Why Resorting To Alternative Medicine To Treat Cancer Is A Bad Idea

In In The News by Barbara Jacoby

By: Geoffrey Kabat

From: forbes.com

We can’t say that Steve Jobs shortened his life by delaying, for 9 months, obtaining conventional treatment for his rare cancer, but it is clear that alternative treatments are no match for standard cancer treatment.

In 2003 Apple CEO Steve Jobs was diagnosed with a rare form of pancreatic cancer. Rather than immediately embarking on conventional treatment with surgery and chemotherapy, for 9 months Jobs resorted to a combination of alternative treatments, including acupuncture, special fruit juices, and “spiritual healing.” Eventually he agreed to receive conventional treatment with surgery and chemo and worked with oncologists to try cutting edge strategies to cure his cancer. He later expressed regret that he had delayed getting medical treatment. In spite of his access to the best medicine could offer, Jobs died in 2011 at the age of 56.

An estimated 43 to 67 percent of cancer patients use some form of complementary and alternative medicine (CAM). While many patients use CAM treatments in conjunction with conventional cancer treatment, a subset opt to rely on alternative medicine alone as a substitute for standard medical treatment. Reasons for resorting to AM over conventional cancer treatment are poorly understood but are likely to include the desire to avoid the toxicity of chemo and radiation, the desire to use more “natural” modalities, and an orientation toward more “spiritual” therapies.

This week an unusual study appeared in the Journal of the National Cancer Institute comparing the survival of patients who received only alternative medical (AM) treatment (i.e., who rejected conventional treatment) for their cancer with cancer patients who received conventional cancer treatment (CCT). Researchers at the Yale School of Medicine used data from the National Cancer Dataset between 2004 and 2013, focusing on the four most common cancers: breast, prostate, lung, and colorectal cancer. A total of 281 cancer patients who chose AM were compared to 560 patients who received CCT, which was defined as surgery, chemotherapy, radiation, and/or hormone therapy.

Compared to patients who selected CCT, patients who opted for AM tended to be more educated, to have higher incomes, to reside in the Pacific region, and to have more advanced disease.

In multivariable analyses, controlling for sociodemographic and clinical factors that might affect survival, patients who received AM had a 2.5 greater risk of dying compared to those who received CCT. For specific cancers, the risk of death among AM patients, compared to CCT patients, was 5.7-fold greater for breast cancer, 2.2-fold greater for lung cancer, and 4.6-fold greater for colorectal cancer. Among patients with prostate cancer, survival was comparable between those receiving AM and those receiving CCT, which is not surprising, given the slow natural course of prostate cancer and the short follow-up period in this study.

As an observational study, the study only demonstrates an association between AM and poorer survival. In addition, information was not available on the specific type of AM used. However, this and other limitations are unlikely to account for the results, and the substantial magnitude of the survival difference is suggestive of a real effect.

This study serves to underscore several crucial points that can easily get obscured in discussions of CAM/AM vs. conventional medical treatments.

First, conventional cancer treatment varies widely depending on the type of cancer and the stage at which it is diagnosed. For example, treatment of breast cancer is generally highly effective, and women diagnosed with breast cancer have a high survival rate. In contrast, treatments for ovarian cancer, lung cancer, and, particularly, pancreatic cancer are much less effective, and these diseases are associated with poor survival.

Second, in spite of popularity of CAM/AM, to date there is no evidence that CAM/AM offers effective treatment against any cancer.

Finally, there has been dramatic progress in recent years in developing “targeted therapies” for cancers that have specific genetic features as well as in devising strategies to harness the patient’s immune system to fight his/her cancer. While one doesn’t want to overstate the difficulty of devising effective treatments for the huge variety of cancers, we can expect to see continued progress.

Steve Jobs had a rare type of pancreatic cancer and delayed embarking on conventional treatment for 9 months. We can’t say, in this particular case, that he would have lived longer had he not delayed treatment. However, for the reasons mentioned above, it is a tragic mistake to forego established cancer treatments in favor of “alternative,” “natural,” and “New Age” treatments with no proven efficacy against cancer. The new study provides a strong indication that, in general, those who opt for AM over CCT have a substantially increased risk of dying as a result of their choice.