Vital Signs Blog

Blog: Patients using alternative treatments more likely to delay chemo

Not all women initiate recommended breast cancer treatment despite the survival benefits. A study published Thursday suggests the delays in starting treatment might, in part, be related to whether or not the women use complementary and alternative medicines.

The more alternative therapies a woman reported using when first diagnosed with breast cancer, the less likely she was to start chemotherapy at the time it was clinically recommended, the study published in JAMA Oncology finds.

Of 685 women with breast cancer that had not spread to other parts of the body, most in the survey said they engaged in some form of complementary therapy, like taking vitamins and herbs or doing yoga.

While 88% of women who did not begin chemotherapy when it was indicated said they used a form of alternative treatment, only 62% of women who started chemo on time said they used one.

Previous studies have shown that delaying chemotherapy for breast cancer significantly increases the odds of premature death and metastasis. Other research finds delays in treatment are generally longer for poor women, for those with non-private insurance and for Black and Hispanic patients.

Researchers thought women with early-stage breast cancer who sought out complementary and alternative treatments would still be more likely to start chemotherapy since they could do so on a discretionary basis. “We did not find that this was true,” said researchers in the study published online Thursday. “Instead, in the group with a clear clinical indication for chemotherapy, users of CAM were significantly overrepresented.”

The multi-site study recruited women from Columbia University Medical Center, Kaiser Permanente Northern California and the Henry Ford Health System between May 2006 and July 2010. The women were surveyed about their use of complementary and alternative medicine (or CAM) at the beginning, and were followed for up to 12 months.

The researchers noted several limitations. For one, participants could have been long-time users of the alternative treatments they listed. Their histories were not tracked in the study. And overall, most women in the study did initiate chemotherapy on time. “Non-initiation was a rare event, in a relatively small population of women,” the researchers said.

Clinical practice guidelines issued in 2014 in the Journal of the National Cancer Institute looked at a list of alternative therapies and graded their effectiveness. Yoga and mindfulness-based stress reduction got the highest grade of A because those practices curbed depression and mood issues associated with a breast cancer diagnosis. Many others, however, got a C grade or lower, meaning the net benefits are small or nonexistent.

In commentary accompanying the JAMA Oncology study, one author notes that patients may turn to such alternatives, especially in the beginning, because they need to cope with the sense of lost control.

Decision-making for patients with cancer “occurs as a complex, nonlinear, dynamic process of information-seeking and evaluation,” wrote Robert Zachariae, from the department of psycho-oncology and health psychology at the Aarhus University Hospital in Denmark.

Indeed the cost of treatment may also add to the decision-making complexity. The median cost of chemo- and radiation therapy increased substantially, leading to a near doubling of overall cancer-related costs since the early 1990s, according to a 2014 Health Affairs study.

It's difficult to know how much treatment will cost, as it varies per patient. A 2009 review of 29 US cost-of-illness studies for breast cancer estimated the lifetime per-patient costs of breast cancer ranged from $20,000 to $100,000.

Oncologists should more readily engage patients in discussions about the complementary and alternative medicine they may already be taking and discuss how it relates to the standard treatment of the disease, he said.

Better communication can not only improve outcomes, but boost the patient-physician relationship and lead to higher patient satisfaction. He encourages clinicians to “respectfully explore” patients' preferences and beliefs and provide evidence-based information about treatment options “in a non-judgmental fashion.”


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