Alternative Medicine [AM] & PCa.

[pjoshea13]

This is a follow-on from Dan59's thread, but the focus is PCa. However, the full paper is below [1].

The first thing to note is:

"Notably, there was no statistically significant association between AM use and survival for patients with prostate cancer."

i.e. the use of AM did not affect PCa mortality in the follow-up period.

"Among our study population, approximately 74.6% of prostate cancer patients had low- to intermediate-risk disease, a subgroup with level 1 evidence showing no difference in risk of death when comparing observation with surgery or radiotherapy and hormone therapy at 10 years. [12]" The link [12] (see below) is to a 2016 British study, which concluded that:

"At a median of 10 years, prostate-cancer–specific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. {Surgery and radiotherapy were associated with lower incidences of disease progression and metastases than was active monitoring.}"

...

When I was diagnosed 14 years ago, the assumption behind screening was that if cancer was found, it would be treated. Most men with Gleason score 3+3 opted for treatment, & doctors were complicit.

Nowadays, GS 3+3 cases are encouraged to opt for active surveillance, but I suspect most who do, also try supplements, dietary modifications &/or AM. For some, it is no longer such a crazy idea to choose AM in lieu of conventional treatment.

...

In 14 years, I have come across a number of men who refused treatment because they put their sex lives before survival. Dr. Steve Freedland has said that a loss of sexual function is NOT a side effect of PCa treatment - it is an expected consequence.

While many men eventually see improvement, one study reported that less than 5% of men ultimately claimed that their sex lives were unchanged.

A few I have known refused treatment because they were terrified that they might need diapers afterwards.

Some doctors downplay the risk of morbidity, & even claim amazing success rates. But this involves very loose definitions of "erection" & "penetration".

I used to think that men who cared more about sex than life were crazy, but I'm more sympathetic these days.

...

The US Preventive Services Task Force [USPSTF].

The USPSTF initial recommendation for men to avoid PSA tests & digital rectal exams was flawed, IMO. However, a couple of studies seemed to show that treatment had little effect on overall survival. There must have been men who concluded that the morbidity of treatment wasn't justified if survival was not significantly extended.

Regardless, the USPSTF recommendation sent a message that screening was useless because early detection coupled with intervention was useless. It certainly isn't my view, but I can see why some men might be leery of conventional treatment.

...

The new study "identified 281 patients with nonmetastatic breast, prostate, lung, or colorectal cancer who chose AM". About 70 PCa cases? - & mostly lesser cancer. I don't think this study says a lot about AM use in PCa.

-Patrick

[1] academic.oup.com/jnci/artic...

Use of Alternative Medicine for Cancer and Its Impact on Survival

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

JNCI: Journal of the National Cancer Institute, Volume 110, Issue 1, 1 January 2018, Pages 121–124, doi.org/10.1093/jnci/djx145

Abstract

There is limited available information on patterns of utilization and efficacy of alternative medicine (AM) for patients with cancer. We identified 281 patients with nonmetastatic breast, prostate, lung, or colorectal cancer who chose AM, administered as sole anticancer treatment among patients who did not receive conventional cancer treatment (CCT), defined as chemotherapy, radiotherapy, surgery, and/or hormone therapy. Independent covariates on multivariable logistic regression associated with increased likelihood of AM use included breast or lung cancer, higher socioeconomic status, Intermountain West or Pacific location, stage II or III disease, and low comorbidity score. Following 2:1 matching (CCT = 560 patients and AM = 280 patients) on Cox proportional hazards regression, AM use was independently associated with greater risk of death compared with CCT overall (hazard ratio [HR] = 2.50, 95% confidence interval [CI] = 1.88 to 3.27) and in subgroups with breast (HR = 5.68, 95% CI = 3.22 to 10.04), lung (HR = 2.17, 95% CI = 1.42 to 3.32), and colorectal cancer (HR = 4.57, 95% CI = 1.66 to 12.61). Although rare, AM utilization for curable cancer without any CCT is associated with greater risk of death.

Topic: hormone replacement therapy radiation therapy survival analysis lung alternative medicine cancer chemotherapy regimen colorectal cancer comorbidity socioeconomic factors surgical procedures, operative breast prostate surgery specialty lung cancer endocrine therapy cancer therapy

Issue Section: Brief Communication

Delay or refusal of conventional cancer treatment (CCT), when done in favor of alternative medicine (AM), may have serious survival implications for cancer patients (1–7). However, there is limited research evaluating the use and effectiveness of AM, partly due to data scarcity or patient hesitance to disclose nonmedical therapy to their providers (8,9). To address this knowledge gap, we used the four most prevalent cancers (breast, prostate, lung, and colorectal) in the United States (10) from the National Cancer Database between 2004 and 2013 to identify the factors associated with AM selection and compared survival outcomes between AM and CCT.

Patients who underwent AM were identified as those coded as “other-unproven: cancer treatments administered by nonmedical personnel” and who also did not receive CCT, defined as chemotherapy, radiotherapy, surgery, and/or hormone therapy. Patients with metastatic disease at diagnosis, stage IV disease based on the American Joint Commission on Cancer (AJCC) staging system (11), receipt of upfront treatment with palliative intent, and unknown treatment status or clinical or demographic characteristics were excluded.

Demographic and clinical factors were evaluated using the chi-square test and the t test for categorical and continuous variables, respectively. Independent associations with AM use (vs CCT alone) were identified using multivariable logistic regression. Two-to-one nearest-neighbor propensity score matching without replacement was performed to compare overall survival (OS). Univariate survival analyses were completed using the Kaplan-Meier estimator, log-rank test, and Cox proportional hazards regression. Variables with P value of .10 or less on univariate analyses were entered into a multivariable Cox proportional hazards survival model using forced entry for the 2:1 matched sample. The assumption of proportionality was verified graphically using log-log survival plots. All statistical tests were two-sided, and a P value of less than .05 was considered statistically significant.

We identified 281 cancer patients who chose AM in lieu of CCT. Patient characteristics between AM and CCT are shown in Supplementary Table 1 (available online). Notably, patients in the AM group were more likely to be younger, to be female, to have a lower Charlson-Deyo Comorbidity Score (CDCS), and to have higher cancer stage, income, and education. In multivariable analysis, when controlling for clinical and demographic factors, patients undergoing AM were more likely to have breast (odds ratio [OR] = 2.56, 95% confidence interval [CI] = 1.40 to 4.68) or lung (OR = 3.16, 95% CI = 1.85 to 5.40) cancer (vs prostate), higher education (OR = 1.46, 95% CI = 1.02 to 2.08), Intermountain West (OR = 3.09, 95% CI = 1.81 to 5.29) or Pacific (OR = 3.16, 95% CI = 2.10 to 4.74) regions of residence, stage II (OR = 3.31, 95% CI = 2.21 to 4.95) or III (OR = 3.87, 95% CI = 2.47 to 6.07) disease, and a lower CDCS (Supplementary Table 2, available online).

Following 2:1 matching, 560 patients who received CCT were matched to 280 patients who received AM based on cancer type, age, clinical group stage, CDCS, insurance type, race, and year of diagnosis; a total of 840 patients were analyzed. There were no statistically significant differences in matched characteristics (chi-square or t test, all P > .10). The median follow-up was 66 months. On matched univariate survival analysis, AM was associated with worse five-year survival (54.7%, 95% CI = 47.5% to 61.3%, vs 78.3%, 95% CI = 74.2% to 81.8%, log-rank P < .001; hazard ratio [HR] = 2.21, 95% CI = 1.72 to 2.83) (Figure 1A) and remained an independent predictor of greater risk of death (HR = 2.50, 95% CI = 1.88 to 3.27) when controlling for clinical and sociodemographic factors (Table 1). When stratified by cancer type, receipt of AM was associated with statistically significantly worse five-year survival for breast 58.1%, 95% CI = 46.0% to 68.5%, vs 86.6%, 95% CI = 80.7% to 90.7%, P < .001; HR = 5.68, 95% CI = 3.22 to 10.04), lung (19.9%, 95% CI = 9.9% to 32.4%, vs 41.3%, 95% CI = 31.1% to 51.2%, P < .001; HR = 2.17, 95% CI = 1.42 to 3.32), and colorectal cancer (32.7%, 95% CI = 15.8% to 50.8%, vs 79.4%, 95% = CI 66.3% to 87.8%, P < .001; HR = 4.57, 95% CI = 1.66 to 12.61), but not for prostate cancer (86.2%, 95% CI = 73.9% to 92.9%, vs 91.5%, 95% CI = 84.7% to 95.4%, P = .36; HR = 1.68, 95% CI = 0.68 to 4.17) (Figure 1, B–E) on univariate and multivariable analyses.

Table 1.

Cox-regression of covariates associated with overall survival

Variables Univariate

Multivariable*

HR (95% CI) P† HR (95% CI) P†

Treatment type

 Conventional 1.00 (reference) 1.00 (reference)

 Alternative 2.21 (1.72 to 2.83) <.001 2.50 (1.88 to 3.27) <.001

Age 1.02 (1.01 to 1.03) <.001 1.01 (0.99 to 1.03) .16

Cancer type

 Prostate 1.00 (reference) 1.00 (reference)

 Breast 2.48 (1.59 to 3.87) <.001 2.34 (1.42 to 3.87) .001

 Lung 11.80 (7.70 to 18.08) <.001 6.52 (3.83 to 11.10) <.001

 Colorectal 3.73 (2.23 to 6.26) <.001 2.62 (1.42 to 4.85) .002

Sex

 Male 1.00 (reference) — —

 Female 1.20 (0.93 to 1.56) .15 — —

Race

 White 1.00 (reference) 1.00 (reference)

 Black 0.70 (0.45 to 1.09) .08 0.65 (0.36 to 1.18) .16

 Hispanic 0.40 (0.18 to 0.91) .03 0.11 (0.01 to 0.77) .03

 Other 0.40 (0.18 to 0.90) .03 0.25 (0.07 to 0.85) .03

Income‡

 <$48 000 1.00 (reference) — —

 ≥$48 000 1.05 (0.80 to 1.37) .74 — —

Education§

 <80% HSE 1.00 (reference) — —

 ≥80% HSE 1.00 (0.77 to 1.31) .86 — —

Residence setting

 Metropolitan 1.00 (reference) — —

 Nonmetropolitan 1.13 (0.79 to 1.63) .51 — —

Geographic area

 Northeast 1.00 (reference) — —

 South Atlantic 0.96 (0.62 to 1.46) .96 — —

 Midwest 1.25 (0.85 to 1.84) .40 — —

 South 1.01 (0.62 to 1.66) .98 — —

 Intermountain West 1.04 (0.58 to 1.88) .60 — —

 Pacific 1.15 (0.75 to 1.75) .97 — —

Insurance type

 None 1.00 (reference) 1.00 (reference)

 Private 0.72 (0.41 to 1.28) .15 0.96 (0.44 to 2.13) .93

 Medicaid 1.78 (0.87 to 3.63) .27 1.40 (0.54 to 3.62) .48

 Medicare 1.13 (0.64 to 2.03) .68 1.12 (0.49 to 2.60) .78

 Government/unknown 0.18 (0.06 to 0.55) .007 0.40 (0.11 to 1.37) .14

Facility type

 Community 1.00 (reference) 1.00 (reference)

 Academic 1.42 (1.05 to 1.91) .02 1.22 (0.90 to 1.64) .21

Clinical stage

 I 1.00 (reference) 1.00 (reference)

 II 0.82 (0.55 to 1.22) .34 1.37 (0.87 to 2.16) .17

 III 3.76 (2.59 to 5.46) <.001 2.68 (1.78 to 4.04) <.001

Charlson-Deyo Comorbidity

 0 1.00 (reference) 1.00 (reference)

 1 2.32 (1.63 to 3.32) <.001 1.32 (0.88 to 1.97) .18

 ≥2 3.82 (1.88 to 7.77) <.001 1.08 (0.48 to 2.44) .86

*

Variables included in the multivariable model include treatment type, age, cancer type, race, insurance type, facility type, clinical stage, and Charlson-Deyo Comorbidity. — designates terms not included in the model. CI = confidence interval; HR = hazard ratio; HSE = high school education.

†

P values were calculated by a two-sided Cox proportional hazards regression.

‡

Income is expressed as median household income by ZIP code of residence.

§

Education is expressed as the percentage of residents by ZIP code receiving a high school education.

Figure 1.

Overall survival of patients receiving alternative medicine (solid lines) vs conventional cancer treatment (dashed lines). Overall survival of alternative medicine vs conventional cancer treatment for (A) all patients, (B) breast, (C) prostate, (D) lung, and (E) colorectal cancers. P values were calculated by a two-sided log-rank test.

View largeDownload slide

Overall survival of patients receiving alternative medicine (solid lines) vs conventional cancer treatment (dashed lines). Overall survival of alternative medicine vs conventional cancer treatment for (A) all patients, (B) breast, (C) prostate, (D) lung, and (E) colorectal cancers. P values were calculated by a two-sided log-rank test.

Patients who initially chose AM for treatment of curable cancer in lieu of CCT were rare and had statistically significantly worse survival. After controlling for sociodemographic and clinical factors, the magnitude of difference was largest for breast cancer because women who used AM as initial treatment without CCT had more than a fivefold increased risk of death. Patients with colorectal and lung cancer had a more than fourfold and twofold increase in risk of death, respectively. Notably, there was no statistically significant association between AM use and survival for patients with prostate cancer. This is not unexpected, given the long natural history of prostate cancer and the short median follow-up in this study. Among our study population, approximately 74.6% of prostate cancer patients had low- to intermediate-risk disease, a subgroup with level 1 evidence showing no difference in risk of death when comparing observation with surgery or radiotherapy and hormone therapy at 10 years (12).

It is important to note that complementary and integrative medicine are not the same as AM as defined in our study (13). Whereas complementary and integrative medicine incorporate a wide range of therapies that complement conventional medicine, AM is an unproven therapy that was given in place of conventional treatment. As there is limited evidence of patients who chose AM as the primary treatment for their cancer, accurate comparisons between our cohort and other studies remain difficult. However, there are several important similarities between AM use characteristics and those who seek complementary cancer therapies, including younger age, breast cancer, higher education and income, Pacific region, and more advanced stage (9,14–16).

One important limitation of our analysis is its observational nature, which may have underascertained the use of CCT for patients who received treatment at another facility or patients who initially received AM prior to presenting to a data-collecting facility. However, these underreported or late presentations would have likely biased our study toward the null (ie, lack of survival difference), making our findings potentially more clinically meaningful. Other limitations of the data include unmeasured confounders or selection bias that could impact survival. However, because patients receiving alternative medicine were more likely to be younger, more affluent, more well-educated, and less burdened with comorbidities, this would not likely account for the observed survival differences. Last, we lack information regarding the type of alternative therapies delivered, though there is limited to no available evidence that specific AM therapies have been shown to improve cancer survival.

In conclusion, we found that cancer patients who initially chose treatment with AM without CCT were more likely to die. Improved communication between patients and caregivers and greater scrutiny of the use of AM for the initial treatment of cancer is needed.

Notes

The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the results herein. This study was granted exemption by the Yale Human Investigations Committee. Skyler B. Johnson, MD, has no relevant financial interests, activities, relationships, or affiliations. Henry S. Park, MD, MPH, has received honoraria from Varian Medical Systems, Inc., and RadOncQuestions, LLC. Cary P. Gross, MD, receives research funding from 21st Century Oncology, Johnson and Johnson, Medtronic, and Pfizer. James B. Yu, MD, MHS, receives research funding from 21st Century Oncology.

The authors would like to acknowledge Yi An, MD, Trevor Bledsoe, MD, Benjamin Kann, MD, Jacqueline Kelly, MD, MSc, Adam Kole, MD, PhD, Nataniel Lester-Coll, MD, and John Stahl, MD, for their contributions to data collection. The above acknowledged are affiliated with The Department of Therapeutic Radiology at Yale School of Medicine and have no conflicts of interest to disclose.

References

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© The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: [e-mail]

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[12] nejm.org/doi/full/10.1056/N...

[Roland632017]

Hi Patrick

I like you. As per my assumption and like clock ticking you have put out a magnificent report. You ought to be congratulated.

Now what do you think of my hypothesis for I was trying to engage you a couple of times but you are still in a very tied lip situation.

No pressure my dear friend so only quote when you are ready.

Thanks again for your help all this time. And knowing you I admire your cautious approach as often you mentioned IMO,

Roland

[Dan59]

Patrick ,Thank You for your followup and analysis of the study. This study was a general cancer study. “ 74.6 of the Prostate Cancer Patients in the study had low to intermediate risk”and really not at risk of death in a 5.5 year time frame with no treatment ,although not relevant to most men in this group, as most Men here are stage 4. Nor did they say what the alternative treatments were.Although it did seem clear that across the cancer spectrum standard of care was more effective as a primary treatment than alternative. Probably better yet is standard of care followed up with alternative means as Nalakrats does. Your imput an analysis as always is spot on.

Sincerely,

Dan

[Neal-Snyder in reply to Dan59]

I agree with Patrick & with Dan. This study tells us nothing about whether stage 4 men who accept standard of care treatments but also use alternative treatments do better than men who use SOC alone. It's called COMPLEMENTARY medicine when you use alternative medicine only in support of standard treatments.

[Hidden]

What is so non-sense about the posting Dan59 put here? I have NEVER read anywhere showing Dan arguing with anyone. You need take take your manure stirring stick elsewhere. Create traffic? That's asinine.

This site is about helping people, not be vindictive, take a cue.

[Roland632017 in reply to Hidden]

Hi nameless9999

Of course "What do I know?"

I like you to know I am a survivor who is in a condition worse than you.

I know you are very qualified in your own line of work and profession as also served your nation as a dedicated soldier.

The question is I am not putting up non sensical or irrelevant topics.

I am just indicating the Urine & Saliva pH protocol to help all cancer patients.

Just check what I have written and as you do know I preach what I actually worked/treated myself.

Sorry about the WW2 stuff which you hated.

I am more inclined to say that a normal person once he had taken control of his cancer could/never going to achieve the psa nadir from this treatment,

How I know is why I wants to let you know,

In my earlier request with AlanMeyer he and with his vast knowledge has indicated that for my age etc my psa should be 3 (provided I am not in 10-17 %) and those who has little psa cannot be in this group.

As I have said I do know someone has constantly post a regularly psa 1.5 for over a year now with baking soda/molasses cure.

Even basing on his testimony I am indicating that is more relevant to pH of 7.2-7.5 of Urine & Saliva and you can also use only green tea for the very same purpose but on a very strict Alkaline food intake.

Please check me out,

Thanks for your audience and patience.

Just don't get upset,

Roland (Honorary Doctorate????)

[Roland632017 in reply to Roland632017]

Can I just add....

For some of you who has been under your current treatment and if your psa is nadir and if my hypothesis is correct you can maintain the Urine & Saliva 7.2-7.5 pH and since no more cancer cells can reproduce you should be able to stay on your current target for as long as you maintain this pH protocol and if can control/manage this protocol and it works "You can ease/stop the medication you so rely on"

Just check it out no further need for more expensive drugs,

Roland (Honorary Doctorate ????)

[Hidden in reply to Roland632017]

Truce to all, please.

[ctarleton in reply to Roland632017]

Just some more "food" for thought.

snopes.com/everyone-who-has...

ncbi.nlm.nih.gov/pmc/articl...

[Roland632017 in reply to ctarleton]

Hi ctatleton

I just review the first article and I acknowledge tremendous work/understanding has been documented.

In my earlier proposal to Patrick as he is very well versed/informed on the subject.

I again wants to point out this experts had some how overlooked the critical bottleneck.

To achieve the ultimate control they have neglected the constant pH of 7.3-7.5 which is compulsory.

Look what I have to get prepared for all your doubts.

Has anyone of you own a swimming pool of actives manage one and is personally responsible for making your pool water healthy and sparkling.

This is exactly the same requirement,

You will have to keep the pool water to 7.2-7.5 pH to prevent bacteria and algae growth. And baking soda is consider a maintenance addition in keeping the water healthy,

I hope I have not bore anything of you and thanks for your audience and patience.

Roland (Honorary Doctorate ????)

[pjoshea13 in reply to ctarleton]

There are some cancer myths that will never die. But it's always worth the effort to kill them. Life is too short to waste time exploring dead-end "solutions".

Thanks! -Patrick

[Roland632017 in reply to pjoshea13]

Hi Patrick

It good to find you participating on this topic.

Like could be short and a waste of time.

But actually what I am putting out as a hypothesis as it's stand, I am also implementing it to myself,

I like to elaborate that I am so far happy with my progress.

Yesterday I indicated I had some discomfort (aches in the calf) As this is the first time such body pain that I have experienced for more than a day.

So I had Sunday afternoon golf but on a very hot day and I do encounter Gross Haematuria (some of it could be tumour from bladder haemorrhaging from my baking soda/honey regime). More to it they caused was from dehydration (I took the incorrect remedial step when I replaced my body fluids too quickly and by too much)

This morning I also played golf and the weather started hotting up and suddenly I realised that as a very qualified first aider I have neglected/approach with the incorrect treatment for heat/hot dehydration.

So I have learned from my mistakes.

What I am indicating is I am pain/fatigue free this very moment from using this very strict pH 7.2-7.5 close proximity protocol,

Thanks for you attention and patience.

Roland

[Dan59]

Bruce, I certainly did not have any other objectives , other than presenting resource from what I consider a reliable source, I do not think anyone will say I argued and if you notice I took it down when you suggested that is what I was doing.It has never been my intention to argue with anyone, I am here to try to right some of the wrongs I have done in my life , by being helpful to people while I am still here,before judgement day.

Dan

[Dan59]

I never said I did not believe in diet , in addition to conventional stage 4 treatment, I have tried to follow the list snuffy gave me 11 years ago for the entire time.

[Dan59]

Then delete the post where you slandered me.

[Hidden]

OK, truce, it gets no one nowhere.

[j-o-h-n]

to quote Socrates: OY VEY...

Good Luck and Good Health.

j-o-h-n Monday 01/22/2018 12:45 AM EST

Patriots vs Eagles.