Potential Danger of Complementary Therapies

... And a Social Worker's Dilemma

I have often written about complementary and alternative medicine (CAM) therapies. Many cancer patients, many people in general, use one or another CAM treatment, and I have had many patients who felt that acupuncture, massage or meditation was extremely helpful to them as they went through cancer treatment.

The classic caveat is to always talk with your doctor about any of these treatments that interest you, and the classic response is the request that people receiving active cancer treatment (radiation or chemotherapy) abstain from anything that they ingest until the treatment has been concluded. This covers vitamins or supplements or special teas of anything that you swallow and that might negatively interact with the radiation or the chemotherapy drugs. It just seems common sense that, if you are going to accept standard cancer care, you would not choose to do anything that might make it less effective. Once the treatment is done, most doctors have no objections to complementary and alternative medicine therapies.

This post is stimulated by a recent article in the journal JAMA Oncology that found that some patients who chose CAM therapies instead of standard cancer care fared worse, with lower five-year survival rates than those who did not. Note that these were patients who opted out of chemo, radiation and sometimes surgery in favor of other kinds of "treatments." Patients who used both types did as well as their companions in cancer. These generally were people who were younger, well-educated and of higher socioeconomic status.

This study confirms what I have observed over the years, fortunately not too frequently. I suspect that most people who want no part of traditional Western medicine never come to BIDMC or other academic medical centers, and perhaps do not visit any conventional doctor. Sometimes they do come, have consultations, hear recommendations and then reject them, opting instead to treat themselves with special diets, lots of exercise, meditation or other modalities. When I have sat with patients who are planning this course, it has been very tricky to know what is best to say.

I want to be clear that complementary therapies can be offered in a responsible way. On the one hand, I have always, and will always, completely support an individual's right to choose what seems best for them. On the other hand, I know that they may be making a poor choice. Of course this gets more complicated because sometimes, especially if they have accepted surgery and are "only" rejecting radiation and/or chemotherapy, they may end up doing fine. We all know that some patients are over-treated and get drugs or rads that they really don't need. The problem is that we can't always distinguish who should be getting the treatments and who is likely to do well without them. We also all know people who have done everything that their doctors suggest and still eventually die of cancer. Given the stakes (e.g., living or dying), most of us want the treatments.

Should I just nod and validate what they are telling me? They tend to be people who have been healthy, who are skeptical of Western medicine in general and may have strong feelings about pharmaceutical companies, perhaps even believing that cancer cures actually are available, but that doctors and pharma are hiding them in favor of making money. (Important Note: This is not true!) They surely believe that they have control over their bodies, and that doing the right things, however they are defined, will keep them well. In some ways, this belief system is the obvious conclusion of our society's general appreciation of the high value of exercise, nutrition, low stress, etc., in keeping us young and strong.

Or should I metaphorically grab them by the collar and tell them they are making a mistake? Should I tell them a few stories about people I have known who refused conventional medicine and then re-appeared some time later--but, who, by then, had widespread disease that could no longer be cured. We get one chance to try to eradicate our cancers, and that one chance is almost always at the start. Thinking that we can always do treatment later, if the cancer returns, is a fallacy. A dangerous one.