Cancer Survival Takes a Hit with Alternative Medicine

Study shows eschewing conventional therapy is risky

Patients who opted for alternative medicine as the sole treatment for potentially curable cancers had significantly worse survival compared with similar patients who received conventional therapy, a retrospective comparison showed.

Overall, reliance on alternative medicine more than doubled the survival hazard, which increased as much as five- or sixfold, depending on the type of cancer. Patients who opted for alternative strategies tended to be younger, healthier, and more affluent as compared with patients who received conventional care for their cancers.

The study did not include patients who received complementary or integrative therapies in addition to conventional treatment, but focused instead on a small subgroup of patients who chose alternative treatments as their initial and sole therapy, Skyler B. Johnson, MD, of Yale Cancer Center in New Haven, Conn., and co-authors reported in the Journal of the National Cancer Institute.

"[Healthcare providers] are taught to respect patients' wishes, especially with regard to treatment choices," said the senior author, James Hu, MD, director of Yale's Prostate and Genitourinary Cancer Radiotherapy Program. "If patients make an informed decision, because of patient autonomy, they can do whatever they want. We're always advising them; we can't make them do anything. What this study says is that we can advise patients that if they choose an alternative and unproven treatment, they are more likely to die than if they go with [conventional] therapy."

Several prior studies showed that delaying conventional therapy in favor of alternative medicine can adversely affect survival. There have been limited data, however, regarding the use and effectiveness of alternative medicine -- due in part, the authors said, to patient hesitance to disclose nonmedical treatment to healthcare providers.

In an attempt to address the knowledge gap, the team queried the National Cancer Database for 2004 to 2013, seeking information on the four most common cancers: breast, prostate, lung, and colorectal. The primary objectives were to identify factors associated with patient preference for alternative medicine and to compare survival between patients who chose alternative medicine and those who received conventional treatment (defined as chemotherapy, surgery, radiotherapy, and hormonal therapy).

The query identified 280 patients who chose alternative medicine as initial treatment, associated with coding for "other-unproven: cancer treatments administered by nonmedical personnel." The investigators matched each patient with two similar patients who chose conventional therapy as the initial treatment for their cancers.

The study and control groups did not differ significantly with respect to cancer type, age, clinical stage, comorbidity score, insurance type, race, or year of diagnosis. By multivariable analysis (controlling for clinical and demographic factors), the alternative medicine cohort was younger, more likely to have breast or lung cancer, better educated, more likely to have stage II or III disease, more likely to live in Intermountain West and Pacific regions, and had lower comorbidity scores.

The 840 patients assessed had a median follow-up of 66 months. The alternative-medicine cohort had a significantly worse 5-year survival rate (54.7% versus 78.3%, P<.001). The difference translated into a survival hazard of 2.21, which remained significant in a multivariable analysis (HR 2.50, 95% CI 1.88-3.27), the researchers reported.

With respect to the individual types of cancer, alternative medicine was associated with significantly worse 5-year survival rates for breast cancer (58.1% versus 86.6%, P<.001); lung cancer (19.9% versus 41.3%, P<.001); and colorectal cancer (32.7% versus 79.4%, P<.001). The 5-year survival rate did not differ significantly for prostate cancer (86.2% versus 91.5%, P=0.36).

Survival hazards for the four types of cancer were:

• Breast: HR 5.68, 95% CI 3.22-10.04
• Lung: HR 2.17, 95% CI 1.42-3.32
• Colorectal: HR 4.57, 95% CI 1.66-12.61
• Prostate: HR 1.68, 95% CI 0.68-4.17

At the American Society of Clinical Oncology annual meeting earlier this year, then-president Daniel Hayes, MD, of the University of Michigan in Ann Arbor, cautioned against over-reliance on complementary and alternative medical strategies. Commenting on two studies showing improved outcomes attributable to lifestyle and dietary factors, Hayes said, "People should not interpret these two abstracts as suggesting that if you live a healthy lifestyle and you eat tree nuts, you don't need to take the chemotherapy that your oncologist would recommend. That's a very dangerous interpretation."

Hu said patients who choose alternative medicine as initial treatment for cancer make up only a small fraction of the total population of patients with cancer. Nonetheless, the study showed that such patients tend to have a favorable prognosis, but traditional oncologists often don't see the patients until after disease progression.

"Anytime we do these types of retrospective studies, we worry about selection bias," Hu said. "In this study, all the biases were in favor of alternative medicine, in that the cohort was younger, more affluent, and had fewer comorbidities. These patients should be doing better than the standard therapy group, but they're not. That's a scary thing to me. These are young patients who could potentially be cured, and they're being sold snake oil by unscrupulous alternative medicine practitioners."

Johnson reported having no relevant relationships with industry. Hu disclosed a relationship with 21st Century Oncology. Other co-authors disclosed relationships with Varian MedicalSystems, RadOncQuestions, and 21st Century Oncology.

• Reviewed by F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner
• Primary Source Johnson SB, et al "Use of alternative medicine for cancer and its impact on survival." J Natl Cancer Inst 2017; DOI:10.1093/jnci/djx145.

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