The financial burden resulting from complementary and alternative medicine in oncology care.

Abstract

Background: Complementary and alternative medicine (CAM) is widely used by oncology patients to manage symptoms, reduce stress, and improve quality of life. Unlike conventional treatments, CAM is rarely reimbursed in Germany, resulting in significant out-of-pocket costs. These expenses may contribute to financial burden and financial toxicity, yet this dimension remains understudied.

Methods: This multicenter, open-label, cross-sectional study was conducted in 2024. A standardized anonymous questionnaire collected demographic, socioeconomic, and medical data, CAM utilization, out-of-pocket expenditures, and distress levels (NCCN Distress Thermometer). Descriptive statistics, Chi-square tests, Pearson correlations, and independent t-tests were applied.

Results: A total of 209 patients (median age 62.6 years, 52.6% female) participated; 57.4% reported CAM use. Female patients were more likely than males to use CAM (p < 0.001). Among CAM users, 71.7% incurred out-of-pocket expenses, averaging €124/month for women and €153/month for men. Expenditures were highest among patients with hematological malignancies (€229/month). A strong positive correlation was observed between the number of CAM modalities used and monthly costs (p < 0.001). No significant difference in distress was found between CAM users and non-users; however, female CAM users reported lower distress than their male counterparts (p < 0.05).

Conclusions: CAM use is common among German oncology patients and generates substantial out-of-pocket costs, particularly in vulnerable subgroups. When combined with cancer-related income loss, these expenditures increase financial burden and may contribute to financial toxicity. Integrative oncology models, reimbursement strategies, and patient counseling are essential to mitigate economic vulnerability and ensure equitable access to supportive care.