Good press on the use of complementary and alternative medicine (CAM) for cancer does not abound. Steve Jobs famously regretted his nine-month delay getting conventional treatment for pancreatic cancer due to a flirtation with fruit drinks and acupuncture. More recently, Cancer Research UK firmly rejected any benefits of Gerson therapy, which advocates thrice-daily coffee enemas and a hefty intake of crushed veggies as an alternative treatment for the big C.
Those seeking relief from the bad news will find little solace in a new study, published in JAMA Oncology and led by James Yu from the Yale School of Medicine, New Haven, US, which affirms that CAM and cancer make for testy bedfellows.
Scanning the US National Cancer Database, the researchers searched for patients diagnosed between 2003 and 2014 with breast, prostate, lung and bowel cancer that had not spread, and for which at least one conventional treatment had been undergone; surgery, chemotherapy, radiotherapy or hormone treatment. The grand total came to more than 1.9 million patients.
The team then winnowed out patients who had also used complementary medicine, defined as “unproven cancer treatments administered by nonmedical personnel”, including herbs, vitamins and minerals, traditional Chinese medicine, homeopathy, naturopathy, and specialised diets.
This tally was somewhat smaller; a mere 258 patients. That group did, however, differ notably from the overall cohort on a number of counts.
CAM users were more likely to be younger, female, with a more advantaged socioeconomic status and higher education. They also tended to come from the region of the western United States that sweeps down from the Montana prairies across the Rockies to the Pacific coast, an area, the authors note, with a high concentration of CAM schools and legislation that favours CAM.
The outcomes of that group were then compared with 1032 patients who had opted for conventional treatment alone, drawn from the same pool and matched on a range of factors including age, gender, cancer type and education level.
The news was bad, but not all bad.
CAM aficionados were much more likely to have refused some form of conventional treatment. For example, 18 of the 258 CAM users declined surgery, as opposed to just one of the 1032 members of a non-CAM control group, and 88 of the 258 CAM users said “no” to chemotherapy compared to only 33 of the 1032 who eschewed CAM.
That aversion to orthodox treatment came with a big cost.
A preference for CAM led to more than double the risk of death. It was also linked to reduced five-year survival: 82% for CAM users compared to 87% for non-CAM users.
The good news, depending on your world view, was that the miserable results posted by CAM users were wholly linked to their shunning of conventional treatment, with no intrinsic detriment found from CAM itself.
The research builds on work done by the same team, published earlier this year, that found cancer sufferers who used only alternative medicines had higher death risks than those getting conventional treatment – more than twofold for lung cancer up to nearly sixfold for breast cancer.
Those results depart dramatically from the beliefs held by CAM-leaning cancer patients.
The authors cite long standing research showing two-thirds believe CAM will prolong their life and one third expect a cure. A 2014 survey in German cancer patients found more modest, but still troublingly optimistic expectations from CAM, including “boosting the immune system”, “getting active”, getting “better control of the disease” and not “leaving out a chance” of a cure.
Should such beliefs lead users to forgo conventional treatment, the current study suggests it would be a grave mistake, as the authors note in their conclusion.
“For patients with curable cancers who are inclined to pursue complementary treatment methods, timely adherence to all recommended conventional therapies should be strongly advised,” they write.
Commenting on the study, Professor Sanchia Aranda, CEO of Cancer Council Australia said, “These findings are particularly worrying given you would expect the group of people being studied to have generally good chances of cancer survival.”
“We know that negative attitudes towards complementary therapies among health professionals can deter those with cancer being open with their healthcare team […] A more accepting attitude of complementary medicine, as proposed in new models of integrated medicine, is probably more conducive to those with cancer continuing their conventional treatments, as they feel their choices are being accepted,” she said.
Paul Biegler is a philosopher, physician and Adjunct Research Fellow in Bioethics at Monash University. He received the 2012 Australasian Association of Philosophy Media Prize and his book The Ethical Treatment of Depression (MIT Press 2011) won the Australian Museum Eureka Prize for Research in Ethics.
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