The raw data are stark. 40% of US adults in a recent poll believe that “cancer can be solely cured through alternative remedies.” Of young people aged 18-35, the percentage pushes up to nearly half, at 47%. Remarkably, 38% of family members and other caregivers to people with cancer agree. And 22% of cancer survivors do. These beliefs – a shocking contrast to a 2017 study that found that choosing alternatives increases risk of death 2.5 times – are a central reason that the cancer establishment needs integrative and naturopathic oncologists.
The Harris poll was sponsored by the cancer powerhouse, the American Society for Clinical Oncology (ASCO). Results came from responses of 4,887 adults. ASCO’s chief medical officer Richard L. Schilsky, MD, FACP, FASCO spoke to the startling findings:
“The vast majority of alternative therapies either haven’t been rigorously studied or haven’t been found to benefit patients. When patients are making critical decisions about which cancer treatments to undergo, it is always best to follow the evidence from well-designed research studies.”
The article noted above in the 2017 Journal of the National Cancer Institute (JNCI) from Yale researchers Johnson and Yu shows how perilous such beliefs can be. I sadly reflect on one friend who delayed treatment for months and on another who believed she could heal through her own robust health and natural methods. Both succumbed when timely conventional treatment would very likely have saved them.
That cautionary N of 2 speaks to the lack of solid evidence that alternative treatment X for diagnosed cancer Y will routinely be successful in extending life. By this I mean in the way that following the National Comprehensive Cancer Network (NCCN) guidelines of 33 radiation treatments with a little help from 3 doses of Cisplatin burned an early stage cancer off my tonsil in 2009.
Despite evidence of success for many conventional services, a high level of belief in alternatives remains. Some, as noted below, find in these results evidence of deep distrust toward the medical industry. Yet the stark findings are of concern. The media, reasonably, trumpeted them:
Notably, the integrative oncology community has no problem with Johnson and Yu’s 2017 outcomes that found “alternative medicine utilization for curable cancer without any conventional cancer treatment is associated with greater risk of death.” Here for instance is the Oncology Association of Naturopathic Physicians (OncANP) commenting on whether patients with cancer who refuse or delay proven, standard-of-care cancer treatments have a worse overall prognosis and survival:
“This statement actually reinforces the philosophy and benefits of integrative oncology and ultimately the naturopathic approach to cancer care espoused by the Oncology Association of Naturopathic Physicians (OncANP).”
So why are the beliefs in cancer alternatives so prevalent? Are bodacious claims on the internet to blame? Or is it enough to note that in 2017, 51% of Republicans still believed the “birther” claim that Obama was born in Kenya? Or is it the Mansonesque helter-skeltering of truth and fiction in the era of a president who makes 7.9 false claims a day? Responding to a question in a news account on how so many citizens have been separated from reality on the curative value of alternatives in cancer treatment, John Wayne Cancer Institute oncology specialist Jose Carillo, MD opined:
“If I had to speculate, I think that there may be a skepticism of medicine and pharmaceutical industries that play a role in increasing [people’s] willingness to look at alternative therapies in spite of a lack of scientific data.”
Carillo’s perspective was affirmed by Ted Gansler, MD strategic director of pathology research at the American Cancer Society. And why wouldn’t a reasonable person be wary of such a cancer establishment? While it is nominally health care, the cancer business behaves with an industry’s drive for volume. Despite the billions involved and high incomes of principals, it typically invests poorly if at all in the low cost integrative approaches that can limit the harm of often brutal adverse effects of their useful therapies.
If this skepticism is deep, then mightn’t the cancer establishment hasten its uptake of integrative oncologists to build bridges to the skeptical consumers? Integrative practitioners are the experts who can make the distinctions for patients that ACS’s Gansler did:
“It’s very important to distinguish alternative therapies (used instead of conventional treatment with the intent of treating cancer) from complementary or integrative therapies (used together with conventional treatment with the intent of relieving cancer symptoms or side effects of conventional treatment).”
In fact, integrative oncologists tend to be conservative guides toward conventional treatment. Witness this additional statement from the naturopathic doctors with specialty training in cancer treatment at OncANP:
“There are some patients who acquire a strongly-held belief that a ‘non-toxic’ or ‘natural’ approach to treating cancer is superior to conventional approaches presented by their oncologist. To the ND providing integrative cancer care, when these patients come seeking help, there is an opportunity to educate and redirect the patient toward making a fully informed choice, inclusive of conventional therapies.”
This evidence-informed guidance of patients toward conventional treatment has two inescapably valuable features for conventional oncology. First, the integrative practitioners provide a life-saving service by driving patients toward the conventional oncologist’s harsh but necessary treatment. Second, by counseling alternative medicine believers toward more conservative, evidence-based choices, naturopathic and integrative oncologists drive business to regular oncologists. What is there to not like about this scenario?
Via email, I contacted ASCO’s Schilsky with a query about whether he believed that “a better embrace of integrative oncology by the dominant oncology community might be a useful step toward bridging the gap between oncology and public beliefs.” Schilsky’s reply supported evidence-based integrative oncology, in principle – as the organization has with its endorsement of the integrative breast cancer guidelines developed by the Society for Integrative Oncology. But he made no comment on my suggestion that affirmative engagement with the integrative oncology community might be a useful strategy in combating the potentially dangerous ignorance in a high percent of the community. He responded:
“Any treatment provided to cancer patients should be grounded in evidence derived from well-designed research studies. If there’s solid evidence indicating that a complementary therapy provides a benefit, oncologists should discuss the research with their patients.”
This openness is good, if passive. Given the public health-level of concern suggested by the ASCO survey findings, better framing might be: If there is solid evidence that the public does not trust the cancer establishment, perhaps oncologists should actively engage the optimal future for cancer care in partnership with their integrative oncology colleagues.