Dr Raja Chaganti: When I’m OK with cancer patients exploring alternative therapies

Medical oncologist Dr Raja Chaganti doesn’t like the term alternative therapies, preferring to call them complementary. This is what he thinks about them.

Working in oncology, I am often asked about complementary therapies and how these may enhance standard treatments medical oncologists suggest for malignancy.

I prefer not to use the terms ‘alternative’, ‘Eastern’ or ‘Western’ medicine, as these can come with preconceptions and stigma.

All approaches should be considered treatments, although they will vary in their toxicities and efficacies.

It is natural for people to explore alternatives.

People that I am seeing have usually recently found out they have a terminal illness and are searching for all options to help treat their cancer and the symptoms it causes.

I know that the response to this question can vary among oncologists, but I personally have no issue with patients pursuing complementary treatments, provided these will not interact in a harmful way with other treatments they are on.

Dr Raja Chaganti does not like to use the term alternative therapies.

However, I cannot say that I routinely recommend any complementary therapies.

The reason for this is simple: data.

Many of these treatments do not have enough evidence behind them to allow me to recommend them to everyone.

For me to recommend any treatment to a patient, it must have shown

1. That it can be administered safely

2. That it has benefit

3. That the above have been shown in a range of demographics to allow it to be applicable to a broad and diverse population

These three principles are the foundation of modern clinical trials.

New treatments progress through Phase 1 trials (focusing on drug dosing, safety and tolerance), then Phase 2 trials can start to show whether the treatment provides benefit, but often in only a small group of people.

Finally Phase 3 trials test the treatment in larger numbers of people (hopefully of diverse backgrounds, sexes and ages) and compare it to the current standard of care.

Many complementary therapies do not have this evidence behind them, making them difficult to recommend broadly.

This does not however mean they do not work or are not worthy of consideration.

It simply means they have not been studied in the same way.

There may be many reasons for this – for example traditional practices of course do not undergo the modern Western approach to development of treatments.

Another major cause is financial.

Dr Raja Chaganti with his wife Dr Kavya Chaganti and their two children.

Drug development is an expensive process.

Pharmaceutical companies spend many millions of dollars in developing and testing a drug, and as such have a clear interest in creating a trial where their drug is shown to be effective. They have the resources to run these large, multi-centre, multinational trials.

This is a level of financial backing that most complementary medicine practitioners do not have.

Unfortunately, there are many examples within oncology of new drugs being approved despite showing only marginal (and possibly not clinically meaningful) benefit.

Thus, as medical practitioners, we are trained to critically analyse studies and consider possible bias.

There are many other reasons that complementary treatments may not have standard evidence behind them, and I acknowledge that this may not be due to lack of efficacy.

However, when it comes to what I can and should recommend to the patient in front of me, who has placed their trust in me to suggest treatments that will be effective in improving their quality and quantity of life, I would be doing them a disservice to suggest treatments that do not have high levels of reproducible and documented evidence.

Unfortunately having evidence does not necessarily translate into benefit for all, but I will continue to recommend treatments I believe have the greatest chance of success, to avoid wasting one of the most precious resources cancer patients have – time.

I have no objection to patients pursuing complementary therapies if they wish.

There is no reason we should continue to view complementary treatments as foreign and take an ‘us versus them’ approach to discussing them.

We are all on the same team, so we should work together to get the best possible holistic outcome for the person in front of us.

Dr Raja Chaganti is a medical oncologist, while his wife Dr Kavya Chaganti is a GP-obstetrician. They are also parents who are based in Sydney and have the popular Instagram @twoaussiedoctors.