In this cohort study of 1.9 million patients, published in JAMA Oncology , researchers discovered that people who use complementary medicine - stuff like herbs, acupuncture and the like - were more likely to refuse conventional treatments.
Sadly, they also found that this reliance on complementary medicine meant a 2-fold greater risk of dying, compared with patients who did not use complementary medicine.
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October 2018
Complementary Medicine, Refusal of Conventional Cancer Therapy, and Survival Among Patients With Curable Cancers
Skyler B. Johnson, MD1; Henry S. Park, MD, MPH1; Cary P. Gross, MD2; et al James B. Yu, MD, MHS1,2
Question What patient characteristics are associated with use of complementary medicine for cancer and what is the association of complementary medicine with treatment adherence and survival?
Findings In this cohort study of 1 901 815 patients, use of complementary medicine varied by several factors and was associated with refusal of conventional cancer treatment, and with a 2-fold greater risk of death compared with patients who had no complementary medicine use.
Meaning Patients who received complementary medicine were more likely to refuse other conventional cancer treatment, and had a higher risk of death than no complementary medicine; however, this survival difference could be mediated by adherence to all recommended conventional cancer therapies.
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.
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"1.9 million patients" is a bit misleading - there were only "(258 patients in the CM group".
&, of course, "Complementary Medicine" ain't complementary if there is also "Refusal of Conventional Cancer Therapy" - the correct term would be "alternative".
The authors seem to think that CM is like a gateway drug, i.e. dangerous because it might lead to refusal of treatment. Better stop taking that vitamin D. LOL
"The authors seem to think that CM is like a gateway drug, i.e. dangerous because it might lead to refusal of treatment."
I think there is something to that.
You think there is no interaction over time between patient use of supplements and their decisions regarding choice and timing of procedures & treatments?
The real question is, over a large demographic sample, is it associated with decisions that improve or degrade effects.
Keep in mind you are not an average patient Patrick.
There is a lot of bad info and bad advice out there on the internet, isn't there.
Teenagers are not the only ones out there who engage in uninformed and I'll informed risky behavior. Cancer patients have a long and illustrious history of such behavior. Why would you not expect it to have an adverse effect on mortality?
"Complementary and alternative medicines consisted of herbs and botanicals, vitamins and minerals, probiotics, Ayurvedic medicine, traditional Chinese medicine, homeopathy and naturopathy, deep breathing, yoga, Tai Chi, Qi Gong, acupuncture, chiropractic or osteopathic manipulation, meditation, massage, prayer, special diets, progressive relaxation, and/or guided imagery."
Some of the above might quite reasonably be used to help manage disease-related stress or pain. Others seem innocent enough - what's so crazy about "special diets"? Dr. Myers recommends a Mediterranean diet. Anyone here tried the Hallelujah diet yet? (Just kidding)
No mention of the "cures" that many of us have probably read of & rejected, such as:
- Hoxsey
- Gerson
- Budwig
A basic smell test for me is failed if the word "cure" is used.
Patrick, You are missing the point, or maybe resisting it.
The evidence is that there is an association between the two types of behaviors. "Faith Based" self medication vs reliance solely on traditional doctor centric medical decision making.
Causation is a whole different thing. My conjecture is that there are multiple threads of causation occurring within a single population of patients.
Nowhere here is any direct or indirect criticism of what you do. It is the furthest thing from "Faith Based" self medication. It is calculated and well informed. Better calculated and better informed than what is often available from traditional medical facilities.
And actually if you think about it, it isn't about the efficacy of any of these alternative forms of treatment.
It is about their statistical association with often dysfunctional patient decision making.
Patrick: I have been on the Hallelujah Diet since the day after diagnosis in October 2002. I consulted with physicians who recommended surgery, radiation (CRT and seeds) and cryotherapy. ADT was not offered, although at the time a high profile person from NYC had ADT before brachytherapy. Some said I had a poor prognosis and all but 1 tried to sell me on their own specialty, some wanting to begin the day of my consult. I was not impressed by most of them. None of them had statistics for their own "cure" rates. My initial urologist "forbade me" from seeing other physicians and chastised me for doing so. I have not followed the diet perfectly all the time, but when I have it has served me well.
1. "the same circumspection that religion & politics demand"
Such circumspection Re "religion & politics" has generated a fair portion of the death and suffering of human kind over recorded history, over recent history and directly with respect to today's U.S. healthcare policy regarding prostate cancer.
2. "The Hallelujah is basically vegan, isn't it?
(a) It appears to encourage outrageously high dosing with naturally occurring Vitamin A
(b) It appears to encourage the substitution of prayer and diet for medical treatment.
Which supports the original proposition of this thread. That on a demographic basis, regardless of theory, the use of alternative or supplementary treatments is associated with higher death rates.
This is not because all alternative or supplementary treatments are inherently bad or ineffective. It is that their choice and implementation by people who are not as discerning and knowledgeable as yourself tends to be highly dysfunctional.
3. I personally believe there is a high correlation between those individuals who form dysfunctional belief systems around "religion & politics" and those who exhibit dysfunctional behaviors with respect to alternative or supplementary treatments.
If such people were weeded out of the study, I believe that alternative or supplementary treatments would be positively correlated with better as opposed to worse outcomes.
It is completely vegan (85% raw/15% cooked) with the addition of several freshly extracted vegetable juices (mainly carrot) per day. Also the following items are prohibited or discouraged: caffeine, sugar, white flour and salt (Celtic sea salt allowed sparingly). The prep for the juicing and salad making is the part I find hardest. The eating part is easy.
I have been reviewing snake oil claims long enough to weed them out before I buy anything. They don't show ingredients on whatever they're selling. They insist on having you listen to their terrible voices for way too long. If they don't give me the option of reading their spiel I'm out.
They did a separate analysis on alternative medicine, which had even worse effects on survival. They defined "complementary medicine" as “other-unproven: cancer treatments administered by nonmedical personnel” IN ADDITION TO at least one conventional cancer treatment modality, defined as surgery, radiotherapy, chemotherapy, and/or hormone therapy. Patients who get complementary medicine are more likely to refuse conventional treatments (even though they received at least one conventional treatment) and are about twice as likely to die because of that decision.
What might be useful to know is the overall survival of the different CM methods, then patients might want to consider combining the best of them with CCT methods.
Graham49, yes that would be helpful, but our current system doesn't supply the funding or economic incentives for that to occur. (Sad thing about this is that about 3/4 of the old white men who would most benefit from this stridently vote for the very politicians most adverse to correcting the situation... sigh).
Though this study indicates that without such data, clearly most people using such self directed treatment aren't making decisions reasonably calculated to extend their lives.
Politicians who are adverse to funding studies that would identify the overall survival of the different CM methods?
Could you provide a source or sources that would help the "about 3/4 of old white men" or some of them identify and research those politicians and how they don't support these studies? This old white man would like to do whatever he can to help change their position on funding such studies.
Being too specific seems to trigger the cranky old men on this site. Especially the ones who are prone to conspiracy theories.
The voting patterns of elder white men are fairly predictable. They disproportionately vote for a party of politicians that seek to privatize health in order to deny health services for the lazy and undeserving.
And which party consistently, disproportionately and lopsidedly supports the proposition that large pharmaceutical companies (both foreign and domestic) are "people" who are entitled to bribe U.S. politicians with tax deductible campaign contributions for legislation the economically advantages them.
These companies have a conflict of interest with the interests of U.S. healthcare patients. Yet they are able to buy the votes necessary for their interests to prevail over those you, me, and the old cranky white men.
Lazy and undeserving. Describes me fairly well. An old white man with Stage IV Prostate Cancer. Not really so cranky anymore, but have some absolutely stunning episodes of road rage at times. Actually paying almost nothing because of Kaiser Advantage Plan. Always a Democrat, but never asked the people in the chairs next to me their political bent, and they didn't ask mine. 68 years at first chemo and was just stunned to see that there were so many young people in the chairs. Girls and guys of all ages and races of the Central Valley of California. Nervous nods and smiles from us new people, loud "How you doing" from the veterans. Hope they are all doing well. Hoping you and everyone have a nice, mellow New Years Eve.
Absolutely..I understand the triggering of cranky old white men should be avoided. If you could message me with some sources to start with...that would be great and it would give me a good foundation on which to start. I think it is absolutely despicable and disappointing that any politician is adverse to funding effectively planned CM studies which could possibly help us in this fight. I can try to find sources on my own, but if you could provide one or some, then I'll have a headstart. I would love to open a dialog with my congressmen about this, but I need more. I understand the predictable voting patterns of old white men and the effect of large campaign contributions on politicians...can't do anything about those...but I can and will provide probing questions to my congressmen about why CM studies funding is being denied. Would love to ask them specifically why they denied funding for "CM study (TBD)". In case none of my congressmen denied funding, then at least I could try to fire them up about it. I'll share here any feedback I get from my congressmen...hoping to get support for a push to fund CM studies.
I am so interested in this since I had an older brother who passed a little over two years ago from this horrible disease. He was diagnosed in 2013 and passed in 2016. He did not complement his conventional medicine and treatments with any sort of complementary meds or supplements. In my opinion he passed much too quickly...just a little over two years. I am guilty of not tracking his condition closely enough and only relying on his caregiver to do the right thing....as I was working in South Korea at the time. Not a good excuse but the only one I have.
If I could turn back the clock I would return from South Korea and do my best to convince him to complement his conventional med treatments. I would also convince him to seek treatment at one of the major centers like MD Anderson, Memorial Sloan Kettering...etc. His conventional treatments were about the same as mine, but he did not have Provenge, kyphoplasty, or any ablations...nor was he lucky enough to get into a trial. Sorry for the rant and length.
Its more nuanced than that. Pretty much the current system, as designed, funds only studies that are likely to generate profitable patentable drugs.
Profitable drugs are drugs that have to be taken over long period of time for chronic illnesses. Cure treatments are not so profitable.
This is why very little money is being dedicated to new anti-biotics. Nothing is being spent on Metformin or other drugs that might be useful.
Any major change to the current healthcare system will be fought to a standstill by interests who benefit from the current change. They can buy as many votes as they need... even if they are foreign corporations. The Repub party fights in unison, as a team, to protect this system. White folks for for them, old folks vote for them, and white men vote for them. White, Old Men vote for them a real lot. Just plain demographics.
OK. This old white man lean Repub will do some research in his spare time on his state's congressmen voting records...Dems and Repubs...hoping to find any votes that could be directly connected to suppressing studies on CM. I'll be focusing my search to studies on CM only...not major healthcare system changes. Gotta try to eat the elephant one bite at a time. If I am lucky enough (and it will take luck for me) to find a no vote associated with the funding of a CM study, I will let the no voting congressman or congresswoman know that he/she is not representing me...and are hurting me (us). I know that anything I do alone will likely not change anything, but I'll give it a shot. Somebody should let them know.
The problem can't be fixed untill the voting process is fixed. Gerrymandering, voter suppression, giving corporations the right to make legal campaign contributions. That needs to be brought to heel. The House of Representatives can't begin to make these repairs to the Repub vandalism done by Repub party.
I'm guilty too. Sorry whats, ces, & all. Was going to ask if Dems did anything to promote studies of CM when they controlled the House and the Senate from 2006 to 2010, but that is a question for another forum.
MontyB, this would be some evidence of the problem I was discussing being a version or blending of: “We have met the enemy and he is us” and "I've got mine, screw you". LOL
I don't think so. I was really thinking of ballot issues where the item is worded so that low iq americans pick the wrong choice. Should have left Congress out- they're voting by how much they'll get for approving it versus how much they might get for disapproving it.
I've recently quickly lost way too much ground in my fight to be able to donate any time or effort chasing down this political conspiracy rabbit hole. I'm now focused on researching on how to enjoy today and tomorrow...focused on researching how to enjoy what time I have left here.
"Complimentary medicine is just that, medicine to be used with traditional medicine not stand alone treatments."
In theory you would expect that to be so. The study indicates that in reality it appears that when you look at a statistically valid sample of people, the decision making of those who use "Complimentary medicine" is skewed in a manner that increases their mortality from cancer. And not by a little.
It may be that the patients are not even aware of how their use of complementary treatments or supplements is affecting their decisions regarding the use of or the delay of conventional forms of treatment.
This doesn't necessarily mean that complementary treatments or supplements don't have the intended effect. It is just that many people end up foregoing or delaying more effective forms of conventional treatment... to the extent that it materially impairs their mortality from cancer.
I understand your concern. But I don't want big pharma taking over these supplements. Something like this study could give them the excuse they need. I worry about who paid for this study and why is it being brought up for the second time.
" big pharma" is a political problem. You can start by reevaluating your voting patterns. If you are like 2/3 to 3/4 of old white men, your voting patterns are the true source of the problem.
"Little Pharma" is no less rapacious than big pharma. With much lower quality control. Why would you trust them any more? My personal solution is to limit my personal source of supplement supply to left.org.
"Little pharma" like "Big Pharma" has the same goal- repeat business. So one aide in looking for worthy supplements- some significant time in business. I'm not going to make a big list but the Carlson Company from Illinois has been in business over 50 years providing Vitamins and Minerals. I've heard complaints on here about the price of Vitamins and Minerals- probably the same people complaining that the products are in-effective. Guess they're buying the drug store crap.
One reason I like lef.org is that they have a bad rep with their suppliers that they assay every shipment, and if it is just a little off, they return the entire shipment.
This probably increases their costs and their prices, but I'm good with that.
I posted this a while ago, it appears to be a different study?
Source: Yale Cancer Center 2018
According to Altmetric, which tracks the distribution and discussion of research papers online, a July article by several Yale physicians is the most-discussed paper ever published in the Journal of the National Cancer Institute (JNCI). The title of this blockbuster: “Use of Alternative Medicine for Cancer and Its Impact on Survival.”
“It struck a chord,” said senior author James Yu, MD, MHS, Associate Professor of Therapeutic Radiology.
The Yale researchers used the U.S. National Cancer Database to collect information on patients with non-metastatic breast, lung, colon, and prostate cancer from 2004 to 2013. They looked for people who reported using only unproven alternative treatments instead of conventional medical therapies such as surgery, radiation, and chemotherapy. The researchers found 280 such people and then compared their outcomes after 5½ years to 560 people with the same cancer, diagnosis, age, and race who had received conventional treatment.
The results were clear. Patients who initially relied on unproven alternatives were, on average, 2.5 times more likely to die within the 5½ year window. Within particular cancers, the risk associated with alternative medicine was often much worse—almost six times higher for patients with breast cancer, four times for colon cancer, two times for lung cancer.
Skyler Johnson, MD, Resident in Therapeutic Radiology and the paper’s lead author, thinks the discrepancy in survival rates would be even more alarming if the patients had been followed for longer than five years to take into account slow-growing cancers such as prostate cancer. He also calls the 280 people identified as using only alternative medicine “a huge underestimate” because the researchers excluded a large group of patients who had been coded as having refused treatment, with no reason given. Dr. Johnson suspects that many of them chose an alternative therapy first but did not report it to their physicians.
Another interesting finding from the paper was that people who preferred alternative treatments tended to have had more formal education, and higher incomes.
The researchers have some theories about this seeming conundrum. Dr. Johnson mentions the Dunning-Kruger effect, in which people overestimate their knowledge, in part by relying on the Internet. Dr. Yu speculates that people with higher incomes can afford more types of healthcare and know how to seek them out, such as clinical trials. “But in this case it’s wishful thinking,” he said. “These alternatives don’t necessarily cause harm, but they’re placebos, and placebos don’t cure cancer, but they can delay real cancer care.”
Co-author Cary P. Gross, MD, Professor of Medicine and of Epidemiology, wasn’t that surprised by the demographic finding, citing increased skepticism about science and conventional medicine that has driven things such as the anti-vaccination movement. “And just as the Internet and social media have fueled discord in the political process,” he added, “they also have enabled conspiracy theories about medicine and health to spread rapidly and wildly.”
The researchers also believe, based on their own patients, that the number of people choosing alternative treatments over conventional ones is increasing. “I understand the human impulse to think there’s got to be something else,” said Dr. Yu. “And when the answer is ‘no, there isn’t’, then there’s the opportunity for someone to say, ‘Just rub these crystals or sit in a salt bath or eat special food.’”
All of the researchers noted that the problem should not be pinned only on patients and providers of alternative medicine. “Physicians need to shoulder some of the blame as well,” said Dr. Johnson. “We need to take the time to really listen to patients’ concerns and explain things more clearly. That builds a relation of trust, and makes them more willing to believe the data.”
Dr. Yu agrees. “We need to bring these conversations about alternative therapies to the forefront,” he said, “and because of this study we now have the data to help us.” The researchers also noted that their work focused on alternative medicine, when patients choose not to receive conventional medical therapies, rather than “complementary medicine,” in which patients undergo conventional cancer treatment as well as additional therapies from disciplines that are not part of traditional Western medicine.
The researchers know that facts and data won’t be enough to persuade everyone, a common symptom of our time, but their paper is a start. They hope it convinces a few people to reconsider relying on alternative treatments, or prompts someone to insist that a loved one see an oncologist. “That’s why we do research,” said Dr. Johnson. “We try to help people one at a time, and hopefully our research can help patients and families to make more informed decisions.”
"Another interesting finding from the paper was that people who preferred alternative treatments tended to have had more formal education, and higher incomes.
The researchers have some theories about this seeming conundrum. Dr. Johnson mentions the Dunning-Kruger effect, in which people overestimate their knowledge, in part by relying on the Internet."
Interesting. Formal education as an adjuvant to Dunning-Kruger. I guess that makes sense.
Both of you missed the phrase in my post "who paid for this study". I could find as many or more studies that say complementary supplements extended the life of patients. Sometimes I think these researchers put out some of those studies just to meet their quota of publications and maintain their university status. Lots of them are junk.
1. "researchers put out some of those studies just to meet their quota of publications and maintain their university status. Lots of them are junk."
Yes. So what. Jama is not a junk journal.
2. "who paid for this study".
That info isn't in the abstract. But it's not the kind of captive study that big pharma pays for. They pay for studies out of drug specific budgets. It's more cost effective.
3. This type of study is just massaging data collected by others. It mostly involved the researchers time. It was cheap and easy to notch up one more published study.
4. It is a Jama peer reviewed study. It's one of the top medical research journals in the entire world. You don't even get to talk to them without a solid track record, hacks need not apply.
5. On the other hand, have you considered that your denial might be anchored in a self absorbed non-evidenced based belief system that is just plain more emotionally satisfying. Something that the study was basically attempting to measure.
6. Oh did I forget to mention it's a Jama article?
It is open to criticism, it leaves a number of questions and nuance yet to be answered. But criticising it as a hack study... with no good reason or evidence? I think that speaks more to your lack of objectivity, than that of the authors.
I don't care if is JAMA, all medical research is suspect. The bottom line is money and research is steered toward whatever the BIG PHARMA and the medical community want. This is not to say good things don't come from these sources but everyone has an agenda and is suspect. BIG PHAMA pays for a lot of studies is those studies reflect their view.
Granted supplements are not well researched. But the realities still stand. Accidental findings do happen and some have success with supplements. As long as they do no harm I don't see the problem.
This study shows that some people will use supplements and avoid standard medical procedures. That will always be the case as long as we live in a society where some go without because they cannot afford the high cost of medicine. We in the US have been frightened of socialized medicine. It is a crime that a country such as our cannot provide good medical care for it's people. Good healthcare should be a right not privilege.
"This study shows that some people will use supplements and avoid standard medical procedures. That will always be the case as long as we live in a society where some go without because they cannot afford the high cost of medicine. "
You're not getting it. The study shows evidence of irrational healthcare decision-making by patients.
The supplements are not causing the morbidity. Their use just happens to be associated with emotionally satisfying self destructive decision making.
Could some of this be laid at the feet of our medevil healthcare system? It's possible, but I believe other studies show that supplement use is most prevalent among higher income, better educated demographics that are more likely, not less, to have access to insurance coverage.
"I believe - You believe", we are getting no where. My last word on the subject is still, I don't want BIG PHARMA taking over the supplements markets. If they do we will be paying 100's of times more for everything.
"I could find as many or more studies that say complementary supplements extended the life of patients."
Easier said than done, unless you are talking about hack researchers doing hack studies, published in questionable journals. You know, the types of studies you call "Junk", but I guess their your studies feeding your outcome bias. So they Good! LOL
Check out the so called university study on so called "Gator Blood" LOLOLOL
Many studies have been paid for by mega corporations. Their desired outcome is stapled to the check. These checks are paid to top university professors not hacks.
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