Treating cancer in an age of alternative therapies

With alternative cancer treatments blossoming around the world, oncologists caution patients to collaborate with their doctors before making radical decisions about their own treatment.

Oncologists in South Africa have suggested that patients should be wary of spending thousands per month on unproven alternative cancer remedies that are generally not recommended as a substitute for evidence-based and peer-reviewed treatments as used in modern medicine.

While some alternative therapies may provide symptomatic relief or comfort for patients, says Dr Ernst Marais of the Independent Clinical Oncology Network (ICON), it is important that patients make sure they have the right facts when it comes to deciding on any treatment be it evidence-based or not.

“In a time of information overload, it is not just patients who are faced with difficult choices. Clinicians are also bombarded with a multitude of often conflicting information – and it is an increasingly demanding challenge to stay ahead of the information curve in their field,” says Dr Marais.

“If it is sometimes challenging for clinicians to separate the wheat from the chaff, how much more challenging must it be for patients? It is here that the clinician’s role, as a guide, is critical.”

Cancer remains a serious illness with only around 40% survival rate, according to CANSA. Alternative remedies are increasingly popular in South Africa. CANSA adds that up to 30% of patients turn to alternative remedies. But where financial resources are limited, this can increase pressure on patients. The ICRF (Independent Cancer Research Foundation) in a list of the “strongest” alternative cancer treatments, notes that the least expensive costs around $200 per month, that’s an additional R2 700 each month for patients who may already be cash-strapped.

The desperation felt by many cancer patients – and the fear inspired by their diagnosis – can further open them up to exploitation in an industry that is not regulated as mainstream medicine is, points out Dr Marais. In extreme cases, the potential for harm is great. Australian blogger Belle Gibson, for example, made world headlines when she came clean for lying about being a cancer survivor. Gibson claimed to have beaten cancer using Ayurvedic medicine, oxygen therapy and a diet free of gluten and refined sugar. She launched a successful app and cookbook and gathered a worldwide following that followed her regime, but later admitted that she had fabricated the diagnosis.

This is not to say there is no place for alternative therapy if it brings comfort and relief to the patient, says Marais, but it is best done under medical supervision. Organisations such as the American Cancer Society and take a less strict stance on alternative therapy, saying that some complementary medicine can help improve the quality of life in cancer patients. They do not, however, endorse its use for primary medical treatment or diagnosis. Additionally, CANSA warns that some alternative remedies may interfere with existing treatments or carry a risk of toxicity to the patient, so it is essential for patients always to consult with their physicians before embarking on any treatment regime. Any cancer patient must ensure that their oncologist knows all the medications they are taking. Not only can interactions of medicines impede the therapeutic action of anti-cancer drugs but also increase the side-effects. This can lead to dangerous and, in some cases, fatal consequences.

According to a study published in Current Oncology, many patients who choose to go the alternate route indicate that they value ongoing follow-up care from their oncologists, provided that the oncologists respect their beliefs. The study notes that patients declining conventional treatments have a strong sense of internal control and prefer to make the final treatment decisions after considering the opinions of their doctors.

Few studies have looked at the response by physicians to patients making such a decision. Where research has been done, it found that a tendency by doctors to dichotomise patient decisions as rational or irrational may interfere with the ability of the doctors to respond with sensitivity and understanding.

The difficulty, oncologist James Salwitz has pointed out, is that increased access to information has driven a greater level of patient empowerment. “Once-upon-a-time, the doctor decided for patients… The movement toward individual patient empowerment has changed the tone and balance of the conversation. The doctor is no longer the final decision maker.” This means physicians must be more aware than ever of current treatment trends – both mainstream and alternative – so that they can advise patients in their best interests, believes Marais.

The increased vulnerability that often accompanies a cancer diagnosis can drive patients to make rash decisions, says CANSA’s Dr Carl Albrecht. “Patients seek greater assurance of therapeutic success and consequently turn to alternative medicines with or without conventional treatment.” The pitfalls, however, include a lack of peer-reviewed articles on laboratory and clinical aspects in reputable journals; a lack of solid scientific evidence; unproven modes of action; a lack of clinical trials (which presents ethical problems); often arbitrary dosage; no toxicity data for human use; and often at high cost, says Dr Albrecht.

“Doctors have to respect the wishes of their patients, but a key ethical concern is not to peddle false hope. Our patients deserve to know what their options truly are. In turn, patients need to respect their doctors and play open cards about their beliefs and the way they wish to be treated. With this approach, there is less chance of misunderstandings and unexpected outcomes,” concludes Dr Marais.

What seems to be crucial is good communication between patient and doctor. This needs to be respectful, honest and open from both sides to achieve the best outcome.