Patients with cancer who receive complementary medicine (CM) are more likely to refuse conventional cancer treatment (CCT) and may have a higher risk of death, according to a study published in JAMA Oncology.

CM, a group of wide-ranging interventions (eg, herbs, minerals, traditional Chinese medicines, homeopathy, specialized diets, meditation, yoga), is used in addition to CCT and has been shown to help patients improve their quality of life and feel more hopeful, but its effect on actual survival outcomes is unknown.

For this retrospective observational study, researchers accessed the National Cancer Database and evaluated the data of 1,901,815 patients with nonmetastatic breast, prostate, lung, or colorectal cancers. All patients had undergone at least 1 CCT, such as chemotherapy, radiotherapy, surgery, and/or hormone therapy. Overall, 258 patients were identified as having used CM, and were matched with 1032 patients in the control group.

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Results showed that although patients who elected to receive CM did not have a greater delay in initiating CCT, there were higher rates of CCT refusal. Patients who received CM had a higher rate of refusal for surgery (7% vs 0.1%; P <.001), chemotherapy (34.1% vs 3.2%; P <.001), radiotherapy (53.0% vs 2.3%; P <.001), and hormone therapy (33.7% vs 2.8%; P <.001).

CM use was also associated with a worse 5-year overall survival (OS) rate, with 82.2% in the CM group vs 86.6% in controls (P =.001), and was found to be independently associated with a nearly 2-fold increase in mortality risk when treatment delay or refusal were excluded from multivariate analyses. Upon adjusting for treatment delay or refusal, however, no significant associations between CM and an increased risk of death were observed.

The authors concluded that “health care professionals need to be proactive in discussing CM and adherence to conventional medicine treatment with their patients. For patients with curable cancers who are inclined to pursue complementary treatment methods, timely adherence to all recommended conventional therapies should be strongly advised.”


Johnson SB, Park HS, Gross CP, Yu JB. Complementary medicine, refusal of conventional cancer therapy, and survival among patients with curable cancers [published online July 19, 2018]. JAMA Oncol. doi: 10.1001/jamaoncol.2018.2487