"Unorthodox therapies in oncology" is a very sensitive issue that enrages the
medical establishment. Few controversies in cancer therapy have been so fierce
as the laetrile issue which is still regarded as a hallmark of quackery. Then
came other drugs, e.g. , hydrazine sulfate, Burton's immunological method and
antineoplastons (1). What went wrong ? Why should our sane and rational society
fall prey to malevolent quacks ? (2). In 1990, the Office of Technology Assessment
of the United States Congress (OTA) published a report on unconventional cancer
treatments (3) which was criticized by a distinguished representative of the
medical establishment in the following phrases: "The report could be an almost
pathognonomic symptom of a serious, chronic disease affecting our government...
Its symptoms are clear-fuzzy thinking, irrationality, confusion,..." (2). For
decades such utterances had a devastating effect on practitioners of unorthodox
therapies. Now that NCI has officilally admitted that there is "stalemate" in
the war on cancer" (4,5) the public gets suspicious of traditional treatment
and unproven methods in oncology become respected (6). Next year a tumour biology
center that will devote itself to alternative cancer therapies will be opened
in Freiburg.
The name "Unproven methods of oncology" implies that conventional therapy has
been proven to be effective, and yet in many chronic cancers, e.g., breast cancer,
traditional therapy fails to cure most of the patients.
Fig. 1 depicts age-adjusted mortality from breast cancer (7,8). In spite
of a wealth of "proven methods", for 50 years, age-adjusted mortality from breast
cancer has continuously risen. Conventional treatment, e.g., surgery, chemotherapy
and irradiation, did not improve the prospect of the average cancer patient.
Obviously when the patient seeks help it is already too late and the establishment
turns to new technologies, e.g., biological response modifiers, and IL-2. Yet
these methods are still unproven, exactly as those of quacks and charlatans,
and may even fail. Why not then test the unorthodox methods like any other
scientific theory ?
The expert assures us that "none of these putative treatments is unknown to
the medical community. All have been reviewed and examined many times before...
Some have been studied and discredited as a result of scientifically designed
clinical trials" (2). These statements hide several fallacies. It is true that
unorthodox methods failed to prolong patient survival, yet are the "proven"
methods more effective ? None prolongs survival of adult patients with disseminated
cancer ! When unorthodox therapies were tested they were usually supplemented
to the traditional, which makes any comparison therapies between the two impossible.
Previously such designs were justified for ethical reasons. Now that, at least
in breast cancer, treatment has failed the whole issue should be reconsidered.
There is an important message in unorthodox therapy that is still ignored by
the traditional. According to oncology, cure means tumor eradication and since
most patients seek help when the disease is widespread they cannot be cured.
It then attempts to slow down cancer progression by reducing the tumor load,
while some unorthodox therapies attempt to curb cancer progression without eradicating
the tumor. This is also the objective of "semi-orthodox" treatments, e.g., psychotherapy,
that are still opposed by the establishment. A Stanford psychiatrist reported
recently "that psychotherapy lengthened by a year and a half the lives of
women with metastatic breast cancer, while reducing their anxiety and pain
as well" (9).
Unorthodox ideas ought therefore be subjected to unbiased clinical trials in
which their efficacy is compared with that of other methods, e.g., surgery,
chemotherapy and psychotherapy, and judged by their merit to improve the quality
of life and prolong remission.
G. Zajicek
References:
1. Moss RW. The cancer industry Paragon House New York, 1989.
2. Durant JR. If it quacks... Cancer 67 : 2225-2226, 1991.
3. U.S. Congress, Office of Technology Assessment. Unconventional Cancer Treatment.
OTA-H-405, Washington D.C. US Government printing office, 1990.
4. Marshall E. Breast cancer : stalemate in the war on cancer. Science 254,
1719-1720, 1991.
5. Zajicek G. Cancer starts as a systemic disease. The Cancer J. in press, 1992.
6. Hauser SP. Unproven methods in onclology. Europ. J. Cancer 27 : 1549-1551,
1991.
7 Cancer mortality in the U.S. 1950-1977. NCI Monogr. 59, 1982.
8 Silverberg E. Lubera J. Cancer statistics 1988, CA 38 : 5 5-22, 1988.
9 Barinaga M. Can psychotherapy delay cancer deaths ? Science 246 : 448-449,
1989.
Figure 1. Age adjusted mortality rate. Breast cancer in the U.S.