CANCER THERAPY & EVIDENCE-BASED HEALTHCARE [2008-04-06]
While I have written about all sorts of natural/alternative/complementary therapies as well as non-conventional medical therapies ( not yet generally accepted and practised by the majority of doctors in a particular country ), I have also been trying to bring awareness of the evidence-based concept to the non-medical fraternity.
Writing about these methods do not mean that I endorse all of them. This column is about the many health-enhancement and healing methods and modalities being practised ( that I have come across ) for the knowledge and interest of the readers. They may then wish to investigate further and consider any of these modalities for themselves. Patients with illnesses should of course seek the advice of their own trusted doctors or complementary health practitioners as well. I trust the readers are smart enough to distinguish the significance between the results of any treatment method testified by a few versus that produced by a scientific study.
Conventional medicine does not have a monopoly over healing. If all the billions spent on medical research have produced satisfactory results, then all of us would not be looking for alternative/complementary therapies. I have stated many times that I am glad that I was trained in conventional medicine as it is based on scientific principles and evidence-based practice. However, while I value the scientific understanding of health and diseases modern medicine has taught me, and the diagnostic methods and machines it has made available, it is in the treatment methods and results achieved for certain diseases that I feel it has failed to live up to expectations. The case in point is cancer therapy.
Evidence-based medicine requires that any treatment be proven through valid scientific studies. However there can be a vast difference in opinions in the interpretation of the results, and acceptance of what constitute "acceptable" or "effective" treatment.
First the methodology needs to be foolproof and valid. Next is whether the findings or results are accurate. Third, is trying to correctly interpret the results, translated to conclusions and claims. Lastly, some recommendations are usually made based on the findings.
Unfortunately, even large, good and valid studies can still cause confusion because experts interpret the results differently, and often make conflicting conclusions.
Take the case of cytotoxic cancer chemotherapy. Oncologists all over the world are using these toxic drugs, presumably based on such valid scientific studies, meaning that chemotherapy is evidence-based medical treatment.
However, the journal Clinical Oncology (2004 Dec;16(8):549-60) reported a study that reviewed randomised clinical trials reporting a 5-year survival benefit attributable solely to cytotoxic chemotherapy for 22 major adult malignancies in Australia and USA.
Results - The overall contribution of curative and adjuvant cytotoxic chemotherapy to 5-year survival in adults was estimated to be 2.3% in Australia and 2.1% in the USA.
The authors concluded that cytotoxic chemotherapy only makes a minor contribution to cancer survival and questioned its continued use. "A rigorous evaluation of the cost-effectiveness and impact on quality of life is urgently required" ( Authors - Morgan G, et al ).
In view of the above, many of us wonder if the continued use of chemotherapy is valid evidence-based medicine?
WHAT HOPE FOR CANCER?
100 years ago, only 3% of people died of cancer in USA. Now it is approaching 30%. The late President Reagen declared war on cancer and allocated billions of dollars to cancer research. Unfortunately, the cancer scenario continued to get worse. Ironically, he himself had skin and colon cancers, his wife had breast cancer, and daughter also had skin cancer. Now in USA, 1 in 3 will get cancer, and 1 in 4 will die of it. In other words, out of every 12 people, 4 will get cancer, and of the four, 3 (75%) will die because of the cancer, and the other 1 of other causes. Malaysians are not too far behind. One in four of us will get cancer and probably 75% of these will die of the cancer.
In 1996, 60 top physicians and scientists in USA made a joint-statement that doctors involved in cancer treatment had not given the true picture and that there had been no significant improvement in cancer therapy in the previous 20 years. Now over 10 years later many of us believe the situation has not improved much.
Since conventional medicine cannot cure many of the cancer cases, we should be more open to other options. I have been promoting nutritional therapy and qigong as adjuvant ( additional ) therapy to all the cancer patients who sought my advice, whatever is their decision regarding conventional medical treatment. Nutritional and complementary therapies also cannot claim to cure all the cancer cases, but together, an integrated approach could be beneficial to the cancer patients. That is my holistic integrated approach - encouraging patients to combine modern, natural, nutritional and complementary therapies. For the believers, I even give spiritual advice.
Since cytotoxic chemotherapy, which only increases 5-year survival rates by only about 2% ( generally presumed rate previously was about 5% ), is still approved and practised widely by oncologists to treat these malignancies, it is my opinion that any other method or machine giving similar or better results (best if scientifically validated) should be made available to the cancer patients, especially if the other methods do not have the severe side-effects of chemotherapy. They should be given more options to choose, provided they are given accurate information about all these methods.
Even if there is insufficient scientific evidence ( as in qigong therapy and many nutritional or complementary methods ), the patients could till be informed of the methods, provided that no invalid claims are made. And they need not wait until the doctors give up on them to consider these other options, especially as adjuvant or additional therapies, and not as alternatives, to medical treatment.
WHAT IF EVIDENCE-BASED MEDICINE FAILS?
Recently the President of the Breast Cancer Welfare Association and Malaysian Breast Cancer Council criticized ( The need to protect consumers of healthcare services, Sunday Star 23/03/08 ) my reporting of the Cytotron machine ( Hope For Healing, Fit For Life, 16/03/08 ).
She wrote: "Based on my knowledge of research and clinical trials, a study conducted on "more than 100 terminal cancer patients" is not sufficient to conclude that the method is proven and can be used on consumers. The Malaysian public is gullible enough to fall into the trap of such marketing gimmicks."( End of quote ).
I wholly agree with her that consumers need to be protected, and that all medical claims must be evidence-based. I also endorse her proposals to have guidelines for cancer screening, diagnosis and therapies. However, I do not think that it was fair to say that the report on the Cytotron study was a marketing gimmick.
The study I quoted was on terminal cancer patients who had undergone all possible conventional interventions such as chemotherapy, radiotherapy and/or surgery prior to Cytotron and yet the disease could not be controlled. Which meant that the doctors had applied their evidence-based medicine, failed, gave up and told the patients that they were supposed to die within a few days to a few months.
I have no reason to doubt the results as the study is being conducted at the respectable Indian Institute of Aerospace Medicine, Bangalore. The study has been submitted for publication in a medical journal. After the first 1 year, more than 60% of the 106 patients survived, and now after 2 years, more than 35% are cancer-free and living normal lives. Be reminded that they were terminal patients who were not expected to live beyond a few months. I also hope the Health Ministry or others can verify the report. When the study is published, then all the details can be scrutinized.
The Cytotron is not based on pseudoscience. Even the inventor of the MRI machine ( Dr Raymond Damadian ) has praised Dr Vijay Kumar for successfully innovating on the MRI's technology of detecting and evaluating cancers, to eradicating them.
Terminal cancer patients should be informed of any treatment option that may help them. When modern medicine fails, it has no right to stop the patient from trying anything else, nor dictate terms to them. Neither does anyone else have that right. However, the patients have the right to accurate information to make an informed choice. And yes, they need to be protected from quacks and charlatans.
INFORMED CHOICE & DECISION
Opinions, advice and guidelines for the treatment of cancer vary greatly even among experts who claim to be guided by evidence-based practice.
One area where there is much controversy is in the treatment of breast cancer. ''If the medical profession is not even close to being of one mind, how is the woman to know?'' said Donald A. Berry, a statistician at the University of Texas M. D. Anderson Cancer Center, the lead author of a recent paper questioning the benefits of chemotherapy.
Barbara Brenner, a breast cancer survivor and executive director of the advocacy group Breast Cancer Action (USA), said, ''We finally tell people at the end of the day: 'You're going to get a lot of information. Trust your gut. Nobody has the answers.' ''
The cancer patient needs to have informed and balanced ( ie. including different opinions ) discussions with his/her doctors or other health practitioners along with doing additional reading and researching on his/her own, to determine what is right for him/her. The choice of who to seek treatment from, and what treatment to undergo, is the patient's right. We only hope that the choice is made after adequate information, explanation and considerations in all aspects have been made available. The support of family and friends, and adequate counseling are all much needed to help the cancer patient make difficult decisions trying to face this potentially fatal disease.
Dr Amir Farid Isahak