Of the 200 hospitals provided by Newsweek, 69 were excluded for the following reasons: incomplete English translation (n=66), invalid SSL Certificate (n=2), and department no longer existed (n=1). As such, 131 hospitals met our inclusion criteria and were reviewed. The complete data extraction form with raw data extracted from all eligible websites can be found as in Supplementary File 1.
Regarding patient information, 66 out of 131 hospitals (50.38%) provided a description of CAIM, while 65 (49.62%) did not provide any information on CAIM. Additionally, 63 (48.09%) hospitals provided a description of one or more CAIM therapies, while 68 (51.91%) did not provide a description of any CAIM therapy.
Shown in Table 1 are the terms extracted from hospital websites that were used to describe CAIM. It should be noted that some hospital websites provided more than one theoretical definition of CAIM. Of the 66 hospitals that provided such a definition, common terms used to refer to CAIM included ‘integrative medicine’ (n=27), ‘complementary therapy’ (n=16), and ‘complementary and alternative medicine’ or ‘complementary alternative therapies (n=13). Terms used less common on hospital websites included ‘complementary medicine’ (n=5), ‘integrative oncology’ (n=4), ‘complementary and integrative medicine’ (=3), ‘alternative medicine’ (n=2), and ‘integrative health’ (n=2). Notably, use of the all-encompassing term, ‘complementary, alternative, and integrative medicine,’ appeared once.
Organized under each CAIM category, the number of hospitals that describe and offer each CAIM therapy is shown in Table 2. We calculated the frequencies of each CAIM therapy described and percentages were calculated by dividing frequencies by the total number of hospitals from which we extracted data (total n=131). It was found that CAIM therapies described, from most to least common, included: massage (n=53, 40.46%), special foods and diets (n=49, 37.40%), acupuncture (n=46, 35.11%), meditation (n=42, 32.06%), yoga (n=40, 30.53%), creative outlets (n=40, 30.53%), vitamins and dietary supplements (n=34, 25.95%), reflexology (n=29, 22.14%), reiki (n=29, 22.14%), imagery (n=28, 21.37%), tai chi (n=26, 19.85%), hypnosis (n=26, 19.85%), biofeedback (n=25, 19.08%), botanicals (n=23, 17.56%), chiropractic therapy (n=17, 12.98%), therapeutic touch (n=14, 10.69%), homeopathy (n=14, 10.69%), traditional Chinese medicine (n=12, 9.16%), Ayurvedic medicine (n=11, 8.40%), and naturopathic medicine (n=7, 5.34%).
Regarding patient care, 83 out of 131 hospitals (63.36%) offered one or more CAIM therapies to cancer patients. CAIM therapies were provided through centres and departments relating to health and wellness, supportive care, integrative cancer care, oncology and haematology, and nutrition.
We then calculated the frequencies of each CAIM therapy offered and percentages were calculated by dividing frequencies by the total number of hospitals from which we extracted data (total n=131). As shown in Table 2, it was found that CAIM therapies offered, from most to least common, included: special foods and diets (n=63, 48.09%), massage (n=55, 41.98%), creative outlets (n=51, 38.93%), acupuncture (n=48, 36.64%), meditation (n=47, 35.88%), yoga (n=46, 35.11%), vitamins and dietary supplements (n=28, 21.37%), reiki (n=28, 21.37%), tai chi (n=27, 20.61%), reflexology (n=24, 18.32%), biofeedback (n=20, 15.27%), imagery (n=20, 15.27%), hypnosis (n=19, 14.50%), therapeutic touch (n=12, 9.16%), botanicals (n=10, 7.63%), chiropractic therapy (n=10, 7.63%), traditional Chinese medicine (n=5, 3.82%), Ayruvedic medicine (n=2, 1.53%), naturopathic medicine (n=2, 1.53%), and homeopathy (n=1, 0.76%).
Table 3 shows whether CAIM benefits and side effects were provided in website descriptions. We calculated the sum of each response (‘yes,’ ‘no,’ ‘unclear,’ ‘not mentioned’) pertaining to benefits, and each response (‘yes,’ ‘no,’ ‘unclear,’ ‘not mentioned’) pertaining to side effects across all CAIM therapies. Percentages for each of the aforementioned responses were calculated relative to the number of hospitals that provided descriptions of each CAIM therapy. Benefits were provided for the vast majority of CAIM therapies described (e.g., for all descriptions of meditation, yoga, creative outlets, and traditional Chinese medicine), with the exception of homeopathy. In contrast, side effects were generally not mentioned (e.g., meditation, imagery, creative outlets, therapeutic touch). Proportionally, side effects accompanied descriptions of biologically based practices (i.e., vitamins and dietary supplements, botanicals, and special foods and diets) as well as Ayurvedic medicine.