Mondays at 8.30am, repeated at 8.00pm
with Natasha Mitchell
Breast Cancer and Alternative Medicine
12 July 1999
A recent study in the U.S. looked at a large group of women with early stage breast cancer who used alternative therapies as well as conventional medical treatment.
Natasha Mitchell: Some women diagnosed with breast cancer make the decision to turn to alternative medicines. A recent study in the United States looked at a large group of women with early stage breast cancer. Some of what was found, you might expect. The women who used alternative therapies were younger, wealthier, and better educated than those who didn't. But perhaps surprisingly, they were also more depressed and more anxious about the cancer.
Rae Fry and Brigitte Seega took a closer look at the study, and what it says about how people deal with the initial shock of a cancer diagnosis.
Ann Sudano: I was devastated. There was no warning, there was no sign, there was nothing. And in fact when I had my mammogram and they called me back in to do it again, I still had no inkling. So when the doctor rang and said 'Come and see me straight away', it was like a bolt out of the blue. It hadn't even entered my head.
Rae Fry: That was Ann Sudano from Melbourne, talking to Brigitte Seega. Ann had a partial mastectomy in 1996.
Ann Sudano: I had the radiotherapy, then it was suggested that I should have tomoxofin and that I should have chemotherapy, both of which I refused.
Brigitte Seega: Do you mind me asking why?
Ann Sudano: My gut instinct just told me I didn't need it. It was really nothing. It was just something that I knew that that was the right thing to do, and having said I wouldn't have this treatment, then of course I had to help myself. I had to do something, I had to be proactive, I had to be part of my health maintenance program.
Brigitte Seega: Where did you go from there? What type of therapy did you have?
Ann Sudano: I suppose the main one was because I'm oestrogen positive, I became a vegetarian, and I don't eat any dairy food, I eat organic food; I filter all my water, that sort of thing. I walk, do yoga, stretching, meditate; I tried all the spiritual healing and the crystal healing and all the other things, the New Age type things that people do.
Brigitte Seega: How did you find out which types of alternative treatment were good for you?
Ann Sudano: Well I started listening to myself. And if I went along and I tried it, and I felt good about it, then I would say, 'Yep, fine', and I'd go back again. And then if I didn't, if I went and I thought 'No this is not for me, or it's not something that given time that I can use myself', then I decided that was no good.
Rae Fry: Ann's story is not necessarily typical. She's different to many of the women in the US study in that she not only used alternatives, but also opted out of some conventional treatments. But she's one of an increasing number of people using therapies not prescribed by their doctor. And some doctors are now starting to ask, well why are alternative therapies so popular?
The US study was done by a group of researchers at Harvard University. They looked at 480 women who found out that they had breast cancer when it was still in its early stages. The researchers followed the women through for the next 12 months, keeping track of their choices of treatments and their general wellbeing.
Dr Harold Burstein is from Harvard's Dana-Farber Cancer Institute.
Harold Burstein: We found that 28% of the women who had been diagnosed with breast cancer started to use some kind of alternative therapy in the year after their diagnosis, and so we began to explore why they were doing this. And the first thing we found is that they were not using alternative medicine as a real substitute for conventional care. The women who started to use alternative therapy made the same decisions about regular cancer care like surgery, or radiation or chemotherapy, as women who did not use alternative therapy.
The next thing we looked at was the quality of life data that was also collected as part of this study, and what we found was that as a group, the women who started to use alternative medicine reported worse quality of life in the year after their breast cancer diagnosis. They reported more depression, greater fear of cancer recurrence, globally impaired mental health function, greater sexual dysfunction, all of these things that pointed us towards believing they were having more psycho-social distress.
Rae Fry: So what's that telling you?
Harold Burstein: It calls into question this idea that people who are using alternative therapies are really the strongest, you know, that they are taking charge of their own destiny, and that they are the best-informed and really go-getters on top of things, perhaps suggesting that in fact these are people who may really not be doing so well and who may be looking for some other thing, some other reassurance or something else to quell their concerns.
Rae Fry: So you're not suggesting that using alternative medicine is actually causing the distress?
Harold Burstein: Our data just shows us that there's an association, it doesn't tell us what causes what. Our leading hypothesis is that women who are having a harder time are looking for something else. We know that certain women do have a hard time after that diagnosis, and it's certainly understandable, it's a life-threatening diagnosis, it's a life-changing set of treatments, and what we'd like to be able to do is identify women who really are struggling, who might need additional help.
Rae Fry: I understand that you also found that women under 40 years old were particularly likely to be using alternative medicine. I mean it's not surprising, is it, that younger women might be more open to using alternative medicine, but is it also possible that they are the ones who found their diagnosis of breast cancer particularly difficult?
Harold Burstein: It certainly is. There's been a large number of studies that have looked at quality of life amongst breast cancer survivors, and we know that younger women have a more difficult time in the wake of a diagnosis. We also know that younger women, better educated people overall, wealthier families overall, are all more interested in alternative therapies. Our point here is that this is something that doctors and patients should be talking about.
Rae Fry: There's little data on whether alternative therapies work or not. In this study, the women used a wide range of different therapies, from vitamins and massage to spiritual healing and hypnosis. But often they didn't communicate that to their doctor.
Ann Sudano from Melbourne, talking to Brigitte Seega.
Brigitte Seega: When you started using alternative therapies after your surgery, did you actually talk with your doctor about this? Was he aware that you were doing this?
Ann Sudano: I don't know if he was aware. I don't think I ever spoke to him about it. I mean I told him that I was vegetarian and what I was doing and I just ran it past him that these were things that I felt that would help, and he just agreed, he didn't really enter into discussion about it.
Brigitte Seega: Were you made aware of counselling services, support services for women with breast cancer?
Ann Sudano: I don't remember being, no. He might have done. I mean, at that point of course I was distraught. Nobody from any sort of support group rang me and talked about it, nothing like that happened.
Brigitte Seega: And you're healthy, you're well, everything's going fine?
Ann Sudano: Absolutely, yes. I'm working part-time. I must admit I'm finding that a bit tiring, and I think that's probably the residual from the radiotherapy, that my energy levels never really quite got back.
Brigitte Seega: When did you have your last radiotherapy?
Ann Sudano: Well, it's three years ago. It's not the same as it was, and I'm healthier in terms of what I eat, and exercise, and I'm lighter, you know I lost huge amounts of weight. Except that I get tired.
Brigitte Seega: So you changed your diet radically by the sounds of it.
Ann Sudano: Oh yes, completely.
Harold Burstein: Our study doesn't tell us if alternative medicines help or hurt, or are simply neutral in terms of how patients feel. As I said, we view these perhaps as a marker for an association with women who are having a harder time in the wake of their diagnosis, something that clinicians and patients can start to talk about more fully.
The good news is that everyone gets better over time. By one year, most patients are telling us that they are feeling a lot better than they were in the near term after their diagnosis. So that's very reassuring.
We found that women who had started to use alternative medicine still had quality of life scores that lagged behind their compatriots who did not use alternative therapy.
Rae Fry: Do you think it's important for conventional medicine to be dealing with the problems that it seems people are turning to alternative medicine to deal with? Do you think there's a gap in the conventional medicine treatment that people are looking to fill?
Harold Burstein: I think there may be, and as oncologists, as cancer specialists, many of us really like to pride ourselves on taking care of the whole patient, not just treating the tumour, but really treating the whole patient, dealing with their entire experience of illness. So to that extent, I think it really does give us a challenge to do better, a challenge to find out more about what the patient's experience of illness is like, how the woman is doing, and in what ways we might be able to help her get through this.
Natasha Mitchell: Dr Harold Burstein, from the Dana-Farber Cancer Institute and Harvard Medical School. That report prepared by Rae Fry and Brigitte Seega.
Harold J. Burstein, Shari Gelber, Edward Guadagnoli, and Jane C. Weeks, 'Use of alternative medicine by women with early-stage breast cancer', The New England Journal of Medicine, Vol.340 No.22, June 3, 1999, pp 1733-1739
'Complementary medicine - where lies its appeal?' Editorial, Medical Journal of Australia March 15, 1999, Vol 170, pp 2347-248
Guests on this program:
Dr. Harold Burstein
Dana-Farber Cancer Institute,
Harvard Medical School,
Presenter: Natasha Mitchell
Producer: Brigitte Seega
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