publication date: Nov. 2, 2018

Clinical Roundup

Survey shows 4 in 10 Americans believe alternative therapies can cure cancer

Nearly four in 10 Americans believe cancer can be cured solely through alternative therapies, according to the American Society of Clinical Oncology’s second annual National Cancer Opinion Survey.

This is despite research showing that patients who use alternative therapies instead of standard cancer treatments have much higher mortality rates. The survey also found that amid the ongoing opioid crisis, nearly three in four Americans are opposed to limiting access to opioids for people with cancer, and many cancer patients report difficulty obtaining these medications.

In addition, just as many Americans say they are worried about the financial impact of a cancer diagnosis as about dying of cancer, with caregivers and rural Americans bearing the weight of cancer’s financial and access challenges. The National Cancer Opinion Survey is a large, nationally representative survey conducted online by The Harris Poll.

The national survey, commissioned by ASCO, was conducted online by The Harris Poll from July 10 – August 10, 2018 among 4,887 U.S. adults ages 18 and older. Of these adults, 1,001 have or had cancer.

Nearly four in 10 Americans (39%) believe cancer can be cured solely through alternative therapies such as enzyme and oxygen therapy, diet, vitamins, and minerals. However, according to a recent study published in the Journal of the National Cancer Institute, patients with common cancers who chose to treat them using only alternative medicine had a 2.5 times higher mortality rate than patients who received standard cancer treatments such as surgery, radiation, chemotherapy, immunotherapy, and hormone-based therapies.

Even many of those with direct cancer experience—people who have or had cancer and family caregivers—believe cancer can be cured solely through alternative medicine (22% and 38% respectively). The survey also found that younger people—47% of people ages 18-37 and 44% of people ages 38-53—are the most likely to hold these views.

“There’s no question that evidence-based cancer therapy is necessary to effectively treat the disease,” said ASCO Chief Medical Officer Richard Schilsky. “The vast majority of alternative therapies either haven’t been rigorously studied or haven’t been found to benefit patients. When patients are making critical decisions about which cancer treatments to undergo, it is always best to follow the evidence from well-designed research studies.”

If faced with a cancer diagnosis, 57% of Americans say they would be most concerned about either the financial impact on their families or about paying for treatment, compared to 54%, each, who say they would be most concerned about dying or about cancer-related pain and suffering.

Even more than patients, family caregivers bear the brunt of the high cost of cancer treatment:

Among caregivers responsible for paying for cancer care, nearly three in four (74%) say they’re concerned about affording it.

More than six in 10 caregivers (61%) say they or another relative have taken an extreme step to help pay for their loved one’s care, including dipping into savings accounts (35%), working extra hours (23%), taking an early withdrawal from a retirement account or college fund (14), postponing retirement (14%), taking out a second mortgage or other type of loan (13%), taking on an additional job (13%), or selling family heirlooms (9%).

Four in 10 rural Americans who have or had cancer (40%) say there aren’t enough doctors specializing in cancer care near their home, compared to 22% of urban and suburban patients.

Rural patients typically spend 50 minutes traveling one way to see their cancer doctor, versus 30 minutes for non-rural patients.

Most Americans believe that cancer patients should not have their access to opioids curtailed amid efforts to curb the opioid epidemic: 73% say any new rules and regulations that make prescription opioids harder to obtain should not apply to cancer patients.

Yet, the survey shows that accessing opioids for cancer pain is already difficult for many people with cancer. In a small sample, 40% of cancer patients who have used opioids in the past 12 months to manage pain or other symptoms have had trouble accessing them.

According to the survey, the vast majority of Americans (83%) support the use of medical marijuana among people with cancer. However, 48% of a small sample of patients who have used medical marijuana in the past 12 months say they have had difficulty obtaining it. In addition, 58% of people who have or had cancer say they wish more information were available about the benefits of medical marijuana for symptom relief.

Regardless of political affiliation, Americans want the U.S. government to take action in several key areas, including lowering the cost of prescription drugs. For example:

  • 88% say Medicare should be allowed to directly negotiate prescription drug prices with drug makers.

  • 86% say the government should regulate the price of cancer drugs to help lower their cost.

  • 77% say it should be legal for U.S. residents to buy cancer drugs from pharmacies in other countries.

In addition, Americans are calling for greater investment in cancer research, screenings and care, even if it means higher taxes or adding to the deficit:

  • Two in three Americans (67%) say the government should spend more money to develop cancer treatments and cures.

  • Over half of Americans (58%) think the government should spend more money to help Americans afford cancer screenings and care.

Still, the overwhelming majority of cancer patients are happy with the cancer care they have received: nearly 9 in 10 people with cancer believe they are receiving/have received the best possible cancer care (89%) and are satisfied with the quality of the doctors who specialize in cancer care near where they live (88%).

The  survey was conducted online in the U.S. by The Harris Poll on behalf of ASCO between July 10 – August 10, 2018 among 4,038 U.S. adults ages 18+, including 152 people who have or had cancer. An oversample of 849 adults with cancer was added to have a large enough sample size to draw conclusions about the population of people with cancer, bringing the total number of adults with cancer surveyed to 1,001.

Figures for age, sex, race/ethnicity, education, region, household income, household size, employment status and marital status were weighted where necessary to bring them into line with their actual proportions in the population. Propensity score weighting was also used to adjust for respondents’ propensity to be online. The adults with cancer were weighted separately, as needed, using population distributions from the CDC’s NHIS for those diagnosed with cancer, using the same demographic variables as above.

 

Study identifies factors for reducing risk of immunosuppression, fever in people treated with chemotherapy

Research in the October 2018 issue of JNCCN—Journal of the National Comprehensive Cancer Network–identifies risk factors for chemotherapy-induced febrile neutropenia.

The researchers studied 15,971 patients who were diagnosed with non-Hodgkin lymphoma, breast, lung, colorectal, ovarian, or gastric cancer and treated with myelosuppressive chemotherapy[1] at Kaiser Permanente Southern California between the years 2000 and 2009. Of those, 4.3% developed FN in the first chemotherapy cycle.

The study’s authors found that longer term use and more recent use of corticosteroids appeared to increase the risk of FN the most, leading to three and two times the risk, respectively. Certain dermatologic and mucosal conditions (including gastritis, dermatitis, and psoriasis), as well as the use of intravenous antibiotics prior to chemotherapy were also associated with higher risk of FN during the first chemotherapy cycle.

The research team was surprised to find a lack of association between prior or concurrent radiation therapy and FN, since radiation has been linked to bone marrow suppression.

However, they did not account for radiation field or dose, and believe more comprehensive evaluation is needed. They also found no clear association between oral antibiotic use and FN risk.

The results suggest IV antibiotics may have a more profound impact on the balance of bacterial flora and other immune functions, though it is also possible that patients who received antibiotics intravenously rather than orally were generally sicker and more prone to severe infection.

The study was led by Chun Rebecca Chao of the Kaiser Permanente Southern California Department of Research & Evaluation, with the intention of learning how to reduce the number of patients who experience this serious and life-threatening side effect in the future.

Copyright (c) 2018 The Cancer Letter Inc.