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Cancer patients using alternative therapies decrease survival chances

Multicolored pills vitaminsCancer patients who use alternative therapies are be more likely to shun conventional treatments and risk their chances of survival, a study of 1,290 patients in the US found. People who received such therapies often refused life-saving care such as chemotherapy or surgery and fewer survived five years after starting treatment compared to those on standard care.

Experts urged patients not to ditch proven cancer medicines.

Researchers said the use of alternative therapies, which include certain diets, minerals and vitamin infusions, was growing in the US but there was limited research on how effective they are. Their study looked at 258 patients who had used these therapies with at least one standard treatment, compared to 1,032 who only received conventional care.

The study found a smaller proportion of those who received such treatment had survived five years after beginning treatment – 82.2% compared to 86.6%. Separately, they were found to be more than twice as likely to die at any point over the course of the nine-year study, as a result of either refusing or delaying standard treatment.

Comparing people who received alternative therapies with those who did not, the report says the study found: 34% refused chemotherapy compared to 3.2%; 53% refused radiotherapy compared to 2.3%; and 7% refused surgery compared to 0.1%.

Also, the report quotes the study’s authors as saying that it was likely the results for those who used alternative therapies would have been worse were it not for the fact that they were a group that had better cancer survival chances to begin with. As a group, they were more likely to be women, younger, more affluent and healthier, the study's authors noted.

Although researchers linked the lower chances of survival to refusing or delaying standard treatments, lead author Dr Skyler Johnson, from Yale School of Medicine, is quoted in the report as saying it was also possible some alternative therapies could interact with conventional treatments and make them less effective.

The study did not include data on the exact therapies people used. But Johnson said they were more likely to be alternative medicines – treatments that lack clear scientific evidence and are often used in place of conventional care – rather than complementary therapies like yoga or massage, which are usually used alongside standard treatments. "The reality is despite the fact that many patients believe that these types of unproven therapies will improve their survival and possibly even improve their chances of a cure, there's really no evidence to support that claim…" Johnson in the report.

"Although they may be used to support patients experiencing symptoms from cancer treatment, it looks as though they are either being marketed or understood to be effective cancer treatments."

Martin Ledwick, Cancer Research UK's head information nurse, said complementary medicine might help improve wellbeing or quality of life for some patients. "But it is important that patients considering them do not see them as an alternative to conventional treatments that have been shown though clinical trials to make a real difference to survival," he said.

Professor Arnie Purushotham, director at King's Health Partners Comprehensive Cancer Centre, said in the report that there was a clear difference between alternative therapies and complementary treatments. "The medical community is united in agreeing that alternate therapy is not an effective means of treating cancer patients. However, there is increasing evidence that complementary therapy like acupuncture, yoga and relaxation therapy may be beneficial in alleviating cancer patients' symptoms like pain and fatigue."

Abstract
Importance: There is limited information on the association among complementary medicine (CM), adherence to conventional cancer treatment (CCT), and overall survival of patients with cancer who receive CM compared with those who do not receive CM.
Objectives: To compare overall survival between patients with cancer receiving CCT with or without CM and to compare adherence to treatment and characteristics of patients receiving CCT with or without CM.
Design, Setting, and Participants: This retrospective observational study used data from the National Cancer Database on 1 901 815 patients from 1500 Commission on Cancer–accredited centers across the United States who were diagnosed with nonmetastatic breast, prostate, lung, or colorectal cancer between January 1, 2004, and December 31, 2013. Patients were matched on age, clinical group stage, Charlson-Deyo comorbidity score, insurance type, race/ethnicity, year of diagnosis, and cancer type. Statistical analysis was conducted from November 8, 2017, to April 9, 2018.
Exposures: Use of CM was defined as “Other-Unproven: Cancer treatments administered by nonmedical personnel” in addition to at least 1 CCT modality, defined as surgery, radiotherapy, chemotherapy, and/or hormone therapy.
Main Outcomes and Measures: Overall survival, adherence to treatment, and patient characteristics.
Results: The entire cohort comprised 1 901 815 patients with cancer (258 patients in the CM group and 1 901 557 patients in the control group). In the main analyses following matching, 258 patients (199 women and 59 men; mean age, 56 years [interquartile range, 48-64 years]) were in the CM group, and 1032 patients (798 women and 234 men; mean age, 56 years [interquartile range, 48-64 years]) were in the control group. Patients who chose CM did not have a longer delay to initiation of CCT but had higher refusal rates of surgery (7.0% [18 of 258] vs 0.1% [1 of 1031]; P < .001), chemotherapy (34.1% [88 of 258] vs 3.2% [33 of 1032]; P < .001), radiotherapy (53.0% [106 of 200] vs 2.3% [16 of 711]; P < .001), and hormone therapy (33.7% [87 of 258] vs 2.8% [29 of 1032]; P < .001). Use of CM was associated with poorer 5-year overall survival compared with no CM (82.2% [95% CI, 76.0%-87.0%] vs 86.6% [95% CI, 84.0%-88.9%]; P = .001) and was independently associated with greater risk of death (hazard ratio, 2.08; 95% CI, 1.50-2.90) in a multivariate model that did not include treatment delay or refusal. However, there was no significant association between CM and survival once treatment delay or refusal was included in the model (hazard ratio, 1.39; 95% CI, 0.83-2.33).
Conclusions and Relevance: In this study, patients who received CM were more likely to refuse additional CCT, and had a higher risk of death. The results suggest that mortality risk associated with CM was mediated by the refusal of CCT.

Authors
Skyler B Johnson; Henry S Park; Cary P Gross; James B Yu

[link url="https://www.bbc.co.uk/news/health-44884601"]BBC News report[/link]
[link url="https://jamanetwork.com/journals/jamaoncology/fullarticle/2687972"]JAMA Oncology abstract[/link]

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