title: Colon cancer survival with herbal medicine and vitamins combined with standard therapy in a whole-systems approach: ten-year follow-up data analyzed with marginal structural models and propensity score methods.
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.
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: Donald I
authors.initials: DI
authors.lastname: Abrams
authors.forename: Jin
authors.initials: J
authors.lastname: Gao
authors.forename: John M
authors.initials: JM
authors.lastname: Colford
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000188:drug therapy / Q000628:therapy*; D003131:Combined Modality Therapy; D004032:Diet; D004365:Drugs, Chinese Herbal / Q000008:administration & dosage*; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D029001:Herbal Medicine / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; 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; D014815:Vitamins / Q000008:administration & dosage*
chemical_list: D004365:Drugs, Chinese Herbal; D014815:Vitamins