How do you counsel young and educated patients with non-metastatic breast cancer who choose non-proven "natural" treatments over standard therapy?

It is extremely difficult to persuade individuals skeptical of medicine to make evidence-based decisions. Most research related to changing scientific beliefs come from literature related to antivaccination attitudes. Previous research has suggested that provaccine messages about safety (messages countering any autism link) have failed to improve attitudes about vaccination and may even result in further strengthening of an individual’s antivaccine beliefs (backfire effect) [1, 2]. However, recent research suggests that an emphasis on the dangers of not vaccinating (messages about risk of disease) can improve antivaccine attitudes and may change behavior [3]. Based on this evidence, an informed discussion with breast cancer patients incli...

Patients have autonomy to make their own choices, of course, so I put my efforts into patient education so that they can make informed decisions.

To educate, I need to know what the patient's understanding of the disease is and her motivations for choosing one treatment strategy or another. For example, if a patient is staunchly opposed to chemotherapy, I ask her to tell me about her prior experiences with chemo. Maybe a friend of hers had chemotherapy 20 years ago before we had many of our current supportive care medications, and she's worried about being nauseated or having to live in the hospital for chemo.

There are common misunderstandings to address as well, so I also discuss these. For ER+HER2- breast cancer, she may not realize th...

As someone who has watched patients die due to their choice of “natural” treatment, the one major piece of advice I can give you is that belief in these products will often approach that of a religious conviction.

As a result, one must be cautious in criticizing their decision. The best option, when possible is to try to get them to agree to standard treatment in conjunction with the “natural” one.

However, some naturopaths will put in great effort to dissuade them from doing that, and if that’s what they choose to do, you must accept that is their right.

A strong condemnation on your part will only serve to convince them that the naturopath is the way to go, because they’ll have predicted your response.

I agree with the excellent responses above. I believe the first and foremost thing is to be non-judgemental, I often say "I don't know enough about alternative medicine but given my expertise in evidence-based anti-cancer treatments, I would recommend such and such treatment".

I do discuss the paper from Johnson et al., PMID 28922780.

I often let the patient continue their alternative treatments in conjunction with evidence-based cancer therapy as long as interactions are acceptable. In select cases, I also involve our pharmacist.

These are tough discussions, but I generally present them with data that shows what happens when we do no treatment (believe it or not this data includes 250 cases from 1805-1933), surgery versus nothing, and this paper that compares CAM with treatment/no treatment, all for breast cancer.

I agree with above that promoting an inclusive approach will be more successful at getting them to accept treatment. I also go through all patient supplements to assess for any preclinical data for energy/toxicity/interaction with treatment. Many are harmless and some are culturally important for patients to include with their treatment, so it is important to have an understanding as to why they are using some of these herbs/supplements in the first place...

This is very common and I try to be as clear as possible and unambiguous. Sometimes patients ask because they are told about these alternatives by a relative or a friend and they really want to get expert advice from their oncologist. Other times, they are more inclined to go that route and want to avoid approved appropriate therapy. I tell patients that there is no benefit and that there could be harm, both from drug interactions, liver dysfunction, or false hope. It helps to not be hesitant or spend too much time on this because patients could interpret this as equivocal. Sometimes, it is not so easy.