ALTERNATIVE ENDINGS
Lure of the unproven can prove fatal to cancer patients
When a London, Ont., cancer patient was told she would need surgery to remove an oral cancer, then have a piece of leg or arm tissue grafted into her mouth, it seemed too much to bear.
So she turned to a naturalhealth practitioner, who for two years treated the malignancy with applications of rosehip oil.
by time the woman returned to hospital, “literally half her face had been eaten away by cancer,” says dr. Leigh Sowerby, the ear nose and throat surgeon who was part of her treatment team.
“The family had been told by the alternative-health provider that it was a good sign, because it meant the treatment was drawing the cancer out of the body,” he recalls. “She ended up dying in hospital before we could do the surgery.”
It’s just one example of what doctors say is a persistent and troubling phenomenon: cancer patients who lose valuable time — and risk their lives — by trying unproven alternative therapies.
Steve Jobs caused a posthumous sensation when it emerged he had delayed surgery on a treatable form of pancreatic cancer to try acupuncture and other nonmedical remedies.
but at a time when Canadian governments are validating natural-health professionals and products like never before, the Apple chief executive officer is far from alone.
research from Alberta, never before publicly reported, suggests at least one in every 100 breastcancer patients rejects standard care and doubles her likelihood of death as a result.
There is no systematic, national tracking of the phenomenon, but apply those findings to everyone newly diagnosed with cancer, and they suggest almost 2,000 Canadians are exposing themselves to similar risk every year.
meanwhile, there seems to be little pressure on alternative practitioners to warn patients of the dangers of forgoing medical cancer care, or turn away those who need immediate intervention by a physician.
A spokesman for the College of Naturopaths of Ontario, which regulates the profession, says its members’ “scope of practice” does not include handling potentially treatable cancers on their own. but cancer care remains a significant focus for alternative health practitioners.
dozens of Canadian naturopaths promote their membership in the Oncology Association of Naturopathic Physicians, though that affiliation requires no training on top of the profession’s basic four-year program.
An informal survey suggests many are willing to treat patients who have abandoned their oncologists, doctors trained for five years in their specialty after medical school.
Posing as a patient’s relative, the National Post asked naturopaths in british Columbia, Ontario and Nova Scotia if they would treat someone newly diagnosed with b-cell lymphoma, with enlarged glands in the chest and groin, who refused to undergo chemotherapy. Thirteen of the 18 who responded said they would take on the patient solo — only one said no.
“This is exactly what I do,” said one Ontario-licensed practitioner.
“He has many specialized protocols that he has seen work well,” said an assistant to naturopath Neil Mckinney of victoria, “prolonging life, increasing quality of life, stabilizing tumours and the disease progression, and shrinking tumours.”
Mckinney said in a followup interview he does advise patients to stick with conventional medicine if he thinks it would help them, and stresses to them there is little definitive science backing up what he does.
but mentally capable adults in Canada are ultimately free to choose what type of care they get — and Mckinney argues many naturopathic treatments, while not completely proven, are founded on solid research.
That includes some herbal and Chinese medicines, intravenous vitamin C and “myto-condrial rescue,” he says, some of which are so successful he claims clients were cured of cancer.
“We (also) sometimes shrink the tumours enough that the surgeon can get them out,” he says, echoing his assistant. “I had a case like this recently — sarcoma that was considered incurable, reduced to a point where it was curable.”
There is, in fact, a détente of sorts these days between traditional and alternative healers, primarily to alleviate the side-effects of conventional therapy. many alternative-health professionals argue their focus is on working alongside mainstream medicine to make treatments like chemotherapy more effective and tolerable, and doctors say they’re willing to accommodate them, to a point.
Jawaid younus, a medical oncologist at London Health Sciences Centre, says research supports the use of hypnotherapy to curb menopausal symptoms triggered by some drugs and reduce the pain caused by others. Acupuncture can help with treatment-related pain, he adds, and ginseng can counter fatigue.
most of the patients at the pioneering Ottawa Integrative Cancer Centre simply want support — from nutrition and lifestyle advice to herbal remedies that combat fatigue and nausea — as they go through medical treatment at an allied hospital, says dugald Seely, a naturopath and the centre’s founder.
Physicians also say some people diagnosed with advanced, terminal disease are unlikely to be helped by modern medicine, so have little to lose by rejecting the unpleasantness of chemo or radiation and trying an alternative.
What disturbs cancer specialists are the patients who stand to benefit from science-based treatment, yet choose to spurn it in favour of a questionable alternative that becomes their sole treatment.
dr. david bell, head of dalhousie university’s urology department, recalls an older patient who eschewed conventional therapy for prostate cancer, treating himself instead with garlic and honey — until the disease became so advanced, it could not be combated by any means.
“I would get these pleading emails from his wife, saying, ‘Please help him, he can’t get out of bed. He’s in pain all the time,’ ” says bell.
dr. Kurian Joseph, a radiation oncologist at the university of Alberta, says he had a patient who rejected treatment after her breast cancer spread to her shoulder, fearful she might damage the nerves leading to her hand.
When she returned 18 months later, the disease was in a late stage, with fluid in her chest.
“It was a disastrous situation,” says Joseph. “She told me, ‘I made a mistake.’ … She died two months later.”
Spurred by such cases, he examined records for breast-cancer patients in Alberta’s northern health region from 1980-2006, and discovered 1.2 per cent had declined treatment.
If that seems like a small proportion of patients, the impact of their decisions was not: just 43 per cent were still alive after five years, compared to 81 per cent of women at a similar disease stage who received conventional treatment, Joseph reported in the Journal of Surgical Oncology in 2012.
What motivates patients to tackle likely their greatest health crisis without the help of conventional medicine?
Mckinney, who sees about 50 such patients a year in his clinic, says some are philosophically opposed to the pharmaceutical industry or the medical profession, while others believe they cannot tolerate chemotherapy.
He also says medical doctors often alienate patients by dogmatically rejecting all alternatives.
Fear of the disease or of treatment itself is another key factor, says dr. Stephen Sagar, a radiation oncologist at mcmaster university in Hamilton.
Sagar believes the system is failing those patients, as many cancer centres lack counselling to address the deep psychological fallout of cancer, pushing them to adopt “magical thinking” and look instead toward alternative healers.
“They approach these practitioners with a sense of mystery,” he says. “Some people like the mystery, because it gives them the hope that anything is possible.”
younus recalls a patient diagnosed with breast cancer but free of actual symptoms; she chose to undergo naturopathic and homeopathic treatments for six months.
“The tumour grew and it actually was coming out of her skin from the breast site,” he says. “From a potentially curable situation, she went off to an incurable situation, with only palliative care possible.”
Sylvia rickard, though, says she had quite rational reasons for rejecting chemotherapy after surgery for advanced colon cancer.
even with the treatment, doctors said the b.C.-based composer would have at most a year to live. unwilling to spend what she thought would be her last days in discomfort, the vancouver Island resident instead had Mckinney infuse her twice weekly with highdose vitamin C.
Seven years later rickard, 78, says she is cancer free and rejects what she calls the destructive nature of conventional oncology.
“All they want is to sell stuff to the patients and feed the drug companies, and they don’t tell you anything about nutrition,” she complains.
The problem: evidence for vitamin-C infusions, as well as another mainstay of naturopathic cancer care, mistletoe-extract injections, remains hazy — lab experiments and less-rigorous human studies point to some benefit, but no highquality, randomized trials have yet proved they work.
Seely acknowledges more research is needed, but says it’s difficult to raise money for rigorous clinical trials of natural treatments that have little profit potential for investors.
meanwhile, some of the newest cancer drugs, while fully studied and approved, bring marginal benefit and sky-high costs.
Still, science shows conventional treatment — despite its limitations — can often extend life and even cure people stricken with cancer.
When patients choose to rebuff those benefits for dubious substitutes, it can take a toll not just on them but on their health-care team, too.
“These sorts of cases stick in your mind,” says oncologist malcolm moore, president of the b.C. Cancer Agency. “you don’t want to see someone lose their life because they made the wrong decision.”
Some cancer patients adopt ‘magical thinking’