with cancers, the current status and reasons for CAM use are unclear. Physicians should ascertain what CAMs are being used and for what purpose. We focused on UUCT among many CAMs and surveyed the families of patients with cancers who died in the palliative care unit to understand the actual use of UUCT. This study revealed the economic impact of UUCT administration on the bereaved family members of patients with cancer and their psychological experiences. We focused on the bereaved family members of patients who received immune cell therapy to explore the factors that led to their use. Methods Study procedure We conducted a cross-sectional, anonymous, self-report questionnaire survey between July and August 2018. This study was conducted as part of the Japan Hospice and Palliative Care Evaluation Study 4 (J-HOPE4 Study) [ 6 ], one of the projects undertaken by the Japan Hospice Palliative Care Foundation. To identify potential participants, we requested that each institution identify and list up to 80 bereaved family members of patients who had died before January 31, 2018. The inclusion criteria were death due to cancer, age was aged > 20 years, and bereaved family members aged > 20 years. The exclusion criteria were patients who had received palliative care for < 3 days, missing contact information for the bereaved family members, deaths caused by any medical or surgical treatment or that had occurred in an intensive care unit, severe psychological distress of the bereaved family members, as judged by the physician, or inability of the potential participant to complete the self-report questionnaire because of health issues and/or disability. Questionnaires were sent to bereaved family members identified by each participating institution. The participants were asked to return the completed questionnaire to the Secretariat Office (Tohoku University) within one month. One month after sending the questionnaire, we sent reminders to non-responders. A document explaining the aims and procedures of the J-HOPE 4 study was sent along with the questionnaire, and the return of a completed questionnaire was considered consent to participate in the study. Ethical approval for the study was granted by the ethics committee of Tohoku University Hospital and all participating institutions (2017-2-236-1). Questionnaires Patient backgrounds, including age, sex, primary site, marital status, presence of cohabitants, presence of minor children, population of the area of residence, annual income, and medical expenses in the month prior to death, were surveyed. The backgrounds of the bereaved family members, including age, sex, relationship, last education, health status during the patient's hospitalization, number of days of attendance before death, presence of supporters, and religion, were surveyed. Survey items related to CAM were defined by the National Institute of Health as "a variety of medical and health care systems, practices, and generative products that are not generally regarded as conventional medicine." A list of CAMs, including various psychosomatic therapies that are not easily recognized as CAM in Japan, was compiled, and questions were asked regarding the duration and timing of CAM use. We focused on UUCT among many CAMs. We asked the bereaved families about immunotherapy, gene therapy, and other treatments that patients received at clinics and hospitals at their expense, such as UUCT. We inquired about which therapies they received as UUCT, such as immune cell therapy (dendritic cell vaccine therapy, peptide vaccine therapy, and autologous lymphocyte therapy), gene therapy, or high-concentration vitamin C infusion therapy. We asked whether the doctor properly explained the benefits of UUCT and the circumstances under which the patient underwent UUCT. The purpose of UUCT was categorized into four areas: "cure of disease," "control of disease progression," "alleviation of side effects," and "spiritual hope," based on the previous literature [ 7 ]. Regarding their experiences with UUCT, respondents were asked about the effects and side effects of CAM, the financial burden, methods of obtaining information, and patient communication with their doctors [ 8 ]. Stastistical analyses Logistic regression analysis was performed to determine the factors influencing the receipt of self-payment alternative therapies that have not been proven to be effective. Multivariate analyses were performed for univariate analyses with significant differences. All results were considered significant when the P -value was less than 0.05. All analyses were performed using SPSS software (version 29.0; IBM SPSS Inc. Japan). Results Questionnaires were sent to 1039 bereaved family members, 661 (64%) responses were received. Of these, 558 were included in the study after excluding the 103 who did not complete the questionnaire. Patients and caregiver characteristics are presented in Table 1. Characteristics of participants (Table 1-1.1-2) The median age of the patients was 77 years (range: 26 to 99 years). 54% were man. The most frequent primary tumor was gastrointestinal cancer, followed by hepatobiliary cancer, and the median average length of stay in the palliative care unit was 21 days (range, 34-84 days). Bereaved family members had a mean age of 65 years (range; 34 to 84 days), and 62% were women. The bereaved person was most frequently the patient’s spouse, followed by the child. The most common annual income of the bereaved family members was $13,333-26,666, assuming $1 is 150 yen, followed by $6,667-13,332. Medical expenses one month prior to death were less than $267 in 78% of the cases. The actual use of UUCT (Table2-1. 2-2) In total, 7.3% (41/558) of the patients received at least one type of UUCT. The most frequent kind of UUCT was immuno-cell therapy, which was administered to 28 of the 41 patients (68%). Twenty-five (61%) patients underwent UUCT combined with standard cancer treatment. In the contrast, four (10%) patients underwent self-funded UUCT because the standard treatment for their cancer was ineffective. Thirty patients (73%) requested UUCT. Among the patients who underwent UUCT, only four (10%) distrusted their doctors, and eight (20%) felt abandoned by them. Thirty-three patients (80%) expected UUCT to slow cancer progression. Nineteen (46%) patients expected it to alleviate the painful symptoms caused by cancer treatment, such as loss of appetite. From the professional perspective, 31 (76%) primary doctors did not object to their patients undergoing UUCT. Twenty (49%) of them informed their patients that it might not work. However, 25 (61%) patients expected UUCT to completely cure their disease. Only 12 patients (29%) underwent UUCT without consulting their primary doctors. The cost of UUCT was less than $20,000 for 30 patients (73%) and ranged from $6,666 to $20,000 for 14 patients (34%). Thirty-five (85%) bereaved family members did not object to UUCT. Thirty-five (85%) believed that receiving UUCT provided spiritual hope for the patients. Twenty-two (54%) of them felt that the cost was too high. However, thirty-two bereaved family members (78%) did not regret the patients having undergone UUCT. Univariate and multiple logistic regression analysis (Table3) In the univariate analyses, several items exhibited significant differences. Most patients received treatment for more than one year (odds ratio 2.27 [95% Confidence interval (CI) 1.11-4.65], p=0.021). Annual income during treatment was more than $26700 (odds ratio 2.04 [95% CI 1.63-3.92], p=0.029). Medical expenses for the month before their death were more than $267 (odds ratio 2.06 [95% CI 1.00-4.21], p=0.045). More people underwent CAM than UUCT (odds ratio 3.58 [95% CI 1.86-6.89], p<0.001). Patients who could discuss CAM with their doctors were more likely to receive UUCT (odds ratio 2.02 [95% CI 0.99-4.15], p=0.051). Multivariate analyses were performed for univariate analyses with significant differences. The multiple logistic regression analysis identified independent determinants influencing the use of CAM over UUCT (odds ratio 2.41 [95% CI 1.15-5.03], p =0.024). Furthermore, patients who could discuss UUCT with their doctors tended to undergo UUCT (odds ratio 2.6 [95% CI 0.96-6.89], p =0.054). Discussion To our knowledge, this is the first nationwide survey of bereaved family members of patients with cancer conducted to identify the actual situation of UUCTs among those who died in palliative care units. We clarified the financial burden and psychological experiences of families who used UUCT, and clarified factors affecting the use of UUCT in terminally ill patients. In this study, the purpose of using UUCT was primary to maintain their mental hope, suggesting that UUCT may provide mental support for patients with cancers. As 61% of the patients received UUCT concurrently with standard treatment and were given its high cost, the economic impact was not negligible. Honda et al . used the Comprehensive Score for Financial Toxicity (COST) tool to measure financial toxicity (FT) in Japanese cancer patients with cancer [ 9 ]. Several reports from high-income countries have suggested a negative correlation between FT and the length and quality of life [ 10 ]. The study involved 156 participants who responded to a questionnaire. Cancer treatment is expensive, and patients often need to make adjustments in their lives to afford cancer treatment. Strategies to cope with the cost of cancer care included using savings to pay for cancer treatment (n = 95, 63%), reducing expenses on leisure (n = 67, 44%), and reducing spending on food or clothing (n = 42, 28%). In multivariable analyses associated of the COST score using linear regression, non-regular employment (β, -5.37; 95% CI, -10.16 to -0.57; p = 0.03), retirement because of cancer (β, -5.42; 95% CI, -8.62 to − 1.37; p = 0.009), and using coping strategies (β, -5.09; 95% CI, -7.87 to -2.30; p < 0.001) were significantly associated with lower COST scores, indicating higher FT. This study suggests that many patients who use ingenious strategies to manage the high cost of cancer treatment. Owing to the low percentage of physicians who were consulted about UUCT and the finding that about half of them advised about the risks associated with UUCT, logistic analysis revealed that patients with cancers who discussed with doctors were more likely to receive UUCT. We initially assumed that the patients underwent UUCT because they were dissatisfied with their doctors, but that was not the case. We believe that doctors provided the correct information, but they could not deter the patients from undergoing UUCT. This finding highlights the challenge of communicating with patients with cancers and their families. Tamels et al. reported that nearly 70% of patients with cancers did not understand that their cancers could not be cured with anticancer treatment [ 11 ]. Weeks et al. as well as Tamels et al . suggested that many patients receiving chemotherapy for advanced cancer with metastases may not understand that chemotherapy is unlikely to cure them [ 12 ]. When palliative care is provided to such patients from the early (not terminal) stage of treatment (during treatment with anticancer agents), patients have a more accurate understanding of their disease condition. This thorough consideration of their condition and the limitations of anticancer treatment results in fewer patients continuing anticancer treatment until just before death [ 13 ]. Patients must be involved in the decision-making process of "how long to continue anticancer treatment," as studies have revealed that receiving anticancer treatment in the months immediately prior to death increases the likelihood of the patient not dying in their preferred location and undergoing more invasive medical measures [ 14 ]. Early palliative care interventions for patients with cancer may improve their quality of life and prolong survival; thus, and the importance of early palliative care is being recognized worldwide [ 15 ]. However, we also considered the difficulties of these early decision-making efforts in palliative care. Patients who believe they have good communication with their doctors also have higher rates of misunderstanding, which leads to a more rigorous discussion about prognosis and medical conditions, resulting in lower patient satisfaction. Tasaki et al. conducted semi-structured interviews with 143 patients with cancers to explore their experiences with CAM use. Using qualitative research methods, they examined interview data from 93 CAM users who provided sufficient information about communication issues. Three themes emerged describing barriers to successful communication from the patient's perspective: doctors' indifference or opposition to CAM use, physicians' emphasis on scientific evidence, and patients' anticipation of a negative response from their doctors [ 16 ]. Increasing education on CAM and regular assessments of CAM use may help physicians become more aware of their patients' CAM use. Consequently, doctors may provide patients with information on the risks and benefits of CAM use and refer them to other services that may address their unmet needs. Additionally, lack of communication is problematic in the health care context because the development of openness and trust between doctors and patients is contingent upon effective interpersonal communication. Techniques such as preparing the environment for conversation, checking the other person's understanding during the conversation, and empathizing with the other person's sentiments have been established; however, the specific words and methods needed to overcome communication barriers must be acquired through experience and sensitivity, in addition to these communication techniques. This study has three limitations. First, because it is a survey of bereaved family members and not of the patients themselves, it may be subject to bias and may not accurately reflect the actual use of UUCT. Surveying bereaved families provided a broad view of the process leading up to death; however, they are not the patients and may lack specific details. Second, this survey was conducted on the bereaved family members of patients who died in palliative care units and is not representative of all terminally ill patients. The actual use of UUCT in patients who die in hospitals setting other than palliative care units or at home may differ. Third, the survey is less reliable because it is retrospective. Conclusion Currently, many patients with cancer use some form of CAM. Good communication with patients is necessary for cancer treatments. This study revealed that those who communicated better with their doctors were more likely to undergo UUCT. Declarations Competing interests The authors have no relevant financial or non-financial interests to disclosure. Ethical approval Ethical approval for the study was granted by the ethics committee of Tohoku University Hospital and all participating institutions (2017-2-236-1). Consent to participate The return of the questionnaires was considered as informed consent for this study. Funding This study was part of the Japan Hospice and Palliative Evaluation Study4, funded by the Japan Hospice Palliative Care Foundation with the cooperation of Hospice Palliative Care Japan. Author Contribution Hideko Akagi wrote the main manuscript text. Noriyuki Katsumata and I prepared all of tables1-3. All authors reviewed the manuscript. Acknowledgement: Corresponding author: Hideko Akagi, MD, Department of Oncology, Nippon Medical School Musashi-Kosugi hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki-shi, Kanagawa, 211–8533, Tel: (81) 44-733-5181, [email protected] Conflict of Interest: This study was part of the Japan Hospice and Palliative Evaluation Study 4, funded by the Japan Hospice Palliative Care Foundation, with the cooperation of Hospice Palliative Care Japan. We have no relevant or non-financial interests to disclosure. References Health Information (2019) Complementary, alternative or integrative health: what’s in a name? National Institute of Health. https://nccih.nih.gov/health/integrative-health . Accessed 9 January 2019 Horneber M, Bueschel G, Dennert G et al (2012) How many cancer patients use complementary and alternative medicine: a systematic review and meta-analysis. Integr Cancer Ther 11:187–203. http://doi.org/10.1177/1534735411423920 Falci L, Shi Z, Greenlee H (2016) Multiple chronic conditions and use of complementary and alternative medicine among US adults: results from the 2012 National Health Interview Survey. Prev Chronic Dis 13: E61. http://doi.org/10.5888/pcd13.150501 Richardson MA, Sanders T, Palmer JL et al (2000) Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology. J Clin Oncol 18:2505–2514 http://doi.org/10.1200/JCO.2000.18.13.2505 Indira G, Maria de LAM, Matthew W et al (2022) How do I: Evaluate the safety and legitimacy of unproven cellular therapies? Transfusion 62:518–532. http://doi.org/10.1111/trf.16814 Masukawa K, Aoyama M, Morita T et al (2008) The Japan hospice and palliative evaluation study 4: a cross-sectional questionnaire survey. BMC Palliative Care 17:66. http://doi.org/10.1186/s12904-018-0319-z Boon H, Stewart M, Kennard MA et al (2000) Use of complementary/alternative medicine by breast cancer survivors in Ontario: prevalence and perceptions. J Clin Oncol 18:2515–2521. http://doi.org/10.1200/JCO.2000.18.13.2515 Richardson MA, Masse LC, Nanny K et al (2004) Discrepant views of oncologists and cancer patients on complementary/alternative medicine. Support Care Cancer 12:797–804. http://doi.org/10.1007/s00520-004-0677-3 Honda K, Gyawali B, Ando M et al (2019) Prospective survey of financial toxicity measured by the comprehensive score for financial toxicity in Japanese patients with cancer. J Glob Oncol 5:1–8. http://doi.org/10.1200/JGO.19.00003 Ramsey SD, Bansal A, Fedorenko CR et al (2016) Financial insolvency as a risk factor for early mortality among patients with cancer. J Clin Oncol 34:980–986. http://doi.org/10.1200/JCO.2015.64.6620 Tamel JS, Greer JA, Admane S et al (2011) Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer: results of a randomized study of early palliative care. J Clin Oncol 29:2319–2326. http://doi.org/10.1200/JCO.2010.32.4459 Weeks JC, Catalano PJ, Cronin A et al (2012) Patients’ expectations about effects of chemotherapy for advanced cancer. N Eng J Med 367:1616–1625. http://doi.org/10.1056/NEJMoa1204410 Greer JA1, Pirl WF, Jackson VA et al (2012) Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non-small-cell lung cancer. J Clin Oncol 30:394–400. http://doi.org/10.1200/JCO.2011.35.799 Wright AA, Zhang B, Keating NL et al (2014) Associations between palliative chemotherapy and adult cancer patients end of life and place of death: prospective cohort study. BMJ. 348: g1219. http://doi.org/10.1136/bmj.g1219 Tamel JS, Greer JA, Muzikansky A et al (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. NEJM. 363:733–742. http://doi.org/10.1056/NEJMoa1000678 Tasaki K, Maskarinec G, Shumay DM, et al (2002) Communication between physicians and cancer patients about complementary and alternative medicine: exploring patients' perspectives. Psychooncology. 11:212–220. http://doi.org/10.1002/pon.552 Tables Table1-1. Patient and caregiver characteristics (n=558) 1-1. Patients n % Age Median 77 Range 26-99 Sex Male 303 54 Female 255 46 Primary cancer Lung cancer 116 21 Gastrointestinal cancer 146 26 Hepatobiliary cancer 120 22 Breast cancer 20 4 Gynecologic cancer 24 4 Urologic cancer 46 8 Hematologic cancer 26 5 Others 60 11 Duration of treatment/medical care received > 3 years 140 25 1-3 years 164 29 6-12 months 101 18 3-6 months 80 14 <3 months 67 12 Annual income during treatment (reported by bereaved family member, $1»150JPY) $53,333 37 7 Medical expenses in the month prior to death ( $267 = 1, $1=150JPY) $267 100 18 Length of stay in palliative care unit (days) Median 21 Range 0 Table1-2. Patient and bereaved family member characteristics (n=558) 1-2. Bereaved family member n % Age 65 Range 34-84 Sex Male 202 36 Female 346 62 Unknown 10 2 Relationship with patient Husband/wife 233 42 Child 235 42 Daughter-in-law or son-in-law 30 5 Parents 5 1 Siblings 35 6 Others 12 2 Unknown 8 1 Table2-1. The actual use of UUCT(total n=41) 1. Itemization of UUCT n % Immuno-cell therapy 28 68 Highly concentrated vitamin therapy 10 24 Gene therapy 1 3 Others 2 5 2. When UUCT was introduced n % When standard treatment is not effective 4 10 Refusing standard treatment 7 17 Concurrent with standard treatment 25 61 Others 3 7 Unanswered 2 5 3. Patient's request n % Yes 30 73 No 8 20 Unanswered 3 7 4. Distrust of their doctors n % Yes 4 10 No 34 83 Unanswered 3 7 5. Feeling abandoned by doctors n % Yes 8 20 No 31 76 Unanswered 2 4 6. Expecting UUCT to completely cure cancer n % Yes 25 61 No 14 34 Unanswered 2 5 7. Expecting UUCT to slow cancer progression n % Yes 33 80 No 6 15 Unanswered 2 5 8. Hopeing UUCT to alleviate painful symptoms caused by cancer treatments n % Yes 19 46 No 19 46 Unanswered 3 8 Table 2.2 9. Whether primary doctors were opposed to UUCT n % Yes 5 12 No 31 76 Unanswered 5 12 10．Whether primary doctors explained that UUCT may not work n % Yes 20 49 No 4 10 The bereaved didn't know that 13 31 Unanswered 4 10 11. Consulting their primary doctors about UUCT n % Yes 25 61 No 12 29 Unanswered 4 10 12. Cost of UUCT ($1=150) n % $20000 5 12 Unanswered 6 15 13. Whether the patients' bereaved family members objected to UUCT n % Yes 2 5 No 35 85 Unanswered 4 10 14. Whether the bereaved family members believed that receiving UUCT provided a spiritual hope for patients with cancer n % Yes 35 86 No 3 7 Unanswered 3 7 15. Whether the bereaved family members think the cost of UUCT was too expensive. n % Yes 22 54 No 15 36 Unanswered 4 10 16. Whether the bereaved family members regret having undergone UUCT. n % Yes 4 10 No 32 78 Unanswered 5 12 Table3. Association of UUCT with physician communication and patients/bereaved family member backgrounds Univariate analysis Multivariate analysis OR 95% CI P OR 95% CI P Patient age ( 60 = 1) 0.35 0.15-0.85 0.027 0.68 0.24-1.92 0.469 Patient sex (male = 1 and female =0) 0.97 0.51-1.84 0.932 Family members age (60 = 1) 0.99 0.97-1.02 0.469 Family members sex (male = 1 and female =0) 1.15 0.59-2.23 0.669 Primary cancer (hematologic cancer = 0 and solid tumor = 1) 0.95 0.22-4.17 1 Marriage status (married = 0 and others = 1) 0.7 0.35-1.41 0.322 Duration of treatment/medical care received ( 1 year = 1) 2.27 1.11-4.65 0.021 2.21 0.98-4.97 0.056 Annual income during treatment ( $26700 = 1, $1»150JPY) 2.04 1.63-3.92 0.029 1.53 0.71-3.30 0.279 Medical expenses in the month prior to death ( $267 = 1, $1»150JPY) 2.06 1.00-4.21 0.045 1.48 0.64-3.43 0.358 Length of stay in a palliative care unit 1 0.99-1.01 0.483 Complementary and alternative medicine other than UUCT (yes = 1 and no = 0) 3.58 1.86-6.89 ＜0.001 2.41 1-15-5.03 0.024 Communication with oncologist Had good communication with my doctor (yes = 1 and no = 0) 0.96 0.44-2.12 0.926 0.48 0.17-1.41 0.184 Could discuss with my doctor about complementary alternative medicine (yes = 1 and no = 0) 2.02 0.99-4.15 0.051 2.6 0.98-6.89 0.054 Could discuss with my doctor how to spend my daily life other than treatment (yes = 1 and no = 0) 1.21 0.62-2.39 0.563 1.01 0.41-2.48 0.978 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 02 Dec, 2024 Read the published version in Supportive Care in Cancer → Version 1 posted Editorial decision: Revision requested 06 Oct, 2024 Reviews received at journal 05 Oct, 2024 Reviewers agreed at journal 23 Sep, 2024 Reviews received at journal 18 Sep, 2024 Reviewers agreed at journal 09 Sep, 2024 Reviews received at journal 31 Jul, 2024 Reviewers agreed at journal 21 Jul, 2024 Reviewers invited by journal 19 Jul, 2024 Editor assigned by journal 19 Jul, 2024 Submission checks completed at journal 11 Jun, 2024 First submitted to journal 09 Jun, 2024 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. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-4553487","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":334509456,"identity":"9e274778-4585-4e95-abaf-7627f5127f5f","order_by":0,"name":"Hideko Akagi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYBACAwYGZiAlIQcTYCZaizHJWhgSG4h2mDkD82ODH78s0reLHX/A8KOGgd2ckBbLBjbjxN4+idyds3MMGHuOMTBbErLP4P4D4wO8PRK5G27nMDDwNjAwGxwgpOUA++eDf3sk0g1upz9g/EucFh7jZJ4fEgkGtxMMmIm0hafYWLZBwhDoMIPDMsckiPDLAfbNkm/+1MkDHfbw4Zsam2SCIQYGjG0QGugkiWQDorQw/EEw7YjUMgpGwSgYBSMIAAAGXDxPDIMX+AAAAABJRU5ErkJggg==","orcid":"","institution":"Nippon Medical School Musashi-Kosugi Hospital","correspondingAuthor":true,"prefix":"","firstName":"Hideko","middleName":"","lastName":"Akagi","suffix":""},{"id":334509457,"identity":"4c75955a-65fd-4355-a439-477b6358521e","order_by":1,"name":"Noriyuki Katsumata","email":"","orcid":"","institution":"Nippon Medical School Musashi-Kosugi Hospital","correspondingAuthor":false,"prefix":"","firstName":"Noriyuki","middleName":"","lastName":"Katsumata","suffix":""},{"id":334509458,"identity":"87080617-09ca-4942-9989-957b3e879f24","order_by":2,"name":"Kozue Suzuki","email":"","orcid":"","institution":"Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kozue","middleName":"","lastName":"Suzuki","suffix":""},{"id":334509459,"identity":"4a73f129-21b7-4ea9-a45c-65ae41058727","order_by":3,"name":"Kento Masukawa","email":"","orcid":"","institution":"Tohoku University Graduate School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Kento","middleName":"","lastName":"Masukawa","suffix":""},{"id":334509460,"identity":"a85c4583-65bf-4d53-8082-1679eb596145","order_by":4,"name":"Tatsuya Morita","email":"","orcid":"","institution":"Seirei Mikatahara General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tatsuya","middleName":"","lastName":"Morita","suffix":""},{"id":334509461,"identity":"71683560-5ab4-492e-9e43-57245ec8c86f","order_by":5,"name":"Yoshiyuki Kizawa","email":"","orcid":"","institution":"University of Tsukuba","correspondingAuthor":false,"prefix":"","firstName":"Yoshiyuki","middleName":"","lastName":"Kizawa","suffix":""},{"id":334509462,"identity":"aab777ec-4b8d-4bd9-a1d2-902da65a7f2e","order_by":6,"name":"Satoru Tsuneto","email":"","orcid":"","institution":"Kyoto University","correspondingAuthor":false,"prefix":"","firstName":"Satoru","middleName":"","lastName":"Tsuneto","suffix":""},{"id":334509463,"identity":"4e1d9889-8171-4449-b662-155ec6c90fd3","order_by":7,"name":"Yasuo Shima","email":"","orcid":"","institution":"Tsukuba Medical Center Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yasuo","middleName":"","lastName":"Shima","suffix":""},{"id":334509464,"identity":"1d225356-ebc2-4bd3-be8d-82b1d7892d33","order_by":8,"name":"Mitsunori Miyashita","email":"","orcid":"","institution":"Tohoku University Graduate School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mitsunori","middleName":"","lastName":"Miyashita","suffix":""}],"badges":[],"createdAt":"2024-06-09 10:53:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4553487/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4553487/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00520-024-09057-2","type":"published","date":"2024-12-02T15:56:51+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":70964437,"identity":"9276fd68-f9fe-416a-955f-84785b6d368b","added_by":"auto","created_at":"2024-12-09 16:02:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":572798,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4553487/v1/b02b79af-9792-43c3-b317-3e32864186d7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Unapproved and unproven cancer treatments in patients admitted to palliative care units","fulltext":[{"header":"Introduction","content":"\u003cp\u003eComplementary and Alternative Medicine (CAM) is a broad set of non-mainstream practices, including the use of natural products, mind-body therapies, and entire medical systems [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Its use among patients with cancer has increased in the last decades [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. CAM therapies are used by an estimated 60\u0026ndash;80% of patients with a history of cancer [3.4]. CAM therapies may be used to promote overall health and wellness, mitigate cancer-related symptoms, provide supportive care during cancer treatment to mitigate side effects, address the late effects of cancer treatment during survivorship care, and improve the overall quality of life during the continuum of cancer care, including end-of-life care.\u003c/p\u003e \u003cp\u003eUnapproved and unproven cancer treatment (UUCT), administered by doctors as an alternative medicine for treating cancer, is expensive and not covered by insurance. UUCT refers to treatments for various conditions and diseases for which standard treatments have failed and for which the efficacy is unclear and unproven in clinical trials. For example, the use of untested cellular therapies presents a worldwide problem [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, patients are unaware of the risks associated with such therapies. Therefore, focusing on the potential limitations and adverse effects of these therapies is critical to preventing misinformation.\u003c/p\u003e \u003cp\u003eGiven the high frequency of CAM use and the various reasons for its use in patients with cancers, the current status and reasons for CAM use are unclear. Physicians should ascertain what CAMs are being used and for what purpose.\u003c/p\u003e \u003cp\u003eWe focused on UUCT among many CAMs and surveyed the families of patients with cancers who died in the palliative care unit to understand the actual use of UUCT. This study revealed the economic impact of UUCT administration on the bereaved family members of patients with cancer and their psychological experiences. We focused on the bereaved family members of patients who received immune cell therapy to explore the factors that led to their use.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy procedure\u003c/h2\u003e \u003cp\u003eWe conducted a cross-sectional, anonymous, self-report questionnaire survey between July and August 2018. This study was conducted as part of the Japan Hospice and Palliative Care Evaluation Study 4 (J-HOPE4 Study) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], one of the projects undertaken by the Japan Hospice Palliative Care Foundation. To identify potential participants, we requested that each institution identify and list up to 80 bereaved family members of patients who had died before January 31, 2018. The inclusion criteria were death due to cancer, age was aged\u0026thinsp;\u0026gt;\u0026thinsp;20 years, and bereaved family members aged\u0026thinsp;\u0026gt;\u0026thinsp;20 years. The exclusion criteria were patients who had received palliative care for \u0026lt;\u0026thinsp;3 days, missing contact information for the bereaved family members, deaths caused by any medical or surgical treatment or that had occurred in an intensive care unit, severe psychological distress of the bereaved family members, as judged by the physician, or inability of the potential participant to complete the self-report questionnaire because of health issues and/or disability. Questionnaires were sent to bereaved family members identified by each participating institution. The participants were asked to return the completed questionnaire to the Secretariat Office (Tohoku University) within one month. One month after sending the questionnaire, we sent reminders to non-responders. A document explaining the aims and procedures of the J-HOPE 4 study was sent along with the questionnaire, and the return of a completed questionnaire was considered consent to participate in the study. Ethical approval for the study was granted by the ethics committee of Tohoku University Hospital and all participating institutions (2017-2-236-1).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eQuestionnaires\u003c/h2\u003e \u003cp\u003ePatient backgrounds, including age, sex, primary site, marital status, presence of cohabitants, presence of minor children, population of the area of residence, annual income, and medical expenses in the month prior to death, were surveyed. The backgrounds of the bereaved family members, including age, sex, relationship, last education, health status during the patient's hospitalization, number of days of attendance before death, presence of supporters, and religion, were surveyed.\u003c/p\u003e \u003cp\u003eSurvey items related to CAM were defined by the National Institute of Health as \"a variety of medical and health care systems, practices, and generative products that are not generally regarded as conventional medicine.\" A list of CAMs, including various psychosomatic therapies that are not easily recognized as CAM in Japan, was compiled, and questions were asked regarding the duration and timing of CAM use. We focused on UUCT among many CAMs. We asked the bereaved families about immunotherapy, gene therapy, and other treatments that patients received at clinics and hospitals at their expense, such as UUCT. We inquired about which therapies they received as UUCT, such as immune cell therapy (dendritic cell vaccine therapy, peptide vaccine therapy, and autologous lymphocyte therapy), gene therapy, or high-concentration vitamin C infusion therapy. We asked whether the doctor properly explained the benefits of UUCT and the circumstances under which the patient underwent UUCT.\u003c/p\u003e \u003cp\u003eThe purpose of UUCT was categorized into four areas: \"cure of disease,\" \"control of disease progression,\" \"alleviation of side effects,\" and \"spiritual hope,\" based on the previous literature [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding their experiences with UUCT, respondents were asked about the effects and side effects of CAM, the financial burden, methods of obtaining information, and patient communication with their doctors [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStastistical analyses\u003c/h2\u003e \u003cp\u003eLogistic regression analysis was performed to determine the factors influencing the receipt of self-payment alternative therapies that have not been proven to be effective. Multivariate analyses were performed for univariate analyses with significant differences. All results were considered significant when the \u003cem\u003eP\u003c/em\u003e-value was less than 0.05. All analyses were performed using SPSS software (version 29.0; IBM SPSS Inc. Japan).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eQuestionnaires were sent to 1039 bereaved family members, 661 (64%) responses were received. Of these, 558 were included in the study after excluding the 103 who did not complete the questionnaire. Patients and caregiver characteristics are presented in Table 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCharacteristics of participants (Table 1-1.1-2)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe median age of the patients was 77 years (range: 26 to 99 years). 54% were man. The most frequent primary tumor was gastrointestinal cancer, followed by hepatobiliary cancer, and the median average length of stay in the palliative care unit was 21 days (range, 34-84 days). Bereaved family members had a mean age of 65 years (range; 34 to 84 days), and 62% were women. The bereaved person was most frequently the patient’s spouse, followed by the child. The most common annual income of the bereaved family members was $13,333-26,666, assuming $1 is 150 yen, followed by $6,667-13,332. Medical expenses one month prior to death were less than $267 in 78% of the cases.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe actual use of UUCT (Table2-1. 2-2)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn total, 7.3% (41/558) of the patients received at least one type of UUCT. The most frequent kind of UUCT was immuno-cell therapy, which was administered to 28 of the 41 patients (68%). Twenty-five (61%) patients underwent UUCT combined with standard cancer treatment. In the contrast, four (10%) patients underwent self-funded UUCT because the standard treatment for their cancer was ineffective. Thirty patients (73%) requested UUCT. Among the patients who underwent UUCT, only four (10%) distrusted their doctors, and eight (20%) felt abandoned by them. Thirty-three patients (80%) expected UUCT to slow cancer progression. Nineteen (46%) patients expected it to alleviate the painful symptoms caused by cancer treatment, such as loss of appetite. From the professional perspective, 31 (76%) primary doctors did not object to their patients undergoing UUCT. Twenty (49%) of them informed their patients that it might not work. However, 25 (61%) patients expected UUCT to completely cure their disease. Only 12 patients (29%) underwent UUCT without consulting their primary doctors. The cost of UUCT was less than $20,000 for 30 patients (73%) and ranged from $6,666 to $20,000 for 14 patients (34%). Thirty-five (85%) bereaved family members did not object to UUCT. Thirty-five (85%) believed that receiving UUCT provided spiritual hope for the patients. Twenty-two (54%) of them felt that the cost was too high. However, thirty-two bereaved family members (78%) did not regret the patients having undergone UUCT.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eUnivariate and multiple logistic regression analysis (Table3)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn the univariate analyses, several items exhibited significant differences. Most patients received treatment for more than one year (odds ratio 2.27 [95% Confidence interval (CI) 1.11-4.65], p=0.021). Annual income during treatment was more than $26700 (odds ratio 2.04 [95% CI 1.63-3.92], p=0.029). Medical expenses for the month before their death were more than $267 (odds ratio 2.06 [95% CI 1.00-4.21], p=0.045). More people underwent CAM than UUCT (odds ratio 3.58 [95% CI 1.86-6.89], p\u0026lt;0.001). Patients who could discuss CAM with their doctors were more likely to receive UUCT (odds ratio 2.02 [95% CI 0.99-4.15], p=0.051). Multivariate analyses were performed for univariate analyses with significant differences. The multiple logistic regression analysis identified independent determinants influencing the use of CAM over UUCT (odds ratio 2.41 [95% CI 1.15-5.03], \u003cem\u003ep\u003c/em\u003e=0.024). Furthermore, patients who could discuss UUCT with their doctors tended to undergo UUCT (odds ratio 2.6 [95% CI 0.96-6.89],\u003cem\u003e\u0026nbsp;p\u003c/em\u003e=0.054).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo our knowledge, this is the first nationwide survey of bereaved family members of patients with cancer conducted to identify the actual situation of UUCTs among those who died in palliative care units. We clarified the financial burden and psychological experiences of families who used UUCT, and clarified factors affecting the use of UUCT in terminally ill patients.\u003c/p\u003e \u003cp\u003eIn this study, the purpose of using UUCT was primary to maintain their mental hope, suggesting that UUCT may provide mental support for patients with cancers. As 61% of the patients received UUCT concurrently with standard treatment and were given its high cost, the economic impact was not negligible.\u003c/p\u003e \u003cp\u003eHonda \u003cem\u003eet al\u003c/em\u003e. used the Comprehensive Score for Financial Toxicity (COST) tool to measure financial toxicity (FT) in Japanese cancer patients with cancer [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Several reports from high-income countries have suggested a negative correlation between FT and the length and quality of life [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The study involved 156 participants who responded to a questionnaire. Cancer treatment is expensive, and patients often need to make adjustments in their lives to afford cancer treatment. Strategies to cope with the cost of cancer care included using savings to pay for cancer treatment (n\u0026thinsp;=\u0026thinsp;95, 63%), reducing expenses on leisure (n\u0026thinsp;=\u0026thinsp;67, 44%), and reducing spending on food or clothing (n\u0026thinsp;=\u0026thinsp;42, 28%). In multivariable analyses associated of the COST score using linear regression, non-regular employment (β, -5.37; 95% CI, -10.16 to -0.57; p\u0026thinsp;=\u0026thinsp;0.03), retirement because of cancer (β, -5.42; 95% CI, -8.62 to \u0026minus;\u0026thinsp;1.37; p\u0026thinsp;=\u0026thinsp;0.009), and using coping strategies (β, -5.09; 95% CI, -7.87 to -2.30; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significantly associated with lower COST scores, indicating higher FT. This study suggests that many patients who use ingenious strategies to manage the high cost of cancer treatment.\u003c/p\u003e \u003cp\u003eOwing to the low percentage of physicians who were consulted about UUCT and the finding that about half of them advised about the risks associated with UUCT, logistic analysis revealed that patients with cancers who discussed with doctors were more likely to receive UUCT. We initially assumed that the patients underwent UUCT because they were dissatisfied with their doctors, but that was not the case. We believe that doctors provided the correct information, but they could not deter the patients from undergoing UUCT. This finding highlights the challenge of communicating with patients with cancers and their families. Tamels \u003cem\u003eet al.\u003c/em\u003e reported that nearly 70% of patients with cancers did not understand that their cancers could not be cured with anticancer treatment [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Weeks \u003cem\u003eet al.\u003c/em\u003e as well as Tamels \u003cem\u003eet al\u003c/em\u003e. suggested that many patients receiving chemotherapy for advanced cancer with metastases may not understand that chemotherapy is unlikely to cure them [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. When palliative care is provided to such patients from the early (not terminal) stage of treatment (during treatment with anticancer agents), patients have a more accurate understanding of their disease condition. This thorough consideration of their condition and the limitations of anticancer treatment results in fewer patients continuing anticancer treatment until just before death [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Patients must be involved in the decision-making process of \"how long to continue anticancer treatment,\" as studies have revealed that receiving anticancer treatment in the months immediately prior to death increases the likelihood of the patient not dying in their preferred location and undergoing more invasive medical measures [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Early palliative care interventions for patients with cancer may improve their quality of life and prolong survival; thus, and the importance of early palliative care is being recognized worldwide [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, we also considered the difficulties of these early decision-making efforts in palliative care. Patients who believe they have good communication with their doctors also have higher rates of misunderstanding, which leads to a more rigorous discussion about prognosis and medical conditions, resulting in lower patient satisfaction. Tasaki \u003cem\u003eet al.\u003c/em\u003e conducted semi-structured interviews with 143 patients with cancers to explore their experiences with CAM use. Using qualitative research methods, they examined interview data from 93 CAM users who provided sufficient information about communication issues. Three themes emerged describing barriers to successful communication from the patient's perspective: doctors' indifference or opposition to CAM use, physicians' emphasis on scientific evidence, and patients' anticipation of a negative response from their doctors [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Increasing education on CAM and regular assessments of CAM use may help physicians become more aware of their patients' CAM use. Consequently, doctors may provide patients with information on the risks and benefits of CAM use and refer them to other services that may address their unmet needs.\u003c/p\u003e \u003cp\u003eAdditionally, lack of communication is problematic in the health care context because the development of openness and trust between doctors and patients is contingent upon effective interpersonal communication. Techniques such as preparing the environment for conversation, checking the other person's understanding during the conversation, and empathizing with the other person's sentiments have been established; however, the specific words and methods needed to overcome communication barriers must be acquired through experience and sensitivity, in addition to these communication techniques.\u003c/p\u003e \u003cp\u003eThis study has three limitations. First, because it is a survey of bereaved family members and not of the patients themselves, it may be subject to bias and may not accurately reflect the actual use of UUCT. Surveying bereaved families provided a broad view of the process leading up to death; however, they are not the patients and may lack specific details. Second, this survey was conducted on the bereaved family members of patients who died in palliative care units and is not representative of all terminally ill patients. The actual use of UUCT in patients who die in hospitals setting other than palliative care units or at home may differ. Third, the survey is less reliable because it is retrospective.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCurrently, many patients with cancer use some form of CAM. Good communication with patients is necessary for cancer treatments. This study revealed that those who communicated better with their doctors were more likely to undergo UUCT.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors have no relevant financial or non-financial interests to disclosure.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eEthical approval\u003c/h2\u003e \u003cp\u003eEthical approval for the study was granted by the ethics committee of Tohoku University Hospital and all participating institutions (2017-2-236-1).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to participate\u003c/strong\u003e \u003cp\u003eThe return of the questionnaires was considered as informed consent for this study.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study was part of the Japan Hospice and Palliative Evaluation Study4, funded by the Japan Hospice Palliative Care Foundation with the cooperation of Hospice Palliative Care Japan.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eHideko Akagi wrote the main manuscript text. Noriyuki Katsumata and I prepared all of tables1-3. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement:\u003c/h2\u003e \u003cp\u003eCorresponding author: Hideko Akagi, MD, Department of Oncology, Nippon Medical School Musashi-Kosugi hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki-shi, Kanagawa, 211\u0026ndash;8533, Tel: (81) 44-733-5181, [email protected]\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConflict of Interest:\u003c/strong\u003e \u003cp\u003e This study was part of the Japan Hospice and Palliative Evaluation Study 4, funded by the Japan Hospice Palliative Care Foundation, with the cooperation of Hospice Palliative Care Japan. We have no relevant or non-financial interests to disclosure.\u003c/p\u003e \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHealth Information (2019) Complementary, alternative or integrative health: what\u0026rsquo;s in a name? National Institute of Health. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://nccih.nih.gov/health/integrative-health\u003c/span\u003e\u003cspan address=\"https://nccih.nih.gov/health/integrative-health\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 9 January 2019\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHorneber M, Bueschel G, Dennert G et al (2012) How many cancer patients use complementary and alternative medicine: a systematic review and meta-analysis. Integr Cancer Ther 11:187\u0026ndash;203. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1177/1534735411423920\u003c/span\u003e\u003cspan address=\"10.1177/1534735411423920\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFalci L, Shi Z, Greenlee H (2016) Multiple chronic conditions and use of complementary and alternative medicine among US adults: results from the 2012 National Health Interview Survey. Prev Chronic Dis 13: E61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.5888/pcd13.150501\u003c/span\u003e\u003cspan address=\"10.5888/pcd13.150501\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRichardson MA, Sanders T, Palmer JL et al (2000) Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology. J Clin Oncol 18:2505\u0026ndash;2514 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1200/JCO.2000.18.13.2505\u003c/span\u003e\u003cspan address=\"10.1200/JCO.2000.18.13.2505\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIndira G, Maria de LAM, Matthew W et al (2022) How do I: Evaluate the safety and legitimacy of unproven cellular therapies? Transfusion 62:518\u0026ndash;532. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1111/trf.16814\u003c/span\u003e\u003cspan address=\"10.1111/trf.16814\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMasukawa K, Aoyama M, Morita T et al (2008) The Japan hospice and palliative evaluation study 4: a cross-sectional questionnaire survey. BMC Palliative Care 17:66. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1186/s12904-018-0319-z\u003c/span\u003e\u003cspan address=\"10.1186/s12904-018-0319-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoon H, Stewart M, Kennard MA et al (2000) Use of complementary/alternative medicine by breast cancer survivors in Ontario: prevalence and perceptions. J Clin Oncol 18:2515\u0026ndash;2521. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1200/JCO.2000.18.13.2515\u003c/span\u003e\u003cspan address=\"10.1200/JCO.2000.18.13.2515\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRichardson MA, Masse LC, Nanny K et al (2004) Discrepant views of oncologists and cancer patients on complementary/alternative medicine. Support Care Cancer 12:797\u0026ndash;804. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1007/s00520-004-0677-3\u003c/span\u003e\u003cspan address=\"10.1007/s00520-004-0677-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHonda K, Gyawali B, Ando M et al (2019) Prospective survey of financial toxicity measured by the comprehensive score for financial toxicity in Japanese patients with cancer. J Glob Oncol 5:1\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1200/JGO.19.00003\u003c/span\u003e\u003cspan address=\"10.1200/JGO.19.00003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamsey SD, Bansal A, Fedorenko CR et al (2016) Financial insolvency as a risk factor for early mortality among patients with cancer. J Clin Oncol 34:980\u0026ndash;986. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1200/JCO.2015.64.6620\u003c/span\u003e\u003cspan address=\"10.1200/JCO.2015.64.6620\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTamel JS, Greer JA, Admane S et al (2011) Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer: results of a randomized study of early palliative care. J Clin Oncol 29:2319\u0026ndash;2326. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1200/JCO.2010.32.4459\u003c/span\u003e\u003cspan address=\"10.1200/JCO.2010.32.4459\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeeks JC, Catalano PJ, Cronin A et al (2012) Patients\u0026rsquo; expectations about effects of chemotherapy for advanced cancer. N Eng J Med 367:1616\u0026ndash;1625. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1056/NEJMoa1204410\u003c/span\u003e\u003cspan address=\"10.1056/NEJMoa1204410\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreer JA1, Pirl WF, Jackson VA et al (2012) Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non-small-cell lung cancer. J Clin Oncol 30:394\u0026ndash;400. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1200/JCO.2011.35.799\u003c/span\u003e\u003cspan address=\"10.1200/JCO.2011.35.799\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWright AA, Zhang B, Keating NL et al (2014) Associations between palliative chemotherapy and adult cancer patients end of life and place of death: prospective cohort study. BMJ. 348: g1219. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1136/bmj.g1219\u003c/span\u003e\u003cspan address=\"10.1136/bmj.g1219\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTamel JS, Greer JA, Muzikansky A et al (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. NEJM. 363:733\u0026ndash;742. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1056/NEJMoa1000678\u003c/span\u003e\u003cspan address=\"10.1056/NEJMoa1000678\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTasaki K, Maskarinec G, Shumay DM, et al (2002) Communication between physicians and cancer patients about complementary and alternative medicine: exploring patients' perspectives. Psychooncology. 11:212\u0026ndash;220. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.1002/pon.552\u003c/span\u003e\u003cspan address=\"10.1002/pon.552\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"441\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\"\u003e\n \u003cp\u003eTable1-1. Patient and caregiver characteristics (n=558)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003e1-1. Patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.57369614512471%\" colspan=\"2\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.426303854875286%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.35294117647059%\" colspan=\"2\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.35294117647059%\" colspan=\"2\"\u003e\n \u003cp\u003e26-99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.57369614512471%\" colspan=\"2\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.94331065759637%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.482993197278912%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e255\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.57369614512471%\" colspan=\"2\"\u003e\n \u003cp\u003ePrimary cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.94331065759637%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.482993197278912%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003eLung cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003eGastrointestinal cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003eHepatobiliary cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003eBreast cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003eGynecologic cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003eUrologic cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003eHematologic cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\"\u003e\n \u003cp\u003eDuration of treatment/medical care received\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003e\u003cu\u003e\u0026gt;\u003c/u\u003e3 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003e1-3 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003e6-12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003e3-6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003e\u0026lt;3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eAnnual income during treatment (reported by bereaved family member, $1\u0026raquo;150JPY)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003e\u0026lt;$6,666\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003e$6,667-13,332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003e$13,333-26,662\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003e$26,663-39,999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003e$40,000-53,332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003e\u0026gt;$53,333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\"\u003e\n \u003cp\u003eMedical expenses in the month prior to death \u0026nbsp; \u0026nbsp; (\u0026lt;$267 = 0 and \u0026gt; $267 = 1, $1=150JPY)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003e\u0026lt;$267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e434\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003e\u0026gt;$267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.8868778280543%\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.46606334841629%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\"\u003e\n \u003cp\u003eLength of stay in palliative care unit (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.35294117647059%\" colspan=\"2\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"5.203619909502263%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"62.44343891402715%\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.35294117647059%\" colspan=\"2\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"389\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\"\u003e\n \u003cp\u003eTable1-2. Patient and bereaved family member characteristics (n=558)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"83.07692307692308%\" colspan=\"2\"\u003e\n \u003cp\u003e1-2. Bereaved family member\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.256410256410257%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"72.82051282051282%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.923076923076923%\" colspan=\"2\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.256410256410257%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"72.82051282051282%\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.923076923076923%\" colspan=\"2\"\u003e\n \u003cp\u003e34-84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.256410256410257%\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"72.82051282051282%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.256410256410257%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"72.82051282051282%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003e202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.256410256410257%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"72.82051282051282%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003e346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.256410256410257%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"72.82051282051282%\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"83.07692307692308%\" colspan=\"2\"\u003e\n \u003cp\u003eRelationship with patient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.256410256410257%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"72.82051282051282%\"\u003e\n \u003cp\u003eHusband/wife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003e233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.256410256410257%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"72.82051282051282%\"\u003e\n \u003cp\u003eChild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003e235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.256410256410257%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"72.82051282051282%\"\u003e\n \u003cp\u003eDaughter-in-law or son-in-law\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.256410256410257%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"72.82051282051282%\"\u003e\n \u003cp\u003eParents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.256410256410257%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"72.82051282051282%\"\u003e\n \u003cp\u003eSiblings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.256410256410257%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"72.82051282051282%\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.256410256410257%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"72.82051282051282%\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.923076923076923%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"520\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\"\u003e\n \u003cp\u003eTable2-1. The actual use of UUCT(total n=41)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003e1. Itemization of UUCT\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003en\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eImmuno-cell therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eHighly concentrated vitamin therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eGene therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003e2. When UUCT was introduced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eWhen standard treatment is not effective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eRefusing standard treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eConcurrent with standard treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eUnanswered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003e3. Patient\u0026apos;s request\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eUnanswered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003e4. Distrust of their doctors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eUnanswered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003e5. Feeling abandoned by doctors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eUnanswered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003e6. Expecting UUCT to completely cure cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eUnanswered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003e7. Expecting UUCT to slow cancer progression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eUnanswered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003e8. Hopeing UUCT to alleviate painful symptoms caused by cancer treatments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"82.6923076923077%\"\u003e\n \u003cp\u003eUnanswered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26923076923077%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.038461538461538%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2.2\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003e9. Whether primary doctors were opposed to UUCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eUnanswered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003e10．Whether primary doctors explained that UUCT may not work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eThe bereaved didn\u0026apos;t know that\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eUnanswered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003e11. Consulting their primary doctors about UUCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eUnanswered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003e12. Cost of UUCT ($1=150)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003e\u0026lt;$20000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003e\u0026gt;$20000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eUnanswered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003e13. Whether the patients\u0026apos; bereaved family members objected to UUCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eUnanswered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003e14. Whether the bereaved family members believed that receiving UUCT provided a spiritual hope for patients with cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eUnanswered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003e15. Whether the bereaved family members think the cost of UUCT was too expensive.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eUnanswered\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003e16. Whether the bereaved family members regret having undergone UUCT.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"86.59611992945327%\"\u003e\n \u003cp\u003eUnanswered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.701940035273369%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"939\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" style=\"width: 48.2289%;\"\u003e\n \u003cp\u003eTable3. Association of UUCT with physician communication and patients/bereaved family member backgrounds\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"1.5957446808510638%\" style=\"width: 1.4341%;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.97872340425532%\" style=\"width: 24.3802%;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.04255319148936%\" colspan=\"3\" style=\"width: 16.619%;\"\u003e\n \u003cp\u003eUnivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.893617021276597%\" colspan=\"3\" style=\"width: 14.1726%;\"\u003e\n \u003cp\u003eMultivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"1.5940488841657812%\" style=\"width: 1.4341%;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.93304994686504%\" style=\"width: 24.3802%;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.458023379383635%\" style=\"width: 5.3991%;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.73326248671626%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.926673751328375%\" style=\"width: 5.146%;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.545164718384697%\" style=\"width: 4.3024%;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.839532412327312%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.482465462274177%\" style=\"width: 3.7119%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.46808510638298%\" colspan=\"2\" style=\"width: 25.8143%;\"\u003e\n \u003cp\u003ePatient age (\u0026lt;60 = 0 and \u003cu\u003e\u0026gt;\u003c/u\u003e60 = 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.46808510638298%\" style=\"width: 5.3991%;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74468085106383%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e0.15-0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.936170212765957%\" style=\"width: 5.146%;\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.553191489361702%\" style=\"width: 4.3024%;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.851063829787234%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e0.24-1.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.48936170212766%\" style=\"width: 3.7119%;\"\u003e\n \u003cp\u003e0.469\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.46808510638298%\" colspan=\"2\" style=\"width: 25.8143%;\"\u003e\n \u003cp\u003ePatient sex (male = 1 and female =0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.46808510638298%\" style=\"width: 5.3991%;\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74468085106383%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e0.51-1.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.936170212765957%\" style=\"width: 5.146%;\"\u003e\n \u003cp\u003e0.932\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.553191489361702%\" style=\"width: 4.3024%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.851063829787234%\" style=\"width: 6.1583%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.48936170212766%\" style=\"width: 3.7119%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.46808510638298%\" colspan=\"2\" style=\"width: 25.8143%;\"\u003e\n \u003cp\u003eFamily members age (\u0026lt;60 = 0 and \u0026gt;60 = 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.46808510638298%\" style=\"width: 5.3991%;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74468085106383%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e0.97-1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.936170212765957%\" style=\"width: 5.146%;\"\u003e\n \u003cp\u003e0.469\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.553191489361702%\" style=\"width: 4.3024%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.851063829787234%\" style=\"width: 6.1583%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.48936170212766%\" style=\"width: 3.7119%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.46808510638298%\" colspan=\"2\" style=\"width: 25.8143%;\"\u003e\n \u003cp\u003eFamily members sex (male = 1 and female =0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.46808510638298%\" style=\"width: 5.3991%;\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74468085106383%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e0.59-2.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.936170212765957%\" style=\"width: 5.146%;\"\u003e\n \u003cp\u003e0.669\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.553191489361702%\" style=\"width: 4.3024%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.851063829787234%\" style=\"width: 6.1583%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.48936170212766%\" style=\"width: 3.7119%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.46808510638298%\" colspan=\"2\" style=\"width: 25.8143%;\"\u003e\n \u003cp\u003ePrimary cancer (hematologic cancer = 0 and solid tumor = 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.46808510638298%\" style=\"width: 5.3991%;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74468085106383%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e0.22-4.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.936170212765957%\" style=\"width: 5.146%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.553191489361702%\" style=\"width: 4.3024%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.851063829787234%\" style=\"width: 6.1583%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.48936170212766%\" style=\"width: 3.7119%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.46808510638298%\" colspan=\"2\" style=\"width: 25.8143%;\"\u003e\n \u003cp\u003eMarriage status (married = 0 and others = 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.46808510638298%\" style=\"width: 5.3991%;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74468085106383%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e0.35-1.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.936170212765957%\" style=\"width: 5.146%;\"\u003e\n \u003cp\u003e0.322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.553191489361702%\" style=\"width: 4.3024%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.851063829787234%\" style=\"width: 6.1583%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.48936170212766%\" style=\"width: 3.7119%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.46808510638298%\" colspan=\"2\" style=\"width: 25.8143%;\"\u003e\n \u003cp\u003eDuration of treatment/medical care received (\u0026lt;1 year =0 and \u003cu\u003e\u0026gt;\u003c/u\u003e1 year = 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.46808510638298%\" style=\"width: 5.3991%;\"\u003e\n \u003cp\u003e2.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74468085106383%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e1.11-4.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.936170212765957%\" style=\"width: 5.146%;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.553191489361702%\" style=\"width: 4.3024%;\"\u003e\n \u003cp\u003e2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.851063829787234%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e0.98-4.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.48936170212766%\" style=\"width: 3.7119%;\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.46808510638298%\" colspan=\"2\" style=\"width: 25.8143%;\"\u003e\n \u003cp\u003eAnnual income during treatment (\u0026lt;$26700 = 0 and \u003cu\u003e\u0026gt;\u003c/u\u003e\u0026nbsp;$26700 = 1, $1\u0026raquo;150JPY)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.46808510638298%\" style=\"width: 5.3991%;\"\u003e\n \u003cp\u003e2.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74468085106383%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e1.63-3.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.936170212765957%\" style=\"width: 5.146%;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.553191489361702%\" style=\"width: 4.3024%;\"\u003e\n \u003cp\u003e1.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.851063829787234%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e0.71-3.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.48936170212766%\" style=\"width: 3.7119%;\"\u003e\n \u003cp\u003e0.279\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.46808510638298%\" colspan=\"2\" style=\"width: 25.8143%;\"\u003e\n \u003cp\u003eMedical expenses in the month prior to death \u0026nbsp; \u0026nbsp; (\u0026lt;$267 = 0 and \u003cu\u003e\u0026gt;\u003c/u\u003e\u0026nbsp;$267 = 1, $1\u0026raquo;150JPY)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.46808510638298%\" style=\"width: 5.3991%;\"\u003e\n \u003cp\u003e2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74468085106383%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e1.00-4.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.936170212765957%\" style=\"width: 5.146%;\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.553191489361702%\" style=\"width: 4.3024%;\"\u003e\n \u003cp\u003e1.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.851063829787234%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e0.64-3.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.48936170212766%\" style=\"width: 3.7119%;\"\u003e\n \u003cp\u003e0.358\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.46808510638298%\" colspan=\"2\" style=\"width: 25.8143%;\"\u003e\n \u003cp\u003eLength of stay in a palliative care unit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.46808510638298%\" style=\"width: 5.3991%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74468085106383%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e0.99-1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.936170212765957%\" style=\"width: 5.146%;\"\u003e\n \u003cp\u003e0.483\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.553191489361702%\" style=\"width: 4.3024%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.851063829787234%\" style=\"width: 6.1583%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.48936170212766%\" style=\"width: 3.7119%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.46808510638298%\" colspan=\"2\" style=\"width: 25.8143%;\"\u003e\n \u003cp\u003eComplementary and alternative medicine other than UUCT (yes = 1 and no = 0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.46808510638298%\" style=\"width: 5.3991%;\"\u003e\n \u003cp\u003e3.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74468085106383%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e1.86-6.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.936170212765957%\" style=\"width: 5.146%;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.553191489361702%\" style=\"width: 4.3024%;\"\u003e\n \u003cp\u003e2.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.851063829787234%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e1-15-5.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.48936170212766%\" style=\"width: 3.7119%;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.46808510638298%\" colspan=\"2\" style=\"width: 25.8143%;\"\u003e\n \u003cp\u003eCommunication with oncologist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.46808510638298%\" style=\"width: 5.3991%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.74468085106383%\" style=\"width: 6.1583%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.936170212765957%\" style=\"width: 5.146%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.553191489361702%\" style=\"width: 4.3024%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.851063829787234%\" style=\"width: 6.1583%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.48936170212766%\" style=\"width: 3.7119%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"1.5940488841657812%\" style=\"width: 1.4341%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"42.93304994686504%\" style=\"width: 24.3802%;\"\u003e\n \u003cp\u003eHad good communication with my doctor\u0026nbsp;(yes = 1 and no = 0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.458023379383635%\" style=\"width: 5.3991%;\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.73326248671626%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e0.44-2.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.926673751328375%\" style=\"width: 5.146%;\"\u003e\n \u003cp\u003e0.926\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.545164718384697%\" style=\"width: 4.3024%;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.839532412327312%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e0.17-1.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.482465462274177%\" style=\"width: 3.7119%;\"\u003e\n \u003cp\u003e0.184\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"1.5940488841657812%\" style=\"width: 1.4341%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"42.93304994686504%\" style=\"width: 24.3802%;\"\u003e\n \u003cp\u003eCould discuss with my doctor about complementary alternative medicine (yes = 1 and no = 0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.458023379383635%\" style=\"width: 5.3991%;\"\u003e\n \u003cp\u003e2.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.73326248671626%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e0.99-4.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.926673751328375%\" style=\"width: 5.146%;\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.545164718384697%\" style=\"width: 4.3024%;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.839532412327312%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e0.98-6.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.482465462274177%\" style=\"width: 3.7119%;\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"1.5940488841657812%\" style=\"width: 1.4341%;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.93304994686504%\" style=\"width: 24.3802%;\"\u003e\n \u003cp\u003eCould discuss with my doctor how to spend my daily life other than treatment (yes = 1 and no = 0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.458023379383635%\" style=\"width: 5.3991%;\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.73326248671626%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e0.62-2.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.926673751328375%\" style=\"width: 5.146%;\"\u003e\n \u003cp\u003e0.563\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.545164718384697%\" style=\"width: 4.3024%;\"\u003e\n \u003cp\u003e1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.839532412327312%\" style=\"width: 6.1583%;\"\u003e\n \u003cp\u003e0.41-2.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.482465462274177%\" style=\"width: 3.7119%;\"\u003e\n \u003cp\u003e0.978\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"unapproved and unproven cancer treatment (UUCT), Complementary and Alternative Medicine (CAM), Cancer, Palliative care","lastPublishedDoi":"10.21203/rs.3.rs-4553487/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4553487/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo clarify the current use of unapproved and unproven cancer treatment (UUCT) among the bereaved families of patients with cancer who died in palliative care units, the financial burden and psychological experiences of the families, and the relationship between patients in palliative care who used UUCT and communication with their physicians\u0026rsquo;.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study was conducted as part of a cross-sectional, anonymous nationwide survey of the bereaved family members of patients with cancer in Japan.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eQuestionnaires were sent to 1,039 bereaved family members, and responses were received from 661 (64%). Of these, 558 were included in the study after excluding the 103 who did not complete the questionnaire. A total of 7.3% (41 of 558) of patients received UUCT. Of these, 34% (14 of 41) of patients were formed that the treatment was in the research phase, and 49% (20 of 41) were informed that the efficacy of the treatment was unknown. Regarding expectations for UUCT, 61% (25/41) expected to be cured, and 80% (33/41) expected it to slow disease progression. In multivariate logistic regression analysis, more patients received complementary and alternative medicine (CAM) than UUCT (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.024), and patients who could discuss CAM with their doctors tended to receive UUCT (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.054).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePatients with cancer want to be cured and improve their condition, no matter what it takes. These results highlight the challenge of telling patients that UUCT is ineffective and informing them of their prognosis and severe medical conditions.\u003c/p\u003e","manuscriptTitle":"Unapproved and unproven cancer treatments in patients admitted to palliative care units","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-09 07:12:16","doi":"10.21203/rs.3.rs-4553487/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-06T20:44:01+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-05T09:23:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"75904031263060124584074101027353016865","date":"2024-09-24T01:47:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-18T12:16:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"3520575365420139656072119938018360973","date":"2024-09-09T07:41:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-01T03:39:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"129539276035777484384303309184197467461","date":"2024-07-21T18:53:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-20T02:43:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-19T13:57:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-12T03:28:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2024-06-09T10:51:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"914d49a9-ff76-4fac-b18a-acd4f6cd88ae","owner":[],"postedDate":"August 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-09T15:58:25+00:00","versionOfRecord":{"articleIdentity":"rs-4553487","link":"https://doi.org/10.1007/s00520-024-09057-2","journal":{"identity":"supportive-care-in-cancer","isVorOnly":false,"title":"Supportive Care in Cancer"},"publishedOn":"2024-12-02 15:56:51","publishedOnDateReadable":"December 2nd, 2024"},"versionCreatedAt":"2024-08-09 07:12:16","video":"","vorDoi":"10.1007/s00520-024-09057-2","vorDoiUrl":"https://doi.org/10.1007/s00520-024-09057-2","workflowStages":[]},"version":"v1","identity":"rs-4553487","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4553487","identity":"rs-4553487","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}