Danielle Lee: Good evening, Jacksonville, and happy Saturday. I’m Danielle Lee and welcome to the conversation with Dr. Lee Kasraeian. You too can join the conversation, give us a call, 340-1045. Dr. Lee, how are you today?
Dr. Kasraeian: I am good. How are you?
Danielle Lee: I am good. Talking before the show, we’re going to be talking about a study today.
Dr. Kasraeian: Yes. A very interesting study, maybe, controversial. People are going to be passionate on one side or the other. Basically, the study was published late in, I guess, mid- to late-July, last week in JAMA Oncology, The Journal of the American Medical Association’s Oncology arm, which show that cancer patients who choose to use alternative medicines, alternative therapies, something they call complimentary medicine, actually, have a twofold survival disadvantage than those who do not choose such alternative medicines and complimentary medicines. Today, we’re going to talk about that and see why that is.
In studio is a good friend of mine, Dr. Jamie Cesaretti, an amazing radiation oncologist, works at Terk Oncology with his partner Mitchell Terk. We work very closely together in the world of prostate cancer trying to take information and data to optimize and personalize the care of people with prostate cancer. Which is one of the cancers that was studied in the JAMA Oncology paper, to see how we can use all the tools we have in our armamentarium, or tool chest, of therapies to make people’s lives, those who have prostate cancer, and the people that care about them, not only better, in terms of a quantity of life, and survivorship of their cancer, but also in terms of their quality of life.
That’s a big thing in the world of prostate cancer and the world of cancer, in general, and fortunately now in the world of health. We try to make sure that the cure isn’t worse than the disease and that the therapies that we use, we have sensitivities to the implications and the impact of that therapy on those who are surviving and dealing with the therapies and their families. Jamie, thank you for being here.
Cesaretti: Thanks for having me.
Dr. Kasraeian: When you first read this study, and you love clinical research, as much as I do.
Cesaretti: I do, thanks.
Dr. Kasraeian: We’re actually leaving here to go do some statistics on our prostate cancer research, so a very thrilling day. Everyone around us probably thinks we’re nuts.
Danielle Lee: Not really.
Dr. Kasraeian: We’re looking forward to that, actually, we get to hangout. But when you read the study, what did you think?
Cesaretti: You know, it promised more than it delivered. There are a lot of problems in the study, so I’ll review the study. It was two million patients treated in early 2000, or mid-, late-2000. It was four kinds of cancer: prostate, breast, lung, and colon. Basically, what the authors wanted to know was that if using complimentary medicine had an adverse effect on survival. The way they did it, and it’s a bit of a problem, they found two million patients to analyze who had traditional medicine. And they found 258 patients who did complimentary medicine. They actually compared those cohorts, as if that was a valid comparison.
Dr. Kasraeian: One of the issues with this study, now that you’re bringing up, is that they looked at two million patients in what’s called, a retrospective manner. So they went back in the chart reviews and database reviews, and things of that nature. And prostate cancer, lung cancer, colorectal cancer, and breast cancer, and sometimes ovarian cancer are used in a lot of these studies that people talk about. The PLCO study for prostate cancer, because there’s a lot of data that’s been kept over a long period of time, so you can go back and look at these databases and be able to collect data. Here, they went back and looked through a large, large, large body of patients and found 258 who used complimentary medicine, or admitted to it.
Cesaretti: It was .001% of the other population.
Dr. Kasraeian: Very small. And they did a match control, so they basically took and tried to find, what amounted to, almost 1,000 patients who were the same, in terms of age, in terms of stage and grade of their cancer, comorbidities, insurance types, in terms of their ethnicities, and a lot of things to try to make sure, at least, that’s a valid … This was actually the first study that looked at it and had to. There have been other studies that have raised the same question of whether complimentary medicines, or alternative therapies, may not have impact, or they could, potentially, even be hurtful for people who have cancer from that standpoint.
Here, one of the very obvious things is that you have all these patients you’re looking at, only 258 out of two million use of that.
Cesaretti: Yeah. You and I practice in the south, thankfully. What was really interesting is there was a preponderance of patients who did select not to follow their doctor’s advice for cancer care, and they tended to occur on the west coast, and the inner mountain region.
Dr. Kasraeian: Same places where vaccinations issues seem to be a big, big complimentary, so that’s one thing that seemed to be consistent.
Cesaretti: Really, only … It was interesting, only 5% of the cohort was from the south. It was the smallest percentage in the U.S. of people not following their physician’s advice for cancer.
Dr. Kasraeian: Which is interesting. The other thing that’s interesting from the study, in my perspective, was that people that used complimentary medicine, and things of that nature, with “standard of care therapies,” which for cancer tend to be surgery, radiation therapy, chemotherapy, and sometimes hormonally based therapies.
Cesaretti: Which they looked at, specifically.
Dr. Kasraeian: Absolutely. When you look at those, one thing that they found was when people used complimentary, alternative medicines, things like herbs, supplements, different diets, yoga, acupuncture, homeopathic medicines, traditional Chinese therapies. They found when it’s using complimented it actually can improve the quality of life and it didn’t really hinder survival. Where it became an issue was when patients, and those who are dealing with a cancer, chose not to do standard of care therapies for their cancers, again, surgery, radiation therapy, chemotherapy, or hormonal based therapy. It seems like in the population studies, those who chose alternative, or complimentary, therapies seemed to have a higher likelihood of refusing standard of care therapies. That’s when you found the survival disadvantage, from that standpoint. Why do you think that is that statistic was found? Why people would choose to do that?
Cesaretti: Yeah. It’s interesting. I had my preconceptions before I read the article, because I read the headline.
Dr. Kasraeian: Which was what?
Cesaretti: That it’s a self-empowerment issue. You can’t go and prescribe your own medicine, the doctor has to do it. Also, there are just, probably, accurate and sometimes misperceptions of just how toxic these therapies really are. They haven’t really modernized or, often, a loved one from decades ago went through a certain treatment. My thoughts were that the actual results would be more evenly spread across the U.S., and they would be more evenly spread across the cancer diagnoses, and male/female. That’s not what the actual paper showed, even though the implication of the headline was that, the paper showed that it tended to be young patients, in the far west, who were breast cancer patients, predominantly. Really, otherwise, the sample of colon, prostate, lung was tiny.
Dr. Kasraeian: Yeah, breast and colon seemed to be the one that showed a different … I’m sorry. Breast and colon cancer were the ones that showed a little bit of a difference, lung and prostate did not. I think that was interesting. You know, the way I think of that, this philosophically, it’s a very human response. That if you’re facing a therapy that seems toxic, it may potentially be with concern for potential side effects. It’s not beyond reason that someone would wonder, or search for, alternatives that may not be quite as “toxic,” or plagued with side effects, as you perceive them to be. And when they seem like they are more natural, and things of that nature, it’s a very, very appealing thought.
Cesaretti: It is and this is why I said the actual paper, itself, wasn’t what the headline implied. The other thing that was interesting was that the authors associated the misperceptions of west coast, inter-mountain, people to a high immigrant population. Sort of hearkening back to native beliefs in public health that they would have gotten in childhood abroad. Then, also, a high incidence of alternative medicine schools. Which, apparently, is quite a thing out in the west.
Dr. Kasraeian: It’s basically how your perception is shaped and what your thoughts are, in terms of the implications of therapy and the potential impact on cure, but also the potential impact on quality of life and whether an alternative therapy can match those with less side effects. Meaning you get equivalent care with less side effects.
Cesaretti: Yeah, but the paper, itself, actually was almost studying a mindset of patients. The rejection of the standard. It wasn’t really saying that alternatives don’t work. It was saying that if you chose an alternative, you were more likely to make an irrational choice when your doctor presented you with a choice.
Dr. Kasraeian: That’s the big thing I took away from this study. Where it wasn’t so much the complimentary medicine impacts your quality of life, as long as they don’t hurt you. I want to talk about something that I-