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Study Abstracts: Pine Street 10 Year Survival Studies

For patients with lung or colon cancer, does adding complementary and alternative medical (CAM) therapy to standard treatment extend survival? We analyzed more than 10 years of follow-up data from the Pine Street Clinic for patients who used CAM therapy and compared their outcomes to a control group of matched controls from the California Cancer Registry. In two papers published this autumn in Integrative Cancer Therapies, one of the most important peer-reviewed journals in this field, we found that patients who took an integrative approach had significantly improved survival when compared to those patients who only had standard treatment.

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Lung Cancer Survival With Herbal Medicine & Vitamins In A Whole-Systems Approach: 10-Year Follow-Up Data Analyzed With Marginal Structural Models and Propensity Score Methods

McCulloch MF, Broffman M, van der Laan M, Hubbard A, Kushi L, Kramer A, Gao J, Colford JM: Lung Cancer Survival With Herbal Medicine & Vitamins In A Whole-Systems Approach: 10-Year Follow-Up Data Analyzed With Marginal Structural Models and Propensity Score Methods. 2011. [Epub ahead of print, PMID 21964510] Integrative Cancer Therapies.

PubMed link: http://www.ncbi.nlm.nih.gov/pubmed/21824893

Abstract: Complementary and alternative medicines are used by up to 48% of lung cancer patients but have seen little formal assessment of survival efficacy. In this 10-year retrospective survival study, the authors investigated Pan-Asian medicine + vitamins (PAM+V) therapy in a consecutive case series of all non-small-cell lung cancer patients (n = 239) presenting at a San Francisco Bay Area Chinese medicine center (Pine Street Clinic). They compared short-term treatment lasting the duration of chemotherapy/radiotherapy with long-term therapy continuing beyond conventional therapy. They also compared PAM+V plus conventional therapy with conventional therapy alone, using concurrent controls from the Kaiser Permanente Northern California and California Cancer Registries. They adjusted for confounding with Kaplan-Meier, Cox regression, and newer methods – propensity score and marginal structural models (MSMs), which when analyzing data from observational studies or clinical practice records can provide results comparable with randomized trials. Long-term use of PAM+V beyond completion of chemotherapy reduced stage IIIB deaths by 83% and stage IV by 72% compared with short-term use only for the duration of chemotherapy. Long-term PAM+V combined with conventional therapy reduced stage IIIA deaths by 46%, stage IIIB by 62%, and stage IV by 69% compared with conventional therapy alone. Survival rates for stage IV patients treated with PAM+V were 82% at 1 year, 68% at 2 years, and 14% at 5 years. PAM+V combined with conventional therapy improved survival in stages IIIA, IIIB, and IV, compared with conventional therapy alone. Prospective trials using PAM+V with conventional therapy for lung cancer patients are justified.

Colon Cancer Survival With Herbal Medicine & Vitamins In A Whole-Systems Approach: 10-Year Follow-Up Data Analyzed With Marginal Structural Models And Propensity Score Methods

McCulloch MF, Broffman M, van der Laan M, Hubbard A, Kushi L, Abrams DI, Gao J, Colford JM: Colon Cancer Survival With Herbal Medicine & Vitamins In A Whole-Systems Approach: 10-Year Follow-Up Data Analyzed With Marginal Structural Models And Propensity Score Methods. 2011. Sep 30. [Epub ahead of print, PMID 21964510] Integrative Cancer Therapies.

PubMed link: http://www.ncbi.nlm.nih.gov/pubmed/21964510

Abstract: Although localized colon cancer is often successfully treated with surgery, advanced disease requires aggressive systemic therapy that has lower effectiveness. Approximately 30% to 75% of patients with colon cancer use complementary and alternative medicine (CAM), but there is limited formal evidence of survival efficacy. In a consecutive case series with 10-year follow-up of all colon cancer patients (n = 193) presenting at a San Francisco Bay-Area center for Chinese medicine (Pine Street Clinic, San Anselmo, CA), the authors compared survival in patients choosing short-term treatment lasting the duration of chemotherapy/radiotherapy with those continuing long-term. To put these data into the context of treatment responses seen in conventional medical practice, they also compared survival with Pan-Asian medicine + vitamins (PAM+V) with that of concurrent external controls from Kaiser Permanente Northern California and California Cancer Registries. Kaplan-Meier, traditional Cox regression, and more modern methods were used for causal inference-namely, propensity score and marginal structural models (MSMs), which have not been used before in studies of cancer survival and Chinese herbal medicine. PAM+V combined with conventional therapy, compared with conventional therapy alone, reduced the risk of death in stage I by 95%, stage II by 64%, stage III by 29%, and stage IV by 75%. There was no significant difference between short-term and long-term PAM+V. Combining PAM+V with conventional therapy improved survival, compared with conventional therapy alone, suggesting that prospective trials combining PAM+V with conventional therapy are justified.

 

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