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Use of CAM by Insured Pts inWashington State

Original Article

The use of complementary and alternative medical providers by insured cancer patients in Washington state

William E. Lafferty, M.D. 1 *, Allen Bellas, Ph.D. 2, Andrea Corage Baden, L.M.P, M.P.H. 1, Patrick Timothy Tyree 1, Leanna J. Standish, N.D., Ph.D., L.Acup. 3, Ruth Patterson, Ph.D., R.D. 4

1Department of Health Services, University of Washington, Seattle, Washington 2Evans School of Public Affairs, University of Washington, Seattle, Washington 3Research Division, Bastyr University, Kenmore, Washington 4Department of Epidemiology, University of Washington, Seattle Washington

email: William E. Lafferty (billlaf@u.washington.edu)

*Correspondence to William E. Lafferty, Department of Health Services, Box 357660, 1959 NE Pacific Street, Room H694, University of Washington, Seattle, WA 98195

Abstract

BACKGROUND Insurance coverage of complementary and alternative medicine (CAM) is expanding. However, to the authors' knowledge, little is know concerning CAM utilization among cancer patients under the insurance model of financing.

In this study, the authors evaluated CAM provider utilization by cancer patients in a state that requires the inclusion of alternative practitioners in private, commercial insurance products.

METHODS

An analysis was carried out of year 2000 claims data from two large Washington State insurance companies.

RESULTS

Of 357,709 claimants, 7915 claimants (2.3%) had a cancer diagnosis. Among cancer patients, 7.1% had a claim for naturopathy, acupuncture, or massage; and 11.6% had a claim for chiropractic during the study year.

The use of naturopathy (odds ratio [OR], 2.0; P < 0.001) and acupuncture (OR, 1.4; P < 0.001) were more common, and the use of chiropractic was less common (OR, 0.9; P < 0.001) for cancer patients compared with those without cancer. No significant differences were noted in the use of massage between the two groups.

Except in 2 individuals (0.03%), cancer patients also had at least 1 conventional provider claim during the year. Factors associated with nonchiropractic alternative provider use were female gender, the presence of metastatic cancer, hematologic malignancy, and the use of chemotherapy. Increased use of naturopathic physicians accounted for much of this trend.

Musculoskeletal pain was the most common diagnosis at the CAM provider visit. Billed amounts for alternative services were < 2% of the overall medical bills for cancer patients.

CONCLUSIONS

A substantial number of insured cancer patients will use alternative providers if they are given the choice.

The cost of this treatment is modest compared with conventional care charges.

For individuals with cancer, CAM providers do not appear to be replacing conventional providers but instead are integrated into overall care.

Cancer 2004;100:1522-30.

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