VANCOUVER, British Columbia — Integrative oncology might be helping to extend the lives of patients with advanced cancer, new research indicates.
Although the outcomes data are far from conclusive, they are nevertheless interesting and promising. However, controlled studies are needed.
Integrative oncology is an emerging field that looks at the whole patient — body, mind, and spirit. It incorporates evidence-based mainstream oncology practices (such as surgery, chemotherapy, radiation) with therapies considered to be complementary (such as nutrition, naturopathic, yoga, meditation).
To date, the survival data compare favorably with national and regional statistics, explained Leanna Standish, PhD, ND, Lac, from the School of Public Health at the University of Washington and the Bastyr University Integrative Oncology Research Center (BIORC), both in Seattle.
However, the comparative use of publicly available survival datasets is limited, and a prospective matched controlled study is needed to determine the cause of the apparent survival benefit.
Dr. Standish presented the data here at the 10th International Conference of the Society for Integrative Oncology. She emphasized that "I am just reporting the data we have;" they are not from a randomized trial.
She explained that her team gathered preliminary survival data to answer the most common patient questions: "How long am I going to live and what is my quality of life going to be?"
The BIORC opened in 2009, after receiving a $50,000 grant from a man whose wife had died from breast cancer who wanted to see if there was a better way to treat the disease. To date, 521 cancer patients have been enrolled in a prospective consecutive case series that involves all disease stages, including ductal carcinoma in situ, Dr. Standish reported.
Originally, all patients were from the Seattle area, but they are now coming from around the country. The most common types of cancers seen at BIORC are breast cancer, lung, colon, pancreatic, brain, and Merkel cell carcinoma, which is a highly aggressive skin cancer. About 30% of the patients have stage IV disease.
Limited Comparison Data
One of the major challenges in doing a prospective consecutive case series is finding the right comparison data," she said. "The Seattle Cancer Care Alliance, which is just next door, has outcomes online for all the major types of cancer, so we have been matching our outcomes with their data."
But the problem with those data, even though they were collected in the same city, is that they date from 1998 to 2002. The SEER data are also out of date, Dr. Standish pointed out. "In fact, every kind of cancer registry that you can find is out of date."
Encouraging Stats
Since 2009, the BIORC has treated 8 patients with stage IV colon cancer. Three years after the initiation of their care, 80% were still alive; only 15% of Seattle Cancer Care patients in this group were alive at 3 years.
Of the 12 consecutive patients with stage IV lung cancer treated at BIORC, 64% were still alive at 3 years. This compares favorably with the 15% reported by Seattle Cancer Care and the 3% reported by SEER.
To calculate median survival, you have to wait until 50% of your patients have died, Dr. Standish explained. "We haven't lost 50% of our patients, so we can't calculate it. Even though the Seattle data are old, the comparison is interesting."
However, at this point, it is unclear whether "these are just special people or it's something we are doing," she added.
The BIORC has treated 12 patients with stage IV ovarian cancer. Median survival is 2 years, which is about the same as reported in the published data. "But I am encouraged that our 4- and 5-year survival will be better," she noted. "In the literature, the highest survival at 5 years is 18%."
Preventing Recurrence
Dr. Standish and colleagues also looked at preventing recurrence. "We've now had 11 consecutive stage III ovarian cancer patients. At 3 years, 83% of them are still alive," she said. "The SEER national data report 49%. So a hypothesis is generated — integrative oncology may prevent or delay recurrence."
The scope of naturopathic medicine in Washington state is quite broad. At BIORC, intravenous therapies are used. The researchers compared patients with stage IV breast cancer who had received intravenous therapy with those who had not. "Right now, it looks like there might be a better outcome for stage IV breast cancer patients who received it," she said.
Of 46 patients, 18 received intravenous therapy. At 3 years, it looks like there might be an effect. "Right now, 100% of patients who received intravenous treatments are alive, compared with 70% who didn't," she said.
One of the intravenous therapies used is artemisinin, which is approved by the US Food and Drug Administration to treat malaria and has shown promise as a cancer treatment. So far, the 6 patients with stage IV cancer treated with artemisinin remain alive after 3 years. "It doesn't mean anything," she pointed out. "They could be alive for any number of reasons, but it is encouraging. It suggests a hypothesis that the combination of artemisinin and ascorbic acid is especially effective in breast cancer."
A better grasp of the effect of integrative oncology is in the works. The National Center for Complementary and Alternative Medicine has given funding for Dr. Standish and her team to conduct a matched comparison study of breast cancer. "We started in 2010 and have enrolled 571 patients to date," she said. "What is exciting is that we are now into this sufficiently that we know the groups are well matched."
"That means that we have a really good chance of seeing the outcomes of integrative oncology," she concluded.
10th International Conference of the Society for Integrative Oncology (SIO): Abstract 79. Presented October 21, 2013.