MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Use of complementary and alternative medicine (CAM) is common among cancer patients, not least because all sorts of claims are being made for CAM. One of these claims is that it prolongs survival.  But does it improve survival? This new study from the US was aimed at finding out; specifically, the authors wanted to determine whether CAM use impacts on the prognosis of breast cancer patients.

Health Eating, Activity, and Lifestyle (HEAL) Study participants (n = 707) were diagnosed with stage I-IIIA breast cancer. Participants completed a 30-month post-diagnosis interview including questions on CAM use (natural products such as dietary and botanical supplements, alternative health practices, and alternative medical systems), weight, physical activity, and comorbidities.

Outcomes were breast cancer-specific and total mortality, which were ascertained from the Surveillance Epidemiology and End Results registries in Western Washington, Los Angeles County, and New Mexico. Cox proportional hazards regression models were fit to data to estimate hazard ratios (HR) and 95 % confidence intervals (CI) for mortality. Models were adjusted for potential confounding by socio-demographic, health, and cancer-related factors.

Among the 707 participants, 70 breast cancer-specific deaths and 149 total deaths were reported. 60.2 % of participants reported CAM use post-diagnosis. The most common CAM were natural products (51 %) including plant-based estrogenic supplements (42 %). Manipulative and body-based practices and alternative medical systems were used by 27 and 13 % of participants, respectively. No associations were observed between CAM use and breast cancer-specific (HR 1.04, 95 % CI 0.61-1.76) or total mortality (HR 0.91, 95 % CI 0.63-1.29).

The authors concluded that CAM use was not associated with breast cancer-specific mortality or total mortality. Randomized controlled trials may be needed to definitively test whether there is harm or benefit from the types of CAM assessed in HEAL in relation to mortality outcomes in breast cancer survivors.

These findings tie in with the results of several other studies, some of which even seem to show that cancer patients who use CAM die sooner than those who don’t. I have previously pointed out that this could have several reasons, for instance:

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.

Therefore, I totally agree with the conclusions of the present paper: Randomized controlled trials may be needed to definitively test whether there is harm or benefit…

One Response to No effect of CAM use on mortality of breast cancer patients

  • Other patients might employ alternative treatments which cause direct harm […]

    I think this is the biggest worry. The claim is all too often that SCAM does no harm, but that is undeniably untrue, is it not? It would be nice to know whether specific SCAM treatments/policies actually shorten patients’ lives (We already know for certain that chiropractic has such an effect, but what about the others?). We can then worry about the other questions.

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