Oregon Health & Science University, Portland, OR, USA.
Ann Surg Oncol. 2011 Apr;18(4):912-6. doi: 10.1245/s10434-010-1487-0. Epub 2011 Jan 12.
The use of complementary and alternative medicine (CAM) has escalated over the past decade, despite the fact that clinical studies validating the efficacy of CAM remain sparse. Clinicians frequently encounter patients who reject standard treatment, but data on outcomes of patients choosing CAM as primary treatment for breast cancer are also lacking.
Breast cancer patients who refused/delayed standard treatments in favor of alternative therapies were identified in a community surgical practice over a 10-year period. A retrospective chart review was performed with telephone interviews when possible. Estimated 10-year survival given recommended treatment was calculated.
A total of 61 patients was identified; median age was 53. Median follow-up was 54 months. Patients were stratified into 2 subgroups: those who omitted/delayed surgery (SSG, n = 26) and those who were nonadherent to adjuvant therapy recommendations (ASG, n = 35). In the SSG, 96.2% experienced disease progression; 50% died of disease. Mean stage at initial presentation was II; mean stage at re-presentation after primary treatment with alternative therapies was IV. Disease progression occurred in 86.2% of those in the ASG; 20% died of disease. The mean 10-year survival calculated for those omitting surgery was 69.5%; observed survival for this group was 36.4% at a median follow-up of 33 months.
Alternative therapies used as primary treatment for breast cancer are associated with disease progression and increased risk of recurrence and death. Diminished outcomes are more profound in those delaying/omitting surgery. Reviewing these results with our patients may help bridge the gap between CAM and standard treatments.
尽管验证补充和替代医学（CAM）疗效的临床研究仍然很少，但在过去十年中，CAM 的使用呈上升趋势。临床医生经常遇到拒绝标准治疗的患者，但选择 CAM 作为乳腺癌主要治疗方法的患者的结局数据也同样缺乏。
在一个社区外科实践中，我们在过去 10 年中确定了拒绝/延迟标准治疗而选择替代疗法的乳腺癌患者。对可能的患者进行了回顾性图表审查和电话访谈。根据推荐的治疗方法计算了估计的 10 年生存率。
共确定了 61 例患者；中位年龄为 53 岁。中位随访时间为 54 个月。患者分为 2 个亚组：手术遗漏/延迟组（SSG，n=26）和辅助治疗建议不依从组（ASG，n=35）。在 SSG 中，96.2%的患者出现疾病进展；50%的患者死于疾病。初始表现的平均分期为 II 期；在接受替代疗法的原发性治疗后再次表现的平均分期为 IV 期。ASG 中 86.2%的患者出现疾病进展；20%的患者死于疾病。不手术组的 10 年生存率为 69.5%；在中位随访 33 个月时，该组的观察生存率为 36.4%。
作为乳腺癌主要治疗方法的替代疗法与疾病进展以及复发和死亡风险增加相关。手术延迟/遗漏的患者预后更差。与我们的患者一起审查这些结果可能有助于弥合 CAM 与标准治疗之间的差距。
