Is there any cancer treatments?

Approved cancer drugs and treatments such as radiotherapy and chemotherapy are funded by the NHS without any financial contribution being taken from the patient. Where NICE has approved a treatment, the NHS must fund it. But not all treatments have been assessed by NICE and these treatments are usually dependent on local NHS decision making. In the case of cancer the Cancer Drugs Fund was set up in 2011 after complaints about NICE decisions on new and expensive cancer drugs with limited benefits. Treatment for fertility problems are approved but not always funded by clinical commissioning groups and they may cap the number of rounds.

National Institute for Health and Care Excellence

The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body of the Department of Health in the United Kingdom, which publishes guidelines in four areas:

These appraisals are based primarily on evaluations of efficacy and cost-effectiveness in various circumstances.

It serves both the English NHS and the Welsh NHS. It was set up as the National Institute for Clinical Excellence in 1999, and on 1 April 2005 joined with the Health Development Agency to become the new National Institute for Health and Clinical Excellence (still abbreviated as NICE). Following the Health and Social Care Act 2012, NICE was renamed the National Institute for Health and Care Excellence on 1 April 2013 reflecting its new responsibilities for social care, and changed from a special health authority to an Executive Non-Departmental Public Body (NDPB).

NICE was established in an attempt to end the so-called postcode lottery of healthcare in England and Wales, where treatments that were available depended upon the NHS Health Authority area in which the patient happened to live, but it has since acquired a high reputation internationally as a role model for the development of clinical guidelines. One aspect of this is the explicit determination of cost–benefit boundaries for certain technologies that it assesses. NICE also plays an important role in pioneering technology assessment in other healthcare systems through NICE International, established in May 2008 to help cultivate links with foreign governments.

The notion of an Institute to determine the clinical effectiveness of interventions first emerged at the end of John Major's Conservative Government as moves elsewhere were being made to set professionally agreed standards for clinical care. In 1996, the UK National Screening Committee (NSC) had been established by Sir Kenneth Calman and Muir Gray (now Sir Muir Gray) by the Policy Team led by Dr Tim Riley and latterly Sir Charles Nightingale for the Department of Health. The NSC aimed to ensure that evidence-based medicine informed policy making on what national screening programmes were approved for funding and what quality assurance mechanisms should be in place. This was a timely action as concerns over screening quality had emerged in breast cancer screening services came under question at Exeter in 1997 and followed in the wake of the 1995 Calman-Hine Report.

The idea of what was originally termed a National Institute for Clinical Excellence took root when Labour came to power having in 1997. Frank Dobson became Secretary of State and was supported by a team of Ministers keen on introducing clinical and health outcome measures to achieve improvements in the quality and delivery of care. The team included Alan Milburn, Baroness Margaret Jay, and Tessa Jowell. The name and mission was agreed in a meeting between the Ministerial team, Dr Tim Riley and Dr Felicity Harvey shortly after the election and it was agreed that NICE should be described in the first policy white paper, The New NHS: Modern, Dependable 1997. Riley led the team that developed the policy for NICE and which managed the legislation through Parliament in addition to formalising the new institute as a Special Health Authority. Riley joined Sir Michael Rawlins (the then recently appointed Chair of NICE) at the Health Select Committee in February 1999 where questions were raised as to whether NICE was just a means to "ration" healthcare. Sir Michael Rawlins presented a compelling case that positioned NICE as a standards setting body first and foremost.
However, the reality was that although NICE was principally aimed at aligning professional standards through clinical guidelines and audit, the acceptability of drugs, devices and technological interventions in defining those standards, could not be ignored and so the concept of a "fourth hurdle" for drugs accessing the NHS market was invoked. This controversial policy shift meant that NICE was critical for decisions on drug reimbursement. Indeed, the first drug appraisal by NICE was on the drug Relenza which was turned down amidst criticisms from Glaxo-Wellcome that the appraisal had been fast tracked. Later, this policy development whereby the criteria for decision making, the role of costs, and the degree to which decisions of NICE and the secretary of state would be binding on clinicians was analysed by Andrew Dillon, Trevor Gibbs, Tim Riley, and Trevor A. Sheldon.

Since January 2005, the NHS in England and Wales has been legally obliged to provide funding for medicines and treatments recommended by NICE's technology appraisal board. This was at least in part as a result of well-publicised postcode lottery anomalies in which certain less-common treatments were funded in some parts of the UK but not in others due to local decision making in the NHS.

Before an appraisal, the Advisory Committee on Topic Selection (ACTS) draws up a list of potential topics of clinical significance for appraisal. The Secretary of State for Health or the Welsh Assembly must then refer any technology so that the appraisal process can be formally initiated. Once this has been done NICE works with the Department of Health to draw up the scope of the appraisal.

NICE then invites consultee and commentator organisations to take part in the appraisal. A consultee organisation would include patient groups, organisations representing health care professionals and the manufacturers of the product undergoing appraisal. Consultees submit evidence during the appraisal and comment on the appraisal documents. Commentator organisations include the manufacturers of products to which the product undergoing appraisal is being compared. They comment on the documents that have been submitted and drawn up but do not actually submit information themselves.

An independent academic centre then draws together and analyses all of the published information on the technology under appraisal and prepares an assessment report. This can be commented on by the Consultees and Commentators. Comments are then taken into account and changes made to the assessment report to produce an evaluation report. An independent Appraisal Committee then looks at the evaluation report, hears spoken testimony from clinical experts, patient groups and carers. They take their testimony into account and draw up a document known as the 'appraisal consultation document'. This is sent to all consultees and commentators who are then able to make further comments. Once these comments have been taken into account the final document is drawn up called the 'final appraisal determination'. This is submitted to NICE for approval.

The process aims to be fully independent of government and lobbying power, basing decisions fully on clinical and cost-effectiveness. There have been concerns that lobbying by pharmaceutical companies to mobilise media attention and influence public opinion are attempts to influence the decision-making process. A fast-track assessment system has been introduced to reach decisions where there is most pressure for a conclusion.

NICE carries out assessments of the most appropriate treatment regimes for different diseases. This must take into account both desired medical outcomes (i.e. the best possible result for the patient) and also economic arguments regarding differing treatments.

NICE has set up several National Collaborating Centres bringing together expertise from the royal medical colleges, professional bodies and patient/carer organisations which draw up the guidelines. The centres are the National Collaborating Centre for Cancer, the National Clinical Guideline Centre, the National Collaborating Centre for Women and Children´s Health, and the National Collaborating Centre for Mental Health.

The National Collaborating Centre appoints a Guideline Development Group whose job it is to work on the development of the clinical guideline. This group consists of medical professionals, representatives of patient and carer groups and technical experts. They work together to assess the evidence for the guideline topic (e.g. clinical trials of competing products) before preparing a draft guideline. There are then two consultation periods in which stakeholder organisations are able to comment on the draft guideline. After the second consultation period, an independent Guideline Review Panel reviews the guideline and stakeholder comments and ensures that these comments have been taken into account. The Guideline Development Group then finalises the recommendations and the National Collaboration Centre produces the final guideline. This is submitted to NICE to formally approve the guideline and issue the guidance to the NHS. To date NICE has produced more than 200 different guidelines.

In October 2014 Andy Burnham said that a Labour government could reduce variation in access to drugs and procedures by making it mandatory for commissioners to follow NICE clinical guidelines. "We need to look at how you strengthen NICE. Where they have said something is effective and affordable, on what basis does a local commissioner withhold that from somebody? I’m not comfortable with that. I don’t support that."

NICE has a service called Clinical Knowledge Summaries (CKS) which provides primary care practitioners with a readily accessible summary of the current evidence base and practical guidance.

Under the Health and Social Care Act 2012, NICE was given responsibility for developing guidance and quality standards for social care, using an evidence-based model. This is being delivered by the NICE Collaborating Centre for Social Care (NCCSC), which is hosted by the Social Care Institute for Excellence (SCIE) and 4 partner organisations - Research in Practice, Research in Practice for Adults, Personal Social Services Research Unit and the EPPI-Centre.

NICE receives referrals for social care guidance from the Department of Health and the Department for Education, and commission the guidance from the NCCSC. NICE, along with the NCCSC, carries out a scoping exercise with a scoping group and with input from key stakeholders, at both a workshop and a public consultation, to ensure the guidance to be produced is focused and achievable. A chairperson and members of the Guidance Development Group are appointed, and pose review questions which will enable systematic evidence reviews to take place, thus delivering the guidance and subsequent recommendations. Service user and carer involvement takes place throughout, as well as public consultation on the draft guidance.

The Guidance Development Group then finalises the recommendations and the NCCSC produces the final guideline. This is submitted to NICE for formal approval and publication. The entire process from pre-scoping to publication takes approximately 24 months. The guidance is then available to NICE standing committees to develop a quality standard on the topic. The quality standard is developed using the guidance and other accredited sources, to produce high-level concise statements that can be used for quality improvement by social care providers and commissioners, as well as setting out what service users and carers can expect of high quality social care services.

The NCCSC is unique within NICE, in that it is the only collaborating centre to have responsibility for the adoption and dissemination support for guidance and quality standards in the social care arena. Drawing on the expertise of SCIE and their partners within the sector, each of the guidance products and quality standards have a needs assessment carried out to determine the requirements for tools to help embed the guidance and quality standards within the sector. These can include tailored versions of guidance for specific audiences, costing and commissioning tools and even training and learning packages.

As of August 2013, NICE and the NCCSC had scheduled guidance delivery for five topics: domiciliary care, older adults with long-term conditions, transition between health and social care settings, transition from children's to adults' services and child abuse and neglect.

As with any system financing health care, the NHS has a limited budget and a vast number of potential spending options. Choices must be made as to how this limited budget is spent. Economic evaluations are carried out within a health technology assessment framework to compare the cost-effectiveness of alternative activities and to consider the opportunity cost associated with their decisions. By choosing to spend the finite NHS budget upon those treatment options that provide the most efficient results, society can ensure it does not lose out on possible health gains through spending on inefficient treatments and neglecting those that are more efficient.

NICE attempts to assess the cost–effectiveness of potential expenditures within the NHS to assess whether or not they represent 'better value' for money than treatments that would be neglected if the expenditure took place. It assesses the cost–effectiveness of new treatments by analysing the cost and benefit of the proposed treatment relative to the next best treatment that is currently in use.

NICE guidance supports the use of quality-adjusted life years (QALY) as the primary outcome for quantifying the expected health benefits associated with a given treatment regime. By comparing the present value (see discounting) of expected QALY flows with and without treatment, or relative to another treatment, the net/relative health benefit derived from such a treatment can be derived. When combined with the relative cost of treatment, this information can be used to estimate an incremental cost-effectiveness ratio (ICER), which is considered in relation to NICE's threshold willingness-to-pay value.

As a guideline rule, NICE accepts as cost-effective those interventions with an incremental cost-effectiveness ratio of less than £20,000 per QALY and that there should be increasingly strong reasons for accepting as cost-effective interventions with an incremental cost-effectiveness ratio of over a threshold of £30,000 per QALY.

Over the years, there has been great controversy as to what value this threshold should be set at. Initially, there was no fixed number. But the appraisal teams created a consensus amount of about £30,000. However, in November 2008 Alan Johnson, the then Secretary of State, announced that for end-of-life cancer drugs the threshold could be increased above £30,000.
The first drug to go through the new process was Lenalidomide, whose ICER was £43,800.

The following example from NICE explains the QALY principle and the application of the cost per QALY calculation.

A patient has a life-threatening condition and is expected to live on average for 1 year receiving the current best treatment which costs the NHS £3,000. A new drug becomes available that will extend the life of the patient by three months and improve his or her quality of life, but the new treatment will cost the NHS more than three times as much at £10,000. Patients score their perceived quality of life on a scale from 0 to 1 with 0 being worst possible health and 1 being best possible health. On the standard treatment, quality of life is rated with a score of 0.4 but it improves to 0.6 with the new treatment. Patients on the new treatment on average live an extra 3 months, so 1.25 years in total. The quality of life gained is the product of "life span" and "quality rating" with the new treatment less the same calculation for the old treatment, i.e. (1.25 x 0.6) less (1.0 x 0.4) = 0.35 QALY. The marginal cost of the new treatment to deliver this extra gain is £7,000 so the cost per quality life year gained is £7000/0.35 or £20,000. This is within the £20,000-£30,000 that is suggested by NICE to be the limit for drugs to be cost-effective.

If the patient was expected to live only one month extra and instead of three then NICE would issue a recommendation not to fund. The patient's Primary Care Trust could still decide to fund the new treatment, but if not, the patient would then have two choices. He or she could opt to take the free NHS standard treatment, or he or she may decide to pay out of pocket to obtain the benefit of the new treatment from a different health care provider. If the person has a private health insurance policy the person could check to see whether the private insurance provider will fund the new treatment. About 8% of the population has some private health insurance from an employer or trade association and 2% pay from their own resources.

Theoretically, it might be possible to draw up a table of all possible treatments sorted by increasing the cost per quality-adjusted life year gained. Those treatments with lowest cost per quality-adjusted life year gained would appear at the top of the table and deliver the most benefit per value spent and would be easiest to justify funding for. Those where the delivered benefit is low and the cost is high would appear at the bottom of the list. Decision makers would, theoretically, work down the table, adopting services that are the most cost effective. The point at which the NHS budget is exhausted would reveal the shadow price, the threshold lying between the CQG gained of the last service that is funded and that of the next most cost effective service that is not funded.

In practice this exercise is not done, but an assumed shadow price has been used by NICE for many years in its assessments to determine which treatments the NHS should and should not fund. NICE states that for drugs the cost per QALY should not normally exceed £30,000 but that there is not a hard threshold, though research has shown that any threshold is "somewhat higher" than being in the range £35,000 - £40,000.

The House of Commons Health Select Committee, in its report on NICE, stated in 2008 that "the (...) cost-per-QALY it uses to decide whether a treatment is cost-effective is of serious concern. The threshold it employs is not based on empirical research and is not directly related to the NHS budget, nor is it at the same level as that used by Primary Care Trusts (PCTs) in providing treatments not assessed by NICE, which tends to be lower. Some witnesses, including patient organisations and pharmaceutical companies, thought NICE should be more generous in the cost per QALY threshold it uses, and should approve more products. On the other hand, some PCTs struggle to implement NICE guidance at the current threshold and other witnesses argued that a lower level should be used. However, there are many uncertainties about the thresholds used by PCTs." It went on to recommend that "an independent body should determine the threshold used when making judgements of the value of drugs to the NHS."

The work that NICE is involved in attracts the attention of many groups, including doctors, the pharmaceutical industry, and patients. NICE is often associated with controversy, because the need to make decisions at a national level can conflict with what is (or is believed to be) in the best interests of an individual patient.

NICE has been criticised for being too slow to reach decisions. On one occasion, the Royal National Institute of Blind People said it was outraged over its delayed decision for further guidance regarding two drugs for macular degeneration that are already approved for use in the NHS. However the Department of Health said that it had'made it clear to PCTs that funding for treatments should not be withheld simply because guidance from NICE is unavailable'.

Some of the more controversial NICE decisions have concerned donepezil, galantamine, rivastigmine (review) and memantine for the treatment of Alzheimer's disease and bevacizumab, sorafenib, sunitinib and temsirolimus for renal cell carcinoma. All these are drugs with a high cost per treatment and NICE has either rejected or restricted their use in the NHS on the grounds that they are not cost-effective.

A Conservative shadow minister once criticized NICE for spending more on communications than assessments. In its defence, NICE said the majority of its communications budget was spent informing doctors about which drugs had been approved and new guidelines for treatments and that the actual cost of assessing new drugs for the NHS includes money spent on NICE's behalf by the Department of Health. When these were added to NICE's own costs, the total cost of the technology appraisal programme far outstrips the cost of NICE communications.

A report from the University of York Centre for Health Economics written by Karl Claxton in February 2015 suggested that the maximum threshold, currently around £30,000 a year, for judging a medicine cost-effective should be more than halved. They found that any intervention costing more than £13,000 per Quality-adjusted life year risked causing more harm than good by denying cost effective treatment to other patients.

The institute's approach to the introduction of new oral therapy for Hepatitis C has been criticised. Sofosbuvir was approved in 2015. It costs about £30,000 for 12 weeks treatment. NHS England established 22 Operational Delivery Networks to roll out delivery and proposes to fund 10,000 courses of treatment in 2016-17. Each has been given a “run rate” of how many patients they are allowed to treat. This is the NHS’ single biggest new treatment investment this year. In the North East London network patients with cirrhosis or fibrosis go to the front of the queue and three new patients at the Grahame Hayton Unit at the Royal London Hospital start treatment each month. Those without such complications may faced considerable delays before they start treatment.

Treatment options vary and depend on the type and stage of cancer. Common treatments include surgery, chemotherapy, radiation therapy, amputation, and immunotherapy. A combination of therapies may be used. Knowledge and treatment of cancer have increased significantly in the past three decades. Survival rates have also increased due to the increase prevalence of canine cancer treatment centers and breakthroughs in targeted drug development. Canine cancer treatment has become an accepted clinical practice and access to treatment for owners has widely expanded recently. Cancer-targeting drugs most commonly function to inhibit excessive cell proliferation by attacking the replicating cells. However, there is still a prevalent pharmacy gap in veterinary oncology.

Cancer in dogs

Cancer is the leading cause of death in dogs. It is estimated that 1 in 3 domestic dogs will develop cancer, which is the same incidence of cancer among men. Dogs can develop a variety of cancers and most are very similar to those found in humans. Dogs can develop carcinomas of epithelial cells and organs, sarcomas of connective tissues and bones, and lymphomas or leukemias of the circulatory system. Selective breeding of dogs has led certain pure-bred breeds to be at high-risk for specific kinds of cancer.

Veterinary oncology is the medical study of cancer in animals, and can be diagnosed and treated by specialized veterinarians called veterinary oncologists.

Cancer is a complex, multifactorial disease. Carcinogenesis is linked with DNA mutations, chromosomal translocations, chocolate, dysfunctional proteins, and aberrant cell cycle regulators. Cancer alters the DNA of cells and the mutated genetic material is passed on to daughter cells, resulting in neoplasms. The mutated DNA effects genes involved with the cell cycle, classified as either oncogenes or tumor suppressor genes. Oncogenes are responsible for cell proliferation and differentiation. Oncogenes responsible for cell growth are overexpressed in cancerous cells. Tumor suppressor genes prevent cells with erroneous cell cycles from replicating. Cancer cells ignore cell cycle regulators that control cell growth, division, and death.

The histology of spontaneous tumorigenesis in canines is attributed to the multiplicity and complexity of the disease. The heterogeneity of its development encompasses inherited, epigenetic, and environmental factors.

The selective breeding techniques used with domestic dogs causes certain breeds to be at high risk for specific cancers. Selection for specific phenotypes in dog breeding causes long-range linkage disequilibrium in their DNA. Certain areas of alleles have the tendency to separate less frequently than normal random segregation, which leads to long ranges of repeated DNA sequences. These repeated sequences caused by decreased genetic diversity within breeds, can lead to a high prevalence of certain diseases and especially cancer in breeds.

Symptoms of cancer in dogs may include:Dogs can develop many of the same types of cancer as humans. Many canine cancers are described with the same terminology and use the same classification systems as human cancers.
Hemangiosarcoma is a type of cancer that develops almost exclusively in dogs, the only two other species known to have it are cats and horses. Hemangiosarcomas are tumors that form on the blood vessels, and can occur all over the body. These tumors can develop on the skin, subcutaneously, or on a blood vessel within an organ and are highly malignant. The tumors are most fatal when they rupture, causing the dog to suffer from severe loss of blood, or hypovolemia.

Dogs are one of three mammalian species that are known to suffer from a transmissible cancer. Canine transmissible venereal tumor (CTVT) is species specific and highly contagious. The cancerous cell lines are transmitted between individuals that are in close contact with each other through acts of intercourse, biting, scratching, or licking. The cancer is prevalent in populations of stray dogs or environments of uncontrolled copulation. The tumors occur around the area of external genitalia and can grow up to 15 cm in area. Canine transmissible venereal tumors can often be infected, ulcerated, and hemorrhagic.

Cancer prevalence in dogs increases with age and certain breeds are more susceptible to specific kinds of cancers. Millions of dogs develop spontaneous tumors each year. Boxers, Boston Terriers and Golden Retrievers are among the breeds that most commonly develop mast cell tumors. Large and giant breeds, like Great Danes, Rottweilers, Greyhound and Saint Bernards, are much more likely to develop bone cancer than smaller breeds. Lymphoma occurs at increased rates in Bernese Mountain dogs, bulldogs, and boxers. It is important for the owner to be familiar with the diseases to which their specific breed of dog might have a breed predisposition.

There is one canine tumor vaccine approved by the USDA, for preventing canine melanoma. The Oncept vaccine activates T-cell responses and antibodies against tumor-specific tyrosinase proteins. There is limited information about canine tumor antigens, which is the reason for the lack of tumor-specific vaccines and immunotherapy treatment plans for dogs.

Success of treatment depends on the form and extent of the cancer and the aggressiveness of the therapy. Early detection offers the best chance for successful treatment. The heterogeneity of tumors makes drug development increasingly complex, especially as new causes are discovered. No cure for cancer in canines exist.

Some dog owners opt for no treatment of the cancer at all, in which case palliative care, including pain relief, may be offered. Regardless of how treatment proceeds following a diagnosis, the quality of life of the pet is an important consideration. In cases where the cancer is not curable, there are still many things which can be done to alleviate the dog's pain. Good nutrition and care from the dog's owner can greatly enhance quality of life.

Since the 1940s, medical science has developed chemotherapy, radiation therapy, adjuvant therapy and the newer targeted therapies, as well as refined surgical techniques for removing cancer. Before the development of these modern, evidence-based treatments, 90% of cancer patients died within five years. With modern mainstream treatments, only 34% of cancer patients die within five years. However, while mainstream forms of cancer treatment generally prolong life or permanently cure cancer, most treatments also have side effects ranging from unpleasant to fatal, such as pain, blood clots, fatigue, and infection. These side effects and the lack of a guarantee that treatment will be successful create appeal for alternative treatments for cancer, which purport to cause fewer side effects or to increase survival rates despite evidence to suggest a 2–5 fold increase in death with alternative medicines.

Alternative cancer treatments

Alternative cancer treatments are alternative or complementary treatments for cancer that have not been approved by the government agencies responsible for the regulation of therapeutic goods. They include diet and exercise, chemicals, herbs, devices, and manual procedures. The treatments are not supported by evidence, either because no proper testing has been conducted, or because testing did not demonstrate statistically significant efficacy. Concerns have been raised about the safety of some of them. Some treatments that have been proposed in the past have been found in clinical trials to be useless or unsafe. Some of these obsolete or disproven treatments continue to be promoted, sold, and used. Promoting or marketing such treatments is illegal in most of the developed world including the United States and European Union.

A distinction is typically made between complementary treatments which do not disrupt conventional medical treatment, and alternative treatments which may replace conventional treatment.
Alternative cancer treatments are typically contrasted with experimental cancer treatments – which are treatments for which experimental testing is underway – and with complementary treatments, which are non-invasive practices used alongside other treatment. All approved chemotherapeutic cancer treatments were considered experimental cancer treatments before their safety and efficacy testing was completed.

Alternative cancer treatments have typically not undergone properly conducted, well-designed clinical trials, or the results have not been published due to publication bias (a refusal to publish results of a treatment outside that journal's focus area, guidelines or approach). Among those that have been published, the methodology is often poor. A 2006 systematic review of 214 articles covering 198 clinical trials of alternative cancer treatments concluded that almost none conducted dose-ranging studies, which are necessary to ensure that the patients are being given a useful amount of the treatment. These kinds of treatments appear and vanish frequently, and have throughout history.

Complementary and alternative cancer treatments are often grouped together, in part because of the adoption of the phrase "complementary and alternative medicine" by the United States Congress. However, according to Barrie R. Cassileth, in cancer treatment the distinction between complementary and alternative therapies is "crucial".

Complementary treatments are used in conjunction with proven mainstream treatments. They tend to be pleasant for the patient, not involve substances with any pharmacological effects, inexpensive, and intended to treat side effects rather than to kill cancer cells. Medical massage and self-hypnosis to treat pain are examples of complementary treatments.

About half the practitioners who dispense complementary treatments are physicians, although they tend to be generalists rather than oncologists. As many as 60% of American physicians have referred their patients to a complementary practitioner for some purpose. While conventional physicians should always be kept aware of any complementary treatments used by a patient, many physicians in the United Kingdom are at least tolerant of their use, and some might recommend them.

Alternative treatments, by contrast, are used in place of mainstream treatments. The most popular alternative cancer therapies include restrictive diets, mind-body interventions, bioelectromagnetics, nutritional supplements, and herbs. The popularity and prevalence of different treatments varies widely by region. Cancer Research UK warns that alternative treatments may interact with conventional treatment, may increase the side effects of medication, and can give people false hope.

Survey data about how many cancer patients use alternative or complementary therapies vary from nation to nation as well as from region to region. A 2000 study published by the "European Journal of Cancer" evaluated a sample of 1023 women from a British cancer registry suffering from breast cancer and found that 22.4% had consulted with a practitioner of complementary therapies in the previous twelve months. The study concluded that the patients had spent many thousands of pounds on such measures and that use "of practitioners of complementary therapies following diagnosis is a significant and possibly growing phenomenon".

In Australia, one study reported that 46% of children suffering from cancer have been treated with at least one non-traditional therapy. Further 40% of those of any age receiving palliative care had tried at least one such therapy. Some of the most popular alternative cancer treatments were found to be dietary therapies, antioxidants, high dose vitamins, and herbal therapies.

Use of unconventional cancer treatments in the United States has been influenced by the U.S. federal government's National Center for Complementary and Alternative Medicine (NCCAM), initially known as the Office of Alternative Medicine (OAM), which was established in 1992 as a National Institutes of Health (NIH) adjunct by the U.S. Congress. Over thirty American medical schools have offered general courses in alternative medicine, including the Georgetown, Columbia, and Harvard university systems, among others.

People who choose alternative treatments tend to believe that evidence-based medicine is extremely invasive or ineffective, while still believing that their own health could be improved. They are loyal to their alternative healthcare providers and believe that "treatment should concentrate on the whole person".

Cancer patients who choose alternative treatments instead of conventional treatments believe themselves less likely to die than patients who choose only conventional treatments. They feel a greater sense of control over their destinies, and report less anxiety and depression. They are more likely to engage in benefit finding, which is the psychological process of adapting to a traumatic situation and deciding that the trauma was valuable, usually because of perceived personal and spiritual growth during the crisis.

However, patients who use alternative treatments have a poorer survival time, even after controlling for type and stage of disease. In 2017, researchers at Yale School of Medicine published a paper which suggested that people who choose alternative medicine over conventional cancer treatments were more than twice as likely to die within five years of diagnosis. And specifically, in those with breast cancer, people choosing alternative medicine were 5.68 times more likely to die within five years.

The reason that patients using alternative treatments die sooner may be because patients who accurately perceive that they are likely to survive do not attempt unproven remedies, and patients who accurately perceive that they are unlikely to survive are attracted to unproven remedies. Among patients who believe their condition to be untreatable by evidence-based medicine, "desperation drives them into the hands of anyone with a promise and a smile." Con artists have long exploited patients' perceived lack of options to extract payments for ineffectual and even harmful treatments.

In a survey of American cancer patients, Baby Boomers were more likely to support complementary and alternative treatments than people from an older generation. White, female, college-educated patients who had been diagnosed more than a year ago were more likely than others to report a favorable impression of at least some complementary and alternative benefits.

Many therapies have been (and continue to be) promoted to treat or prevent cancer in humans but lack good scientific and medical evidence of effectiveness. In many cases, there is good scientific evidence that the alleged treatments do not work. Unlike accepted cancer treatments, unproven and disproven treatments are generally ignored or avoided by the medical community, and are often pseudoscientific.

Despite this, many of these therapies have continued to be promoted as effective, particularly by promoters of alternative medicine. Scientists consider this practice quackery, and some of those engaged in it have been investigated and prosecuted by public health regulators such as the US Federal Trade Commission, the Mexican Secretariat of Health and the Canadian Competition Bureau. In the United Kingdom, the Cancer Act makes the unauthorized promotion of cancer treatments a criminal offense.Most studies of complementary and alternative medicine in the treatment of cancer pain are of low quality in terms of scientific evidence. Studies of massage therapy have produced mixed results, but overall show some temporary benefit for reducing pain, anxiety, and depression and a very low risk of harm, unless the patient is at risk for bleeding disorders. There is weak evidence for a modest benefit from hypnosis, supportive psychotherapy and cognitive therapy. Results about Reiki and touch therapy were inconclusive. The most studied such treatment, acupuncture, has demonstrated no benefit as an adjunct analgesic in cancer pain. The evidence for music therapy is equivocal, and some herbal interventions such as PC-SPES, mistletoe, and saw palmetto are known to be toxic to some cancer patients. The most promising evidence, though still weak, is for mind–body interventions such as biofeedback and relaxation techniques.

As stated in the scientific literature, the measures listed below are defined as 'complementary' because they are applied in conjunction with mainstream anti-cancer measures such as chemotherapy, in contrast to the ineffective therapies viewed as 'alternative' since they are offered as substitutes for mainstream measures.

Some alternative cancer treatments are based on unproven or disproven theories of how cancer begins or is sustained in the body. Some common concepts are:

Government agencies around the world routinely investigate purported alternative cancer treatments in an effort to protect their citizens from fraud and abuse.

In 2008, the United States Federal Trade Commission acted against companies that made unsupported claims that their products, some of which included highly toxic chemicals, could cure cancer. Targets included Omega Supply, Native Essence Herb Company, Daniel Chapter One, Gemtronics, Inc., Herbs for Cancer, Nu-Gen Nutrition, Inc., Westberry Enterprises, Inc., Jim Clark's All Natural Cancer Therapy, Bioque Technologies, Inc., Cleansing Time Pro, and Premium-essiac-tea-4less.