Robyn Boyle, RPh, for MDLinx | April 26, 2018
A recent study found that patients who chose alternative medicine (AM) in lieu of conventional cancer treatment (CCT) for common, curable cancers had an increased risk of death from breast, colorectal, and lung cancer. The study was published in JNCI: The Journal of the National Cancer Institute.
Skyler B. Johnson, MD, from the Yale School of Medicine in New Haven, CT, and colleagues, identified the factors associated with AM selection and compared survival outcomes between AM and CCT for non-metastatic breast, prostate, lung, and colorectal cancer—the four most prevalent cancers in the United States.
Patients who initially elected AM for treatment of curable cancer in lieu of CCT were rare, and had statistically significantly worse survival in most types of cancer evaluated.
The magnitude of difference was largest for breast cancer. Women who used AM as initial treatment without CCT had more than a fivefold increased risk of death. Patients with colorectal and lung cancer had a more than fourfold and twofold increase in risk of death, respectively. However, there was no statistically significant association between AM use and survival for patients with prostate cancer.
The researchers identified 281 cancer patients who chose AM, defined as unproven cancer treatments administered by non-medical personnel, but did not include the wide range of therapies that complement conventional medicine. They were matched 2:1 with 560 patients treated with CCT, defined as chemotherapy, radiotherapy, surgery, and/or hormone therapy.
Compared to patients treated with CCT, patients in the AM group were more likely to be younger, to be female, to have breast cancer, to have a more advanced cancer stage, to have a higher income and education, fewer co-morbidities, and to reside in the Intermountain West or Pacific regions.
Patients who received CCT were matched to AM patients based on cancer type, age, clinical group stage, Charlson-Deyo Comorbidity Score (CDCS), insurance type, race, and year of diagnosis.
There were no statistically significant differences in matched characteristics; the median follow-up was 66 months.
Overall, the five-year survival for AM was 54.7% compared to 78.3% for CTT (P < 0.001; hazard ratio [HR]: 2.21). It remained an independent predictor of greater risk of death (HR: 2.50) when controlling for clinical and sociodemographic factors.
Receiving AM treatment compared to CCT was associated with statistically significantly worse five-year survival for breast (58.1%, vs 86.6%, P < 0.001; HR: 5.68), lung (19.9%, vs 41.3%, P < 0.001; HR: 2.17), and colorectal cancer (32.7% vs 79.4%, P < 0.001; HR: 4.57), but not for prostate cancer (86.2% vs 91.5%, P=0.36; HR: 1.68).
Prostate cancer has a long natural progression, so the authors believe that the difference between prostate cancer treatments was not unexpected, given the short median follow-up in this study. Furthermore, approximately 74.6% of prostate cancer patients in the study had low- to intermediate-risk disease.
The authors acknowledge that limitations of the study included the observational design, unmeasured confounders or selection bias that could impact survival, and lack of information regarding the type of alternative therapies delivered.
“Although rare, AM utilization for curable cancer without any CCT is associated with greater risk of death,” concluded the authors.
To read more about this study, click here.