Does use of alternative medicine predict survival from cancer?

doi:10.1016/S0959-8049(02)00701-3

European Journal of Cancer

Volume 39, Issue 3, February 2003, Pages 372-377

https://doi.org/10.1016/S0959-8049(02)00701-3 Get rights and content

Abstract

This study examines the association between alternative medicines (AM) and cancer survival. A national multicentre study was carried out in Norway in December 1992 to assess the prevalence of AM use among cancer patients. One of the aims of this study was to assess the association between AM and long-time survival. In January 2001, survival data were obtained with a follow-up of 8 years for 515 cancer patients. A total of 112 (22%) assessable patients used AM. During the follow-up period, 350 patients died. Death rates were higher in AM users (79%) than in those who did not use AM (65%). In a Cox regression model adjusted for demographic, disease and treatment factors, the hazard ratio of death for any use of AM compared with no use was 1.30, (95% Confidence Interval (CI) 0.99, 1.70; P=0.056), suggesting that AM use may predict a shorter survival. Sensitivity analyses strengthened the negative association between AM use and survival. AM use had the most detrimental effect in patients with an ECOG (Eastern Cooperative Oncology Group) performance status (PS) of 0 (hazard ratio for use=2.32, 95% CI, 1.44, 3.74, P=0.001), when compared with an ECOG PS of 1 or higher. The use of AM seems to predict a shorter survival from cancer. The effect appears predominantly in patients with a good PS.

Introduction

It is not fully understood why cancer patients use alternative medicines (AM). The inability to cure all cancers, the patient's need for autonomy and active participation, and preferences for “natural” or “holistic” therapy have been suggested as contributing factors 1, 2, 3, 4. It may also be that patients turn to unproven approaches in an attempt to regain control over their health, and avoid helplessness and depression, when given a poor prognosis 5, 6. In addition, there are indications that individuals who seek AM therapies experience higher levels of anxiety than their counterparts 7, 8, 9. Support for this was found in two recent prospective studies of patients with newly diagnosed early-stage breast cancer 9, 10. However, another recent study [11] among patients with a variety of cancer diagnoses did not verify an association between AM use and patients' perceived distress. These authors found that AM use appeared to be a coping strategy in response to patients' hopelessness and despair.

The relationship between patients' use of AM and survival has rarely been studied. A longitudinal study attempting to measure the pattern of AM use and its impact on survival in a heterogenous cancer patient cohort from Northern Norway was reported in 1998 [12]. No overall survival differences between the groups were found, although there was a tendency towards better survival among non-users at 4 months of follow-up. However, this difference could be explained by the more extensive disease found among the AM users.

The aim of the present study was to determine the use of AM in Norwegian cancer patients and to assess any association between AM use and long-time survival. Our hypothesis was that AM use does not have any effect on the survival of cancer patients.

Section snippets

Project and patients

The Norwegian Board of Health initiated the basic data collection. Data were obtained from all five regional cancer centres in Norway in December 1992. Cancer patients were asked to complete a questionnaire concerning demographic factors, quality of life and use of AM. The participating physicians at each centre reported the medical characteristics and intention of care for all participants. A questionnaire was developed at the University of Tromsø, Norway. It was designed by a consensus of

Results

Demographic and disease-related factors are described in Table 1, which also compares differences between users of AM and non-users. Use of AM was more common among patients with symptoms related to their cancer, those receiving only palliative treatment, patients with metastatic disease and among those diagnosed with cancer more than three months previously.

The distributions of diagnoses among patients in this study compared with the distribution of diagnoses in the total national cancer

Discussion

Virtually all studies conducted on cancer patients or healthy individuals show that those who seek AM therapies tend to be female, better educated, of higher socio-economic status and younger than those who do not. These individuals also tend to be more health conscious and to utilise more mainstream medical services. Among cancer patients, most users appear to have non-curative malignant disease and are receiving palliative treatment. It is likely that one of the most important reasons for

Acknowledgements

We thank Olav Dahl, Ole Kristian Andersen, Ole Nome and Stein Sundstrøm for assistance in collecting the data. This study was initiated by the Norwegian Board of Health and supported by a grant from the Norwegian Cancer Society and by The Research Council of Norway.

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View full text

Does use of alternative medicine predict survival from cancer?

Abstract

Introduction

Section snippets

Project and patients

Results

Discussion

Acknowledgements

Ann. Oncol.

Eur. J. Cancer

Compr. Psychiatry.

Eur. J. Cancer

Eur. J. Cancer

Why patients use alternative medicineresults of a national study

JAMA

The whys of cancer quackery

Cancer

Alternative and complementary cancer therapies

Cancer

Alternative treatments in cancer; extent and background of utilization

Ned Tijdschr Geneeskd

Pursuit and practice of complementary therapies by cancer patients receiving conventional treatment

BMJ.