Alternative medicine used instead of standard treatment
Complementary approaches used alongside treatment can help with symptoms. Choosing an alternative therapy instead of surgery, chemotherapy, radiotherapy or hormone therapy is a different decision: in a national US database, people who did so were two and a half times as likely to die within the study period, and more than five times as likely with breast cancer.
Overview
Using the US National Cancer Database, Johnson and colleagues (JNCI 2018) identified 281 patients with non-metastatic breast, prostate, lung or colorectal cancer who chose alternative medicine as their sole treatment and matched them to 560 who received conventional treatment. Alternative medicine users had a hazard ratio for death of 2.50 overall, 5.68 in breast cancer, 4.57 in colorectal cancer and 2.17 in lung cancer, with no significant difference in prostate cancer, where observation is often appropriate anyway. A companion analysis (JAMA Oncology 2018) found that complementary medicine users were more likely to refuse one or more conventional treatments and had worse survival; once treatment refusal was accounted for, complementary medicine itself no longer predicted death. The message is not that complementary approaches are dangerous but that they must be added to, never substituted for, curative treatment, and that oncology teams who ask openly about them are best placed to keep patients on treatment. Evidence-based integrative oncology services exist partly to meet this demand safely.
How it works
Delay or refusal of curative-intent treatment allows progression from curable to incurable stage; the alternative therapies themselves have no demonstrated anticancer activity.
- Large matched cohort with clear, consistent direction of effect
- Motivates non-judgemental asking about complementary use
- Observational; users differ in ways that matched analysis cannot fully remove
- Cannot identify which therapies were used
Latest papers
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