Sunday, August 20, 2017

Alternative Therapies and Cancer

I was listening to Science Friday a few days ago and heard about a study out of Yale that found that those folks who use alternative therapies instead of standard medical therapies to treat their cancer are twice as likely to die from their cancer. So I thought: "This would a be a great thing to blog about," and I looked it up on the internet. Here's a sample of what came up...

I did my best to blank out the banner ad there. Don't want to impugn any company that wants to advertise on! But look at that headline. It seems rather broad, don't you think? It could sound like any alternative therapy in the service of cancer treatment doubles the risk of death. You could read it as "choosing alternative cancer therapy instead of" rather than "in addition to" standard treatment is a risky venture.

In the writer's defense, it did go on to state exactly that, but you know how it is these days. With memes and clickbait and flashy headlines bouncing around on everyone's Facebook feed or Twitter account or randomly popping up when you're googling "alternative medicine", it's easy to see how this might be interpreted.

So I used my fantastic university access to pull the article (which is in electronic publication as of August 10th for a planned release date in print of January 2018). I'll add that to Science Friday's John Dankosky's credit (who was filling in for regular host Ira Flatow) he was careful during his segment to make sure that listeners understood that this was the use of alternative medicine (AM) instead of standard therapy (ST--chemo, radiation, and surgery).

Here's what I found.

First, the researchers did not do a prospective study. That is, they didn't subject cancer patients to randomized treatments of AM versus ST--that would be unethical anyway! What they did do was examine the records of some 560 patients who got ST for 4 types of cancer: prostate, breast, lung, and colon, and matched them to the records of patients who were similar in age, sex, etc. but who opted instead for AM alone to treat their cancer. Ok, so far, so good. The groups were similar enough.

They looked at 5-year survival. This is a pretty standard measure of successful cancer treatment. Basically, if you live 5 years after treatment, you're probably good to go. Here's what they found...

58% of the people in their sample who chose exclusively AM had survived for at least 5 years, in contrast to 78% for all 4 cancers. In statistics, there's a thing called "hazard ratio"--basically, the risk of a chosen hazard (in this case, death). This ratio has to be compared to an "index standard" which is given the number "1". This "1" represents the hazard under standard conditions. The standard condition the authors chose was ST. So, statistically, people choosing AM alone had a hazard ratio of 2.21 to 2.50* or they suffered the "hazard"--death--at twice the rate of those choosing ST.

But there's more.

The study broke out the data and is publishing "survival curves" for all patients and survival by each of the four types. This gets interesting.

Colorectal cancer survival had the widest gap between ST (about 77% survival) and AM (about 30%) at 7 years of follow up.**  The narrowest gap between choosing ST versus AM was prostate cancer, at about 90% and 84% surviving 7 years, respectively. Breast cancer had the clearest display of results clearly favoring ST, more or less matching the overall curves I discussed earlier. Lung cancer looked the worst, with ST survival at about 35% and AM at about 12%. Other cancers? Well, they weren't examined so we don't know.

There's a lot we can ask and say here. What fraction of the deaths may have occurred because of the ST? After all, the commonly-used cancer drug doxorubicin can cause fatal heart failure in some unlucky recipients. This was not able to be teased out of this type of study. The authors note that prostate cancer cases were often early stage and followup--even out to 7 years--may have been too short. However one wonders to what extent an ineffective but largely harmless AM choice might have on reducing prostate cancer deaths compared to ST, which is much more likely to cause serious side effects.

Of note, the striking difference in breast and colon cancer survival rates may reflect the very good protocols now in place for these types of cancer, especially when caught early. Contrast this with lung cancer, which fares poorly with ST anyway. The study also isn't able to highlight individual stories of success with AM--and I have found that such stories are a big driver in why people tend to consider AM-alone as a possible treatment option in cancer. One of the big reasons people say they want to consider AM alone is their impression that ST "poisons" the body, and makes it harder for the body to fight the cancer on its own. In some cases they may be right, but in the aggregate, it seems it is generally not true, at least for some types of cancer.

On my website, under the Medical Conditions section, I share my view that when a cancer has good protocols and high rates of cure, it makes sense to do the ST and use AM as a supplemental therapy to strengthen the system and reduce side effects and the long term effects of ST's like chemo. When someone has a cancer with a poor prognosis under ST, the calculation becomes more difficult. AM alone may be worth a go. If anything, this study tends to reinforce what I was taught in homeopathic training and what I have observed in practice.

The authors argue that the results of this study can be used as a tool to discuss with newly-diagnosed patients with cancer, or with those presenting after a period of time when they've been trying AM exclusively. You know, like, "Oh yes, a study found that using alternative medicine alone to fight cancer means you're twice as likely to die of it." That's efficient if a doctor wants to convince someone to suck it up and take the chemo, but it's hardly a fair and accurate discussion of the results. I don't argue here for AM as a singular cancer treatment--after all, this study didn't state what "alternatives" to ST were used by the cases examined in the study. I suspect the "alternatives" were all over the place. In my practice I have found that "alternative" may mean anything from isopathic homeopathy, to a whole foods diet, to antineoplastons, to healing with crystals, to barking at the moon.

Thus perhaps this study is more about "proving" the superiority of regular medicine to anything else. The authors probably didn't mean to make that socio-political leap on purpose, but no analysis of this study would be complete without paying attention to that point.

The authors meant well, I think. Cancer physicians get really demoralized by the endless parade of deaths they witness. Cancer treatment is still very much a work in progress. So it makes sense that this study would be seen as a way of shaking some "sense" into people who are either scared of ST, or convinced AM is better--or both. However I would argue that it's only part of the story, and the science on this is by no means complete. This study isn't the end of the matter.

* This range reflects the 2 types of statistical tests the authors used and is too technical to be of any use to us here. I included both numbers for completeness--and it gets at the "twice the risk" piece being quoted in the news.

** The average followup of all cancer cases in the study was just over 5 years, but some cases had less or more, so individual graphs show this variability. It's not an error.

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