To (1) determine the attitudes, perceptions, and use of complementary, alternative, and integrative medicine among undergraduate students; (2) assess whether these students would benefit from more academic exposure to complementary and alternative medicine (CAM) and promotion of integrative medicine (IM); and (3) gauge the need and desire of undergraduates, particularly pre-health learners, to take courses about CAM/IM. This cross-sectional electronic survey study was conducted on the campus of the University of California (UC) Irvine. Selection criteria included being at least 18 years of age and a current undergraduate at UC Irvine. All survey responses were collected between November 20, 2010, and June 1, 2011. The data were analyzed by using Stata software, version 11-SE (Stata Corp., College Station, TX). Completed surveys were received from 2839 participants (mean age of respondents, 20.2 years). Thirty-five percent had used CAM within the past 12 months, and 92.8% believed CAM to be at least somewhat effective; however, only 31% had prior education on CAM. After adjustment for variables, familiarity and belief in effectiveness were both highly linked to the use of CAM, with ascending odds ratios (ORs; 95% confidence interval [CI]) of 3.9 (3.1-4.9), 8.1 (5.7-11.5), 13.4 (6.0-30.2), 2.1 (1.3-3.4), 4.9 (3.0-7.8), and 12.7 (6.9-23.4) among increasing categories (all p<0.01). Sex (OR, 1.26 [95% CI, 1.01-1.56]; p<0.05), Asian ethnicity (1.46 [1.14-1.88]; p<0.01), and prior education (1.26 [1.01-1.57]; p<0.05) were also significantly correlated to the use of CAM after adjustment. Most respondents indicated that they were likely to take a CAM college course if it fulfilled a graduation requirement (63.6%) or was offered within their major (56.4%). Overall, this large-scale study supports the ideas that education plays a pivotal factor in the decision to use CAM and that there is a large demand for additional CAM knowledge among college students.

PURPOSE: Androgen receptor signaling inhibitors (ARSIs) are mainstay treatments for metastatic prostate cancer. Hyperglycemia is a common side effect, but limited data exist on outcomes such as acute care use among patients on these medications. This study aimed to assess the impact of diabetes on acute care use in older patients with metastatic prostate cancer on ARSIs. METHODS: We used SEER-Medicare data for patients 66 years and older with de novo metastatic prostate cancer who were prescribed abiraterone, enzalutamide, or apalutamide from 2010 to 2017. Negative binomial regression calculated incidence rate ratios of acute care use (total hospital or emergency admissions divided by total time at risk) for each model covariate among diabetic and nondiabetic patients after initiation of ARSI. RESULTS: A total of 2,697 patients were included, of which 17.4% had diabetes. The average age was 75.0 years, and most were White (80.3%). Most (85.3%) patients received androgen deprivation therapy before ARSI. Acute care use within 6 months occurred in 29.5% of patients, with 39.9% in the diabetes group and 27.4% in the nondiabetes group ( P < .0001). Adjusted for covariates, patients with diabetes had an increased rate of acute care use (Incidence rate ratio [IRR] = 1.38 [95% CI, 1.11 to 1.70]; P = .003) compared with those without diabetes. In addition, compared with those who were prescribed only enzalutamide or apalutamide, patients who were prescribed abiraterone had an increased rate of acute care use (IRR, 1.43 [95% CI, 1.12 to 1.82]; P = .005). CONCLUSION: Acute care use was common among patients with metastatic prostate cancer on ARSIs. Patients with diabetes experienced higher rates of acute care use compared with those without diabetes among all ARSI types. Future studies should assess potential interventions in older patients with diabetes on ARSIs.

Background: Management of metastatic prostate cancer often requires combining androgen deprivation therapy (ADT) with novel androgen receptor signaling inhibitors (ARSIs). Although these agents improve survival, older patients may face acute care utilization from medication burden, reflected in polypharmacy and nonadherence. Methods: Using SEER‐Medicare data, the authors identified patients ≥66 years old with de novo metastatic prostate cancer prescribed abiraterone, enzalutamide, or apalutamide (2010–2017). Polypharmacy was defined by the Youden index (≥8 medications). ARSI adherence was measured by medication possession ratio (≥0.8) from initiation to discontinuation, assessed over 6 months. Acute care use was defined as any inpatient hospitalization or emergency visit within 6 months. Demographic characteristics were compared by t ‐tests/χ ² . Negative binomial regression estimated incidence rate ratios (IRRs) for acute care use. Results: Among 2697 patients (mean age, 75 years), most were White (80.3%), married (63.1%), and received prior ADT (85.3%). Polypharmacy was present in 50.6% of patients before ARSI initiation, whereas ARSI nonadherence in the 6 months post‐initiation was 34.0%. Polypharmacy and adherence were not significantly associated. In adjusted analyses controlling for demographic, clinical, and treatment factors, both polypharmacy (IRR, 1.59; 95% confidence interval [CI], 1.28–1.98) and ARSI nonadherence (IRR 2.50; 95% CI, 2.00–3.03) independently prognosticated higher acute care use. Conclusions: Medication burden, as characterized by suboptimal adherence and polypharmacy, is an independent risk factor for acute care use among older adults initiating ARSI treatment for metastatic prostate cancer. These findings highlight an opportunity for potential interventions to reduce downstream acute care use.