title: Lung cancer survival with herbal medicine and vitamins in a whole-systems approach: ten-year follow-up data analyzed with marginal structural models and propensity score methods.
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.
authors.affiliation: Pine Street Foundation, San Anselmo, CA, USA. mcculloch@pinestreetfoundation.org
authors.forename: Michael
authors.initials: M
authors.lastname: McCulloch
authors.forename: Michael
authors.initials: M
authors.lastname: Broffman
authors.forename: Mark
authors.initials: M
authors.lastname: van der Laan
authors.forename: Alan
authors.initials: A
authors.lastname: Hubbard
authors.forename: Lawrence
authors.initials: L
authors.lastname: Kushi
authors.forename: Alan
authors.initials: A
authors.lastname: Kramer
authors.forename: Jin
authors.initials: J
authors.lastname: Gao
authors.forename: John M
authors.initials: JM
authors.lastname: Colford
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D004365:Drugs, Chinese Herbal / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D029001:Herbal Medicine / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008516:Medicine, Chinese Traditional / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D014815:Vitamins / Q000008:administration & dosage*
chemical_list: D004365:Drugs, Chinese Herbal; D014815:Vitamins