Practice Update: Oncology

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Use of AlternativeMedicine
for Cancer AssociatedWith
IncreasedMortality
Journal of the National Cancer Institute
Take-home message
• The authors followed 281 patients with nonmetastatic breast,
prostate, lung, or colorectal cancer who did not receive
conventional cancer therapy but chose alternative medicine
as their sole anticancer treatment. Factors associated with an
increased chance of choosing alternative medicine included
having breast or lung cancer, higher socioeconomic status,
Intermountain West or Pacific location, disease stage II or III,
and low comorbidity score. Compared with patients treated
conventionally, alternative medical treatment was associated
with an overall increased risk of mortality.
• The use of alternative medicine as the sole treatment for
potentially curable cancer is associated with a higher risk
of death.
Abstract
There is limited available information on patterns of utilization and efficacy
of alternative medicine (AM) for patients with cancer. We identified 281
patients with nonmetastatic breast, prostate, lung, or colorectal cancer who
chose AM, administered as sole anticancer treatment among patients who
did not receive conventional cancer treatment (CCT), defined as chemo-
therapy, radiotherapy, surgery, and/or hormone therapy. Independent
covariates on multivariable logistic regression associated with increased
likelihood of AM use included breast or lung cancer, higher socioeco-
nomic status, Intermountain West or Pacific location, stage II or III disease,
and low comorbidity score. Following 2:1 matching (CCT = 560 patients
and AM=280 patients) on Cox proportional hazards regression, AM use
was independently associated with greater risk of death compared with
CCT overall (hazard ratio [HR] = 2.50, 95% confidence interval [CI] = 1.88
to 3.27) and in subgroups with breast (HR=5.68, 95% CI =3.22 to 10.04),
lung (HR=2.17, 95% CI = 1.42 to 3.32), and colorectal cancer (HR=4.57, 95%
CI = 1.66 to 12.61). Although rare, AM utilization for curable cancer without
any CCT is associated with greater risk of death.
Use of alternative medicine for cancer and its impact on survival. J Natl
Cancer Inst 2018 Jan 01;110(1)djx145, SB Johnson, HS Park, CP Gross, JB Yu.
decisions. To increase the clinical utility of the reported panel,
additional genes could improve the detection rate of ear-
ly-stage cancers. Expanding the gene panel may better guide
the follow-up testing necessary to identify the primary site of
disease. Future clinical trials incorporating ctDNA could stratify
treatment decisions based on ctDNA levels, and long-term fol-
low-up would prospectively evaluate ctDNA levels as a marker
of recurrence.
This study has expanded the potential applications for ctDNA
testing and the hope for improved detection of early-stage
cancers.
Dr Schenk is Hematology/Oncology Fellow,
Clinician-Investigator Training Program, Mayo
School of Graduate Education.
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GENERAL ONCOLOGY 27
VOL. 1 • NO. 3 • 2017