Hodgkin's lymphoma is a highly curable form of cancer when treated with chemotherapy and radiation. But Daniel Hauser (a young teenager) and his parents rejected chemotherapy after a single treatment, with the boy's mother saying that putting toxic substances in the body violates the family's religious convictions. Daniel's mother  said she had been treating the boy's cancer instead with herbal supplements, vitamins, ionized water and other natural alternatives - a regimen based mostly on information she found on the Internet. Since then the disease has advanced, and Daniel's mother has abducted him away from his concerned oncologist in Minnesota.

The Society for Integrative Oncology advocates the best scientifically proven standards for cancer treatment and distinguishes clearly between helpful evidence-based and safe complementary therapies used to reduce symptoms and to help patients cope, in contrast to so-called alternative therapies that are bogus interventions often promoted for commercial gain. In this case, the Hausers have pursued a path of alternatives therapies which cannot be condoned by any rational arguments.

So why do some patients turn to alternative therapies? There are multiple reasons including exasperation with the treatment they have received in traditional care modalities, are terrified of the adverse reactions to conventional therapies, or desperate for a cure, having been told that their cancer is incurable. In this case, it would appear that the oncology staff were exceedingly compassionate and concerned, and had indicated clearly the high probability of cure with chemotherapy, albeit with adverse effects that are minimized as much as possible.

Alternative therapies provide  short-term hope, but are not usually successful. With few anecdotal exceptions, if conventional therapies offer an evidence-based opportunity for long-term benefit, then substituting an unproven alternative treatment may result in losing the best opportunity for survival. This is clearly futile gambling with one's life and diminished personal responsibility. Pundits for alternative therapies often argue that they have been suppressed by the establishment, despite the fact that the Office of Cancer Complementary and Alternative Medicine of the National Cancer Institute (OCCAM) provides ample opportunity for innovative research on best case series(1, 2). Unjustified Pollyanna branding of alternative therapies has negatively influenced patients in deciding to enter clinical trials.

The term “complementary therapy” (or “complementary medicine”) is to be distinguished from “alternative medicine.” Historically, the two are bundled together under the term “complementary and alternative therapies” (CAM). Alternative therapies are typically promoted as viable treatment options: “alternatives” to so-called mainstream therapies such as chemotherapy, radiation, and surgery. Alternative therapies are unproved, rarely based on credible scientific rationale, and potentially harmful—especially when patients are led away from effective, proven therapies by the lure of false promises and an emphasis on a lack of adverse side effects as compared with conventional therapies (4,5). There is no alternative to scientifically evaluated, evidence-based medicine. Most patients who use unconventional therapies (all but 2%) do so to complement rather than to replace mainstream treatment (6). However, because of desperation or fear, or because of inadequate support and communication, patients may seek alternative therapies.

Research studies conclude that patients who abandon conventional biomedical treatments do so for the following reasons: (7,8,9,10,11)

1. Anger and fear.
The patient may be angry at the health care system or their physician. Others may fear the clinical health  care environment, adverse side effects, or the blunt presentation of prognosis. Some patients may not be able  to cope because of underlying depression.

2. Lack of control.
Some patients may feel a loss of control in the conventional health care system, whereas a primary alternative  approach can give them a sense of empowerment. On the other hand, open-decision making may be overwhelming,  and some patients give themselves over to the alternative practitioner.

3. Belief in a cure.
The alternative approach may provide a more positive belief system for cure. A negative prognostic approach by  a conventional practitioner may persuade a patient to seek an alternative therapy that is unjustly branded as  delivering a cure.

4. Social group association.
A peer group of social support may be very persuasive at encouraging alternative therapies, based on  misinformation but the urge to be helpful.

5. Mysticism
Healing symbols and spiritual healing give some patients the feelings of control and coping. This may carry  them through the rough places of their experiences, cushioning them against fears.

This is not just a North American problem. Worldwide, many patients may be deprived of effective modern anticancer therapies secondary to primitive cultural beliefs and a lack of modern resources (7). In developing countries, factors such as ignorance, socioeconomics, and inadequate access to mainstream medical facilities are some major factors that play an important role in patients opting for alternative therapies that are replacements for, rather than adjuncts to, mainstream therapy (12,13,14,15,16) Communication between patients and health professionals appears to be the major cause of biomedical abandonment. The research by Montebriand et al. contains numerous instances of angry confrontations and inadequate communication strategies by health professionals(7). When diagnosed with cancer, patients are vulnerable and emotions are easily stimulated. Anger may arise within the consultation. Health professionals may distance themselves from the anxiety of the cancer situation. Both verbal and nonverbal messages can be interpreted as lack of interest and lack of hope. Conversely, the informants believe they receive hope when communicating with alternative practitioners.

Exclusive use of alternate therapies is often associated with hope for a cure and unresolved personal issues or unrealized biomedical expectations. Health professionals need improved communication skills; medical information should give hope. Spiritual isues should be addressed, utilizing representatives from the religious community as champions for good quality health care. Patients bring more than just their concerns about cancer to the clinical situation. They bring present and past experiences, social schemata, and spiritual interpretation. Patients should be encouraged to express their personal perceptions of health care. Frank and caring communication can happen only if professionals take time to listen (without anger), especially when patients discuss alternatives. Negative biomedical experiences, such as iatrogenic complications, are often concealed from the health professional. Frank exploration of these experiences is appropriate. Patients tend to suppress negative revelations lest their future care be jeopardized. Aware of patients' possible hesitancy, professionals should develop thoughtful strategies for accessing patients' histories. Education is imperative. Of concern, is that one survey in a country with a highly developed health care system suggested that one-third thought that alternative therapies could be used instead of conventional cancer treatments (17).

Despite the best efforts of well-informed oncologists, sometimes patients and their responsible relatives still forego life-saving treatment and follow a mythical and fantastic quest for alternative answers. Unfortunately these quests inevitably and tragically end with widely disseminated cancer, thereby missing the opportunity to cure. Only by communicating within their cultural belief system and compassionately discussing their deepest (mis) beliefs can sensible persuasion be achieved. This approach can allow families to still maintain their belief systems about different approaches, yet still ensure that a child receives the chemotherapy. In fact, many cancer centers offer complementary therapies for supportive care and coping (45% of NCI designated cancer centers)…. it’s not just about oncologists pushing harsh chemotherapy treatments without regards for their side effects.

The Society for Integrative Oncology provides education and research to support the clinical encounter, offering the best of evidence-based complementary therapies that allow patients to choose supportive interventions that reduce adverse effects and allow them to cope with their chemotherapy, but encourages them NOT to pursue alternative medicine.

For more details, see SIO Media Release

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