The reason that this blog came to be is the existence of cancer quackery, sometimes called alternative cancer treatments.
Many websites including this blog explain what is wrong with alternative cancer treatments and why they are dangerous and there are horrible examples of what happens to patients who chose to forgo conventional treatment and opt for some kind of alternative treatment instead. But the internet is littered with testimonials touting the successes of miraculous alternative cancer cures that are often claimed to be suppressed. Such testimonials can be very persuasive, especially if the reader/video viewer is afraid and not aware of what to look for, so it is no wonder that people get confused.
One type of reasoning we see is:
“you can always try the alternative treatment first, and if it doesn’t work you can then just have the conventional treatment” .
In this post we will show why that is a very dangerous idea.
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Success stories and horror stories are not that informative in the big picture as long as they are not backed up by reliable research. Therefore, systematic follow-up on patients who receive one or the other treatment and compare which group fares best, is much more informative and that is basically what is done in clinical trials.
Ideally we would want a randomised trial where an alternative cancer treatment was compared to conventional treatment. A randomised trial is one where neither the patient nor the doctor decide which patient get which treatment, for in this kind of trials the groups of patients who receive either treatment are as similar as possible, in order to generate reliable outcomes. However, in this case, such a trial is neither practical nor ethical: patients who despise/mistrust alternative therapy would not take part in such a trial and people who really don’t want conventional treatment should not be forced to have it because of a randomisation number.
Three studies that follow cancer patients who chose alternative cancer treatments only
Fortunately there are other ways of doing systematic follow-up. There are a few studies where the researchers tracked down all cancer patients they could identify who had chosen treat their cancer with alternative treatments only. They could then compare what actually happened to them to what could have been expected had they chosen to undergo conventional treatment.
We have been able to locate three such studies, published in 2006, 2011 and 2012 respectively.
2006: forgoing or delaying surgery or chemotherapy significantly increased progression and death
In 2006 this study was published and it has also been analysed by Orac. The researchers identified 47 patients who were diagnosed with breast cancer and chose alternative treatment instead of conventional treatment. The researchers were able to do a follow-up on 33 of them. What they found was that the risk of progression/death significantly increased – most notably in those who refused surgery, but also in those who refused additional radio-chemotherapy. Not in a single case did the cancer even shrink.
As Orac puts it in his analysis:
This study strongly suggests that forgoing or delaying surgery or chemotherapy is at the very least associated with a significantly decreased chance of recurrence-free survival. The authors do note that it is impossible to tell whether this increase in mortality was solely due to delay or refusal of effective therapy or whether the modalities chosen were deleterious. My guess is that it was almost certainly due to the ineffectiveness of the alternative therapies chosen.
2011: more patients, longer follow-up time, but results of alternative cancer treatments again dismal
This study from 2011 originates from the same institution as the 2006 study. The 2011 study includes more patients and longer follow-up time. The findings are similar to the previous study, but let’s have a look at some of the data in more detail.
In all they identified 61 patients with breast cancer who rejected conventional treatment upfront. Of these, 26 of these refused surgery, 35 had surgery but refused additional hormone, chemo- and/or radiotherapy.
Of the 26 patients who refused surgery, 25 had progression of their cancer, while 1 remained stable during the follow-up time. At the time of diagnosis the median tumour size was 2,0 cm. This means that half of the tumours were smaller and half of them were larger. At the time of follow-up, the median tumour size was 7,8 cm.
This photo is from the article. The patient had chosen diet and herbal therapies instead of surgery. At the time of diagnosis 11 months earlier, the size of this tumour was 2 cm. 
Based on various factors such as tumour size, hormone receptor status etc. it is possible to estimate survival. An online tool can be used, and was in fact used in the 2006 study as well as in this one.
For those who chose to completely forgo surgery, no less than 63,6% had died at median follow-up time of 33 months. Had they chosen standard treatment, an estimated 69,5% would have been alive after 10 years.
Things were a little bit better, but not good enough for those who delayed surgery. At median follow-up time of 58 months, 60% were alive. Had they chosen standard treatment, estimated 10-year survival rate was 73,6%.
As in the 2006 study, the impact of refusing additional radio-/chemotherapy was less pronounced. It was possible to follow-up on 29 patients who chose to forgo additional treatment. Of these, 25 experienced a recurrence. Only 4 patients did not experience a recurrence during follow-up.
2012: forgoing systemic therapy significantly increased risk of cancer recurrence
This study was published in a journal called Complementary Therapies in Medicine. It is a bit different from the above described studies. This study is part of a larger study called “WHEL”, where the researchers looked into the impact of diet on risk of breast cancer recurrence. From this larger study, the researchers identified 177 patients who didn’t receive systemic treatment (ie. chemotherapy and/or hormone treatment). It is not clear from the article how many of these patients had risk factors making systemic treatment adequate, but comparing the information presented in the WHEL study, we assume that the 177 patients were eligible to systemic therapy, but didn’t receive it. This also makes sense since they compare this group to a group in the WHEL population who did receive systemic treatment. The purpose of randomisation in a controlled trial is to make the groups of patients who are being compared are as similar as possible. This is also what is attempted in a study like this one. A careful mathching of the patients who had systemic therapy with the patients who refused in terms of various risk factors for recurrence or death, is a reasonable substitute for a randomised controlled trial. This is what was found in this study:
1) Those who didn’t receive systemic treatment had a 90% increased risk of recurrence compared to those who had systemic treatment.
2) Those who didn’t receive systemic treatment had a 70% increased risk of death compared to those who had systemic treatment.
3) Dietary supplements and/or other alternative treatments had no influence on these risks.
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Studies show that alternative cancer treatments do not work
So what can we learn from such studies? Despite the shortcomings, they are the best we´ve got. So the best available evidence from systematic follow-up of more than 200 patients tells us that the suggestion to “Try the alternative treatment first, and if it doesn’t work you can then just have the conventional treatment.”
really is the worst thing to do.
UPDATE – August 26 2012:
One more study has just been published. This one is from Canada, and the researchers identified 87 patients younger than 75 years who refused primary standard treatment (surgery with or without preoperative radio-/chemotherapy). Patients who refused additional (postoperative) treatments were not included in this study.
For each of the patients who refused treatment, 5 matching patients who had treatment were identified. The patients were matched by age , calendar year and clinical stage. The purpose of matching patients is to make sure that comparisons between the two groups is as fair as possible. For instance if the group of patients who refused treatment were at a more advanced stage, it is to be expected that this alone would result in poorer outcomes.
Then they reviewed the charts to identify reasons for the patients refusal of treatment. 50 of these patients were known to use alternative therapy instead. It is unclear what the remaining 37 patients did. Some of them may have had alternative therapy – we just have no way of knowing.
30 out of the 87 patients had surgery later on. This table shows what happened to the stages:
In 4 of the patients, the cancers had not progressed. They had so in the remaining 83 patients. Not in a single case did the cancer even shrink.
The researchers also looked into survival statistics.
Such a curve is a way of illustrating differences in survival among groups being compared. The higher the curve, the more survivors. This set of curves tells us that there is a big difference in survival among those who received standard treatment and those who didn’t. 5 years after the diagnosis was made, 18,1% of those who had standard treatment had died from their cancer. Of those who refused treatment 56,8% had died within 5 years. You may also have noticed the “p< 0,0001″ between the two curves. This is a way of telling how reliable this difference in survival is. Some lived longer than others in both groups, so there is always a possibility, that the difference could be the result of chance. The “p-value” is a way of saying how probable it would be for this difference to be a result of play of chance. The lower the p-value, the more likely it is that this difference is real. In medical research, a p-value less than 0,05 is widely accepted as evidence, that the result is reliable.
It would also be interesting to know if those who had alternative treatment fared better than those who just refused to have treatment:
It may be tempting to see this curve as some evidence that those who use “CAM” fare better than those who use “nothing”. But unknown does not equal “nothing”. As mentioned above, some of the patients in the unknown group may very well have had alternative therapy. Furthermore we have no idea of how the patients in the two groups match in terms of stage etc. And then there is the p-value again. p=0,14 means, that the observed differences may as well be a play of chance. There is no way, it can be claimed that this show survival benefits for those who had alternative therapy instead of “nothing”. And other way to put this is, that having alternative therapy for breast cancer is just as effective as doing nothing.
So the results of this study back up the results of the other studies we have mentioned.
The collective evidence is strong that “Alternative therapy instead of standard conventional treatment for breast cancer is a really bad idea”
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Psiram/Esowatch
Every study you post,have gov in the url.
I trust it to be authentic ,about as much as i think Pam andersons boobs are real.
The alleged pic of the cancer run wild,looks photoshopped.
If cancer were ever cured ,or made easily treatable,cheaply,all those oncologists and chemo and radiation techs,would no longer be able to fill their pockets,on other peoples misery .
You can try to keep debunking alternative treatments as some absolutely DO WORK ,but people know .
The photo is unfortunately not photoshopped. And neither are the photos shown in the bottom link in this post. The photo displayed in the post was an extreme case, but the median size of all of the cases increased from 2 cm to 7,8 cm, as we explained in the post.
As someone working in cancer research, and with family members who have been affected by cancer, I take offense to the common conspiracy theory that “the money is in treatment, not cure” – we all work hard at advancing new therapies (including cancer vaccines, and things like HPV vaccines, which would indeed “cure” the bulk of cervical cancer), and nothing is left on the table with regards to potential therapies. Indeed, there are researchers that look at alternative treatments, and find things like certain properties of curcumin (turmeric) that have anti-cancer properties. But they have to be studied in proper clinical trials in order for the true benefit of the treatment to be measured – you can’t just take someone’s advice, or anecdotal evidence (or just claim “but people know”), as evidence of the success of alternative treatments. I applaud this website’s attempt to fight against the quackery, and bring some honesty and rationality to the search for new treatments. Another blog post here: http://www.sciencebasedmedicine.org/index.php/the-hidden-cancer-cure/ also describes the fallacy of the “hidden cancer cure” and the mistaken notion of a simple cure – cancer is a complex collection of diseases, and is going to require a complex collection of treatment options to manage effectively. But don’t start claiming conspiracy theories, .gov links, and “suppression” of alternative treatments – its an insult to the people working hard on advancing research and clinical practice, and the patients taking place in clinical trials for these new treatments.
Assuming that you thereby state that you don’t believe in anything with with a gov in the url, you demonstrate a poor understanding of what pubmed is. It’s a database holding records (often including summaries) of published medical research. Also studies on alternative (to) medicine with positive results are found. It even holds records of articles with criticism of “Big Pharma”, which I am convinced you will find absolutely credible.
If such a treatment was available it would be in use. Every cured patient is a success for the patient as well as the treating oncologist. But cancer is a collective term for approximately 200 different diseases. Every cell type in your body can (in principle) develop into its own type of cancer. On top of that individual cancer cells in every cancer are also different from one another. On top of that, the cancer cells interact in very complex ways with the surrounding normal cells. So it is not all that surprising that we don’t have, and most likely won’t find a single cure for all cancers.
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Tamoxifen is quite cheap AND effective (in cases that are responsive to hormone treatment) I believe…. http://www.lancet.com/journals/lancet/article/PIIS0140-6736(11)60993-8/fulltext?_eventId=login Just a little nitpicking(?): a p value of .14 says there is about a 1 in 6 chance that the nulhypothesis would be rejected IF the nulhypothesis were in fact right. (saying ‘chance’ isn’t really true) An outcome with a very low p-value could álso have arisen by the unjust rejection of the nulhypothesis (which usually states there is no dfifference between treatment) and, more importantly a very low p-value doesn’t necessarily infer a great deal of info! In huge studies with thousands of participants it is quite easy to get to p<.0001 with an effect that is actually worthless. Nowadays way more emphasis is layed on the effectsize and the confidence intervals around it.
I’m not sure I understand the relevance of your reference to tamoxifen…
But that aside, as I understand it, the p value says something about the probability (ranging from zero to one) that the results observed in a study could have occurred by chance, and the p value is generally accepted as a statistically significant indicator for this (although I realise that the choice of significance level – usually less than 0.05 – remains arbitrary, but we’re talking probablilities here, not dead-certains).
What is being tried in scientific studies is not to prove something right, but to prove something wrong. The hypothesis we’re trying to prove wrong is the “null hypothesis”, and the lower the p-value, the lower the probability that the null hypothesis is correct. In this case the null hypothesis would be that there is no difference in survival time between breast cancer patients treated with conventional treatments and patients treated with alternative treatments.
The alternative hypothesis – the one that is actually being observed – would be something like: “is there a significant difference – not due to chance – in survival time between groups A and B, if group A receives conventional treatments and group B receives alternative treatments?”
If the p value is less than a significance level of 0.05 it means there is less than a 5% chance of the null hypothesis being right and therefore in most cases it will be rejected.
But do correct me if I’m wrong.
Jli tried to explain this in layman’s terms, which means that sometimes you cannot help but having to skip a few steps.
Thank you so much for this post!
When I was diagnosed with breast cancer myself a few years ago, I spent a lot of time both giving (I hope!) and receiving support from a huge online breast cancer patient forum (BCO). I know you used to post there too, speaking out against the woo there, as did I. As you know, “What have you got to lose by trying alt therapy” is practically a given there,
The woo there is very strong, as you know, and I’m so very disappointed that the mods there have chosen to not only ignore but encourage more quackery. It’s horrifying to go there and see them discussing things like breast cancer self diagnosis, treating with oleander and rife machines, and black salve, etc. Of course, anyone who dares to post factual corrections or even questions, is driven away, so your blog here is especially critical in getting the word out! I’ve always appreciated your blog and your anti-quackery efforts, but now even more so.
Thanks again,
Thenewme
@ Thenewme
I know I am not Beatis, but I am very glad that you find this post useful. There is a shortage of such studies in the medical literature. And consequently we felt that a post like this one is needed on the blogosphere.
Cancer woo unfortunately has a very strong foothold in some people. We can only try our best to show those who need it, why the woo is what it is.
@jli – thanks for all you do!
I had treat many patient with sequele of breast cancer that patients and/or family member refuse conventional treatment .
The breast cancer is disappointing disease
whether you treat or not treat you can survive for 2 or 3 years without any problems
the problems will show them up in the 3rd year and later , local recurrence , another breast , or distant metastasis
for 2 or 3 year that pass , that quack doctor had gone somewhere for long time.
and for someone that try to tell that the picture is photoshopped
I bet you never seen the real breast cancer patient, the real breast cancer patient who refused conventional therapy … most will end up in that state
In my practice (7years in GP 1year in Internal medicine) I had seen not less than 10 patient with that size of lesion.