- The Washington Times - Thursday, July 19, 2018

Cancer patients who refuse conventional therapies and turn to natural remedies are more likely to die sooner, research shows.

“Complementary medicine, as far as we can tell, will not help you live longer,” said Dr. James B. Yu, co-author of a study published Thursday in the Journal of the American Medical Association Oncology.

For the study, Dr. Yu and his research team scoured data of 1.9 million people in the National Cancer Database and found 258 patients who had cited using complementary therapies in addition to, or in place of, proven cancer treatments.

Those cases were compared with a cohort of 1,043 patients with four of the most common cancers — breast, prostate, colorectal and lung — but who did not use complementary medicine.

The doctors found that patients who used complementary medicine were more likely to refuse at least one additional form of cancer treatment, which was associated with a decrease in their chances for long-term survival.

Those patients also exhibited similar characteristics. The researchers noted that they were more likely to be young, educated women with a higher socioeconomic status and private insurance, among other factors.

“They seem to be a more privileged cohort than those who did not use complementary therapy,” said Dr. Yu, director of the Prostate and Genitourinary Cancer Radiotherapy Program at Yale Cancer Center.

According to the 2012 National Health Interview Survey, Americans in one year spent an estimated $30.2 billion out of pocket for complementary or alternative medicines.

An estimated 4 in 10 adults and 1 in 9 children use some form of complementary or alternative medicine, according to the National Center for Complementary and Integrative Health, part of the National Institutes of Health — although this is for all people, not just cancer patients.

According to news reports, Apple founder Steve Jobs delayed surgery to remove a cancerous tumor on his pancreas for nine months as he experimented with alternative medical procedures. He died of pancreatic cancer in 2011.

Complementary therapies, while not defined in the research study, can run the gamut of herbal and vitamin supplements, Eastern medicine, special diets, homeopathy and naturopathy, among others.

Physicians do not discourage these treatments if they are used with conventional cancer treatments, Dr. Yu said, but he and co-author Dr. Skyler Johnson were increasingly concerned about patients who were forgoing treatment in favor of a “holistic” approach.

“In a way, it was our day-to-day experience with patients who were presenting with cancers that were more advanced than we thought needed to be,” Dr. Yu said, “that they were ignoring their cancer and trying nonmedical therapy first and the cancer was continuing to grow.”

Not all patients abandoned conventional cancer treatment, but the doctors conducting the study were surprised to find that people who had dual treatments did not live longer compared with patients who underwent just standard cancer treatment.

Physicians are more likely to recommend “integrative” therapies: herbal supplements, dietary changes or mind-body exercises that complement the standard of care.

The problem arises, however, when people put more faith in a holistic approach than in standard treatment, the researchers said.

“In the study, this group of people, they used an unproven cancer treatment that was delivered by a medical professional,” said Dr. Johnson, chief resident of radiation oncology at Yale University. “It’s more likely that these groups of people were using things like oral medications, IV medications, topical medications, that are under this broad category of dietary, herbal and vitamin supplements.”

Dr. Sameer Nath, assistant professor of radiation oncology at the University of Colorado in Denver, said herbal and holistic therapies are an open topic of conversation among his patients and a favored treatment option.

“I’ve had several patients with brain, breast and skin cancers refuse standard curative intent therapy in lieu of a variety of alternative therapies, most of which are unproven,” said Dr. Nath, who was not involved in the study. “I’ve even had some patients traveling to other countries for specific alternative therapies.”

Part of this stems from attitudes toward medical and recreational marijuana, which is one of the longest-running legalized programs. Twenty-nine states and the District of Columbia have legalized medical marijuana, and nine states and the District have legalized recreational pot.

“Here in Colorado, where recreational marijuana has been legal for several years, we see a lot of enthusiasm for marijuana derivatives such as CBD oil,” Dr. Nath said.

In the District of Columbia, Dr. Asma Dilawari, a breast cancer specialist at Georgetown Lombardi Comprehensive Cancer Center, said she also has seen patients refuse chemotherapy and instead find someone to deliver them intravenous vitamin C.

“I’ve had a couple patients come back from these places [using complementary/alternative medicine] and have had progression of their disease,” said Dr. Dilawari, who was not involved in the study. “And then there’s some that don’t come back, and I’m not sure if they’ve gone somewhere out of town or they’ve really not done well.”

The frustration is clear in Dr. Loren K. Mell’s voice when he talks about patients choosing alternative, natural therapies over radiation.

“I have a patient on treatment who sought out alternative therapy initially for her cancer and, as expected, the cancer progressed, and this makes it much more difficult to treat,” said Dr. Mell, a professor of radiation medicine at the University of California-San Diego. “By and large, that industry survives and preys upon the public to really separate cancer patients from their money.” He was not involved in the study.

Combatting false claims

The Food and Drug Administration has targeted a number of herbal and vitamin supplement companies for advertising “miracles cancer cures” that are “more effective than chemotherapy.”

In November, the FDA sent out four warning letters to companies selling CBD oils — containing cannabidiol, a non-psychoactive component of marijuana — that claims the products “combats tumor and cancer cells”; “CBD makes cancer cells commit ‘suicide’ without killing other cells”; among other claims.

Over the past 10 years the FDA has sent out about 90 of these “warning letters,” telling manufacturers to remove any claims of preventing, diagnosing, treating or curing cancer that haven’t been cleared by the administration.

While the FDA can exercise authority over companies making unproven claims, more difficult is countering personal narratives online from people endorsing natural remedies as their personal cancer cure.

“The internet, it’s the wild west and people can make really random, and strange and out-there claims,” said study co-author Dr. Johnson, chief resident in radiation oncology at Yale.

For example, popular alternative medicine websites can tout the value of supplements that are unproven, but because it’s not a company making the claims or providing the products, there’s little to counteract the content, he said.

In 2014 the FDA issued a draft recommendation letter to give companies more guidance on how they can voluntarily correct misinformation in the public realm. This included that if companies became aware of third-party websites or users making unfounded claims about their product, they could request to have their own disclaimers added within the content.

The letter was open to public comment for a month but has yet to be finalized as an official recommendation.

Additional risks are that it’s unclear how some of these products react with conventional cancer treatments — it can interfere with chemotherapy making it more toxic, or on the other side, less effective.

“There are some issues with these types of therapies because they can actually directly impact your conventional cancer therapies,” Dr. Johnson said.

A difficult conversation

Dr. Yu said that their most recent research highlights the importance of communicating with their patients about their fears and anxieties about undergoing treatments.

“It’s a very natural human response to wonder whether there’s some other magical way that can help them,” he said.

More cancer centers are starting to establish official integrative medicine departments and offering services such as acupuncture, dance therapy, healing touch, hypnosis, massage, meditation, Qigong, and yoga, according to a 2017 review published in the journal JNCI Monographs.

Dr. Channing Paller, an assistant professor of oncology at Johns Hopkins School of Medicine, is hoping to bring more legitimacy to herbal remedies in this realm through rigorous experimentation.

“In my experience, the patients ask for it every single day,” Dr. Paller said.

She is leading a number of clinical trials looking at the benefits or drawbacks of injections of mistletoe extract on patients with solid tumors, or muscadine grape extract for patients with prostate cancer.

“We want to test it rigorously so that if it helps, insurance companies can pay for it and the FDA can consider approving it, and if it doesn’t, people stop wasting their money buying supplements that don’t work,” she said.


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