Survival Impact of Integrative Cancer Care in Advanced Metastatic Breast Cancer

Abstract

Integrative cancer treatment is of substantial interest to many cancer patients. Research is needed to evaluate the effects of integrative treatment on patient outcomes. We report survival data for a consecutive case series of advanced metastatic breast cancer patients who received a comprehensive clinical program combining conventional treatments with nutrition and supplementation, fitness and mind-spirit instruction at the Block Center for Integrative Cancer Treatment. Treatment outcomes using integrative care for this disease have not previously been documented; survival data will thus contribute to decisions concerning future research directions and design. Ninety consecutive patients with metastatic breast cancer diagnosed during 1984-1997 who received chemotherapy at the integrative cancer center were included. Prognostic factors, treatments and survival from onset of metastases were determined from analysis of scans, labs, pathology and medical records. The log-rank test and Cox proportional hazards analyses were used, and a Kaplan-Meier curve was calculated. All patients had metastatic disease at baseline, 96% were relapsed and 52% had received prior chemotherapy for metastatic disease. Median age at onset of metastasis was 46 years. Median survival was 38 months (95% CI 27,48). Published literature on populations with somewhat more favorable prognostic factors treated in conventional clinics showed median survivals of 20 to 23 months. Through the 1990s, median survival reported in metastatic breast cancer trials or observations generally ranged from 12 to 24 months. Five-year survival was 27% for Center versus 17% for comparison patients. Despite a higher proportion of younger and relapsed patients, survival of metastatic breast cancer patients at the Center was approximately double that of comparison populations and possibly even higher compared to trials published during this period. Explanations for the advantage relative to conventional treatment alone may include the nutritional, nutraceutical, exercise and psychosocial interventions, individually or in combination; self-selection of patients cannot be ruled out. Further research to evaluate the impact of integrative breast cancer treatment on survival is warranted.

Submental lymph node metastasis from invasive ductal breast carcinoma

“…Further, expectations of treatment, both in terms of efficacy and of toxicity, vary greatly based upon the specific treatment, patient characteristics, and tumour characteristics [22,23]. Thus, the goals of treatment for patients with metastatic breast cancer are influenced by estimates of prognoses as well as a balance between physician and patient preferences regarding efficacy and toxicity considerations [22][23][24].…”

“…Traditionally, objective measures of response and survival have been the targeted end points in clinical trial design and in physician selection of therapy for metastatic breast cancer [22,23]. More recently, issues on quality of life have surfaced as important end points, especially from the perspective of the patient [22,23]. The decision-making process in selecting the optimal treatment for patients with metastatic breast cancer is therefore, a multidimensional process involving subjective as well as objective goals of the treatment [22][23][24].…”

“…More recently, issues on quality of life have surfaced as important end points, especially from the perspective of the patient [22,23]. The decision-making process in selecting the optimal treatment for patients with metastatic breast cancer is therefore, a multidimensional process involving subjective as well as objective goals of the treatment [22][23][24]. Palliative chemotherapy or hormone therapy is the option for metastatic breast cancer depending on hormone receptors [22,23,25].…”

“…Thus, the goals of treatment for patients with metastatic breast cancer are influenced by estimates of prognoses as well as a balance between physician and patient preferences regarding efficacy and toxicity considerations [22][23][24]. Traditionally, objective measures of response and survival have been the targeted end points in clinical trial design and in physician selection of therapy for metastatic breast cancer [22,23].…”

“…For patients with multiple metastases, palliative care is an essential part of treatment [22,23]. A multidisciplinary approach that takes quality of life into consideration is the most appropriate choice for patients with breast carcinoma metastases to the submental region [22][23][24][25][26].…”