Cancer patients who opt for alternative treatment at greater risk of death, study finds

Cancer patients who initially chose alternative medicine therapies as the sole treatment for their cancers were more than twice as likely to die compared with patients who chose to undergo conventional cancer treatment, a US study has found.1 The study was published by JNCI: Journal of the National Cancer Institute.

In the study, Skyler B Johnson and colleagues, at the Yale School of Medicine, identified 281 patients from the US National Cancer Database from 2004 to 2013 with breast, prostate, lung, or colorectal cancer who chose to be treated with alternative medicine therapies as their sole initial anticancer treatment. Patients with metastatic disease were not included.

The survival rates of the patients who chose alternative medicine were compared with 560 patients, matched for demographic and clinical factors, who underwent conventional cancer treatment. Conventional cancer treatment was defined as chemotherapy, radiotherapy, surgery, or hormone therapy. Alternative medicine was defined as treatments that were coded in the database as “other or unproven: cancer treatments administered by nonmedical personnel.” The median follow-up was 66 months.

The researchers found that, overall, patients who chose alternative medicine had significantly worse five year survival rates compared with those who underwent conventional therapy (54.7%, 95% CI=47.5% to 61.3% v 78.3%, 95% CI=74.2% to 81.8%, log rank P<0.001; hazard ratio+2.21, 95% CI=1.72 to 2.83) and that, after controlling for clinical and sociodemographic factors, choosing alternative medicine for treatment was an independent predictor of a greater risk of death (HR=2.50, 95% CI=1.88 to 3.27).

Risk varied by type of cancer: among those with breast cancer who chose alternative medicine treatment there was a more than fivefold increase in the risk of death (HR=5.68, 95% CI=3.22 to 10.04); among those with colorectal cancer a more than fourfold increase (HR=4.57, 95% CI=1.66 to 12.61); and among those with lung cancer a more than twofold increase in risk (HR=2.17, 95% CI=1.42 to 3.32).

In the case of prostate cancer there was no significant difference in five year survival or risk of death (86.2%, 95% CI=73.9% to 92.9%, v 91.5%, 95% CI=84.7% to 95.4%, P=0.36; HR=1.68, 95% CI=0.68 to 4.17). This finding was not unexpected, the researchers wrote, “given the long natural history of prostate cancer and the short median follow-up in this study.”

The researchers noted that, in their study, alternative medicine was not the same as complementary or integrative medicine: “Whereas complementary and integrative medicines incorporate a wide range of therapies that complement conventional medicine, [alternative medicine] is an unproven therapy that was given in place of conventional treatment.”