Original Article Unproven Cancer Therapies: A Multi-Headed Hydra Malcolm L. Brigden MD, FRCPC* Summary More than half of all cancer patients will try alternative · therapy during their illness. Much of the appeal of alternative therapy is related to a dissatisfaction with the technological and impersonal nature of conventional medicine. Unproven or alter- native therapies are often begun early in the patient's disease, and their use may not be revealed to health-care professionals. The range of alternative therapies is staggering, but multivi- tamins, diet and herbal therapy, and metabolic therapies are probably most commonly used. A few alternative therapies are harmful, and their promoters may be dishonest. Health-care pro- fessionals need to be aware of which alternative therapies are in vogue in their geographic area. The use of such therapies should be discussed early in the therapeutic relationship with each can- cer patient. Attention has recently focused on incorporating those aspects of alternative therapy that make these treatments '-.../active to patients into the mainstream of cancer care. Introduction Unproven, unorthodox, or questionable cancer treatments are those that have not been objectively, responsibly, and repro- ducibly shown in studies to be more effective than doing nothing. 1 • 2 • The abandonment of conventional by patients for unorthodox treatment is an ongoing problem. · This is of concern when the patient has a potentially curable disease such as Hodgkin's disease, large-cell non-Hodgkin's ·lymphoma, testicular cancer, or acute lymphocytic leukemia? In Greek mythology. one of Heracles' s most difficult tasks was battling the mythical Hydra. Each time that he cut off one head, two new ones replaced it. In many ways, his struggle is analo- gous to that of physicians dealing with unproven cancer thera- pies, since these continually re-appear in new guises. Many new therapies are promoted on the basis of individ- ual testimony,4-6 but this is insufficient. For most questionable cancer treatments, no trials have been done. Furthermore, when alternatives such as chelation therapy, Essiac, Laetrile, or high- dose vitamin C have been subjected to proper!(.: controlled sci- entific trials, they have been found wanting. · 9 For example, Cassileth compared the length of survival and quality of life in who received unorthodox treatment at the Livingstone- Resume Plus de Ia moitie des cancereux ont recours a des traite- ments fantaisistes durant leur maladie. Ce qui s'explique sans doute par l'insatisfaction que laisse le caractere impersonnel et hautement technique de la medecine actuelle. Les therapies charlatanesques et d'efficacite non demontree soot souvent en- treprises tot au cours de la maladie et sans que les professionnels de Ia sante le sachent. Leur variete est etonnante, bien que les plus utilisees soient les preparations vitaminees, les regimes, les plantes et les interventions « metaboliques ». Certaines de ces therapies soot nuisibles et ceux qui les preconisent, malhon- netes. Aussi les professionnels de Ia sante doivent-ils connaitre les therapies paralleles qui ont cours dans leur milieu et en parler tres tot avec leurs malades porteurs d'un cancer. On s'est in- teresse en effet recemment a incorporer aux soins scientifiques donnes aux cancereux les elements qui rendent ces therapies at- trayantes. Wheeler Clinic to that of control patients who received conven- tional therapy at the University of Pennsylvania Cancer Cen- ter.10 The length of survival did not differ between the two groups, and the quality of life was better for the patients under- going conventional care. The questions that health professionals should ask when evaluating alternative therapies have been outlined by Dr. Vic- tor Herbert: 6 • Is the remedy better than a placebo or doing nothing? • Is the remedy as safe as a placebo or doing nothing? • If there is any question about safety, does the potential benefit exceed the potential harm? Alternative therapies that have not satisfied these condi- tions should not be advocated by the medical establishment. Consumers of Unproven Cancer Therapy Studies in the United States have shown that more than 50 f . .11 . . . th 411 per cent o new patients w1 part1c1pate m unproven erapy. ' *Regional medical oncologist. Address for reprints: M.L Brigden, Dept. of Medica l Oncology, B. C. Cancer Agency, Center for the Southern Interior, 399 Royal Ave., Kelowna BC VJY 51.3. Annals RCPSC, Vol. 31, No.1, February 1998 9