Pretty ominous inference from this headline on NBC, re-tweeted by a doctor who also appears on Fox News. If people read no further into this, will it cause more or fewer people to evaluate all aspects of their cancer care options? If fewer, how is it beneficial to present headlines that don’t include the entire perspective?
I start with my personal bias. I believe complimentary/functional/dietary/non-standard care measures have their place and should be considered in cancer and many other chronic health conditions. I do NOT believe this is combined with an exclusion of standard care; in other words, it is NOT a binary choice.
Now, for the study referenced, I do not know their bias but the money sources cited in the Conflict of Interest Disclosures are medical systems, drug companies, and even a nationwide cancer clinic operation.
The bias of NBC for the headline, unknown.
The Fox News doctor? She works at a hospital so one would assume she wants patients to succeed in care and believes through her training that conventional treatment protocols are the best course. I think a relevant question for her is did she open the study before endorsing with her comment?
Ok, on to what the study claims to be investigating; comparing overall survival and adherence between patients with cancer receiving Conventional Cancer Treatment (CCT) and those who chose to utilize Complementary Medicine (CM). That is worth looking into, however, it is a very tall order with the data available and the lack of standardization on the CM side. Further exasperating this angle is the fact that the data of patients included a search from 2004 thru 2013. Much of the newer metabolic approaches to cancer were just starting to really get out into circulation say around 2011-12 with Thomas Seyfried’s work and book. Even still today, there isn’t a standard CM approach. Further, the study defines CM as “Other-Unproven: Cancer treatments administered by nonmedical personnel”. Again, with my bias toward an integrated care approach, I believe that to utilize any non-CCT approach it is best done in partnership with an educated practitioner.
I took a statistics class in college, but I would probably need to take a few years to parse apart all of the different data massaging techniques used in this study. They looked at almost 2 million patients in a database and found only 258 that met the definition of using CM and then selected just over one thousand CCM patients to compare against. After additional computations, the headline of the study was highlighted. Five-year survival was shown to be poorer (82% vs 86%) for those who used CM compared to those that followed CCM in a univariate analysis (one variable). No quality of living data but they lived longer at the 5-year mark. Case Closed?
The very next paragraph states after including treatment refusal and delay to start treatment there was no longer a significant difference in the risk of death. What? Is that not the OPPOSITE of what the headline infers?
Here is my read on this, assuming I understand all the statistical gymnastics.
One of the many challenges with this analysis is the simply trying to look backward and put everybody into groups and assuming all will proceed the same and as such will get similar results; it won’t. Treatment refusal is a perfect example. CCM includes all the common options, chemo, radiation, surgery, and hormone therapy. The most commonly refused treatment the CM group refused was chemo and radiation. Very few refused surgery. It is well known and documented that chemo and radiation can cause tremendous side effects. By avoiding these, quality of life likely is higher in some cases, and what is not highlighted in the headline is that including these refusals there is not a significant association with increased risk of death by choosing CM. This is worth repeating, CCT vs CM yielded the same results in these data sets. What might be a fantastic variable to add? How about the quality of life, which is the reason most refuse chemo.
CM cannot be interpreted as a singular treatment modality for the purpose of evaluating its effectiveness; there just isn’t any consistency on what that even means in practical terms. However, integrative approaches where evidence-based strategies are utilized in a coordinated manner with conventional options offer many advantages for patients. As I have seen personally, and others have seen throughout the world, the successes gained should not be broadsided carelessly by oversimplified headlines; especially by people who may or may not have a vested interest in seeing one side of the spectrum succeed. There is enough room for integrated partnerships in providing excellent patient-driven care with a diverse set of choices available, in which case the patients can define and chase their success. Manufactured fake-news headline-driven studies and their reporting in the media advance no patient benefit and quite possibly can discourage fair evaluations of expanded options available today that may advance health outcomes.
If Anita saw the tweet above, would that have made her more or less likely to evaluate her options? Hear her story here: