The rise in online websites, posts, blogs and videos has created a space in which mass amounts of information can be freely accessed and published by the public and professionals. The Internet’s lack of regulation has consequently unleashed a rise in misinformation and false claims about medical treatments, particularly cancer treatments. The access to medical information becomes a double edge sword, with truthful science education on one end and fraudulent pseudoscientific marketing on the other. As reviewed by Delgado-López and Corrales-García, some complementary and integrative oncology therapies, that may be outside of mainstream medicine, can be considered safe and beneficial for controlling symptoms, however, the concept and promotion of what is formally known as complementary and alternative medicine (CAM) “may also promote implausible effects, often linked to dishonest financial profits”, and can quickly turn into “cancer quackery”. (2) This misinformation becomes deceptive online and has the potential to be harmful to patients. Newcomers to the idea of CAM for cancer treatment must understand that while a patient’s autonomy should be respected, the health risks surpass the temptation to give these therapies a try.
One of the main issues with CAM is that the exact definition is one that health professionals are still trying to figure out since it is not as straightforward as some may think; this blurring of the lines very well may be intentional in order to lump science-based approaches into the same category as pseudoscientific and disproven ones. Unproven or disproven examples for cancer treatment include, but are not limited to: Laetrile, shark cartilage, Gerson Therapy, hyperbaric oxygen, Cranial Osteopathy, Homeopathy and various Naturopathic supplements. (Delgado-López and Corrales-García 8) Surgical oncologist, David Gorski, MD, PhD, has written extensively about the main issues with integrative and alternative cancer medicine – that is, if it was indeed reliable medicine it would not be “alternative” in the first place. Dr. Gorski explains that, “Unfortunately, most of what is being ‘integrated’ with science-based medicine in integrative oncology is either unproven or has been proven not to work.” (7) Cancer patients do have the right to their autonomy and freedom of choice; however, it is strongly emphasized that they deserve therapies that are proven to be safe and effective. It becomes difficult online for patients to decipher what is a trustworthy medical therapy and what isn’t when these lines are so often blurred.
There is reason for concern over the increased use of some of these therapies due to their ineffectiveness, increased risk of harm, and the likelihood that they will replace modern science based medical care. This is a conversation that needs to be had since pseudoscientific therapies can indeed “directly produce harm … indirectly deprive time and financial resources from supported treatments … [and] further erode the foundations and trust in scientific professions that employ their use.” (Stea) Even back in 2006 many patients had heard of CAM therapies and several had reported using CAM for their tumors. (Armstrong et al.) Of note, most of the patients did not disclose to their physicians that they were using CAM. A 2019 systematic review, totalling 21,249 patients, discovered that an average of 51% of them used CAM; the most common reason was to treat or cure their cancer. (Keene et al.) This is a matter of concern since cancer patients who have used CAM had significantly worse cognitive functioning, fatigue, health-related quality of life, systemic side effects to therapy, and financial difficulty. (Yun et al.; Chui et al.) CAM users were also more likely to postpone chemotherapy treatments compared to nonusers. These findings were expanded upon and it was concluded that, “patients who received complementary medicine were more likely to refuse other conventional cancer treatment, and had a higher risk of death than [the group not receiving] complementary medicine.” (Johnson et al.) This higher risk in death was thought to be associated with delay or refusal of conventional treatment.
One limitation with the studies cited above is that they often pool together the different therapies, and this makes it difficult to assess the detrimental effects of an individual therapy. One therapy that has been specifically isolated and studied is Gerson Therapy, which uses organic plant-based diets, raw juices, coffee enemas and natural supplements as a means of “healing” cancer. In 1990, it was concluded that there was no scientific evidence for the regime and that it had the potential to be dangerous. (“Gerson Method”) Further, a Gerson-like therapy was studied in cancer patients and severely worsened survival and quality of life. After 1 year, 56% of the patients on chemotherapy were alive while only 16% using the alternative treatment survived. During the entire duration of the study, those who chose “chemotherapy survived more than three times as long and had better quality of life than those who chose [the alternative Gerson] treatment.” (Chabot et al.) Not only do these results demonstrate the lack of efficacy these treatments have with regards to survival and quality of life, but their prevalence among patients underscores the need for proper risk vs benefit education in the clinic and online.
The reasons that patients choose CAM are vast and each reason works synergistically with the patient’s right to make their own decisions, however, this becomes a slippery slope when trying to communicate the potential harm and risk of these decisions. The use of CAM has become an attractive option for individuals, particularly those with more holistic beliefs (Bishop et al.), and some may use it to try and increase the likelihood of having a treatment succeed. (O’Keefe and Coat) Pressure from family and friends is another important factor when influencing CAM decisions. (Smith et al.) While alternative cancer therapy advocates tout the notion of informed consent, patient choice, and being open minded (Marshall para 13), failing to disclose the serious risks and lack of efficacy is highly contradictory to the goals of informed consent. (Jepson et al.) Patients do indeed have the option to choose different paths of treatment, however, the perception of informed choice is exploited by promoters of CAM and this makes the information online even more deceptive.
The widespread access to medical information online has given a platform for potentially harmful complimentary and alternative treatments, particularly for cancer. It is imperative that a cancer patient has their autonomy respectfully taken into consideration while simultaneously being provided education and protection against dangerous cancer misinformation. Both this protection and education could lessen the temptation for patients to be drawn towards such deceitful alternative treatments.
Works Cited
Armstrong, Terri, et al. “Complementary and Alternative Medicine Use and Quality of Life in Patients with Primary Brain Tumors.” Journal of Pain and Symptom Management, vol. 32, no. 2, Aug. 2006, pp. 148–54. PubMed, doi:10.1016/j.jpainsymman.2006.02.015.
Bishop, Felicity L., et al. “Why Do People Use Different Forms of Complementary Medicine? Multivariate Associations between Treatment and Illness Beliefs and Complementary Medicine Use.” Psychology & Health, vol. 21, no. 5, Oct. 2006, pp. 683–98. Taylor and Francis+NEJM, doi:10.1080/14768320500444216.
Chabot, John A., et al. “Pancreatic Proteolytic Enzyme Therapy Compared With Gemcitabine-Based Chemotherapy for the Treatment of Pancreatic Cancer.” Journal of Clinical Oncology, vol. 28, no. 12, Apr. 2010, pp. 2058–63. PubMed Central, doi:10.1200/JCO.2009.22.8429.
Chui, Ping Lei, et al. “Quality of Life in CAM and Non-CAM Users among Breast Cancer Patients during Chemotherapy in Malaysia.” PloS One, vol. 10, no. 10, 2015, p. e0139952. PubMed, doi:10.1371/journal.pone.0139952.
Delgado-López, Pedro David, and Eva María Corrales-García. “Influence of Internet and Social Media in the Promotion of Alternative Oncology, Cancer Quackery, and the Predatory Publishing Phenomenon.” Cureus, vol. 10, no. 5. PubMed Central, doi:10.7759/cureus.2617. Accessed 18 Dec. 2019.
“Gerson Method.” CA: A Cancer Journal for Clinicians, vol. 40, no. 4, Aug. 1990, pp. 252–56. PubMed, doi:10.3322/canjclin.40.4.252.
Gorski, David H. “Integrative Oncology: Really the Best of Both Worlds?” Nature Reviews. Cancer, vol. 14, no. 10, 2014, pp. 1–9. PubMed, doi:10.1038/nrc3822.
Jepson, R., et al. “How Should We Measure Informed Choice? The Case of Cancer Screening.” Journal of Medical Ethics, vol. 31, no. 4, Apr. 2005, pp. 192–96. PubMed Central, doi:10.1136/jme.2003.005793.
Johnson, Skyler B., et al. “Complementary Medicine, Refusal of Conventional Cancer Therapy, and Survival Among Patients With Curable Cancers.” JAMA Oncology, vol. 4, no. 10, 01 2018, pp. 1375–81. PubMed, doi:10.1001/jamaoncol.2018.2487.
Keene, Martin R., et al. “Complementary and Alternative Medicine Use in Cancer: A Systematic Review.” Complementary Therapies in Clinical Practice, vol. 35, May 2019, pp. 33–47. PubMed, doi:10.1016/j.ctcp.2019.01.004.
Marshall, Michael. “Why Media Coverage of Alternative Cancer Cures Is Dangerous.” The Guardian, 4 Mar. 2015. http://www.theguardian.com, https://www.theguardian.com/science/blog/2015/mar/04/why-media-coverage-of-alternative-cancer-cures-is-dangerous.
O’Keefe, Maree, and Suzette Coat. “Increasing Health-Care Options: The Perspectives of Parents Who Use Complementary and Alternative Medicines.” Journal of Paediatrics and Child Health, vol. 46, no. 6, June 2010, pp. 296–300. PubMed, doi:10.1111/j.1440-1754.2010.01711.x.
Smith, Peter J., et al. “Why Do Some Cancer Patients Receiving Chemotherapy Choose to Take Complementary and Alternative Medicines and What Are the Risks?” Asia-Pacific Journal of Clinical Oncology, vol. 10, no. 1, 2014, pp. 1–10. Wiley Online Library, doi:10.1111/ajco.12115.
Stea, Jonathan. “3 Ways That Pseudoscientific Therapies Can Be Harmful.” Psychology Today, https://www.psychologytoday.com/blog/writing-integrity/202001/3-ways-pseudoscientific-therapies-can-be-harmful. Accessed 29 Jan. 2020.
Yun, Y. H., et al. “Effect of Complementary and Alternative Medicine on the Survival and Health-Related Quality of Life among Terminally Ill Cancer Patients: A Prospective Cohort Study.” Annals of Oncology: Official Journal of the European Society for Medical Oncology, vol. 24, no. 2, Feb. 2013, pp. 489–94. PubMed, doi:10.1093/annonc/mds469.
Sincerely, Science 