When you hear the words alternative cancer treatment, you're probably picturing things like green juices, acupuncture, coffee enemas, and yes, that's a thing.

Or the many wellness influencers on TikTok who have apparently discovered treatments that oncology has been hiding from us for decades. There's an important distinction between alternative medicine and complementary medicine.

Some of it is ineffective or even dangerous, and some of it is actually helpful. And that's the topic of this week's Healthcare Triage. the National Cancer Institute defines complementary medicine is something used along with standard cancer treatment. Alternative medicine means using something instead of standard treatment, so acupuncture to help with symptoms while someone is receiving chemotherapy will be complementary.

Using acupuncture instead of chemotherapy to treat the cancer would be alternative. that distinction matters because there is evidence to support certain complementary approaches for helping people feel better during cancer treatment, but not for treating the cancer itself. So it's actually a lot more nuanced than just brushing off alternative medicine as useless. Some of these approaches are being studied seriously because they have plausible biological mechanisms that are worth investigating.

Some have evidence for specific symptoms, while others have basically nothing behind the claims being made about them The trick is figuring out which is which. Cancer treatment is brutal. A diagnosis can leave people feeling like their bodies, and sometimes their entire lives are suddenly being controlled by doctors scans, medications, appointments, side effects, and an alarming number of acronyms.

So it makes sense that people look for something else they can actively do. An editorial examining complementary and alternative medicine after cancer diagnosis estimated that roughly 43 to 67% of US cancer patients use some form of it. people may use these approaches to try to treat the cancer itself. Use it alongside conventional treatment to manage side effects or just to promote general wellness. one concern here is that supplements and herbal products can cause harm, interact with medications and in some cases make cancer drugs work less effectively.

For example, taking antioxidant supplements like vitamin C is a no go during chemotherapy because it can reduce the treatment’s ability to kill cancer So how do we approach this subject, and how do we determine what's useful and what isn't? And more importantly, what could be harmful? There are complementary approaches that have been studied for cancer symptoms, treatment side effects, and quality of life.

But no complementary approach has been shown to cure cancer or cause it to go into remission. So the most useful way to think about this entire subject is not to ask, does alternative medicine work? But what does it work for exactly?

Take acupuncture, for example. Several evaluations have found that acupuncture can help manage treatment related nausea and vomiting. A 2020 analysis found acupuncture was associated with reductions in cancer pain, and a 2018 review suggests that it may help with cancer related fatigue.

Some data suggest benefits from mindfulness based interventions for anxiety, depression, fatigue, stress, and quality of life. Reviews of yoga have found small to moderate improvements in fatigue and quality of life in women with breast cancer, as well as improvements in anxiety and depressive symptoms in people with cancer. Tai chi has also been studied for fatigue and sleep.

These are different claims from saying acupuncture and exercise kill cancer cells. There isn't good quality clinical evidence showing that integrative therapies directly target cancer as a biological disease. Instead, the evidence supports using them alongside conventional treatment to manage symptoms and potentially improve quality of life If you're exhausted from treatment and yoga helps you move a little more comfortably, that is useful.

If acupuncture helps with chemotherapy related nausea, that's a big plus. If meditation makes the hours you spend worrying about your next scan a little less miserable, that's amazing. But even here, there are caveats.

Massage, for example, may help with some symptoms, but the evidence is limited and inconsistent, and certain physical approaches aren't appropriate for everyone. Someone with very low blood counts, bone involvement, surgical scars, or other complications may need modifications or may need to avoid particular activities. So it's not an anything goes kind of situation, just worth discussing with your doctor kind of situation Turmeric A good example.

It contains curcumin which has anti-inflammatory and antioxidants properties. And researchers are studying curcumin in cancer. However, while turmeric using cooking can be part of a healthy diet, the evidence from preliminary animal studies does not establish concentrated tumeric supplements as a cancer treatment in humans.

Additionally, high amounts can cause stomach upset or other problems. One of the biggest traps in alternative cancer claims is taking a true statement and stretching it until it becomes a completely different statement. For example, curcumin effects.

Inflammation is a scientific claim. Inflammation is involved in cancer can also be a scientific claim, but neither of those support a leap to the conclusion that curcumin treats cancer. unfortunately, that logical leap happens all the time A 2008 analysis published by researchers Memorial Sloan-Kettering examined the claims made in the book Living Proof, which chronicled the experience of a man with multiple myeloma who rejected conventional chemotherapy and used alternative approaches, particularly nutritional supplements and dietary changes. This books popularity helped turn one person's experience into something masquerading as evidence, the researchers went through the scientific claims being made in the book and found numerous inaccuracies, omissions, and misrepresentations.

They examined claims surrounding Gerson therapy, coffee enemas, vitamin C, medicinal mushrooms and other approaches. They pointed out examples where animal research, observational studies, historical comparisons, or poorly supported claims were being presented as if they were evidence from rigorous clinical trials. And that's a recurring problem with alternative cancer medicine.

The story can sound scientific without actually providing scientific evidence for this specific claim being made, saying that thousands of papers have been published about nutrient X in relation to cancer does not translate to nutrient X treats cancer. In stating that someone survived after taking nutrient X does not tell us whether the treatment caused the survival. That last one is particularly seductive because if someone is diagnosed with cancer, starts an alternative treatment, and then lives for many years, it's very easy to tell that story as proof, But we don't know what would have happened to that person without the alternative treatment.

We don't know whether their cancer was biologically unusual. We don't know what other treatments they received, and we don't know whether someone with a different cancer would have the same outcome. That's the problem with anecdotal evidence.

One of the most famous examples is that of Steve Jobs. He was diagnosed with the rare pancreatic tumor called a gastroenterol pancreatic neuroendocrine tumor, which typically has a high survival rate when caught early. After his diagnosis, he initially pursued complementary and alternative approaches, including acupuncture, botanicals, and dietary changes.

He delayed surgery for about nine months before ultimately undergoing it, and then died seven years after his diagnosis. That story generated enormous speculation on both sides. Did his decision to delay conventional treatment cause his death?

Many medical professionals think so. It is initial use of alternative medicine to help him live longer after diagnosis? Some people think so. the details of his diagnosis and treatment were not publicly available in enough detail to determine whether his outcome would have been different if he'd undergone surgery earlier or pursued another treatment.

Again, we aren't demonizing treatments like acupuncture or lifestyle changes like diet, because there is evidence to support some of it. A population based study from Taiwan examined people receiving conventional breast cancer treatment, including chemotherapy, radiation and surgery, and compared them with people who received these treatments, plus traditional Chinese medicine, including herbs and acupuncture. The results suggested an association with better breast cancer outcomes among people receiving the combination.

But and this is a big but, the researchers themselves said the findings need to be investigated further, with larger trials to determine which patients and which symptoms might actually benefit. That is what good scientific uncertainty sounds like. No solid claims either way, just the assertion that there's an interesting signal that deserves some attention.

There are also cases where research raises concerns rather than hope. Ivermectin, for example, is a real drug with established uses for certain parasitic infections. But there's no solid evidence establishing ivermectin as a treatment for cancer.

Even so, you'll find many proponents of ivermectin for cancer patients. And again, there is a tiny kernel of scientific truth within the claim that gets way overblown. One very small study involving just eight people with triple negative breast cancer combined ivermectin with immunotherapy.

Only one patient experience tumor shrinkage. That's nowhere near enough evidence to establish ivermectin as a cancer treatment. Cannabis and CBD are another complicated example.

People may use these because they believe it helps with anxiety, nausea or insomnia, but there's no clinical evidence that they treat cancer itself. And research suggests that they could actually interfere with certain chemotherapy drugs, potentially affecting their effectiveness or toxicity. Another problem is that some of these alternative treatments are expensive and or difficult to obtain.

But the financial cost isn't just the money spent on the treatment itself. If someone spends thousands on supplements, specialized diets, or alternative treatments that don't work, that's money they don't get back. But the potentially larger costs can come from delaying effective treatment.

A major study published in the Journal of the National Cancer Institute looks specifically at this question. Researchers examined patients with non metastatic breast, prostate, lung, or colorectal cancer who chose alternative medicine as their sole anti-cancer treatment rather than conventional methods recommended by most doctors. They identified 281 people who received alternative medicine without conventional treatment, and compared them with matched patients receiving conventional cancer treatment after matching and adjusting for several factors.

The patients who chose alternative medicine faced a higher risk of death. The five year survival was 54.7% in the alternative medicine group, compared with 78.3% in the conventional treatment group. We don't have to pretend that every natural product is ridiculous, but we can't afford to pretend that every natural product is a miracle drug the pharmaceutical companies are desperately trying to suppress.

If an herb has an interesting biological effect, by all means study it. If acupuncture helps people manage nausea, pain, or fatigue, study it. If a traditional medical practice appears to improve quality of life, study it.

And if the results look great. Test it in appropriately designed trials. That's how medicine has always moved forward.

A lot of people believe that Western medicine automatically rejects anything that comes from nature, but some conventional cancer treatments originally came from plants. Paclitaxel, also known as Taxol, was developed from an active compound originally discovered in the bark of the Pacific Yew tree. Researchers isolated the active compound, studied how it worked, developed a drug, and conducted clinical trials to determine whether it actually treated cancer and whether it was safe.

There's a difference between discovering that something might be biologically interesting and demonstrating that it is an effective cancer treatment, and that's a great thing to keep in mind when evaluating cancer treatment claims. Importantly, cancer care doesn't have to be an either or proposition. There's room for evidence based supportive care that addresses the person rather than just the tumor.

There's room for exercise, mindfulness, acupuncture, massage, yoga, music therapy, nutrition support, and other approaches when they are appropriate and when they are used alongside cancer treatment. There's also room for research into herbs, supplements, traditional medicine and other approaches that might eventually reveal something useful. But using those things instead of effective cancer treatment is a fundamentally different decision.

Patients should feel a sense of control over their treatment. But inform control means knowing what a treatment is actually been shown to do, what it hasn't been shown to do, what risks it carries, whether it could interact with your other treatments and what you're paying for. Hey, do you enjoy this episode?

You might enjoy this previous episode on Cancer Myths. We'd appreciate it if you'd like this video, subscribe to the channel down below. Maybe go on over to Patreon.com/Healthcare Triage where you can help support the show to make it bigger and better.

We'd especially like to thank our research associates, Edward Liljeholm and Christopher Learn, and of course, our Surgeon Admiral, Sam