Practice Update: Oncology

GENERAL ONCOLOGY 27

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.

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.

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.

References 1. Phallen J, Sausen M, Adleff V, et al. Direct detection of early-stage cancers using circulating tumor DNA. Sci Transl Med 2017;9(403): eaan2415. stm.sciencemag.org/content/9/403/eaan2415.short 2.Mandel P, Metais P. Les acides nucléiques du plasma sanguin chez l’homme. C R Seances Soc Biol Fil 1948;142(3-4):241-243. 3. Siravegna G, Marsoni S, Siena S, Bardelli A. Integrating liquid biopsies into the management of cancer. Nat Rev Clin Oncol 2017;14(9):531-548. www.nature.com/nrclinonc/journal/v14/n9/full/nrclinonc.2017.14.html 4. Leon SA, Shapiro B, Sklaroff DM, Yaros MJ. Free DNA in the Serum of Cancer Patients and the Effect of Therapy. Cancer Res 1977;37(3):646-650. cancerres.aacrjournals.org/content/37/3/646.long 5.Tie J, Wang Y, Tomasetti C, et al. Circulating tumor DNA analysis detects minimal residual disease and predicts recurrence in patients with stage II colon cancer. Sci Transl Med 2016;8(346):346ra92. stm.sciencemag. org/content/8/346/346ra92.short 6. Abbosh C, Birkbak NJ, Wilson GA, et al. Phylogenetic ctDNA analysis depicts early-stage lung cancer evolution. Nature 2017;545(7655): 446- 451. www.nature.com/nature/journal/v545/n7655/full/nature22364.html 7. Sausen M, Phallen J, Adleff V, et al. Clinical implications of genomic alterations in the tumour and circulation of pancreatic cancer patients. Nat Commun 2015;6:7686. www.nature.com/articles/ncomms8686

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VOL. 1 • NO. 3 • 2017