MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Many cancer patients use some form of complementary and alternative medicine (CAM), mostly as an adjunct to conventional cancer therapies to improve the symptoms of the disease or to alleviate the side-effects of the often harsh cancer-therapy. The hope is that this approach leads to less suffering and perhaps even longer survival – but is this really so?

In a recently published study, Korean researchers evaluated whether CAM-use influenced the survival and health-related quality of life (HRQOL) of terminal cancer patients. From July 2005 to October 2006, they prospectively studied a cohort study of 481 cancer patients. During a follow-up of 163.8 person-years, they identified 466 deceased patients. Their multivariate analyses of these data showed that, compared with non-users, CAM-users did not have better survival. Using mind-body interventions or prayer was even associated with significantly worse survival. CAM users reported significantly worse cognitive functioning and more fatigue than nonusers. In sub-group analyses, users of alternative medical treatments, prayer, vitamin supplements, mushrooms, or rice and cereal reported significantly worse HRQOL. The authors conclude that “CAM did not provide any definite survival benefit, CAM users reported clinically significant worse HRQOLs.”

Most proponents of CAM would find this result counter-intuitive and might think it is a one-off coincidental result or a fluke. But, in fact, it is not; similar data have been reported before. For instance, a Norwegian study from 2003 examined the association between CAM-use and cancer survival. Survival data were obtained with a follow-up of 8 years for 515 cancer patients. A total of 112 patients used CAM. During the follow-up period, 350 patients died. Death rates were higher in CAM-users (79%) than in those who did not use CAM (65%). The hazard ratio of death for CAM-use compared with no use was 1.30. The authors of this paper concluded that “use of CAM seems to predict a shorter survival from cancer.”

I imagine that, had the results been the opposite (i.e. showing that CAM-users live longer and have a better quality of life), most CAM-enthusiasts would not have hesitated in claiming a cause effect relationship (i.e. that the result was due to the use of alternative medicine). Critical thinkers, however, are more careful, after all, correlation is not causation! So, how can these findings be explained?

There are, of course, several possibilities, for example:

1) Some patients might use ineffective alternative therapies instead of effective cancer treatments thus shortening their life and reducing their quality of life.

2) Other patients might employ alternative treatments which cause direct harm; for this, there are numerous options; for instance, if they self-medicate St John’s Wort, they would decrease the effectiveness of many mainstream medications, including some cancer drugs.

3) Patients who elect to use alternative medicine as an adjunct to their conventional cancer treatment might, on average, be more sick than those who stay clear of alternative medicine.

The available data do not allow us to say which explanation applies. But things are rarely black or white, and I would not be surprised, if a complex combination of all three possibilities came closest to the truth.

67 Responses to Cancer patients who use alternative medicine die sooner

  • Dr Keith Grimes says:

    Fascinating stuff, and well worth further follow-up. Might I suggest a 4th possibility? That those patients with more severe symptoms (possibly correlating to more significant/advanced disease) are more likely to seek and employ alternative therapies.

    I shall be studying in more detail over coffee later I think.

    • Edzard says:

      i am not aware of any comparisons of intelligence between alt med users vs non-users. but there are tons of data showing that users tend to be more educated…not the same, i know, but still…

        • Deirdre Hebert says:

          Looking at the data in this article suggests that the article itself is flawed. The article suggests in the introduction that the mean age at death for medical doctors is 81.5 years. But what is not mentioned is that this is the CURRENT mean age at death, or life expectancy. The data for chiropractor deaths goes back many years. One would expect in any decent analysis, to look at the mean age at death for each year, and compare that to the means for other populations.
          Nor is there any mention in the article of the geographic location of the chiropractors whose deaths were recorded. If we look at table 3 in the article, we find that the mean age at death for medical doctors is based on very little data, and the number chosen was for medical doctors based in 6 different nations, and included only 27 such doctors. A much larger sample of 475 medical doctors located in the UK, having a mean age of death of 75.2 years was ignored. Had the mean age at death for all medical doctors been taken as a whole, that age would have been (off the top of my head) somewhere around 76 years – much closer to the 74.2 years for chiropractors. And given that Table 3 does not reference the years of the deaths of those physicians, it is impossible to do an apples to apples comparison.

  • lottie says:

    I can certianly see example #2 as being plausible. After all, St Johns Wort is touted for low mood and folk get very low after big, life threatening conditions/ operations.

    It does seem, though, that the numbers suggest CAM doesn’t help at all, but I would like to know how other variables affected the numbers. Stuff like health before cancer, lifestyle post treatment and so on. It may be that believing CAM makes you heal quicker/ better would result in people pushing themselves harder/ too hard during recuperation to their recoveries detriment?

    A breakdown of CAM therapy used and if it was an adjunct or a replacement for regular medicine may show some even more useful data.

    It’s certainly fascinating stuff!

  • Bob Dobbs says:

    So this study looks like it says that people who used alt-med felt worse in themselves, and the ones who used prayer had a greater tendency to die. Is that it or did I miss something?

      • mambo says:

        God squad bulls$&T.
        All this stupid talk about God fixing things in modern day????!!!!!
        Read your bibles instead of bashing people with them and you would soon find that God stopped preforming miracles and using men as prophets agggggggeeeeees ago.

        You seem very intelligent so how did that little inconvenience give u the slip?

  • Pete 628 says:

    Is patient locus of control playing a significant role? I suggest that patients having an external locus of control are more likely to believe in fate and use mind-body interventions, other CAM, or prayers; those having an internal locus of control are more likely to believe in evidence-based interventions and take more responsibility for their treatment and quality of life.

    Another factor that could be significant is the patient’s concept of an afterlife: wonderful (something to look forward to) versus non-existent or horrible (something to actively avoid).

    • Edzard says:

      we can speculate endlessly about the factors involved. the existing data sets are probably not sufficient to address any of them adequately. this means that, if we really want to know, we better do the research and generate more data.

  • Bob Dobbs says:

    So the headline scattered across my twitter feed, which seemed to casually imply that alt med, of any and all kinds, hastens your death from cancer, would be, on closer inspection, a misreading on my part?

  • Bob Dobbs says:

    So it was my misinterpretation. I thought it must have been. Clearly the sentence ‘Cancer patients who use alternative medicine die sooner ‘ in the absence of further explanation, does not in any way imply a causal link between a premature death and alternative medicine. At all.
    I can only console myself that I’m not alone in this misapprehension. Various people have excitedly retweeted this. A Mr Kausic Datta has gone so far as to exclaim ‘quelle surprise’ when confronted with this vague study that really warns us of the apparent danger of prayer when gravely ill, at least as far as the death side of things goes. Perhaps that was what he was referring to and I’m wrong again, after all it wouldn’t be the first time.

    • Edzard says:

      if you read the title carefully, you will realise that there is not a hint of implication of causality. if you read the article at all you realise that the question was considered in some detail and that causality was rejected by me. so what are you on about? surely not that someone else wrote “what a surprise” [for those you do not read french].???!

  • Rob says:

    That was meant to be “motivation for use” in the comment above. But, to answer your question, there were 1588 completed survey responders. And the most interesting findings were that 63.6% had some kind of post-secondary education, there was an equal spread of stage I to IV cancer diagnosis, 88% had also received conventional cancer treatment in addition to using the tea blend, almost half had been using the tea blend for more than a year, 50% reported symptom improvements (fatigue, nausea, appetite loss being the top three), 64% discussed their use of CAM with their physicians, and about 5% had some kind of minor side effect like diarrhea or upset stomach. So all in all, it’s more of just a snapshot of who was using it, why, and how they felt it was helping. A self-selecting group with self-reported results but generally positive stuff reported that could help inform other more focused studies. It would be really interesting to have followed mortality rates with usage with this one.

  • Edzard, I am glad you were not my oncologist. What an insensitive title to your post: “Cancer patients who use alternative medicine die sooner”, when as you point out at the end there are many factors which could explain why cancer patients die and somehow I cant see whether they have a massage or not in the Royal Marsden will make a great deal of difference to mortality rates of cancer patients.

    As you know, I was diagnosed with stage 3 rectal cancer exactly two years ago. Radiation, surgery, a colostomy bag and six months chemotherapy, left me with no sensation in my hands and feet, 15 kilos over weight and unable to walk 100 meters without getting breathless. During treatment you just want to feel a bit better, that may be eating sweets, smoking a joint, having a massage anything that might make it a bit easier and help get you to the last session of chemo, I can see why people turn to God for help, I had Popeye the Sailor Man. Then you get to the last treatment and you continue to deteriorate. No statement describes it better; “if it doesn’t kill you it makes you stronger”.

    So what was I to do? August 30th 2012, I was free of cancer the doctors had done their job and they had nothing else to offer me. Nobody knows if the cancer will stay away or what my prognosis is. I could change nothing and see if I make five years or I could take a proactive approach to my health and well being and see if I make five years. I choose the latter, in four weeks time I hope to complete a Marathon, not just any marathon, a marathon on the Great Wall of China which takes the elite about 4 hours. By any objective criteria I am fitter and happier than I have been in 20 years and CAM played a big role in me getting me here. Am I cured? Who knows the grim reaper sits on my shoulder, motivating me to eat my greens exercise and relax by meditating because I believe it will reduce the odds of the cancer returning, then again perhaps I should not be pushing my body like this, with an arthritic right knee and my back aches after every ten mile run, I see a chiropractor three times a week. What does all this prove? Like the study above; Nothing.

    We are all going to die and for many of us its going to be cancer. Even if I become one of the statistics in the above point of view, they have missed the most important factor in my living with cancer. I always had hope of extra day of life. I will have died happy and given it my best shot to see my kids grow up. If I get hit by a bus tomorrow, my mind, body and spirit are ready, not many can say that.

    • Edzard says:

      the whole point of the article was to show that causality is NOT established. i think you mis-interpret the article and even the title. i also ask the question whether, had the correlation been the other way round, would the alt med camp have claimed causality. i see this as an exercise in critical thinking. please try to see it that way too.

  • Sarah - a survivor says:

    Unfortunately I was diagnosed with breast cancer a few years which had badly metastasized and I was pretty ill but I focused. I did a lot of reading, a lot of talking and then a lot more reading. Using what I suppose is “CAM” therapy, I beat my cancer with a combination of approaches – I still read articles like this with interest because I don’t think we will ever truly find an answer to what works best. For me, it was DCA and I’m thankful every day for reading before deciding anything.

    • Alan Henness says:

      Sarah – a survivor said

      Unfortunately I was diagnosed with breast cancer a few years which had badly metastasized and I was pretty ill but I focused. I did a lot of reading, a lot of talking and then a lot more reading. Using what I suppose is “CAM” therapy, I beat my cancer with a combination of approaches…

      So, were you also having conventional treatments as well and how do you know what it was that worked?

      • Sarah - a survivor says:

        A combination of DCA, cutting sugar from my diet and IV Vit C. No “conventional” treatment but wouldn’t rule it out in the future. At this point my doctor (NHS) has declared me cancer free but I’ll never rule anything out should the cancer come back.

  • M Walker says:

    Surely it’s dependent on the patient’s specific cancer, and overall lifestyle. I know people whose cancer has completely disappeared from Gerson therapy alone. I also know people whose cancer had a positive result from chemo/radiotherapy, but of course many who haven’t. I am not taking either side in the argument for or against alternative therapy vs. conventional medicine in treating cancer. However, I believe there should be a choice for the patient when they are diagnosed. They should be told about drugs AND alternative medicine, and the pros and cons of both.

    • Edzard says:

      yes, cancer patients should be told the honest truth and scientific evidence about all options so that they can make up their own minds. if we do this objectively, we will have to say that there is no alternative cancer cure.

    • Alan Henness says:

      M Walker said:

      I know people whose cancer has completely disappeared from Gerson therapy alone.

      You may well know people who have used gerson ‘therapy’ and whose cancer has subsequently disappeared (assuming there was a positive diagnosis in the first place), but I seriously doubt that you know that there was any causation.

      However, I believe there should be a choice for the patient when they are diagnosed. They should be told about drugs AND alternative medicine, and the pros and cons of both.

      So, what do you class as alternative ‘medicine’ and what ‘pros’ do you think those people should be told about them?

  • Rick E says:

    I’m curious about something. I had cancer some years ago and did everything the doctors prescribed – no CAM for me. I religiously have my ongoing cancer check ups and they tell me I am fully recovered and the chance of recurrence is no more for me than for the general population. One side effect of my treatment (among many, both temporary and permanent) was terrible nausea, vomiting and inability to eat or keep food down during treatment. Even taking the anti-nausea medication they prescribed for me (3 pills a day for two months at $75 a pill!) didn’t seem to work for me. Then a friend gave me some marijuana to try (something I never would have thought of). I totally hated (and still do hate) getting high but it did work – one or two puffs and I actually could eat a modest amount and keep it down. Here’s my question – is using marijuana the way I did considered CAM? My evidence is purely anecdotal. It sure felt like a true physiological effect. Placebo effect? Was I fooling myself? Has marijuana been studied?

    • Edzard says:

      i am not an expert in the benefits of cannabis; but i think there is quite a bit of evidence that it is effective for nausea. i would not include it under the umbrella of alt med, however.

  • If the “whole point of the article was to show causality is not established” perhaps you should have used a question mark in the title, as I said the title was “insensitive” to cancer patients using CAM, I did not try to interpret anything from the study, we both agree it proves nothing one could just as easily argue the people who prayed were happier, because they believe they are going to paradise when they die. I just provided a personal experience of cancer treatment and empathy towards terminally ill people who often just want their spirits raised, something you dont give much thought to, in my opinion.

    Last April on Twitter you described a terminally ill elderly man who decided not to have chemotherapy as a “victim of CAM”, were my cancer to come back as terminal and I decided that I could not face another 18 months of treatment, would you also describe me as a victim of CAM? As I think it would be very hurtful to my family, you being a doctor and everything.

    • Edzard says:

      yes, i could have put a “?” on the other hand, i could also have used a “!”
      what you do not seem to realise is that this blog is for critical analysis of alt med; it is not a patient support group exercise. and what i said on twitter some time ago has little impotatnce for this blog or much else. twitter has a different purpose again, in my view.

      • Dogma says:

        What this blog seems to promote are two things:

        1) agree with Professor Ernst and get a pat on the back from him and his regular commentators
        2) disagree with Professor Ernst and his sensationalist headlines and have fun made at your expense

        • Camille says:

          I disagree. To me,

          1. If the pat on the back means that he gives a supportive comments in return to the ones he likes, that makes sense, don’t you think? That’s what happens when people agree with one another; it provokes a positive reaction. I don’t know that that would be any different on any other blog, regardless of topic.

          2. Ernst has said repeatedly that this article and the studies cited are food for thought, and that he’s written this piece because the question is interesting to him, as a scientist and a skeptic. He states in the article, “So, how can these findings be explained?” And then offers three *possibilities*.

          ‘These findings’ is not the same as ‘this fact’; he’s analyzing the results of studies as they raise important questions. “The authors of this paper concluded that “use of CAM seems to predict a shorter survival from cancer.” Obviously he has a slant because he is a skeptic, but he never says, “This is true. I KNEW it!” Both in the article and in his comments, things are left in the air as inconclusive, and reason for further discussion and study. To be honest, I found his approach fair and rather refreshing.

          3. I am not crazy about the title, either; I do think it was irresponsible.

          I don’t see where he’s made fun of the people who disagree with him, though. Which comments did you mean, exactly?

          I think that as blog posts/opinion pieces go, the author has been a generally good and respectful sport.

          Are the exchanges in CAM-supportive blogs usually different somehow? Not sarcastic; it’s an honest question because I don’t know.

        • Pete 628 says:

          In other words, if you:

          1) agree with the requirement for evidence of efficacy then you may get a pat on the back.
          2) disagree with scientific evidence then you then you will likely be thought of as a numpty.

          Simples, innit?

  • Measure for Measure says:

    4) Use of alternative medicine crowds out the conventional kind. This is a variant of #1, whereby alternative medicine patients are not as meticulous with regards to following treatment protocols as other patients.

    5) Physicians who tolerate alternative medicine are less apt to apply aggressive conventional treatments. Or maybe they outsource some of their pain management, to the detriment of the patients.

    Overall, I wasn’t surprised by the longevity results. Quality of life is another matter: I would have thought that the extra attention paid by alternative medicine practitioners would help. It might be interesting to replicate the study in a US region that practices aggressive managed care.

    At any rate, this is an interesting study: it’s worth drilling into a little.

  • Mojo says:

    CAM users reported significantly worse cognitive functioning … than nonusers.

    I suppose a causal relationship there is at least plausible…

  • I realise your blog is not a support group, however you are aware your opinions and statements are widely circulated because you are a professor and a doctor. Not sure I would call your “imagination” getting ahead of the study “critical analysis” when you stated “I imagine that, had the results been the opposite (i.e. showing that CAM-users live longer and have a better quality of life), most CAM-enthusiasts would not have hesitated in claiming a cause effect relationship” . They may have done and they may not have done, its just pure speculation on your part.

    • Edzard says:

      critical analysis can, of course, include imagining what might have happened, had the results be different – not least because in the last 20 years i have come across uncounted occasions where unwarranted conlusions have been drawn based on flimsy data. several previous posts on this blog bear witness of this phenomenon. in contrast to my critics, i do tend to differentiate clearly between imagination and fact.

  • ek sangha says:

    Okay, you are an MD, PhD, FMedSci, FSB, FRCP, FRCPEd heh! How long would you cure flu or cold with your conventional method?

    Me, am none of the above MD, PhD, FMedSci, FSB, FRCP, FRCPEd. I’m a researcher. Without a researcher, none of your MD, PhD, FMedSci, FSB, FRCP, FRCPEd work anyway.

    To prove who can cure a common cold or flu quicker, Let both of us have a contest. We both catch flu at the same time. Who can cure the flu faster win. You are an MD, PhD, FMedSci, FSB, FRCP, FRCPEd and I’m just an ordinary researcher. I already know your answer, There is no cure for flu, WRONG! There is and it took less than three days to cure it.

    ANY, MD, PhD, FMedSci, FSB, FRCP, FRCPEd up for a challenge? For better proof, get all the major broadcasters like CNN, ALJAZEERA and ABC document both of us 24/7.

    I have been testing this cure for the last 10 years and it still work to this day 2013, September 01. I will proof your worlthless MD, PhD, FMedSci, FSB, FRCP, FRCPEd to the dirt!

    Ek Sangha

  • Karen says:

    You have such a chip on your shoulder. I wonder what terrible thing happened to you to fill you with such vitriol. I assume you don’t believe in prayer, but I will pray for you anyway. Just like acupuncture and herbal medicine prescribed and administered by an appropriately trained and skilled practitioner, you don’t have to believe in it in order for it to work.

    :-)

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