Complementary Medicine, refusal of conventional cancer therapy, and survival among patients with curable cancers

Posted 26 July 2018

Alternative Cancer Treatments May Be Bad for Your Health

People who used herbs, acupuncture and other complementary treatments tended to die earlier than those who didn’t.

Nicholas Bakalar July 23, 2018 New York Times

Herbs, acupuncture and other so-called complementary treatments for cancer may not be completely innocuous.

A new study has found that many cancer patients treat these nostrums not as a supplement to conventional treatment, but as an alternative. This, the researchers say, can be dangerous.

The observational analysis, in JAMA Oncology, used data on 258 complementary medicine users and 1,032 people in a control group. Complementary therapies included herbs, vitamins, traditional Chinese medicine, homeopathy, naturopathy, yoga, acupuncture and others.

People who used complementary treatments were more often women, younger, privately insured and of higher socioeconomic status. They did not delay the start of conventional treatment any longer than others, but they had higher rates of refusal of surgery, chemotherapy, radiation and hormone treatments. They also had lower five-year survival rates, and more than double the risk of death.

The complementary treatments did no harm when conventional treatment was carried out simultaneously.

“Cancer treatment is scary,” said the senior author, James B. Yu, an associate professor of therapeutic radiology at Yale. “It’s a human response to seek out therapies that promise no side effects and only benefits. We need to listen to patients, and help them integrate these therapies with conventional therapy.

“Complementary medicines are supposed to help you endure treatment, but some believe they will help cure you. We found no evidence of that.”

Complementary Medicine, Refusal of Conventional Cancer Therapy, and Survival Among Patients With Curable Cancers

Skyler B. Johnson, MD1; Henry S. Park, MD, MPH1; Cary P. Gross, MD2; et al James B. Yu, MD, MHS1,2

https://jamanetwork.com/journals/jamaoncology/fullarticle/2687972

1Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut 2Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut

JAMA Oncol. Published online July 19, 2018. doi:10.1001/jamaoncol.2018.2487

Abstract Importance  There is limited information on the association among complementary medicine (CM), adherence to conventional cancer treatment (CCT), and overall survival of patients with cancer who receive CM compared with those who do not receive CM.

Objectives  To compare overall survival between patients with cancer receiving CCT with or without CM and to compare adherence to treatment and characteristics of patients receiving CCT with or without CM.

Design, Setting, and Participants  This retrospective observational study used data from the National Cancer Database on 1 901 815 patients from 1500 Commission on Cancer–accredited centers across the United States who were diagnosed with nonmetastatic breast, prostate, lung, or colorectal cancer between January 1, 2004, and December 31, 2013. Patients were matched on age, clinical group stage, Charlson-Deyo comorbidity score, insurance type, race/ethnicity, year of diagnosis, and cancer type. Statistical analysis was conducted from November 8, 2017, to April 9, 2018.

Exposures  Use of CM was defined as “Other-Unproven: Cancer treatments administered by nonmedical personnel” in addition to at least 1 CCT modality, defined as surgery, radiotherapy, chemotherapy, and/or hormone therapy.

Main Outcomes and Measures  Overall survival, adherence to treatment, and patient characteristics.

Results  The entire cohort comprised 1 901 815 patients with cancer (258 patients in the CM group and 1 901 557 patients in the control group). In the main analyses following matching, 258 patients (199 women and 59 men; mean age, 56 years [interquartile range, 48-64 years]) were in the CM group, and 1032 patients (798 women and 234 men; mean age, 56 years [interquartile range, 48-64 years]) were in the control group. Patients who chose CM did not have a longer delay to initiation of CCT but had higher refusal rates of surgery (7.0% [18 of 258] vs 0.1% [1 of 1031]; P < .001), chemotherapy (34.1% [88 of 258] vs 3.2% [33 of 1032]; P < .001), radiotherapy (53.0% [106 of 200] vs 2.3% [16 of 711]; P < .001), and hormone therapy (33.7% [87 of 258] vs 2.8% [29 of 1032]; P < .001). Use of CM was associated with poorer 5-year overall survival compared with no CM (82.2% [95% CI, 76.0%-87.0%] vs 86.6% [95% CI, 84.0%-88.9%]; P = .001) and was independently associated with greater risk of death (hazard ratio, 2.08; 95% CI, 1.50-2.90) in a multivariate model that did not include treatment delay or refusal. However, there was no significant association between CM and survival once treatment delay or refusal was included in the model (hazard ratio, 1.39; 95% CI, 0.83-2.33).

Conclusions and Relevance  In this study, patients who received CM were more likely to refuse additional CCT, and had a higher risk of death. The results suggest that mortality risk associated with CM was mediated by the refusal of CCT.

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