Complementary Therapies (CTs): THE EMPEROR S NEW CLOTHES? Edzard Ernst, Emeritus Professor, Uni Exeter PC2-2012 Cancer v1-1
The Emperor's New Clothes (1837) Two crooks promise the emperor new clothes which, they claim to be invisible to those who are stupid, or incompetent. As the Emperor parades before his subjects in his new clothes, nobody dares to say that the emperor is naked for fear of being seen as "stupid, or incompetent". Finally, a child cries out, "But he isn't wearing anything at all!" The story stands for something falsely accepted as desirable due to a general lack of courage or insight to oppose popular opinion. 2
Options for this lecture The chutzpah of some quacks The gullibility of the emperor The naivety of the child 3
PC2-2012 Cancer v1-4
Options for this lecture The chutzpah of some quacks The gullibility of the emperor The naivety of the child 5
Options for this lecture The chutzpah of some quacks The gullibility of some people The naivety of the child or The evidence related to CTs 6
Background Many cancer patients use CTs (often without telling their oncology team). Millions of websites, hundreds of books and newspaper articles promote CTs. Conventional clinicians know little about CTs. Patients are often feel abandoned when deciding about CT-use 7
What is CT? An umbrella term for a highly diverse array of therapeutic methods which are outside the mainstream of medicine. from acupuncture to urine-therapy
CTs: common features Emphasis on holism Natural treatments Concept of energy Safe treatments Individualisation Self-healing properties Long tradition of usage Private healthcare 9
10
Cancer 54 recommended CTs Acupressure Acupuncture Anti-neoplastons Antioxidants Aromatherapy Ayurvedic medicine Bioelectric treatment Biofeedback Carotenoids Cell therapy Cell-specific cancer therapy Chelation therapy Chinese herbs Chinese medicine Co-enzyme Q10 Coley s toxins Dance therapy Detoxification therapy DHEA Diet Enzyme therapy Exercise Guided imagery Green algae Herbal medicine High dose vitamin E High fibre diet Homeopathy Hydrazine sulphate Hydrotherapy Hypnotherapy Imagery Immune enhancement therapies Juice therapy Magnetic field therapy Massage Meditation Melatonin Metabolic therapies Mind-body therapies Naturopathy Nutritional supplements Oxygen therapy Pancreatic enzyme therapy Pets Phytoestrogen Qigong Reflexology Relaxation Shark cartilage Spirituality TCM Therapeutic touch Yoga 11
A sensible differentiation Prevention Treatment Palliative/supportive care 12
1. Prevention 13
Allium for cancer prevention Design: Sample: Result: systematic review 20 (mostly) case control studies with only 1 exception, these studies suggest that allium vegetables convey a protective effect, in particular from GI cancers. Ernst. Phytomed 1997;4:79 15
Green tea for cancer prevention Design: Sample: Result: Cochrane review 51 (mostly epidemiological) studies with a total of 1.6 million participants Risk of certain cancers may be reduced by regular green tea consumption Boehm, et al. Cochrane Database 2009 16
Take home message: (prevention) Very few CTs are supported by sound evidence 17
2. Treatment 18
Cancer 54 recommended CTs Acupressure Acupuncture Anti-neoplastons Antioxidants Aromatherapy Ayurvedic medicine Bioelectric treatment Biofeedback Carotenoids Cell therapy Cell-specific cancer therapy Chelation therapy Chinese herbs Chinese medicine Co-enzyme Q10 Coley s toxins Dance therapy Detoxification therapy DHEA Diet Enzyme therapy Exercise Guided imagery Green algae Herbal medicine High dose vitamin C High fibre diet Homeopathy Hydrazine sulphate Hydrotherapy Hypnotherapy Imagery Immune enhancement therapies Juice therapy Magnetic field therapy Massage Meditation Melatonin Metabolic therapies Mind-body therapies Naturopathy Nutritional supplements Oxygen therapy Pancreatic enzyme therapy Pets Phytoestrogen Qigong Reflexology Relaxation Shark cartilage Spirituality TCM Therapeutic touch Yoga 19
PC2-2012 Cancer v1-20
Mistletoe Method: Sample: Results: systematic review of RCTs 10 RCTs of various mistletoe preparations most RCTs had considerable weaknesses flawed RCTs tended to be positive none of the stronger RCTs showed efficacy in terms of quality of life, survival or other outcomes Ernst, et al. Int J Cancer 2003;107:262-267 22
Laetrile Design: Sample: Conclusion: Cochrane review no RCT or non-randomised trial was found The claim that Laetrile has beneficial effects for cancer patients is not supported by data Milazzo, et al. Cochrane Database 2009. 23
Ukrain Design Systematic review Sample 7 RCTs Result Conclusion All of the 7 RCTs suggested extremely positive effects on tumour growth and survival numerous caveats prevent a positive conclusion Ernst, Schmidt BMC cancer 24
Dietary supplements for prostate cancer Design: Sample: Conclusion: Systematic review 8 RCTs the hypothesis that dietary supplements are effective treatments for PC patients is not supported by sound clinical evidence. Posadski et al Maturitas 2013. 25
The danger of ineffective treatments If used as replacements of effective therapies, they lead to premature deaths. 26
Danger of CTs Design: Sample: Results: Retrospective chart review (1980 2006) 185 breast cancer patients who refused standard treatments in favour of CTs 5-year survival compared in CT-group = 43% (compared to 82% in the other group) Joseph K et al World J Surg Oncol JUNE 2012 27
Take home message: (alternative cancer cures) CTs are not just useless but dangerous, unethical and criminal 28
3.Palliative/supportive care 29
Cancer 54 recommended CTs Acupressure Acupuncture Anti-neoplastons Antioxidants Aromatherapy Ayurvedic medicine Bioelectric treatment Biofeedback Carotenoids Cell therapy Cell-specific cancer therapy Chelation therapy Chinese herbs Chinese medicine Co-enzyme Q10 Coley s toxins Dance therapy Detoxification therapy DHEA Diet Enzyme therapy Exercise Guided imagery Green algae Herbal medicine High dose vitamin C High fibre diet Homeopathy Hydrazine sulphate Hydrotherapy Hypnotherapy Imagery Immune enhancement therapies Juice therapy Magnetic field therapy Massage Meditation Melatonin Metabolic therapies Mind-body therapies Naturopathy Nutritional supplements Oxygen therapy Pancreatic enzyme therapy Pets Phytoestrogen Qigong Reflexology Relaxation Shark cartilage Spirituality TCM Therapeutic touch Yoga 30
Beware of cherry-pickers! 31
Own systematic reviews (1) Therapy Symptom Number of studies Conclusion (quote) Acupuncture Pain 7 the notion that acupuncture may be an effective analgesic adjunctive is not supported by the data Reference Eur J Pain 2005 Acupuncture Hot flushes (breast cancer) 3 the evidence is not convincing Breast Cancer Res Treat 2008 Acupuncture Hot flushes (prostate cancer) 6 the evidence is not convincing Supp Care Cancer 2009 Co-enzyme Q10 Side-effects of conv. Therapy 6 CoQ10 provides some protection against cardio toxicity or liver toxicity during cancer treatment J Clin Oncol 2004 Guided imagery Any symptom 6 GI may be psycho-supportive and increase comfort Psychooncol 2005 32
Own systematic reviews (2) Therapy Symptom Number of studies Conclusion (quote) Reference Homeopathy Any symptom 6 insufficient evidence to support clinical efficacy Eur J Cancer 2006 Massage Any symptom 14 the evidence is encouraging Supp Care Cancer 2009 Moxibustion Any symptom 5 The evidence is limited BMC Cancer 2010 Tai Chi Any symptom 4 The evidence is not convincing Supp Care Cancer 2009 Tai Chi Breast cancer symptoms 7 the existing trail evidence [is] not convincing Breast Cancer Res Treat 2010 Qigong Any symptom 9 the effectiveness is not supported by the evidence from rigorous clinical trials Acta Oncol 2007 33
Own systematic reviews (3) Therapy Symptom Number of studies Conclusion (quote) Reference Reflexology Any breast cancer related 3 evidence does not convincingly show that reflexology is effective Integr Cancer Ther 2010 Acupuncture Pain 15 number of RCTs and their methodological quality were too low to draw firm conclusions Moxibustion Acupuncture Acupuncture Chemoinduced leucopenia Cancer related fatigue Cancer related hiccups 6 number of trials, the total sample size, and the methodological quality are too low to draw firm conclusions 7 quantity and quality of RCTs included in the analysis were too low to draw meaningful conclusions 5 very limited evidence for the effectiveness of acupuncture Supp Care Cancer 2012 Supp Care Cancer 2015 Supp Care Cancer 2013 Comp Ther Med 2012 34
Systematic review: massage for cancer palliation and supportive care Sample: Results: 14 RCTs Most studies were of poor methodological quality All suggest positive effects on symptoms such as: - pain - nausea - anxiety - depression - anger - stress - fatigue Effects could be non-specific Ernst. Supp Care Cancer 2009.
Take home message: (palliative/supportive care) Some CTs might be effective 36
CONCLUSION CTs should be subject to careful evaluation of their effectiveness and safety. It is important that treatments are properly tested and that patients do not receive misleading information NHS provision for CTs should be confined to treatments that are supported by evidence of both effectiveness and safety Royal Society 2006 PPS-07-07 Herb & Alt Med Cancer-50
Much more on my blog: edzardernst.com PC2-2012 Cancer v1-38