MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Cancer

Complementary treatments have become a popular (and ‘political correct’) option to keep desperate cancer patients happy. But how widely accepted is their use in oncology units? A brand-new article tried to find the answer to this question.

The principal aim of this survey was to map centres across Europe prioritizing those that provide public health services and operating within the national health system in integrative oncology (IO). A cross-sectional descriptive survey design was used to collect data. A questionnaire was elaborated concerning integrative oncology therapies to be administered to all the national health system oncology centres or hospitals in each European country. These institutes were identified by convenience sampling, searching on oncology websites and forums. The official websites of these structures were analysed to obtain more information about their activities and contacts.

Information was received from 123 (52.1 %) out of the 236 centres contacted until 31 December 2013. Forty-seven out of 99 responding centres meeting inclusion criteria (47.5 %) provided integrative oncology treatments, 24 from Italy and 23 from other European countries. The number of patients seen per year was on average 301.2 ± 337. Among the centres providing these kinds of therapies, 33 (70.2 %) use fixed protocols and 35 (74.5 %) use systems for the evaluation of results. Thirty-two centres (68.1 %) had research in progress or carried out until the deadline of the survey. The complementary and alternative medicines (CAMs) more frequently provided to cancer patients were acupuncture 26 (55.3 %), homeopathy 19 (40.4 %), herbal medicine 18 (38.3 %) and traditional Chinese medicine 17 (36.2 %); anthroposophic medicine 10 (21.3 %); homotoxicology 6 (12.8 %); and other therapies 30 (63.8 %). Treatments are mainly directed to reduce adverse reactions to chemo-radiotherapy (23.9 %), in particular nausea and vomiting (13.4 %) and leucopenia (5 %). The CAMs were also used to reduce pain and fatigue (10.9 %), to reduce side effects of iatrogenic menopause (8.8 %) and to improve anxiety and depression (5.9 %), gastrointestinal disorders (5 %), sleep disturbances and neuropathy (3.8 %).

As so often with surveys of this nature, the high non-response rate creates a problem: it is not unreasonable to assume that those centres that responded had an interest in IO, while those that failed to respond tended to have none. Thus the figures reported here for the usage of alternative therapies might be far higher than they actually are. One can only hope that this is the case. The idea that 40% of all cancer patients receive homeopathy, for instance, is hardly one that is in accordance with the principles of evidence-based practice.

The list of medical reasons for using largely unproven treatments is interesting, I think. I am not aware of lots of strong evidence to show that any of the treatments in question would generate more good than harm for any of the conditions in question.

What follows from all of this is worrying, in my view: thousands of desperate cancer patients are being duped into having bogus treatments paid for by their national health system. This, I think, begs the question whether these most vulnerable patients do not deserve better.

Reiki is a form of energy healing that evidently has been getting so popular that, according to the ‘Shropshire Star’, even stressed hedgehogs are now being treated with this therapy. In case you argue that this publication is not cutting edge when it comes to reporting of scientific advances, you may have a point. So, let us see what evidence we find on this amazing intervention.

A recent systematic review of the therapeutic effects of Reiki concludes that the serious methodological and reporting limitations of limited existing Reiki studies preclude a definitive conclusion on its effectiveness. High-quality randomized controlled trials are needed to address the effectiveness of Reiki over placebo. Considering that this article was published in the JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE, this is a fairly damming verdict. The notion that Reiki is but a theatrical placebo recently received more support from a new clinical trial.

This pilot study examined the effects of Reiki therapy and companionship on improvements in quality of life, mood, and symptom distress during chemotherapy. Thirty-six breast cancer patients received usual care, Reiki, or a companion during chemotherapy. Data were collected from patients while they were receiving usual care. Subsequently, patients were randomized to either receive Reiki or a companion during chemotherapy. Questionnaires assessing quality of life, mood, symptom distress, and Reiki acceptability were completed at baseline and chemotherapy sessions 1, 2, and 4. Reiki was rated relaxing and caused no side effects. Both Reiki and companion groups reported improvements in quality of life and mood that were greater than those seen in the usual care group.

The authors of this study conclude that interventions during chemotherapy, such as Reiki or companionship, are feasible, acceptable, and may reduce side effects.

This is an odd conclusion, if there ever was one. Clearly the ‘companionship’ group was included to see whether Reiki has effects beyond simply providing sympathetic attention. The results show that this is not the case. It follows, I think, that Reiki is a placebo; its perceived relaxing effects are the result of non-specific phenomena which have nothing to do with Reiki per se. The fact that the authors fail to spell this out more clearly makes me wonder whether they are researchers or promoters of Reiki.

Some people will feel that it does not matter how Reiki works, the main thing is that it does work. I beg to differ!

If its effects are due to nothing else than attention and companionship, we do not need ‘trained’ Reiki masters to do the treatment; anyone who has time, compassion and sympathy can do it. More importantly, if Reiki is a placebo, we should not mislead people that some super-natural energy is at work. This only promotes irrationality – and, as Voltaire once said: those who make you believe in absurdities can make you commit atrocities.

After the usually challenging acute therapy is behind them, cancer patients are often desperate to find a therapy that might improve their wellbeing. At that stage they may suffer from a wide range of symptoms which can seriously limit their quality of life. Any treatment that can be shown to restore them to their normal mental and physical health would be more than welcome.

Most homeopaths believe that their remedies can do just that, particularly if they are tailored not to the disease but to the individual patient. Sadly, the evidence that this might be so is almost non-existent. Now, a new trial has become available; it was conducted by Jennifer Poole, a chartered psychologist and registered homeopath, and researcher and teacher at Nemeton Research Foundation, Romsey.

The aim of this study was to explore the benefits of a three-month course of individualised homeopathy (IH) for survivors of cancer.  Fifteen survivors of any type of cancer were recruited from a walk-in cancer support centre. Conventional treatment had to have taken place within the last three years. Patients saw a homeopath who prescribed IH. After three months of IH, they scored their total, physical and emotional wellbeing using the Functional Assessment of Chronic Illness Therapy for Cancer (FACIT-G). The results show that 11 of the 14 women had statistically positive outcomes for emotional, physical and total wellbeing.
The conclusions of the author are clear: Findings support previous research, suggesting CAM or IH could be beneficial for survivors of cancer.

This article was published in the NURSING TIMES, and the editor added a footnote informing us that “This article has been double-blind “.

I find this surprising. A decent peer-review should have picked up the point that a study of that nature cannot possibly produce results which tell us anything about the benefits of IH. The reasons for this are fairly obvious:

  • there was no control group,
  • therefore the observed outcomes are most likely due to 1) natural history, 2) placebo, 3) regression towards the mean and 4) social desirability; it seems most unlikely that IH had anything to do with the result
  • the sample size was tiny,
  • the patients elected to receive IH which means that had high expectations of a positive outcome,
  • only subjective outcome measures were used,
  • there is no good previous research suggesting that IH benefits cancer patients.

On the last point, a recent systematic review showed that the studies available on this topic had mixed results either showing a significantly greater improvement in QOL in the intervention group compared to the control group, or no significant difference between groups. The authors concluded that there existed significant gaps in the evidence base for the effectiveness of CAM on QOL in cancer survivors. Further work in this field needs to adopt more rigorous methodology to help support cancer survivors to actively embrace self-management and effective CAMs, without recommending inappropriate interventions which are of no proven benefit.

All this new study might tell us is that IH did not seem to harm these patients  – but even this finding is not certain; to be sure, we would need to include many more patients. Any conclusions about the effectiveness of IH are totally unwarranted. But are there ANY generalizable conclusions that can be drawn from this article? Yes, I can think of a few:

  • Some cancer patients can be persuaded to try the most implausible treatments.
  • Some journals will publish any rubbish.
  • Some peer-reviewers fail to spot the most obvious defects.
  • Some ‘researchers’ haven’t got a clue.
  • The attempts of misleading us about the value of homeopathy are incessant.

One might argue that this whole story is too trivial for words; who cares what dodgy science is published in the NURSING TIMES? But I think it does matter – not so much because of this one silly article itself, but because similarly poor research with similarly ridiculous conclusions is currently published almost every day. Subsequently it is presented to the public as meaningful science heralding important advances in medicine. It matters because this constant drip of bogus research eventually influences public opinion and determines far-reaching health care decisions.

It has been estimated that 40 – 70% of all cancer patients use some form of alternative medicine; may do so in the hope this might cure their condition. A recent article by Turkish researchers – yet again – highlights how dangerous such behaviour can turn out to be.

The authors report the cases of two middle-aged women suffering from malignant breast masses. The patients experienced serious complications in response to self-prescribed use of alternative medicine practices to treat their condition in lieu of evidence-based medical treatments. In both cases, the use and/or inappropriate application of alternative medical approaches promoted the progression of malignant fungating lesions in the breast. The first patient sought medical assistance upon development of a fungating lesion, 7∼8 cm in diameter and involving 1/3 of the breast, with a palpable mass of 5×6 cm immediately beneath the wound. The second patient sought medical assistance after developing of a wide, bleeding, ulcerous area with patchy necrotic tissue that comprised 2/3 of the breast and had a 10×6 cm palpable mass under the affected area.

The authors argue that the use of some non-evidence-based medical treatments as complementary to evidence-based medical treatments may benefit the patient on an emotional level; however, this strategy should be used with caution, as the non-evidence-based therapies may cause physical harm or even counteract the evidence-based treatment.

Their conclusions: a malignant, fungating wound is a serious complication of advanced breast cancer. It is critical that the public is informed about the potential problems of self-treating wounds such as breast ulcers and masses. Additionally, campaigns are needed to increase awareness of the risks and life-threatening potential of using non-evidence-based medical therapies exclusively.

I have little to add to this; perhaps just a further reminder that the risk extends, of course, to all serious conditions: even a seemingly harmless but ineffective therapy can become positively life-threatening, if it is used as an alternative to an effective treatment. I am sure that some ‘alternativists’ will claim that I am alarmist; but I am also convinced that they are wrong.

Linus Carl Pauling (1901 – 1994), the American scientist, peace activist, author, and educator who won two Nobel prizes, was one of the most influential chemists in history and ranks among the most important scientists of the 20th century. Linus Pauling’s work on vitamin C, however, generated considerable controversy. Pauling wrote many papers and a popular book, Cancer and Vitamin C. Vitamin C, we know today, protects cells from oxidative DNA damage and might thereby block carcinogenesis. Pauling popularised the regular intake of vitamin C; eventually he published two studies of end-stage cancer patients; their results apparently showed that vitamin C quadrupled survival times. A re-evaluation, however, found that the vitamin C groups were less sick on entry to the study. Later clinical trials concluded that there was no benefit to high-dose vitamin C. Since then, the established opinion is that the best evidence does not support a role for high dose vitamin C in the treatment of cancer. Despite all this, high dose IV vitamin C is in unexpectedly wide use by CAM practitioners.

Yesterday, new evidence has been published in the highly respected journal ‘Nature'; does it vindicate Pauling and his followers?

Chinese oncologists conducted a meta-analysis to assess the association between vitamin C intake and the risk to acquire lung cancer. Pertinent studies were identified by a searches of several electronic databases through December of 2013. Random-effect model was used to combine the data for analysis. Publication bias was estimated using Begg’s funnel plot and Egger’s regression asymmetry test.

Eighteen articles reporting 21 studies involving 8938 lung cancer cases were included in this meta-analysis. Pooled results suggested that highest vitamin C intake level versus lowest level was significantly associated with the risk of lung cancer. The effect was largest in investigations from the United States and in prospective studies. A linear dose-response relationship was found, with the risk of lung cancer decreasing by 7% for every 100 mg/day increase in the intake of vitamin C . No publication bias was found.

The authors conclude that their analysis suggested that the higher intake of vitamin C might have a protective effect against lung cancer, especially in the United States, although this conclusion needs to be confirmed.

Does this finding vindicate Pauling’s theory? Not really.

Even though the above-quoted conclusions seem to suggest a causal link, we are, in fact, far from having established one. The meta-analysis pooled mainly epidemiological data from various studies. Such investigations are doubtlessly valuable but they are fraught with uncertainties and cannot prove causality. For instance, there could be dozens of factors that have confounded these data in such a way that they produce a misleading result. The simplest explanation of the meta-analytic results might be that people who have a very high vitamin C intake tend to have generally healthier life-styles than those who take less vitamin C. When conducting a meta-analysis, one does, of course, try to account for such factors; but in many cases the necessary information to do that is not available, and therefore uncertainty persists.

In other words, the authors were certainly correct when stating that their findings needed to be confirmed. Pauling’s theory cannot be vindicated by such reports – in fact, the authors do not even mention Pauling with one word.

There are many terms for this type of treatment: energy healing, Therapeutic Touch, Reiki, spiritual healing and para-normal healing are just some of the better-known ones. These interventions are based of the belief that some sort of ‘energy’ can be channelled by the healer into the body of the patient to assist its capacity for self-healing. Needless to say that their biological plausibility is suspiciously close to zero.

This new study was aimed at testing the effectiveness of energy healing on the well-being of patients and at assessing the influence on the results of participating in a randomized controlled trial. A total of 247 colorectal cancer patients were included in the trial. One half of them were randomized to either:

  • healing (RH) or
  • control (RC)

The other half of the patients was not randomized and had either:

  • self-selected healing (SH) or
  • self-selected control condition (SC)

All patients completed questionnaires assessing well-being Quality of Life (QoL), depressive symptoms, mood, and sleep quality), attitude toward complementary and alternative medicine (CAM), and faith/spirituality at baseline, 1 week, and 2 months post-intervention. Patients were also asked to indicate, at baseline, whether they considered QoL, depressive symptoms, mood, and sleep quality as important outcomes.

Compared with controls, no overall effect of healing were noted on QoL, depressive symptoms, mood, or sleep quality in the intervention groups (RH, SH). Effects of healing on mood were only found for patients who initially had a positive attitude toward CAM and considered the outcome in question as important.

The authors of this study arrived at the following conclusions: Whereas it is generally assumed that CAMs such as healing have beneficial effects on well-being, our results indicated no overall effectiveness of energy healing on QoL, depressive symptoms, mood, and sleep quality in colorectal cancer patients. Effectiveness of healing on well-being was, however, related to factors such as self-selection and a positive attitude toward the treatment.

Survey after survey shows that ‘energy healing’ is popular amongst cancer patients. But medicine is no popularity contest, and the existing clinical trials have mostly failed to show that these treatments work beyond a sometimes remarkably strong placebo-effect. Consequently, several systematic reviews have arrived at conclusions that were far from positive:

There is no robust evidence that Therapeutic Touch promotes healing of acute wounds

We found inconclusive evidence that interventions with spiritual or religious components for adults in the terminal phase of a disease may or may not enhance well-being

The serious methodological and reporting limitations of limited existing Reiki studies preclude a definitive conclusion on its effectiveness

…the majority do not and the evidence does not support a recommendation either in favour or against the use of intercessory prayer

 …the evidence is insufficient to suggest that reiki is an effective treatment for any condition. Therefore the value of reiki remains unproven

Since the publication of our previous systematic review in 2000, several rigorous new studies have emerged. Collectively they shift the weight of the evidence against the notion that distant healing is more than a placebo

This new and fairly rigorous trial clearly points in the same direction. Thus we a faced with the fact that these treatments are:

  1. utterly implausible
  2. not supported by good clinical evidence

What follows seems as simple as it is indisputable: energy healing is nonsense and does not merit further research.

Traditional Chinese medicine (TCM) is often promoted as an effective therapy for cancer, and are numerous controlled clinical studies published in Chinese literature, yet no systematic analysis has been done of this body of evidence. This systematic review summarizes the evidence from controlled clinical studies published in Chinese on this subject.

The researchers looked for controlled clinical studies of TCM therapies for all kinds of cancers published in Chinese in four main Chinese electronic databases and found 2964 reports including 2385 randomized clinical trials and 579 non-randomized controlled studies.

The top seven cancer types treated were lung cancer, liver cancer, stomach cancer, breast cancer, esophagus cancer, colorectal cancer and nasopharyngeal cancer. The majority of studies (72%) applied TCM therapy combined with conventional treatments, whilst fewer (28%) applied only TCM therapy in the experimental groups. Herbal medicine was the most frequently tested TCM therapy (2677 studies, 90.32%).

The most frequently reported outcome was clinical symptom improvement (1667 studies, 56.24%) followed by biomarker indices (1270 studies, 42.85%), quality of life (1129 studies, 38.09%), chemo/radiotherapy induced side effects (1094 studies, 36.91%), tumor size (869 studies, 29.32%) and safety (547 studies, 18.45%). Completeness and adequacy of reporting appeared to improve with time.

The authors of this paper drew the following conclusion: data from controlled clinical studies of TCM therapies in cancer treatment is substantial, and different therapies are applied either as monotherapy or in combination with conventional medicine. Reporting of controlled clinical studies should be improved based on the CONSORT and TREND Statements in future. Further studies should address the most frequently used TCM therapy for common cancers and outcome measures should address survival, relapse/metastasis and quality of life.

Almost 3000 controlled clinical trials! This number is likely to impress many people – unless, of course, one knows that the quality of these studies is dismal. Interestingly, no formal assessment of study quality was included in this analysis. But it was mentioned that only 63 of these trials reported patient-blinding, and only 5 were deemed to be “relatively well designed” by the authors of this paper (who, incidentally, are strong proponents of TCM).

What I find the most interesting aspect of this article is the fact that the authors fail to mention how many of the studies reported a positive result – in a way, they don’t need to: there is plenty of evidence to show that virtually all of the Chinese studies of TCM are positive. In my view, this invalidates this body of evidence completely.

Analysis like the present one tend to lead us up the garden path. They suggest that there is a realistic hope for effective new treatments hidden in this difficult to access, large amount of data. This might lead other researchers to try to replicate some of the original studies. I fear that they would be wasting their time. From all I know, they are irreproducible.

In all walks of life, we have complete nutters who claim utter nonsense – in homeopathy probably more than in other areas. I knew that for quite some time, of course, but what I discovered on ‘the world’s leading homeopathy portal’ was still somewhat of a revelation to me: the overt promotion of homeopathy as an alternative cancer cure!

Hard to believe? See for yourself!

What follows (in italics) are excerpts from a long and detailed interview with a homeopathic physician published on this website.

Q: What does a typical treatment day look like for the patient?

A: Treatment starts with a comprehensive anamnesis that lasts several hours and includes the entire history of the patient till the occurrence of the tumor. This is followed by the analysis and evaluation of symptoms to find the basic homeopathic remedy [2] and the presently indicated remedy of the patient. We search for remedies for possible miasmatic blockages and also tumor specific remedies. We keep an eye on all iatrogenic damages caused by chemotherapy or radiation and try to have remedies at hand. When these complex considerations are finished an individual treatment concept is worked out. We prepare a list of parameters together with the patient that includes all currently present and disturbing symptoms such as pain, sleep disturbances, appearance and extent of the tumor, psychic problems like anxiety and grief etc. We also include laboratory values such as tumor markers, the erythrocyte sedimentation rate and blood pressure as important control parameters.

After applying the homeopathic remedy, usually in Q-potency, we analyze the patient’s symptoms daily to check their reaction to the remedy. It is very important to assess the patient’s reaction to the Q-potency as the development of symptoms shows us how to proceed with their treatment. The big advantage in the hospital is that we can observe our patients daily and investigate their reaction to the Q potency…

Q: I wish more homeopathic hospitals would be built here in Europe and worldwide! Where do you see the main problems for the establishment of homeopathic hospitals and which difficulties did you have to overcome?

A: A broader acceptance of homeopathy is necessary. Many health insurances still refuse to pay the costs, even though homeopathy is much cheaper than conventional cancer treatment with its chemotherapy or radiation.

I think outpatient clinics should be built first, where cancer patients can be treated without the necessary investment in hospitals. Orthodox medicine and the pharma industry should be open for cooperation with homeopathic physicians…

When homeopathic treatment is successful in rebuilding the immune system and reestablishing the basic regulation of the organism then tumors can disappear again. I’ve treated more than 1000 cancer patients homeopathically and we could even cure or considerably ameliorate the quality of life for several years in some, advanced and metastasizing cases.

Q: Do you include chemotherapy and radiation in your treatment?

A: Orthodox medicine considers the tumor to be a mass of abnormal cells which has to be combated. But it is important to know that the immune system has been disturbed long before the tumor appeared. We try to activate the immune system and to initiate an immune modulation by means of homeopathy. If this is successful tumors can disappear again. I have a very critical view of chemotherapy and radiation as the benefit is often very small and they diminish the chance of a real cure. Radiation can be useful in cases where metastases have invaded the spinal column and there is danger of fracture or there are already some broken vertebral bodies.

Chemotherapy may be useful in children suffering from leukemia, in Hodgkins-Lymphoma, testicular cancer and some forms of ovarian tumors. But these types of cancer only constitute 6% of all tumors. In all other types of cancer the benefit is more doubtful. We apply chemotherapy to gain some time in patients acutely affected by very rapidly growing tumors. But how can chemotherapy or radiation cure a patient ? It is only the immune system that can recognize the damaged DNA of the tumor cell and combat the tumor. However, the more chemotherapy the patient gets the more their immune system is weakened.

A: Yes, even in incurable cases homeopathy can help palliate without detrimental side effects.Even if our primary goal is to cure and prevent cancer, many patients are far beyond this stage. You describe some successfully treated patients with long time follow up in your book. Do any particular cases stand out in your memory?

JW: There are many cases I recall. These are the moments when you are sitting together with the patient to do the case anamnesis, hearing their history and feeling their despair when they were given up “officially” by orthodox medicine.

Now, tell me again that homeopathy is not dangerous – its remedies might be relatively harmless, but its practitioners certainly aren’t.

A new book is currently being promoted. It specifically targets cancer patients and misleads them into thinking that alternative therapies offer hope for this vulnerable group of patients. Here is what the press release says:

Endeavoring to provide the 1.2 million Americans diagnosed with cancer annually with alternative treatments co-authors Johanna C. Schipper and Frank J. Vanderlugt announce the launch of “The Natural Cancer Handbook”. The useful book explores how more than fifty alternative treatments work, their price, and where they can be obtained…. Contributing to the war on cancer with a bevy of scientific and anecdotal evidence to support the effectiveness of the treatments the handbook is a respite from the mixed messages patients often endure.

With more than fifty of the most effective alternative cancer treatments listed The Natural Cancer Handbook is the work of two years of research. Used successfully over the last century, the remedies found in the handbook are significantly cheaper than standard cancer treatments and in most cases can be used alongside them.

…The handbook discusses the successful alternative treatments Budwig Diet, Beta 1, 3D Glucan, and the readily available green food supplements such as barley grass, chlorella and spirulina. The Natural Cancer Handbook also explores the benefits of Melatonin, Noni, Resveratrol and the Canadian Resonant Light and the Hulda Clark generators.

Vanderlugt is a Chartered Accountant with a Bachelor of Science in Biology and Schipper has researched cancer extensively and has five years training in medicine.

Let’s just take the first treatment mentioned above; this is what a reliable source like CANCER RESEARCH UK have to say about it:

The Budwig diet was developed by a German biochemist called Johanna Budwig in the 1950s. It involves eating flaxseed mixed with cottage cheese or milk. Flax is a plant grown in many parts of the world. Pressing its seeds produces linseed oil to use in cooking or as a food supplement. The seeds contain high levels of fibre and many vitamins and minerals. You grind the flaxseed, usually in a coffee grinder. As well as flaxseed and cottage cheese, the Budwig diet is rich in fruit, vegetables and fibre. You also have to avoid sugar, meat, and fats such as butter, margarine and salad oil.

There is no reliable scientific evidence to show that the Budwig diet (or any highly specific diet) helps people with cancer. It is important to make sure that you have a well balanced diet when you are ill, especially if you are undernourished. We know from research that a healthy, well balanced diet can reduce the risk of cancer. You can find information about diet, healthy eating and cancer on our News and Resources website.

This is a polite way of telling us that diets such as this one is not balanced and not what cancer patients need; in fact, such diets are not just ineffective, they can be dangerous to cancer patients.

Texts like the Natural Cancer Handbook tend to make me quite angry. I find it deeply immoral to mislead cancer patients in this way, simply to make a profit. The truth could not be simpler: There is and never will be such a thing as an alternative cancer ‘cure’.

The concept assumes that there exists an effective cure which is being suppressed only because it originates from alternative medicine circles. But this assumption is idiotic. As soon as a treatment shows promise, it will be picked up by the scientific and oncologic communities and researched until its therapeutic value is known. At the end of this process, we might have a new option to treat cancer effectively. Many examples exist where a new drug was developed from a plant; taxol is but one of many examples.

Those who deny these simple facts in order to make a fast buck from the desperation of some of the most vulnerable patients are, in my view, charlatans of the worst kind.

These days, there is so much hype about alternative cancer treatments that it is hard to find a cancer patient who is not tempted to try this or that alternative medicine. Often it is employed without the knowledge of the oncology team, solely on the advice of non-medically qualified practitioners (NMPs). But is that wise? The aim of this survey was to find out.

Members of several German NMP-associations were invited to complete an online questionnaire. The questionnaire explored areas such as the diagnosis and treatment, goals for using complementary/alternative medicine (CAM), communication with the oncologist, and sources of information.

Of a total of 1,500 members of the NMP associations, 299 took part in this survey. The results show that the treatments employed by NMPs were heterogeneous. Homeopathy was used by 45% of the NMPs, and 10% believed it to be a treatment directly against cancer. Herbal therapy, vitamins, orthomolecular medicine, ordinal therapy, mistletoe preparations, acupuncture, and cancer diets were used by more than 10% of the NMPs. None of the treatments were discussed with the respective physician on a regular basis.

The authors concluded from these findings that many therapies provided by NMPs are biologically based and therefore may interfere with conventional cancer therapy. Thus, patients are at risk of interactions, especially as most NMPs do not adjust their therapies to those of the oncologist. Moreover, risks may arise from these CAM methods as NMPs partly believe them to be useful anticancer treatments. This may lead to the delay or even omission of effective therapies.

Anyone faced with a diagnosis of CANCER is understandably keen to leave no stone unturned to bring about a cure of the disease. Many patients thus go on to the Internet and look what alternative options are on offer. There they find virtually millions of sites advertising thousands of bogus cancer ‘cures’. Others consult their alternative practitioners and seek help. This new survey shows yet again that the advice they receive is dangerous. In fact, it might well be even more dangerous than the results imply: the response rate of the survey was dismal, and I fear that the less responsible NMPs tended not to reply.

None of the treatments listed above can cure cancer. For instance, homeopathy, the most popular alternative cancer treatment in Germany, will have no effect whatsoever on the natural history of the disease. To claim otherwise is criminally irresponsible.

But far too many patients are unaware of the evidence and of the dangers of being misled by bogus claims. What we need, I think, is a major campaign to get the word out. It would be a campaign that saves lives!

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