Alternative Treatments are Linked to Lower Breast Cancer Survival

Advances in early screening mammography and new, targeted treatments have reduced overall mortality and recurrence in breast cancer. Yet, despite these advances in traditional treatment options, some patients continue to choose complementary and alternative medicine (CAM), such as dietary supplements, mind and body approaches, and acupuncture.

“I was moved by a patient discussing her decision to go with alternative treatments instead of proven traditional therapies,” says Oluwaseun Ayoade, MD, a hospital resident at Yale School of Medicine (YSM) and first author on the study. “I realized there was not much information to guide women considering alternative treatments.”

Ayoade and her colleagues analyzed therapy choices and outcomes among patients with breast cancer, the second-most common and second-deadliest cancer in women. The results of their findings are reported in JAMA Network Open.

For their analysis, the team turned to the National Cancer Database, a dataset that captures around 70% of patients newly diagnosed with cancer in the United States. The researchers analyzed data from more than 2 million patients with breast cancer. Patients who received exclusively traditional therapies were compared with patients who received at least one type of complementary or alternative medicine.

The vast majority of women in the dataset (98%) had received traditional therapies, including surgery, chemotherapy, endocrine therapy, or radiation. When the researchers looked at the patients who were treated only with CAM, they found that those patients experienced a 3.7-fold higher mortality rate compared to patients who received exclusively traditional treatments. This means these women were nearly four times more likely to die within five years of treatment. In fact, the patients treated with CAM alone experienced outcomes similar to patients who chose not to be treated at all.

Combining traditional and alternative treatments was also associated with worse outcomes compared to patients who received traditional treatments. Patients who received CAM and traditional treatments had 1.4 times higher mortality— a 40% higher chance of dying within five years—compared to patients receiving only traditional treatments.

“There has been so much progress in traditional treatments, we were not surprised that patients who go without them have a far worse outcome,” says Daniel Boffa, MD, professor of surgery at YSM and senior author of study. “We were surprised, however, that the combination group also did worse, because there is some evidence that CAM can reduce the side effects of traditional treatments.”

Digging further into the data yielded clues as to why a combination approach might lead to lower survival rates.

“It seemed from the data that the patients who used CAM in combination [with traditional therapies] were skipping some of the traditional treatments, particularly radiation and endocrine therapies, which likely contributed to the lower survival,” Boffa explains.

These findings highlight the importance of traditional treatments, and the negative consequences of skipping even a portion of them, he adds.

Ayoade and Boffa were surprised how few patients had disclosed plans to use alternative therapy to their treatment teams.

“For the study, we could only see information that was recorded in a patient’s chart,” says Boffa, who is a member of Yale Cancer Center. “If patients didn’t tell their clinicians about plans to use alternative treatments, their use wasn’t reflected in our research.”

Boffa believes some patients may have used CAM during their traditional course of care, which allowed them to better manage side effects associated with a traditional treatment and complete the full course of therapy, resulting in better health outcomes. The team could not explore this further, however, as they did not have enough information to study the question directly.

Patients and their medical teams should be comfortable discussing all forms of treatment, so they can have an open conversation about the risks and benefits of each form of therapy, Boffa adds.

“For every patient, the optimal treatment approach may differ based on their health, their disease, their support and their goals of care,” says Boffa. “The best way to give patients the best care is to discuss the full range of factors influencing their treatment decisions, including their interest in alternative treatment.”