A recent study of cancer patients provides yet another addition to my list of examples of how complementary and alternative medicine (CAM) can do harm.
Yun YH, Lee MK, Park SM, Kim YA, Lee WJ, Lee KS, Choi JS, Jung KH, Do YR, Kim SY, Heo DS, Kim HT, Park SR. Effect of complementary and alternative medicine on the survival and health-related quality of life among terminally ill cancer patients: a prospective cohort study.Ann Oncol. 2012 Oct 30. [Epub ahead of print]
This study was a prospective cohort study which followed 481 terminally ill cancer patients in Korea. The authors compared the use of any alternative therapy with the use of no such therapies, so obviously the study does not evaluate the effectiveness of individual treatments. Its purpose was to see if overall the use of CAM had a measurable effect of survival or quality of life for cancer patients. The essential findings were these:
- There was no overall difference in survival between patients who used CAM and patients who didn’t.
- Overall, CAM users exhibited poorer cognitive function and more fatigue than non-users.
- A series of subgroup analyses (always to be viewed skeptically) identified a number of poorer quality of life scores among CAM users and a poorer survival among those who used prayer as a healing intervention.
This is certainly not the definitive word on CAM in general, nor a clear disproof of the value of any particular CAM practice. What it is, is a sound rebuttal to the unsubstantiated claims that CAM use improves the survival or well-being of cancer patients. It also provides yet another stone in the avalanche of evidence that the blithe assumption that even if CAM doesn’t help it can’t hurt. Previous studies of both general CAM use and specific CAM practices, have found not only no benefit but a significant decrease in the survival and the quality of life of cancer patients using CAM.
All therapies need to be rigorously evaluated scientifically, beginning with the establishment of a plausible theoretical principle, progressing to proof of concept in animal model and in vitro studies and, if this information warrants it, ultimately being subjected to clinical trial evaluation to prove real safety and efficacy. The assumption of either efficacy or safety based on tradition, intuition, theoretical reasoning, or low-level preclinical evidence not only wastes resources on useless therapies but harms patients.
Kurian Joseph, Sebastian Vrouwe, Anmmd Kamruzzaman, Ali Balbaid, David Fenton, Richard Berendt, Edward Yu and Patricia Tai. Outcome analysis of breast cancer patients who declined evidence-based treatment.World Journal of Surgical Oncology 2012, 10:118.
Lim A, Cranswick N, South M. Adverse events associated with the use of complementary and alternative medicine in children. Arch Dis Child. 2010 Dec 22. [Epub ahead of print]
Chang EY, Glissmeyer M, Tonnes S, Hudson T, Johnson N. Outcomes of breast cancer in patients who use alternative therapies as primary treatment.Am J Surg. 2006 Oct;192(4):471-3.
Bostrom, H. Rostrom, S. Quality of alternative medicine–complications and avoidable deaths.
Han E, Johnson N, Delamelena T, Glissmeyer M, Steinbock K. Alternative therapy used as primary treatment for breast cancer negatively impacts outcomes. Ann Surg Oncol 2011;Jan 12 [Epub ahead of print