Traditional medicine may succeed no better than unorthodox cancer treatments, including a vegetarian diet and coffee enemas, in prolonging the life of patients with terminal cancer.
But traditional treatments, despite the notorious side effects of chemotherapy and radiation, afford patients a significantly better quality of life during their remaining months or years than does the alternative approach.
Those are the conclusions of a provocative study published today in the New England Journal of Medicine.
The subjects were 156 patients with advanced cancer and an average life expectancy of a year or less. Half received traditional treatments at the Hospital of the University of Pennsylvania; the other half received their care through the Livingston-Wheeler Clinic, an alternative cancer center in San Diego.
The patients had advanced colon cancer, lung cancer, pancreatic cancer or melanoma.
At the end of a year, slightly over half of the patients in each group were alive and at the end of twoyears, about 15 percent. After three years, four patients receiving traditional therapy and one patient receiving unorthodox treatment were alive.
The Livingston-Wheeler program consists of a vegetarian diet, enemas and a vaccine that purports to energize the immune system. Some patients simultaneously receive chemotherapy.
"The results show very clearly that for patients with advanced cancers our treatments are probably not prolonging life," said Dr. Barrie Cassileth, adjunct associate professor at the University of Pennsylvania Medical School and the author of the report.
"We have to ask how to make these people most comfortable, and in some cases that may mean no treatment at all."
Since the patients in the study had advanced cancer, it is perhaps unsurprising that conventional treatments failed to prolong their lives.
But the study's second finding was much more startling: that theconventional cancer treatments lead to a better quality of life than methods such as dietary changes or vitamin supplements, which are frequently touted as a gentler form of therapy.
From the start of the cancer study, patients treated with conventional treatments consistently reported a more satisfactory existence than the patients receiving unorthodox care.
Each patient answered 22 questions about factors such as pain, sociability, physical well-being andnausea.
All of the answers were compiled into an overall quality-of-life score.
Patients treated with alternative therapies reported more problems with appetite disturbance and pain than those who received only conventional treatment. Despite its bad reputation, chemotherapy was found to have no adverse effect on the quality of life.
"Alternatives to conventional care are not free of side effects, and we should treat with suspicion statements that they are free of toxicities," Dr. Cassileth said.
"Also, I think that for patients on unproven regimens, the discrepancy between their hopes and the reality is so great that it has a very negative effect on their lives."
In a prepared statement, the Livingston-Wheeler Clinic, also known as the Livingston Foundation Medical Center, said that the study results "suggest interesting questions for further study," but noted also that "quality of life, primarily subjective, is notoriously difficult to measure."