A large study published in the Journal of the National Cancer Institute found that patients with nonmetastatic breast, lung, or colorectal cancer who chose to use only alternative medicine had substantially worse survival than patients who received conventional cancer treatment.

The researchers looked at patients whose data were recorded in the National Cancer Database. Of the 1.68 million patients whose initial treatment for nonmetastatic breast, prostate, colorectal, or lung cancer was recorded in the system between 2004 and 2013, a total of 281 used one or more alternative therapies instead of conventional treatment.

They found that, after a median of five years, patients with breast or colorectal cancer had nearly a fivefold higher risk of death if they used an alternative therapy as their initial treatment than if they had received conventional treatment. Patients with nonmetastatic lung cancer had a twofold higher risk of death, but patients with nonmetastatic prostate cancer did not have reduced survival. The researchers noted that the finding in prostate cancer reinforces the understanding that many men with early-stage prostate cancer can live a long time with only active surveillance instead of immediate treatment.

Alternative Therapies

The study defined alternative therapies as any “unproven therapies from a nonmedical provider.” These were interventions used as an alternative therapy instead of conventional treatment, not as complementary therapy in addition to conventional treatment. The database did not collect the specific therapies used, but the authors explained that they may have included herbs, botanicals, vitamins, minerals, traditional Chinese medicine, homeopathy, acupuncture, diets, mind-body techniques, or even IV infusions.

Overall, patients who chose alternative therapies were more likely to be younger, female, and healthier and have higher incomes and education levels. The researchers noted that traits such as overall better health would normally improve the odds of survival with conventional treatment, but instead, the patients increased their risk of death by choosing alternative treatments.

Limitations

The researchers noted several limitations with their study. First, the study looked just at patients who used only alternative treatments, not patients who used complementary medicine alongside conventional cancer treatments, which the researchers said was a more common occurrence.

Second, the researchers could not tell if patients went on to use conventional treatments after they initially used only alternative treatments, because the database only recorded initial treatment approaches.

Finally, no patients with metastatic disease were included, where treatments are usually palliative instead of curative. All patients had early-stage disease that usually has a good chance for cure with conventional therapies.

How Oncology Nurses Can Talk to Patients About Alternative Treatments

Patients with early-stage disease may feel as though they have time to try alternative approaches before conventional treatment, the researchers hypothesized, but the study shows that that choice may affect their risk of death. They emphasized the importance of an open dialogue between patients and providers about unconventional approaches to treatment and that patients should never feel judged or have their questions and concerns dismissed.

Many times, patients are concerned about the side effects of conventional treatments. As the primary point of care for patients with cancer, oncology nurses are in a key position to have these conversations, address the concerns, and discuss the myriad approaches nurses use to manage side effects of cancer and its treatment.

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