Contents lists available at ScienceDirect Complementary Therapies in Clinical Practice journal homepage: www.elsevier.com/locate/ctcp Complementary and integrative health interventions and their association with health-related quality of life in the primary brain tumor population Dina M. Randazzo a,*,1 , Frances McSherry b , James E. Herndon c , Mary L. Affronti a,d , Eric S. Lipp a , Charlene Flahiff a , Elizabeth Miller a , Sarah Woodring a , Susan Boulton a , Annick Desjardins a , David M. Ashley a , Henry S. Friedman a , Katherine B. Peters a a Department of Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, DUMC Box 3624, Durham, NC, 27710, USA b Duke Cancer Institute Biostatistics, Duke University Medical Center, Durham, NC 27710, USA c Department of Biostatistics and Bioinformatics, Duke University Medical Center, DUMC Box 2717, Durham, NC, 27710, USA d Duke University School of Nursing, DUMC 3624, Durham, NC, 27710, USA ARTICLE INFO Keywords: Complementary Glioma Health Integrative Life Quality ABSTRACT Background and purpose: Little is known about complementary and integrative health intervention usage in the primary brain tumor population. We aimed to identify the percentage of patients using these practices and explore the impact on quality of life. Materials and methods: Clinical records from patients seen in clinic between December 16, 2013 and February 28, 2014 were reviewed retrospectively. The questionnaires used were a modified version of the International Complementary and Alternative Medicine Questionnaire, the Functional Assessment of Cancer Therapy- Brain Cancer and the Functional Assessment of Chronic Illness Therapy- Fatigue. Results: 76% of patients utilized a complementary and integrative health modality. The most frequently reported modalities used were vitamins, massage, and spiritual healing, prayer, diet and meditation. Conclusion: These results confirm the usage of complementary and integrative health practices within the pri- mary brain tumor population; however, there was no evidence of association between use and quality of life. 1. Introduction According to the Central Brain Tumor Registry of the United States (CBTRUS), the number of new cases of primary brain and other CNS tumors diagnosed in 2018 is estimated to be 85,440 [1,2]. The most aggressive form of brain tumor is the glioblastoma (GBM), which ac- counts for the majority of all gliomas (55.0%) [1]. After standard treatment with chemoradiation and adjuvant temozolomide, the median overall survival in GBM ranges from 14.6 months to 20.9 months [3,4]. Therapy frequently has long-term side effects including memory loss and fatigue, as well as other potential problems such as hemiparesis or aphasia, depending upon the location of the tumor [5–8]. Given these poor survival outcomes and possible life-changing side effects of therapy, some brain tumor patients go above and beyond standard treatment and seek out alternative therapies in an attempt to possibly cure their cancer and/or improve their quality of life [9]. Complementary and integrative health (CIH) is the term used for a non-traditional approach to medicine using diverse practices and pro- ducts that are not part of the standard of care. The CIH practice en- compasses many modalities including: alternative medical systems, biologically-based therapies, manipulative and body-based therapies, mind-body therapies and energy-healing therapies [10]. The combina- tion of these alternative practices with mainstream medical care is classified as integrative medicine [11]. According to data from the National Health Interview Survey (NHIS) that was collected in 2002, 2007, and most recently in 2012, the adult use of CIH modalities has remained above 30.0% [12]. Based on the 2012 survey results, the most common CIH therapy among adults was non-vitamin and non-mineral natural products (17.7%). Deep breathing (10.9%), meditation (8.0), chiropractic/osteopathic manipulation (8.4%) and massage (6.9%) https://doi.org/10.1016/j.ctcp.2019.05.002 Received 18 December 2018; Received in revised form 17 May 2019; Accepted 17 May 2019 * Corresponding author. E-mail addresses: dina.randazzo@duke.edu (D.M. Randazzo), frances.mcsherry@duke.edu (F. McSherry), james.herndon@duke.edu (J.E. Herndon), mary.affronti@duke.edu (M.L. Affronti), eric.lipp@duke.edu (E.S. Lipp), cflahiff@duke.edu (C. Flahiff), elizabeth.s.miller@duke.edu (E. Miller), sarah.woodring@duke.edu (S. Woodring), susan.boulton@duke.edu (S. Boulton), annick.desjardins@duke.edu (A. Desjardins), david.ashley@duke.edu (D.M. Ashley), henry.friedman@duke.edu (H.S. Friedman), katherine.peters@duke.edu (K.B. Peters). 1 Present address: Dina M. Randazzo, DO, MS, The Preston Robert Tisch Brain Tumor Center, University Medical Center, DUMC Box 3624, Durham, NC 27710. Complementary Therapies in Clinical Practice 36 (2019) 43–48 1744-3881/ © 2019 Published by Elsevier Ltd. T