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The relationship between anxiety about prostate cancer among patients with biochemical cancer recurrence and the use of complementary and alternative medicines, diet, and exercise
  1. Richard T. Lee1,
  2. Joshua A. Hemmerich2,,
  3. Nancy Kwon3,
  4. Kathryn Bylow4,
  5. Walter M. Stadler2,
  6. Supriya G. Mohile5 and
  7. William Dale2
  1. 1. Department of Medicine, Case Western Reserve University and University Hospitals, Cleveland, OH, USA
  2. 2. Department of Medicine, University of Chicago, Chicago, IL, USA
  3. 3. Department of Medicine, Northwestern University, Chicago, IL, USA
  4. 4. Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
  5. 5. Department of Medicine, University of Rochester, Rochester, NY, USA
  1. Corresponding Author: Richard T. Lee Associate Professor, Division of Hematology/Oncology, Case Western Reserve University and University Hospitals, Director of Supportive and Integrative Oncology Seidman Cancer Center, Parker Hannifin-Helen Moss Cancer Research Foundation Professor of Integrative Oncology, Cleveland, OH, USA Tel.: +1-216-3682415 E-mail: richard.t.lee{at}


Objective We aimed to explore associations between anxiety and specific health behaviors such as complementary and alternative medicine (CAM), diet, and exercise among prostate cancer patients.

Methods PCa patients enrolled in a prospective cohort study of men with biochemical cancer recurrence were surveyed about use of CAM, diet, and exercise. Anxiety was measured with the Memorial Anxiety Scale for Prostate Cancer (MAX-PC) and the anxiety subscale of the Hospital Anxiety and Depression Scale.

Results Nearly 70% (44 of 67) of the original cohort of patients completed the supplementary CAM survey. The mean age was 68 years. Eighty percent of respondents reported engaging in a relevant health behavior, and 64% reported doing so in direct response to their PCa diagnosis. Overall, the most prevalent specific behaviors were exercising (56%), making dietary changes (50%), taking calcium supplements (41%), and taking vitamin D supplements (39%). Elevated baseline PCa-specific anxiety (MAX-PC score >16) after biochemical cancer recurrence was associated with use of any CAM (P=0.01), use of herbs/supplements (P=0.01), and dietary changes (P=0.04).

Conclusion PCa patients commonly use CAM, dietary changes, and exercise in response to their diagnosis, and these changes are associated with elevated general and PCa-specific anxiety.

  • Prostate cancer
  • complementary and alternative medicine
  • health behaviors
  • anxiety

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See

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