In July 2018, Media Watch Cancer News listserv sent an article regarding a study published in JAMA Oncology.

Complementary Medicine, Refusal of Conventional Cancer Therapy, and Survival Among Patients With Curable Cancers

The article stated:

Patients with cancer using complementary medicine (CM) were more likely to decline potentially curative conventional cancer treatment, which in turn increased their risk for death, concludes a new study. The patients in this study, drawn from the National Cancer Database, had a variety of nonmetastatic cancers (breast, prostate, lung, or colorectal) and were receiving at least one type of conventional cancer treatment. Patients who chose CM did not delay initiating standard treatment but had higher rates of refusing subsequent modalities, such as surgery, chemotherapy, and radiation therapy.1Nelson R. Complementary medicine and refusal of conventional cancer Tx. Medscape. July 19, 2018. Viewed November 9, 2018.

A similar review was published in Reuters: “Cancer patients using alternative medicine may skip some standard care.”

Cancer patients using alternative medicine may skip some standard care

Several leaders in the field of integrative oncology have since written criticisms of this study. Main points from Moshe Frankel, MD, are included here, followed by links to other commentaries.

Dr. Frankel’s comments

Excerpts from Dr. Frankel’s commentary

Unfortunately the design of the study has a great number of problems, which makes this article extremely biased against the use of complementary medicine in cancer care.

A few points that I would like to emphasize:

  1. The selection criteria: Authors mention that they chose patients whose healthcare teams documented use of alternativein cancer care, alternative practices or therapies such as diets or acupuncture are used instead of conventional treatments such as chemotherapy, surgery, or radiotherapy medicine as an anticancer treatment administered by non-medical personnel. This use is the extreme use of complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture medicine. As a matter of fact, this use is considered alternative treatment which actually is not complementary. Today, the term that is used is CIM—complementary and integrative medicine—referring to treatments that are integrated with conventional treatments, trying to get the best of both worlds. The use of anticancer treatments administered exclusively by non-medical personnel is extremely rare, as supported by this study (only 0.012 percent, 258 patients from a database with close to 2 million patients, compared to 40 to 80% of cancer patients that use CIM). Taking this extremely limited group of patients and generalizing about the use of CIM in cancer care is quite biased.
  2. The group of patients electing to stop all conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy treatments and utilize non-medical practitioners tend to use extreme practices that at times are toxic, such as vitamin B17, high doses of beta carotene supplements, or colloidal silver. You cannot compare these practices to acupuncture, meditation, yoga, massage therapy and others, which we have accumulated scientific data supporting their use in enhancing quality of life.
  3. The authors should have compared this small group to another group of patients, such as patients that refused conventional treatments but either use CIM treatments with the supervision of a physician or do not use any treatments. Patients who refuse treatment but do not choose extreme practices fly under the radar of recognition in the oncology field.
  4. The use of CIM methods such as acupuncture, meditation, herbs, and dietary supplements in addition to conventional cancer treatment is becoming increasingly popular and a visible component of oncology care. We should be aware of the high distress involved with dealing with cancer among patients and their families combined with a high rate of unmet needs that these patients experience.
  5. The bottom-line question is the use of CIM’s effect on survival. Refer to my article on this specific issue: Effects of complementary and integrative medicine on cancer survivorship ›
  6. The bottom-line suggestion to patients and families: Do not go to the extreme practices that are managed by non-medical personnel. Instead, utilize CIM in cancer care in an educated way with the direction of an open-minded physician whom you trust. It can affect quality of life and survivorship.

Integrative oncology has emerged as a scientific discipline geared to address this increased interest. Integrative oncology as defined in a recent document is a patient-centered, evidence-informed field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. Integrative oncology aims to optimize health, quality of life, and clinical outcomes across the cancer care continuum and to empower people to prevent cancer and become active participants before, during, and beyond cancer treatment.2Witt CM, Balneaves LG et al. A comprehensive definition for integrative oncology. Journal of the National Cancer Institute Monographs. 2017 Nov 1;2017(52).

Further commentaries

Resources

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About the Author

Laura Pole, RN, MSN, OCNS

Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years.

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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, RN, MSN, OCNS Senior Clinical Consultant