1. DiGiulio, Sarah

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Skyler Johnson, MD, a resident in the Department of Therapeutic Radiology, and his colleagues at Yale School of Medicine, New Haven, Conn., were bothered by a certain trend they noticed: their patients were refusing conventional cancer treatments at the time of diagnosis. They also were seeing that patients with advanced cancers who had been diagnosed much earlier had refused conventional treatment to try alternative medicines. After those therapies didn't work, they came back to receive conventional therapy.

Skyler Johnson, MD. ... - Click to enlarge in new windowSkyler Johnson, MD. Skyler Johnson, MD

Johnson's group used the National Cancer Database to look at patients diagnosed with the four most common cancers in the U.S. between 2004 and 2013 (breast, lung, prostate, and colorectal cancers). They compared outcomes for patients who chose an "unproven medical therapy delivered by a nonmedical professional" at the time of diagnosis with matched patients who chose conventional therapies. The data was stark.


Overall, the patients who chose alternative therapies had a 2.5-fold increased risk of death compared with patients who chose conventional therapy after 5 years. Looking only at patients with breast cancer, risk of death after 5 years was five times higher among the patients who chose alternative medicine. For patients with colorectal cancer, risk of death was four times higher for patients who chose alternative medicine. For patients with lung cancer, risk of death was two times higher among those who chose alternative medicines. And there was no statistically significant increased risk of death at 5 years for patients with prostate cancer who chose alternative medicine over conventional therapy, which Johnson noted was expected.


The data was published online ahead of print in the Journal of the National Cancer Institute (doi:10.1093/jnci/djx145).


Here's what Johnson said cancer care providers and patients should know about these findings.


1 Were you surprised by the findings?

"I was surprised initially that [the increased risk of death with alternative medicines] weren't higher. Two-point-five sounds like a high number, but based on our anecdotal experience in clinic we thought it might be much worse.


"The data we collected was for initial treatment only, that first treatment decision that patients make [after they are diagnosed with a cancer]. Just like we were seeing patients whose cancers had advanced, gotten worse, and then they were coming [back] in for conventional therapies-that's perhaps what was happening in our dataset. So we likely under-ascertained for the true treatment affect. Some of these patients [who initially chose alternative therapies] may also have received a conventional cancer therapy later, which may have improved their survival.


"Plus the National Cancer Database only collects from accredited cancer centers. A lot of patients who were coming to see us after they had tried these alternative medicines were coming from different centers as well. So, there are a lot of patients treated at places where their data was not likely collected."


2 Is there clear data overall on how many patients choose alternative therapies over conventional treatment-and why?

"This is a really hard question to answer because we know there's a hesitancy on behalf of patients to tell their physicians this is the decision that they're going to make. So we really don't know how to quantify the exact number of patients doing it. Our dataset is small and it's only about 0.02 percent of the total patients in the dataset, but that likely underreports [the true number of patients who choose alternative medicines].


"There was another code in the dataset where patients were refusing conventional cancer therapies and they didn't give a reason. We didn't include those patients because we didn't know what they were doing or why they were refusing, but it's likely that at least a majority or at least a portion of those patients were doing some form of alternative medicine, too. It's an area of further research that's needed.


"And it's hard to know why patients choose alternative over conventional therapies. There's marketing [from the alternative medicine industry]. It could be physicians not doing a good enough job explaining why to choose evidence-based treatment. It could be the patients themselves who feel that alternative medicines might be more effective or less toxic despite the lack of evidence for that claim."


3 What would you say is the bottom-line message about this work and alternative medicines for cancer treatment?

"Alternative medicines can be defined as unproven therapies. They may be being researched in preclinical settings or laboratory settings, but if they're unproven to work, they are not medicine. The discussion becomes more nuanced when talking about some complementary therapies. Someone who receives acupuncture or a botanical or other type of medicine as a complementary medicine may be able to safely do that-but they to do it under the guidance of their physicians in addition to their conventional therapies, not in lieu of conventional therapy.


"The long and short of it is that, if a person chooses alternative medicine for their curable cancer as their initial treatment choice, they are at greater risk of death than if they were to choose conventional cancer therapy. [How great that increased risk is] is dependent on which cancers they have. But there's a real risk associated with taking that decision that can affect their chance at cure and survival."