The purpose of this study was to evaluate whether the use of CAM among newly diagnosed breast cancer patients was associated with delays in presentation, diagnosis or treatment of breast cancer. A multi-centre cross-sectional design was used and the time points of the individual breast cancer patients’ journey from first visit, resolution of diagnosis and treatments were evaluated in six public hospitals in Malaysia.
All newly diagnosed breast cancer patients from 1st January to 31st December 2012 were recruited. Data were collected through medical records review and patient interview by using a structured questionnaire. Complementary and alternative medicine (CAM) was defined as the use of any methods and products not included in conventional allopathic medicine before commencement of treatments. Presentation delay was defined as time taken from symptom discovery to first presentation of more than 3 months. The time points were categorised to diagnosis delay was defined as time taken from first presentation to diagnosis of more than 1 month and treatment delay was defined as time taken from diagnosis to initial treatment of more than 1 month. Multiple logistic regression was used for analysis.
A total number of 340 patients participated in this study. The prevalence of CAM use was 46.5% (n = 158). Malay ethnicity (OR 3.32; 95% CI: 1.85, 5.97) and not interpreting symptom as cancerous (OR 1.79; 95% CI: 1.10, 2.92) were significantly associated with CAM use. The use of CAM was associated with delays in presentation (OR 1.65; 95% CI: 1.05, 2.59), diagnosis (OR 2.42; 95% CI: 1.56, 3.77) and treatment of breast cancer (OR 1.74; 95% CI: 1.11, 2.72) on univariate analyses. However, after adjusting with other covariates, CAM use was associated with delays in presentation (OR 1.71; 95% CI: 1.05, 2.78) and diagnosis (OR 2.58; 95% CI: 1.59, 4.17) but not for treatment of breast cancer (OR 1.58; 95% CI: 0.98, 2.55).
The authors concluded that the prevalence of CAM use among the breast cancer patients is high. Women of Malay ethnicity and not interpreting symptom as cancerous were significantly associated with CAM use. The use of CAM had significantly associated with delay in presentation and resolution of diagnosis. Difficulty in obtaining all medical records may have excluded patients who experienced delays in presentation, diagnosis or treatment but every precaution and resources were utilized to obtain record. This study suggests further evaluation of access to breast cancer care is needed as poor access may promote the use of CAM. However, since public hospitals in Malaysia are heavily subsidized and readily available to the population, CAM use may impact delays in presentation and diagnosis.
We know from previous studies that
- CAM-use is associated with poor adherence to cancer treatments,
- using CAM as an alternative to conventional treatments results in shorter survival of cancer patients,
and now we also know that CAM-use is associated with delayed presentation and diagnosis of cancer. This latter effect can have consequences that are just as serious as the other two. The later cancer is diagnosed, the poorer the prognosis and the shorter the survival.
These findings indicate that all healthcare professionals should be vigilant and inform patients as well as the general public that CAM-users are exposed to considerable dangers.
14 Responses to CAM-use delays cancer diagnosis
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Important study. It would be worth doing on a larger scale, controlling for various forms of CAM. Maybe a least damaging form might be identifiable.
I do deplore the use of the word `allopathic’ by people who should know better. It was invented by homeopaths as a derogatory term.
BY Samuel Hahnemann, to be precise
Indeed, and homeopaths love it. Sadly some proper doctors like to use it.
practically all pharmacies in Germany have a big sign over their entrance announcing: ALLOPATHIE, HOMOEOPATHIE
Couldn’t agree more, it’s a silly term and just serves to suggest homeopathy or CAM is just another (equal) type of medicine. I never learned ‘allopathic medicine’ at vet school!
CAM delaying cancer treatment is also a big problem in veterinary medicine, I’ve seen it first-hand.
Niall
The other problem with ‘allopathy’ being applied to conventional medicine is that it implies that medicine has some single over-arching philosophical principle that it would apply ,unswervingly to every clinical situation which it really doesn’t. And no single adjective should be used to pretend that it does. ‘Medicine’ will do just fine.
Its use betrays the naivety of SCAM advocates who are totally devoted to their simplistic (and mutually contradictory) approaches. Their assorted self-proclaimed unifying principles are also the source of their great weakness. Homeopaths do homeopathy. If they stick to their guns they shouldn’t do herbalism or reiki or whatever. This means they are fundamentally screwed (just realised the double entendre in that. I’ll let it pass) if their single mode of therapy gets disproven. In real medicine, if a modality gets disproven it gets dropped, perhaps not with the efficiency we would all desire, but it gets dropped.
SCAM therapists are the ultimate one-trick ponies.
Additionally, several types of CAM are actually allopathic in character, being based on the concept of ‘humours’.
Dammit, Mojo. You’re asking now for internal consistency as well!!! That’s just a ridiculous demand.
Not to mention ‘reductionist’ too, with fundamentalist-chiropractors believing 95% of diseases are caused by the same lesion and acupuncturists all believing every disease is caused by plugged up meridians – how more un-holistic and reductionist can you get!
At least Mojo has a sense of humour (groan!)
And homoeopathy considers patients as nothing more than collections of symptoms.
“Holistic” has become a euphemism for “not demonstrably effective”.
Check out Wikipedia:
“Hahnemann used ‘allopathy’ to refer to what he saw as a system of medicine that combats disease by using remedies that produce effects in a healthy subject that are different (hence Greek root allo- ‘different’) from the effects produced by the disease to be treated. The distinction comes from the use in homeopathy of substances that are meant to cause similar effects as the symptoms of a disease to treat patients (homeo – meaning similar).”
No question Hahnemann intended the term to be pejorative – he openly declared that he was ‘giving up medicine’ in the light of just how bad he found the practice of medicine in his day.
He was right (and in that sense was a good doctor) – bleeding, poly-pharmacy, purging was no good and usually harmful – but instead of sticking to it and helping the profession of ‘medicine’ develop (as it has done), he invented his own system in rivalry, and needed a snappy marketing terms to distinguish the regular from the alternative.
The use of homeopathic remedies is not medicine, of any kind, as they do not have any effects on any ailment or pathological condition whatsoever.
(“Sugar pill, sugar pill, never cured and never will” – students chanted in Boston, MA in the 1870s.)
A consultation with a practitioner who claims to be a ‘homeopath’ might have effects on patients’ emotions, imaginations and psychological states due to response expectancies (a la hypnosis) and placebo effects (which I regard as pretty much the same).
Now, what can I come up with…? Chakras, meridians, vital forces, wu (Chinese for ‘nothingness’), unseen energies, divine intervention…?
What can I call my new money making scheme?
‘Scientology’, ‘Anthroposophy’, ‘Rosicrucianism’, Christian Science’, ‘Naturopathy’ have been taken.
I may have to stay with ‘Charlatanism’.
Best wishes, and may the Wu be with you all.
Dr Richard Rawlins
Consultant Charlatan
Specialist in the Care of the Gullible
How about;
‘Wallet Bariatrician’