title: 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.
authors.affiliation: Block Center for Integrative Cancer Treatment, Evanston, Illinois 60201, USA. drblock@blockmedical.com
authors.forename: Keith I
authors.initials: KI
authors.lastname: Block
authors.forename: Charlotte
authors.initials: C
authors.lastname: Gyllenhaal
authors.forename: Debu
authors.initials: D
authors.lastname: Tripathy
authors.forename: Sally
authors.initials: S
authors.lastname: Freels
authors.forename: Mark N
authors.initials: MN
authors.lastname: Mead
authors.forename: Penny B
authors.initials: PB
authors.lastname: Block
authors.forename: William C
authors.initials: WC
authors.lastname: Steinmann
authors.forename: Robert A
authors.initials: RA
authors.lastname: Newman
authors.forename: Jacob
authors.initials: J
authors.lastname: Shoham
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000473:pathology; D009367:Neoplasm Staging; D015596:Nutrition Assessment; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents