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CME / ABIM MOC / CE

Can Alternative Medicine Use Up Risk for Death From Cancer?

  • Authors: News Author: Nick Mulcahy; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 10/13/2017
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 10/13/2018
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Target Audience and Goal Statement

This article is intended for primary care clinicians, oncologists, nurses, pharmacists, and other clinicians who care for patients with cancer.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  • Evaluate variables associated with alternative treatment for cancer and outcomes of this therapy
  • Analyze the use of complementary and alternative medicine among cancer survivors

 


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Author(s)

  • Nick Mulcahy

    Journalist, Medscape Oncology

    Disclosures

    Disclosure: Nick Mulcahy has disclosed no relevant financial relationships.

Editor(s)

  • Robert Morris, PharmD

    Associate CME Clinical Director, Medscape, LLC

    Disclosures

    Disclosure: Robert Morris, PharmD, has disclosed no relevant financial relationships.

CME Author(s)

  • Charles P. Vega, MD

    Health Sciences Clinical Professor, UC Irvine Department of Family Medicine; Associate Dean for Diversity and Inclusion, UC Irvine School of Medicine, Irvine, California

    Disclosures

    Disclosure: Charles P. Vega, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: McNeil Consumer Healthcare
    Served as a speaker or a member of a speakers bureau for: Shire Pharmaceuticals

CME Reviewer/Nurse Planner

  • Amy Bernard, MS, BSN, RN-BC

    Lead Nurse Planner, Medscape, LLC

    Disclosures

    Disclosure: Amy Bernard, MS, BSN, RN-BC, has disclosed no relevant financial relationships.


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CME / ABIM MOC / CE

Can Alternative Medicine Use Up Risk for Death From Cancer?

Authors: News Author: Nick Mulcahy; CME Author: Charles P. Vega, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME / ABIM MOC / CE Released: 10/13/2017

Valid for credit through: 10/13/2018

processing....

Clinical Context

Complementary and alternative medicine (CAM) plays an important role in healthcare in the United States, and Mao and colleagues examined data from the 2007 National Health Interview Survey to identify trends in the use of CAM among cancer survivors. Their results were published in the March 2011 issue of the Journal of Cancer Survivorship.[1]

Two thirds of cancer survivors reported using CAM at some time, and 43% had used CAM in the last year. Specifically, adults used CAM for the broad prevention of illness, enhancement of the immune system, and as an analgesic. CAM use was not a completely independent choice on the part of patients who survived cancer. Compared with patients without a history of cancer, more cancer survivors described initiating CAM based on recommendations from their health providers, and they were also more likely to discuss CAM treatment with their provider.

Some patients with active cancer opt for alternative medicine instead of traditional cancer treatment. The current study evaluates how this choice might affect survival rates among patients with cancer.

Study Synopsis and Perspective

It is rare, but it happens: a patient with a curable cancer rejects conventional medicine and initially chooses to receive only alternative treatments.

Now researchers from the Yale Cancer Center in New Haven, Connecticut, find that this choice is associated with a 2.5-fold higher risk for death compared with conventional cancer treatment (CCT).

The team had to comb through 10 years (2004-2013) of records in the National Cancer Database to find 280 patients with early-stage cancer (with breast, prostate, lung, or colorectal disease) whose treatment was coded as "other-unproven: cancer treatment administered by non-medical personnel."

This alternative medicine-only group was then matched to 560 patients with the same types of cancer who received CCT such as radiotherapy, chemotherapy, surgery, and hormone therapy.

The investigators, who performed statistical analyses by cancer type, report that compared with CCT, alternative medicine was associated with a nearly 6-fold increased risk for death among patients with breast cancer; among patients with colorectal cancer, there was a 4.5-fold increase; and among patients with lung cancer, there was a 2-fold increase.

Also, alternative medicine was associated with a significantly worse 5-year survival rate for breast cancer (58.1% vs 86.6%; P<.001), lung cancer (19.9% vs 41.3%; P<.001), and colorectal cancer (32.7% vs 79.4%; P<.001) when compared with CCT.

Median follow-up of patients was 66 months.

Notably, in the fourth subgroup the researchers studied, patients with prostate cancer, alternative medicine was not a handicap. It was not associated with a significantly increased risk for death compared with CCT, and the 5-year survival rates were similar (86.2% vs 91.5%; P=.36)

But the investigators saw that coming.

"This is not unexpected, given the long natural history of prostate cancer and the short median follow-up in this study," write the authors, led by Skyler Johnson, MD, from Yale's Department of Therapeutic Radiology.

The new study was published online July 6 in the Journal of the National Cancer Institute.[2]

Dr Johnson defined alternative medicine: "[Its] an unproven therapy that is given in place of standard therapies. In cancer, this could include things like herbs/botanicals, vitamins and minerals, homeopathy and naturopathy, special diets, prayer, meditation, acupuncture, chiropractic or osteopathic manipulation," he told Medscape Medical News.

He further explained that use these therapies "should be done as a complement [in addition] to cancer treatment." Thus, alternative medicine is distinct from complementary medicine.

Dr Johnson is fairly certain his team managed to find true representatives of the phenomenon of choosing alternative medicine exclusively.

The above-mentioned National Cancer Database code for alternative medicine is "oddly specific," he said, and "one which data collectors would have obtained from the notes." It is also distinct from the code used for those patients with cancer who did not undergo any therapy at all or who refused therapy, which are both coded within the database.

The study authors also point out that many patients with cancer use alternative therapy in addition to CCT, but little is known about patients who use alternative medicine exclusively.

Who are these patients? Compared with CCT patients, alternative medicine patients were more likely to be younger, have breast cancer, have lower comorbidity scores, and have higher cancer stage, income, and education.

Dr Johnson advised that clinicians sound out patients who are hesitant to move forward with treatment. "It's possible that they are considering an unproven therapy that they've read about on the Internet or heard about from friends [or] family," he said.

Newly diagnosed patients with cancer encounter "massive amounts of information, some of it false, and it's not easy," he added.

Dr Johnson aims to develop trust. "Facts are much less influential than the trust and respect that patients and physicians share," he said.

Paula H. Finestone, PhD, from the Division of Psychiatry at Fox Chase Cancer Center, Philadelphia, Pennsylvania, echoed this idea that patients with cancer need support and counseling during the treatment decision-making process.

"Despite the tremendous advances in cancer diagnosis and treatment in the past 20 years, there still is a great deal of anxiety among patients when they first hear the words, 'You have cancer,' " said Dr Finestone, who was not involved with the study.

"I rarely see patients who are seeking alternative treatments for their cancer," Dr Finestone told Medscape Medical News. She explained that Fox Chase is a CCT center and draws patients on that basis.

But there are patients who have relatives or friends who have had a "terrible experience" with CCT or who may introduce "the benefits of 'all natural' treatments," she said.

Dr Finestone educates patients. For example, she may point out that vincristine and  paclitaxel are both plant-based conventional treatments. But mainly she reminds patients that any friend's or relative's bad experience is "an N of 1, and that conventional treatments have been revolutionized in the past 20 years."

A number of the study authors have financial ties to industry, including pharmaceutical companies. Dr Finestone has disclosed no relevant financial relationships.

J Natl Cancer Inst. Published online July 6, 2017.

Study Highlights

  • Researchers evaluated the National Cancer Database and identified cases of breast, lung, colorectal, and prostate cancer reported between 2004 and 2013.
  • Patients with stage IV cancer or metastatic disease at the time of diagnosis were excluded from study analysis, as were those who received palliative care at the time of cancer diagnosis.
  • The main study outcome was the rate of overall survival in comparing patients treated with alternative medicine with those receiving CCT. CCT was defined as chemotherapy, radiotherapy, surgery, and/or hormone therapy.
  • 2 matched patients treated with CCT were compared with each patient treated with alternative medicine in the study analysis.
  • 280 patients were identified who chose alternative medicine instead of CCT. Patients who chose alternative medicine were more likely to live in the Intermountain West or Pacific United States, have a lower degree of comorbid illness, and have higher levels of educational attainment. Patients with breast or lung cancer and stage II or III cancer were particularly more likely to seek alternative medicine.
  • The median follow-up period was 66 months for all-cause mortality. Five-year survival rates in the alternative medicine and CCT cohorts were 54.7% and 78.3% (adjusted hazard ratio [HR], 2.50; 95% confidence interval [CI], 1.88-3.27).
  • Alternative treatment was particularly associated with a higher risk for mortality among women with breast cancer (HR, 5.68; 95% CI, 3.22-10.04).
  • Alternative treatment was also associated with higher mortality rates for lung cancer (HR, 2.17; 95% CI, 1.42-3.32) and colorectal cancer (HR, 4.57; 95% CI, 1.66-12.61).
  • There was a nonsignificant trend toward higher cancer mortality associated with alternative treatment for prostate cancer. Failure to reach statistical significance in this outcome could be explained by the long natural history of this type of tumor and a relatively short follow-up interval.

Clinical Implications

  • In a previous study, two thirds of cancer survivors reported using CAM at some time, and 43% had used CAM in the past year. Compared with patients without a history of cancer, more cancer survivors described initiating CAM based on recommendations from their health providers, and they were also more likely to discuss CAM treatment with their provider.
  • Alternative medicine for cancer was particularly more common among more educated patients with low rates of comorbidity in the current study. Overall, alternative medicine was associated with a higher risk for mortality compared with CCT, especially for breast cancer.
  • Implications for the Healthcare Team: The current study provides the healthcare team good data to share with patients with cancer who believe that alternative medicine may be superior to CCT in the management of common cancers.

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