AUGUST 14, 2014
The Myth of Alternative Care, Growth of Complex Care


When we get sick, it is natural to hope for a cure, no matter how farfetched. Increasingly over the last few decades, patients are looking for answers outside of conventional medicine.

This desire, however, can lead some vulnerable patients to abandon mainstream treatments for alternative therapies. Although very few patients actually do so—less than 4%, by some estimates—those who choose this path put their health in further jeopardy.

2006 study in the American Journal of Surgery found that breast cancer patients who refused or delayed conventional therapy—surgery, chemotherapy, and/or radiation therapy—and opted for an alternative treatment significantly increased their risk of a cancer recurrence and of dying from the disease. Of 11 patients who declined surgery, 10 developed more advanced disease. An additional nine out of 10 patients who refused chemotherapy or radiation therapy boosted their estimated 10-year mortality rate by almost 50% (from 17% to 25%), two developed local recurrences and two died from cancer.

“Alternative medicine is harmful,” said Steven Novella, MD, a neurologist and assistant professor at Yale University School of Medicine who is executive editor of the blog Science-Based Medicine. “If such alternatives were evidence-based at all, they would be considered medicine, not alternative medicine, and would be adopted into mainstream care.”

Although alternative medicine and complementary medicine are often lumped together, there is an important distinction. Complementary interventions are not touted as cancer treatments, rather they are meant to accompany mainstream care, offering patients a variety of ways to relieve pain, nausea, fatigue and anxiety.

“Complementary interventions are designed to make patients feel better and improve quality of life, not replace conventional medicine,” Dr. Novella said.

Patients appear increasingly interested in integrating complementary modalities, such as meditation, acupuncture, massage and a range of diets, nutritional supplements and exercise regimens, into their mainstream treatments. 

To meet patients’ demands for more comprehensive care, integrative programs have been cropping up at leading cancer centers across the United States, including Memorial Sloan-Kettering Cancer Center in New York City, MD Anderson Cancer Center in Houston, and Dana-Farber Cancer Institute in Boston. These integrative oncology programs pair mainstream care with complementary interventions, with the goal of creating a comprehensive care package tailored to each patient’s disease severity and needs.

“Some patients have strong convictions and want to do more so it’s important for oncologists to understand each patient’s psychosocial background and find out what concerns lie beneath the surface,” said Gary Deng, MD, PhD, interim chief of Integrative Medicine at Memorial Sloan-Kettering Cancer Center, New York City. “By delving deeper, oncologists can foster trust with their patients and hopefully dissuade them from trying complementary or alternative interventions that may be harmful.”

According to Dr. Deng, recently diagnosed patients may be the most susceptible to alternative therapies. “Newly diagnosed patients often ask whether there is a different way of treating their cancer to make sure they’ve explored all options,” Dr. Deng said. “I lay out the science of what cancer is, how it arises, what the main treatments are and why they work or sometimes don’t work. I try to explain this in a way that makes patients feel comfortable that they’re not missing out on any alternative options.”

Other patients, however, may be more interested in reducing their symptoms while undergoing mainstream treatment or diminishing their chances of a recurrence while in remission. Such patients may want to explore complementary interventions and are usually beyond wanting to try something alternative, Dr. Deng said. For these patients, Dr. Deng proposes a package of lifestyle changes that may help improve their overall health.

Getting patients to exercise, for instance, is particularly important. There is extensive research showing that exercise may protect people from developing cancer and increase survival in those already diagnosed with a range of tumors, including breastcolorectal and prostate. In fact, the evidence is so robust that many experts now consider exercise a part of mainstream care, not complementary care.

But for most modalities, the evidence is murky. Many studies exploring the benefits of interventions, such as acupuncture, conflict or are inconclusive (see here and here), while others reveal that an intervention may hurt more than it helps. Take, for instance, the use of antioxidant supplements, which actually appear to increase cancer mortality.

According to Harriet Hall, MD, retired family physician and Air Force flight surgeon who writes the SkepDoc column in Skeptic magazine, “The field of CAM is vast: it includes methods that may work but have not been tested and methods that have been tested but have not generated sufficient evidence to have become part of conventional medicine. It also includes methods that have been tested and proven ineffective but that promoters still believe in because of personal experience, anecdotal evidence, rejection of scientific method, or misguided thinking.”
The vastness of CAM often means that the limited or specific benefits of one intervention may be taken to a dangerous extreme. For instance, vitamins may be beneficial for patients with specific vitamin deficiencies, but harmful when taken in large doses, and meditation may help reduce stress and possibly depression, but there is no evidence that it increases survival in patients with cancer. 
However, when complementary interventions are low-risk and given an appropriate context—namely, to reduce symptoms and promote overall health—then they can serve an important purpose: improving quality of life.“Being happy counts for something, said Dr. Deng. “There is no data that happier patients do better in terms of survival, but if an intervention is low-risk and makes a patient’s day-to-day life better, then there is very little downside.”

Updated on Aug 18.

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