The Danger of Complementary and Alternative Medicine

Researchers at Yale did two database analyses. They looked at the National Cancer Database and found 1,901,805 patients who were treated for either nonmetastatic prostate, breast, lung or colorectal cancer between 2004 and 2013. In one analysis they looked at use of complementary medicine; in the other, they looked at use of alternative medicine.

Complementary medicine was defined as use of “other-unproven: cancer treatments administered by nonmedical personnel” in addition to at least one conventional cancer treatment modality, defined as surgery, radiotherapy, chemotherapy, and/or hormone therapy. 258 patients who chose a complementary therapy were matched to 1032 patients who did not use any complementary medicine on age, clinical group stage, Charlson-Deyo comorbidity score (CDCS), insurance type, race/ethnicity, year of diagnosis, and cancer type using the propensity score matching technique.

After 5 years of follow-up, comparing users of complementary medicine to matched non-users:

• There was no difference in delay of treatment, but there was a greater probability of refusal of surgery (7% vs 0.1%), chemo (34% vs 3%), radiotherapy (53% vs 2%), and hormone therapy (34% vs 3%).
• 82% survived for 5 years vs 87% among non-users, and were 2.1 times more likely to die after adjustment.
• The differences in survival were attributable to refusal of conventional treatment.
• Differences in 5-year survival were significant for breast cancer (85% vs 90%), and colorectal cancer  (82% vs 84%), but not for lung cancer  or prostate cancer. 

Alternative medicine was defined as “other-unproven: cancer treatments administered by nonmedical personnel” and who also did not receive conventional cancer therapy, defined as chemotherapy, radiotherapy, surgery, and/or hormone therapy. 281 patients who used alternative medicine were matched to 560 patients with similar characteristics (cancer type, age, clinical group stage, CDCS, insurance type, race, and year of diagnosis) who did not use alternative therapies using propensity score matching.

After 66 months median follow-up, comparing users of alternative medicine to matched non-users:

• 55% survived for 5 years vs 78% among non-users, and were 2.5 times more likely to die after adjustment.
• Differences in 5-year survival were significant for breast cancer (58% vs 87%), lung cancer (20% vs 41%), colorectal cancer  (33% vs 88%), but not prostate cancer  (86% vs 95%)
• The survival curves for prostate cancer had just begun to diverge at 5 years (75% were low or intermediate risk).

Complementary and alternative medicines consisted of herbs and botanicals, vitamins and minerals, probiotics, Ayurvedic medicine, traditional Chinese medicine, homeopathy and naturopathy, deep breathing, yoga, Tai Chi, Qi Gong, acupuncture, chiropractic or osteopathic manipulation, meditation, massage, prayer, special diets, progressive relaxation, and/or guided imagery.

Although these observational studies did not follow prostate cancer patients long enough to detect differences in survival, we see the damage that use of both complementary and alternative medicines had on patients with more virulent cancers. Patients who get complementary medicine are more likely to refuse conventional treatments (even though they received at least one conventional treatment) and are about twice as likely to die because of that decision.

(update 5/2019) The CAPSURE database shows that the use of complementary and alternative medicines among men with prostate cancer is increasing. Comparing the period of 2006-2010 to 2011-2016. They report that:

• Use of complementary medicines increase +128% (from 24% to 54%)
• Vitamin D use has more than doubled in spite of Level 1 evidence that supplementing confers no benefit.
• Happily, Vitamin E use has decreased based on Level 1 evidence from the SELECT trial.
• Almost a quarter of men with prostate cancer take omega-3 fatty acids. A secondary analysis of omega-3 use in the SELECT trial, confirming an earlier study, found an association between high omega-3 fatty acid serum levels and increased risk of prostate cancer. Level 1 evidence showed no association with prostate cancer incidence or prostate cancer death.

note: Level 1 evidence means that a cause/effect relationship was proven by a large randomized clinical trial (RCT). Interested readers may consult the Oxford definition, which is widely accepted. Many patients rely on mouse and lab studies which are almost always disproven when tried in clinical trials. They constitute the lowest quality of evidence (Level 5), and should only be used for hypothesis generation for clinical trials or to demonstrate plausibility for a cause/effect relationship found in an RCT. Additionally, the Bradford Hill checklist is used.