Integrative Oncology Leaders’ Criticisms of JAMA Oncology Article on Complementary Medicine Association with Increased Risk of Death
November 10, 2018
In July 2018, Media Watch Cancer News listserv sent an article regarding a study published in JAMA Oncology. The article stated:
Patients with cancer using complementary medicine (CM) were more likely to decline potentially curative conventional cancer treatment, which in turn increased their risk for death, concludes a new study. The patients in this study, drawn from the National Cancer Database, had a variety of nonmetastatic cancers (breast, prostate, lung, or colorectal) and were receiving at least one type of conventional cancer treatment. Patients who chose CM did not delay initiating standard treatment but had higher rates of refusing subsequent modalities, such as surgery, chemotherapy, and radiation therapy.1
A similar review was published in Reuters: Cancer patients using alternative medicine may skip some standard care.
Several leaders in the field of integrative oncology have since written criticisms of this study. Main points from Moshe Frankel, MD, are included here, followed by links to other commentaries.
Dr. Frankel's Comments
Excerpts from Dr. Frankel's commentary.
Unfortunately the design of the study has a great number of problems, which makes this article extremely biased against the use of complementary medicine in cancer care.
The use of anticancer treatments administered exclusively by non-medical personnel is extremely rare, as supported by this study (only 0.012 percent, 258 patients from a database with close to 2 million patients, compared to 40 to 80 percent of cancer patients that use CIM).
A few points that I would like to emphasize:
The selection criteria: Authors mention that they chose patients whose healthcare teams documented use of alternative medicine as an anticancer treatment administered by non-medical personnel. This use is the extreme use of complementary medicine. As a matter of fact, this use is considered alternative treatment which actually is not complementary. Today, the term that is used is CIM—complementary and integrative medicine—referring to treatments that are integrated with conventional treatments, trying to get the best of both worlds. The use of anticancer treatments administered exclusively by non-medical personnel is extremely rare, as supported by this study (only 0.012 percent, 258 patients from a database with close to 2 million patients, compared to 40 to 80 percent of cancer patients that use CIM). Taking this extremely limited group of patients and generalizing about the use of CIM in cancer care is quite biased.
The group of patients electing to stop all conventional treatments and utilize non-medical practitioners tend to use extreme practices that at times are toxic, such as vitamin B17, high doses of beta carotene supplements, or colloidal silver. You cannot compare these practices to acupuncture, meditation, yoga, massage therapy and others, which we have accumulated scientific data supporting their use in enhancing quality of life.
The authors should have compared this small group to another group of patients, such as patients that refused conventional treatments but either use CIM treatments with the supervision of a physician or do not use any treatments. Patients who refuse treatment but do not choose extreme practices fly under the radar of recognition in the oncology field.
The use of CIM methods such as acupuncture, meditation, herbs, and dietary supplements in addition to conventional cancer treatment is becoming increasingly popular and a visible component of oncology care.
We should be aware of the high distress involved with dealing with cancer among patients and their families combined with a high rate of unmet needs that these patients experience. The use of CIM methods such as acupuncture, meditation, herbs, and dietary supplements in addition to conventional cancer treatment is becoming increasingly popular and a visible component of oncology care.
The bottom-line question is the use of CIM's effect on survival. Refer to my article on this specific issue: Effects of complementary and integrative medicine on cancer survivorship.
The bottom-line suggestion to patients and families: Do not go to the extreme practices that are managed by non-medical personnel. Instead, utilize CIM in cancer care in an educated way with the direction of an open-minded physician whom you trust. It can affect quality of life and survivorship.
Do not go to the extreme practices that are managed by non-medical personnel. Instead,utilize CIM in cancer care in an educated way with the direction of an open-minded physician that you trust.
Integrative oncology has emerged as a scientific discipline geared to address this increased interest. Integrative oncology as defined in a recent document is a patient-centered, evidence-informed field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. Integrative oncology aims to optimize health, quality of life, and clinical outcomes across the cancer care continuum and to empower people to prevent cancer and become active participants before, during, and beyond cancer treatment.2
- Lynda Balneaves' reaction as SIO president: Interview: SIO President Lynda Balneaves on the JAMA Oncology paper linking complementary care with early death
- Glenn Sabin blog response: Does ‘complementary medicine’ in cancer care cause early death?
- Additional responses from John Weeks including his interview with the authors of this manuscript: