The results of a recent survey[1] commissioned by the American Society of Clinical Oncology (ASCO) were published recently in an 82-page report[2]. This study surveyed almost 5000 people with cancer and their family members as well as individuals without any personal experience with this diagnosis.

The survey uncovered several concerning facts about patient care experience and perceptions, in addition to the contributions of specific risk factors to cancer diagnosis. These insights, which are highly relevant to oncology providers and policymakers, include the following:

  • The financial impact of cancer is just as concerning to respondents as the possibility of dying of cancer. Almost 70% of patients and caregivers have experienced anxiety about their financial situation as a result of their diagnosis.
  • 40% of patients had difficulty accessing opioids to manage their cancer-associated pain, while almost half had trouble obtaining medical marijuana for this purpose.
  • Alcohol use was not listed among the top 5 perceived causes of cancer despite being identified, perhaps conservatively, as the cause of up to 10% of cancers by the World Health Organization in 2016[3]

Despite these and other helpful facts uncovered by the analysis, one statistic in particular regarding beliefs about alternative therapies has stirred the most media attention.

Spotlight on alternative treatments

The recent Medscape page entitled “ASCO Poll Finds ‘Frightening’ Views on Alternative Cancer Treatment”[4] provides an example of the laser focus on one component of the study: that 39% of Americans believe “Cancer can be cured solely through alternative therapies, without standard cancer treatment(s)”.

This report and others like it go on to label this statistic as “shocking”, “disturbing”, “alarming” and “disastrous”. The ASCO infographic on the study gives top billing to this statistic, guiding response by media outlets[5]. As a result, we are seeing these statements reposted and quoted repeatedly, leading to some antagonism overall to complementary medicine as well as the use of alternative medicine.

One omission and weakness of note is that the article fails to clearly distinguish “alternative” cancer treatment from “integrative” and “complementary” cancer care. The former implies there has been a refusal of standard cancer care in place of an alternative form of therapy, while the latter describes a care model that includes evidence-informed natural interventions in coordination with standard therapies with the goal of improving outcomes including symptom management and quality of life for cancer patients.

Complementary or integrative medicine in oncology care may include botanical, nutrient, dietary, lifestyle, mind-body, acupuncture or pharmacologic interventions that are used in coordination with standard of care cancer treatments.

Of concern to ASCO and to our integrative oncology community is the possibility that some people may choose unfounded therapies instead of standard or integrative approaches to cancer treatment. The belief that alternative natural therapies can indeed be curative for cancer and the statistics brought to light from the survey is helpful to further guide improved research and education on oncology care.

In this, it is important to state that the Oncology Association of Naturopathic Physicians (OncANP), through its membership, strives to support people living with cancer in a manner that is integrative rather than alternative. The OncANP also supports the conduct of good research that tests the ability of naturopathic medicine to positively impact patients living with cancer in order to support their quality of life and aid in symptom management. As such we support the integrative breast Cancer management guidelines using evidence-based natural therapies.[6] Most encouragingly we would add that ASCO has endorsed these guidelines for consideration and adoption by oncologists.[7]

Survey results are not treatment decisions

As noted, while the 39% statistic of belief in alternative medicine as curative is certainly concerning to the OncANP, the hyperbole used to describe the situation may be more inflammatory than truthful and simply generates more polarization. Those inclined to perceive that big pharma is hiding information and that conventional oncology is in the pocket of economic interests may see this highlighted issue as evidence of an ongoing conspiracy. Those opposed to complementary, integrative and/or alternative medicine will also feel more justified in their beliefs. This is not helpful to anyone. We need to highlight the issue without creating further division. We are opposed to the use of language designed to generate fear.

Is this statistic worthy of the attention it is receiving? As stated by one commentator in another article published on Medscape, survey results are not treatment decisions[8].

Alternative vs. Integrative

Another detail should bring us to question the impact of this survey on the practice of integrative oncology. While 39% “strongly or somewhat agree” with the concept of alternatives as curative, standalone treatments, 75% of respondents agreed with the statement “Alternative therapies are a good supplement to standard cancer treatment(s)”[9] (emphasis added). This speaks directly to the need for a coordinated, integrated approach embraced by many in the field of naturopathic oncology today, which is consistent with the widely-accepted definition of integrative oncology developed by Witt et al. in 2017[10].

Striving for Integration

Non-disclosure of concurrent natural therapies is well documented in the literature with up to 77% of patients reporting that they have not told their care team about their use of complementary and alternative medicine[11]. In response to its survey results, ASCO’s chief medical officer, Dr. Richard L. Schilsky, MD, suggested that oncologists spend more time discussing alternative treatments with their patients[12]. Once again, this resonates well with those of us striving for an integrated approach to care.

Conclusion

Discussion, dialogue and a respectful consideration of the needs and desires of our patients is always critical. The integrative approach espoused by the OncANP is geared to enable fully informed choice and avoid the tendency for patients to choose alternative medicine or unfounded approaches that avoid or negate conventional care. We encourage an open dialogue between patients and their oncologists with the hope that this does not disparage the patient’s beliefs and choices but rather creates acceptance and awareness for integrative therapies that can support best care.

Coordinated, evidence-informed, patient-centered care, free of hyperbole and judgment will ultimately provide for honest discussion, good informed consent and the best service to our patients.

[1] https://www.asco.org/sites/new-www.asco.org/files/content-files/research-and-progress/documents/2018-NCOS-Results.pdf

[2] https://www.asco.org/sites/new-www.asco.org/files/content-files/research-and-progress/documents/2018-NCOS-Results.pdf

[3] https://cancer-code-europe.iarc.fr/images/doc/Alcohol.pdf

[4] https://www.medpagetoday.com/hematologyoncology/othercancers/75998

[5] https://www.asco.org/sites/new-www.asco.org/files/content-files/research-and-progress/documents/2018-NCOS-Infographic.pdf.pdf

[6] Greenlee H, Dupont-Reyes MJ, Balneaves LG, et al. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. CA Cancer J Clin. 2017; 67(3):194-232.

[7] Lyman GH, Greenlee H, Bohlke K et al., Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline, Journal of Clinical Oncology 2018 36:25, 2647-2655.

[8] https://www.medscape.com/viewarticle/904096

[9] https://www.asco.org/sites/new-www.asco.org/files/content-files/research-and-progress/documents/2018-NCOS-Results.pdf

[10] Witt CM, Balneaves LG, Cardoso MJ et a. A comprehensive Definition for Integrative Oncology. J Natl Cancer Inst Monogr. 2017 (52)

[11] https://www.ncbi.nlm.nih.gov/pubmed/22933591

[12] https://www.medpagetoday.com/hematologyoncology/othercancers/75998