Cancer patients who initially chose alternative medicine (AM) rather than conventional therapies for treatment are more likely to die than others. Improved communication between patients and caregivers on the role of AM is warranted.

 

Recent research has suggested that electing for alternative medicine (AM) over conventional cancer treatment (CCT) can lead to serious survival implications for cancer patients. “There is a common belief among some cancer patients that AM may be as effective as CCT despite the fact that there is no evidence to support such claims,” explains Skyler B. Johnson, MD. “There is also limited research about the types of patients who make these decisions and their survival outcomes.”

Dr. Johnson and colleagues had a study published in which they assessed factors associated with AM selection and compared survival outcomes between AM and CCT. Published in the Journal of the National Cancer Institute, the analysis examined these trends using data from the National Cancer Database between 2004 and 2013 on breast, prostate, lung, and colorectal cancer. The research team identified 281 cancer patients who chose AM in lieu of CCT. Patients who underwent AM included those with non-metastatic breast, prostate, lung, or colorectal cancer who were administered AM as their only cancer treatment; they did not previously receive CCT. The authors defined CCT as chemotherapy, radiotherapy, surgery, and/or hormone therapy. Patients were excluded from the study if they had metastatic cancer at diagnosis, received upfront treatment with palliative intent, and/or had an unknown treatment status.

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Key Results

According to the study, patients who elected to receive AM were more likely to be younger, female, have a lower Charlson-Deyo Comorbidity Score (CDCS), and have higher cancer stages, income, and education. After controlling for clinical and demographic factors, variables associated with a higher likelihood of AM use included having breast or lung cancer, a higher socioeconomic status, residing in an Intermountain West or Pacific location, having stage II or III disease, and having a low CDCS (Figure below).

“Our key finding was that, after controlling for clinical and socioeconomic variables, patients with initially curable breast, prostate, colorectal, and lung cancer who chose AM were 2.5-fold more likely to die when compared with those who received CCT during the study period, which had a median follow-up of about 5 years,” says Dr. Johnson. “In subgroups with breast, lung, and colorectal cancer, the hazard ratios for death were 5.68, 2.17, and 4.57, respectively, for those who chose AM.”

The study also revealed that there was a nonsignificant difference in survival favoring CCT among prostate cancer patients, but Dr. Johnson says this was expected. “Prostate cancer progresses slowly over many years, and the median follow-up in our study was short,” he says. “Additionally, about 75% of prostate cancer patients were deemed low-to-intermediate risk. Research shows there is no difference in 10-year survival among these patients when comparing radiation, surgery, and active surveillance.”

Important Considerations

Dr. Johnson says the study highlights the importance of timely proven medical care for the treatment of curable cancers. “Patients need to be warned about the risks of choosing AM to treat their disease because it has dire consequences and could result in an inability to cure the cancer at an earlier stage,” he says. “It’s important to improve our communication with patients and caregivers so that more informed decisions are made regarding AM use for cancer. As a cancer treatment, AM may need to be addressed on a policy level to protect patients from harm.”

There are many critical areas of future research that are needed with regard to AM, according to Dr. Johnson. “We need a better understanding of the geographic and demographic trends seen in our study,” he says. “We also need better documentation of the true proportion of cancer patients who choose AM and more comparisons of the effects of AM in patients with metastatic disease.”

Comparing Overall Survival By Cancer Type

Overall survival of patients receiving alternative medicine (solid lines) vs conventional cancer treatment (dashed lines) for patients with, (A) breast, (B) prostate, (C) lung, and (D) colorectal cancers.

References

Johnson SB, Park HS, Gross CP, Yu JB. Use of alternative medicine for cancer and its impact on survival. J Natl Cancer Inst. 2018;110:121-124. Available at: https://academic.oup.com/jnci/article-abstract/110/1/121/4064136?redirectedFrom=fulltext or https://www.medscape.com/viewarticle/892460.

Ernst E. Intangible risks of complementary and alternative medicine. J Clin Oncol.2001;19:2365-2366.

Davis EL, Oh B, Butow PN, et al. Cancer patient disclosure and patient-doctor communication of complementary and alternative medicine use: A systematic review. Oncologist. 2012;17:1475-1481.

Richardson MA, Sanders T, Palmer JL, et al. Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology. J Clin Oncol. 2000;18:2505-2514.

Gansler T, Kaw C, Crammer C, et al. A population-based study of prevalence of complementary-methods use by cancer survivors. Cancer. 2008;113:1048-1057.