EVIDENCE-BASED (SCIENTIFICALLY TESTED) TREATMENTS ARE SUPERIOR TO ANECDOTALLY BASED (ALTERNATIVE) APPROACHES
Max J. Coppes, Southern Alberta Children’s Cancer Program, Alberta Children’s Hospital and Tom Baker Cancer Center, Calgary, Alberta, Canada.
Introduction
Improving cure rates is the most important goal of pediatric oncologists. We therefore marvel at the considerable improvements in life expectancy for children diagnosed with cancer achieved over the past three decades. This can largely be attributed to the use of multicenter therapeutic clinical trials.
Clinical Trials A clinical trial is an experiment that attempts to answer a medical question, most often about the effect of a therapeutic intervention on disease outcome. Traditionally, we distinguish three types of trials. Phase I studies investigate the toxicities associated with a particular agent and determine the maximum tolerated dose, while a phase II trial estimates the activity of new agents against individual tumor types. Finally, the exact place of new agents in our armamentarium of standard treatments is assessed in phase III studies. The use of clinical trials has allowed systematic advances to standard approaches. Many of the individual advances have been modest, but together they have resulted in dramatic improvements.
Alternative medicine Alternative therapies challenge scientifically based approaches to improving outcome and decreasing morbidity. While the term refers to a remarkably heterogeneous group of practices, what most sets alternative medicine apart, is that the approaches have not been scientifically tested as outlined above. Certain treatments used in conventional medicine have not been rigorously tested either, but the medical community generally acknowledges that this is a failing that needs to be remedied. By contrast, many advocates of alternative medicine believe the scientific methods outlined for testing are simply not applicable to their remedies. Instead, they rely on anecdotes and theories. Under certain conditions alternative therapies may have beneficial effects, for example the feeling of being in control or the feeling of hope. Some studies suggest that these effects can improve the quality of life of patients, a valid end-point of therapy. However, alternative therapies have not been shown to significantly improve outcome for children with cancer.
Conclusion Since the consistent use of evidence-based therapies has resulted in significant gains in outcome for childhood cancer, alternative therapies aimed at improving survival or decreasing morbidity should be scientifically tested prior to widespread use. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. Parents and children have the right to expect solid evidence of efficacy when selecting a treatment.