By Lisa Rapaport

(Reuters Health) – Cancer patients who use alternative, non-medical therapies may be more likely to forgo recommended medical treatments like chemotherapy and radiation, and be more likely to die as a result, a U.S. study suggests.

Researchers examined data on 258 patients treated for early-stage breast, prostate, lung or colorectal malignancies between 2004 and 2013 who used at least one form of so-called alternative or complementary medicine – which can include things like herbs, vitamins, specialized diets, and other types of treatments not proven to have a therapeutic effect. They also looked at a comparison group of 1,032 patients with similar cancers who didn’t use alternative medicine.

At first glance, patients who used alternative medicine were roughly twice as likely to die during the study as people who didn’t. But once researchers factored in delays or refusals of conventional treatment, there was no longer a meaningful difference in survival – which suggests that treatment refusals and delays account for most of the higher mortality in the alternative therapy users, the authors write in JAMA Oncology.

“Cancer and cancer treatment may be scary, but patients need to undergo recommended medical treatment if they are to have the best chance at surviving,” said senior study author Dr. James Yu of Yale School of Medicine in New Haven, Connecticut.

“Complementary medicine may play a role in that if it helps them undergo recommended medical treatment, but it can lead to worse outcomes if it is used as an excuse to forgo curative treatment,” Yu said by email.

In the study, researchers examined a small fraction of the 1.9 million patients included in the National Cancer Database with certain common tumors that hadn’t spread to other parts of the body. Researchers defined complementary or alternative treatments as any “other unproven cancer treatments administered by non-medical personnel.”

Their definition did not include the kinds of complementary treatments such as relaxation training that are often offered by cancer centers along with standard medical care. In this context, complementary or “integrative” medicine can make it easier for some patients to physically and mentally tolerate treatments like chemotherapy, radiation and surgery.

“When I practice integrative medicine, I work with patients to choose therapies such as meditation for depression, acupuncture for nausea and yoga for sleep,” said Dr. Jun Mao, chief of the integrative medicine service at Memorial Sloan Kettering Cancer Center in New York City.

“I also spend a lot of time with patients to motivate them to stay physically active, choose a healthy diet, and improve sleep,” Mao, who wasn’t involved in the study, said by email.

Among patients using alternative medicine in the study, 7 percent refused surgery, 34 percent refused chemotherapy and 53 percent refused radiation.

In the comparison group of patients who didn’t use alternative medicine, 0.1 percent refused surgery, 3.2 percent refused chemotherapy and 2.8 percent refused radiation.

Five years after diagnosis, about 82 percent of patients who used complementary medicine were still alive compared with almost 87 percent of other people in the study.

It’s extremely rare, however, for cancer patients to refuse standard treatment altogether or seek care from nonmedical providers, said Dr. Moshe Frenkel, founder of the Integrative Oncology Clinic at MD Anderson Cancer Center in Houston, Texas.

“The group of patients that elect to stop all conventional treatments and utilize non-medical practitioners, tend to use extreme practices that at times are toxic, such as vitamin B17, high doses of beta carotene supplements and colloidal silver to name a few,” Frenkel, who wasn’t involved in the study, said by email. These practices may make cancer worse, he said.

“You cannot compare these practices to acupuncture, meditation, yoga, massage therapy and others for which we already have accumulated scientific data that support the use in enhancing patients’ quality of life,” Frenkel added.

Among the study’s limitations is a lack of information about the types or total number of alternative treatments patients used, the authors note. It’s also possible that doctors were more likely to note the use of alternative therapies in a patient’s record if it resulted in refusal of standard care, they write.

Most patients using complementary treatments as part of integrated cancer care should be reassured by the study findings, said Dr. David Spiegel of Stanford University School of Medicine in California.

“When there are risks of integrative care, they come not from the integrative treatments, but from using them as an alternative rather than a complement to traditional oncological care,” Spiegel, who wasn’t involved in the study, said by email.

SOURCE: JAMA Oncology, online July 19, 2018.