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Jacobson et al
Cancer Outcomes at the Hufeland
(Complementary/Alternative Medicine) Klinik:
A Best-Case Series Review
Judith S. Jacobson, DrPH, MBA, Victor R. Grann, MD, MPH, Michael A. Gnatt, MD,
Hanina Hibshoosh, MD, John H. M. Austin, MD, Wil iam S. Mil ar, MD, and Alfred I. Neugut, MD, PhD
Purpose: A best-case series review is an efficient tool
herbal agents and specific CAM procedures have been
with which to screen complex complementary and
undertaken or completed. The most successful
alternative treatments for cancer as candidates for
candidates for research funds have been investigators
further study. Study Design: The National Cancer
who proposed studies of standardized single-
Institute and other agencies have adopted the best-case
modality interventions for which conventional
series method to evaluate cancer treatments involving
research methods are well suited. Claims regarding
complementary and alternative medicine (CAM) for
the benefits of complex treatments customized to
further study. The authors conducted a best-case series
review of the Hufeland Klinik. Established in 1985 in
each patient are more difficult to evaluate. Many
Bad Mergentheim, Germany, this facility treats more
cancer clinics outside the United States provide such
than 500 cancer patients per year. Hufeland treatment
treatments, especially to patients who have failed
includes dietary modification, injections, ozone
therapy, active fever therapy, psychotherapy, and
Few providers at CAM cancer clinics have research
training or even a reliable charting system,2 but some
chemotherapy. The goal of the treatment is to prolong
are willing to allow outside investigators to study their
survival and to maintain good quality of life. Methods:
treatments and results. Because conventional clinical
The clinic provided summaries of 27 cases in which
research methods cannot be readily applied to the
patients with longer than expected survival had agreed
assessment of most CAM cancer clinics, the best-case
to make their medical records available for review.
The review involved pathologic confirmation of disease
series method has come into use to identify those
and radiologic confirmation of complete response (CR)
facilities whose patients might have fared better than
or partial response (PR) not attributable to
expected and to evaluate them as candidates for
conventional treatment. Results: Based on the
summaries and an exhaustive 2-year search for medical
First proposed by the Office of Technology Assess-
records, slides, and imaging data, 12 of 27 cases were
ment in 1990, the best-case series method was adopted
selected for full review, and 5 (3 CRs and 2 PRs) were
by the National Cancer Institute (NCI) in 1991 for pre-
judged best cases. Conclusion: Most patients with
liminary evaluation of complex CAM cancer therapies
common cancers receive conventional treatment
for which claims of efficacy were made. The NCI
before coming to Hufeland, and many are treated with
Office of Cancer Complementary and Alternative
chemotherapy and/or hormonal therapy while there.
Hence, only a few could be considered for review. With 5
Medicine Web site publishes the guidelines "The
of 12 patients showing a treatment response, the
Preparation of Best Case Series and the Conduct of
authors conclude that the Hufeland treatment
Pilot Clinical Trials Using CAM Modalities."4 The
merits further study. They also recommend the
development of criteria with which to evaluate best-
JSJ, VRG, and AIN are in the Department of Epidemiology,
case series reviews of complex CAM treatments for
Mailman School of Public Health; VRG and AIN are in the
patients with advanced cancer.
Department of Medicine; HH is in the Department of Pathology; JHMA and WSM are in the Department of Radiology; JSJ, VRG, HH, JHMA, WSM, and AIN are in the Herbert Irving
Keywords: cancer; best-case series; complementary; alternative;
Comprehensive Cancer Center, College of Physicians and
holistic; complete response; partial response; survival
Surgeons; and MAG is in the Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University, New York, New York.
In the past decade, support for research on comple-
Victor R. Grann, MD, MPH, Department of
mentary and alternative medicine (CAM) for cancer Epidemiology, Mailman School of Public Health, 722 West 168th
has grown dramatically, and numerous clinical trials of
Street, R734, New York, NY 10032. E-mail: [email protected]
INTEGRATIVE CANCER THERAPIES 4(2); 2005 pp. 156-167
Cancer Outcomes in a Best-Case Series
guidelines allow practitioners to select for review any formed consent and permission to obtain medical cases that exemplify what their treatment can do for records from the participating patients, and provided cancer patients and specify that every best case must a summary of each case. The reviewers eliminated meet the following 4 entry criteria:
cases that, based on the summary, did not fulfill best-case criteria. For the remainder, in addition to
• The diagnosis of cancer must be well documented.
reviewing the records on file at the Hufeland Klinik,
• There must be evidence that cancer was present at the
we requested medical records including pathology
time the unconventional treatment was started.
slides and radiologic examinations from all the other
• The patient must have received the unconventional
institutions where the patient had received diagnostic
treatment according to the alternative practitioner's
assessment or cancer treatment. After document texts
were translated into English, the cases were reviewed
• The patient must not have received, recently or con
by the investigative team, including oncologists,
currently, another therapy with the potential to affect
pathologists, and radiologists at the Herbert Irving
Comprehensive Cancer Center of the College of
Best cases also must fulfill at least 1 of the Physicians and Surgeons, Columbia University. The
purpose of the pathology review was to confirm the cancer diagnosis of each case. Radiologists reviewed
• Complete response (CR): complete disappearance of
imaging studies in various formats to assess patients'
all evidence of tumor for a set number of weeks.
status before and after the Hufeland Klinik treatment.
• Partial response (PR): decrease by >50% in the sum of
The team then identified those cases that fit the best-
the products of the perpendicular diameters of all
measured lesions in the absence of progression of any
sites or the appearance of any new lesions for a set number of weeks.
Wolfgang Woeppel, MD, graduated from the medical school at the University of Wuerzburg (Bavaria,
Many cases proposed for a best-case series are those Germany) in 1971. Board certified in internal
involving longer than expected survival based on medicine (1978) and naturopathy (1984), he also data for age and stage from the medical literature or a studied acupuncture and neural therapy. From 1976 population-based registry, such as the NCI's to 1982, he was a senior physician in the Department Surveillance, Epidemiology, and End Results of Internal Medicine at Mosbach Regional Hospital database. However, although survival with good (Baden, Germany). From 1982 to 1984, he worked quality of life is the primary aim of cancer treatment, with Josef M. Issels, MD, who developed and it is not interpret-able as evidence of efficacy in an practiced a holistic approach to cancer therapy, at the uncontrolled case series.5
Ringberg Klinik in Tegernsee, in the Bavarian
In this report, we describe the results of our Alps of Germany.6 Dr Issels's theories and methods
assessment of a best-case series submitted by have greatly influenced alternative cancer treatment Wolfgang Woeppel, MD, founder and director of the programs in Europe and Mexico.' Hufeland Klinik in Bad Mergentheim, Germany, to
The Hufeland Klinik
the National Foundation for Alternative Medicine Established by Dr Woeppel in 1985, the Hufeland
(NFAM). Since 1998, NFAM has been visiting clinics Klinik has treated more than 3000 inpatients and 500
that use CAM and inviting them to submit best cases. outpatients and currently treats about 500 inpatients
Of some 60 clinics reviewed in the first 2 years of and 120 outpatients per year. The Klinik is located in
this program, the Hufeland Klinik was found to be Bad Mergentheim, a well-known health resort area
the most rigorous in its record keeping. Hufeland also famous for its mineral springs, in southwestern
has an international reputation that draws patients Germany near Heidelberg, Frankfurt, and
from the United States as well as other countries. For Nuremberg.
those reasons, it was selected for review.
Most patients who come to Hufeland have cancer.
Hufeland treats all malignant diseases except acute
leukemias, regardless of stage and prognosis. The Klinik also treats patients with some other diseases; it
treats adults and children older than 5 years.
The study was approved by the Columbia Presbyterian Medical Center Institutional Review Board. Dr
Woeppel selected the cases for review, obtained in-
According to theories first described by Alfred Pischinger,8 the body's most important systems (eg, the autonomic nervous system, hormones, blood and
Jacobson et al
lymph vessels, and connective tissue) comprise an fruit. They are allowed (but not encouraged) to eat 1 interdependent network. Dr Woeppel views cancer as serving of meat or fish per week. Frequent small meals involving both cells and their interaction with this are recommended for seriously ill patients. Patients network, which constitutes their environment. Under are encouraged to avoid tobacco, caffeine, and conditions such as infection and psychological alcohol. distress, the environment may cease to prevent cancer cells from proliferating. Under more favorable
Nearly every day, patients receive
conditions, the environment may become conducive hydrotherapy (cold water treatments and hot to apoptosis or redifferentiation of cancer cells. showers),16 reflexology,17 massages,18 or special Treatment at Hufeland, therefore, does not primarily treatments with electric fields. target the tumor, as conventional cancer treatment
For at least 2 hours each day, most
does, but focuses on the tumor's environment.
patients inhale oxygen; they continue to do so after
Upon admission, each patient is examined by a physician and has an electrocardiogram, ultrasound
Dr Woeppel states, "Anyone for
imaging, routine laboratory studies, and, in some whom life is unconsciously a burden logically has no cases, a chest x-ray. Depending on the results of these real reason to get well, and his autonomic nervous studies, patients may receive the basic treatment alone system is programmed for death." Therefore, or with fever therapy or conventional treatment.
Hufeland offers patients a variety of approaches to help reduce the undesirable stress in their lives. Dr
Woeppel conducts weekly group hypnosis sessions to
Basic treatment consists of the following.
influence the unconscious and to support the patient's
All patients receive daily will to get healthy again. A psychologist and an art
of therapist offer individual and group therapy sessions.
homeopathic agents, vitamins, and herbal agents and Other modalities include deep relaxation exercises, nonspecific immune stimulators (echinacea, '" respiratory biofeedback, imagery, color therapy, mistletoe, fresh thymus," and microbial extracts). group singing, and walks and hikes. Proteolytic pancreatic enzymes; probiotics (symbiotic intestinal bacterial flora supplements); vitamins A, C,
Hufeland emphasizes the importance of
E; and selenium are administered orally. Twice a complete pain relief. Conventional analgesics, as well
week, patients receive ozone therapy (autologous as acupuncture, therapeutic local anesthesia, infrared
blood is incubated with a mixture of oxygen and (warming) therapy, subcutaneous carbon dioxide
ozone and/or irradiated by ultraviolet light and then injections, and physical therapy are used for pain
reinfused)12 followed by an intravenous infusion. The relief.
intravenous infusion contains trace elements Fever Therapy
(magnesium, selenium, zinc), homeopathics, high-
Patients who have no serious comorbid conditions
dose vitamins, and plant- or microbial-derived may receive active fever therapy, in which Coley's
alter toxins (bacterial lipopolysaccharides and other
metabolism, and stimulate the nonspecific immune agents) are injected intravenously. Patients usually
experience chills, nausea, vomiting, or headache
The basic program also includes dental work to within about 20 minutes, along with a slow rise in
eliminate mucosal pockets; dead, root-filled, or body temperature. The temperature should remain at
impacted teeth; and, if possible, amalgams.13 If tonsils 40°C or higher for several hours."
show signs of chronic inflammation, tonsillectomy is recommended."
Patients are also offered enemas, lime-blossom and In addition, patients without comorbid conditions
other herbal teas, and herbal and homeopathic may receive surgery, chemotherapy, radiation therapy,
remedies. Patients with constipation or digestive or hormonal therapy. The goal of such treatment is
problems are encouraged to drink from Bad not so much to destroy the tumor as to suppress it
Mergentheim's healing springs to activate bile flow enough to allow the host to keep it under control.
Hence, patients who undergo chemotherapy at
All patients follow a low-fat lactovegetarian Hufeland usually receive lower doses or a shorter
diet high in vegetables and whole grains, with some
course of treatment than they would under a conven-
Cancer Outcomes in a Best-Case Series
onal protocol. Some patients receive chemotherapy
cancer case; and 1 melanoma case) were excluded
because the presence of malignant disease was not
electromagnetic field to about 43°C, applied either
confirmed at the time treatment was initiated. Four
locally (eg, to treat liver metastases, prostate cancer,
cases (all 3 cases with advanced breast cancer and 1
or abdominal tumors) or to the whole body. Most
with ovarian cancer) were excluded because they
patients with b reast cancer or p ro state cancer
received conventional therapy (hormonal therapy or
chemotherapy) shortly before or during treatment at Hufeland, 3 because of disease progression (an
ovarian cancer case) or lack of a partial response to
Initially, Dr Woeppel submitted reports of 27 cancer treatment (a stomach cancer case and a lung cancer cases. Based on these reports, we selected 12 cases for case), and 1 (an ovarian cancer case) because slides review. Table 1 lists the 12 cases that were reviewed. Of were unavailable for pathology review. (In Germany, these, 5 met the criteria for best cases.
slides may be discarded after 10 years.)
histologic Since 1985, about 3000 individuals have been treated
interpretation to that of the reviewing pathologist for for cancer at Hufeland. Although some of these
each of the 12 potential best cases. In 6 of the 12 cases, patients achieved remission and remain well, many,
the reviewing pathologist confirmed the original including all patients with metastatic breast cancer
interpretation. In colon cancer case 1, the pathology or prostate cancer, were ineligible for inclusion in
reviewer's diagnosis differed from that in the original the best-case series because they had received
report regarding tumor type, but the differences were conventional and CAM treatment at Hufeland
not relevant to prognosis.21 In ovarian cancer case 1, simultaneously. This exclusion limits best-case series
the reviewer's diagnosis differed from the original review to patients who have cancers for which no
regarding the site of origin and was more consistent conventional treatment is known, refuse conventional
than the original wi t h t h e i n d o l e n t c o u r s e o f t h e treatment, or wait a sufficient time after receiving
d i s e a s e . I n mediastinum cancer case 1, the conventional treatment for restaging to verify
reviewer's diagnosis also differed slightly from that treatment failure. Yet many patients whose disease is
in the original report regarding tumor type, but the spreading and not responding to treatment begin
material was obtained by bronchoscopy and was too immediately to explore alternatives. Moreover,
limited in quantity for a firm histologic diagnosis.
although potential best cases cannot be evaluated
In 3 of 4 brain tumor cases, the histologic diagnosis unless they have had repeat imag-ing just prior to
differed. For this reason, the brain tumor cases were starting the CAM treatment, complete restaging is not
also reviewed separately by a pathologist at the NCI always performed at this time in clinical practice. The
(Table 2). The NCI reviewer noted that prior best-case series, therefore, shares many of the
treatment with chemotherapy and/or radiation difficulties of any retrospective review. As Table 1
therapy in cases 1 and 3 made firm histologic shows, even the patients whose cases we reviewed
diagnoses difficult. The differences between the wasted little time between failing (or being failed
original pathologists and the reviewing pathologists by) conventional treatment and seeking
did not appear to follow any specific pattern.
The best-case series approach to CAM treatments
for cancer requires pathologic confirmation of the
Table 3 shows the results of the radiology review of the
cancer diagnosis, evidence that cancer was present at
available films and the radiologists' conclusions
the time the CAM treatment was initiated, no recent
regarding tumor response. Three patients were
conventional treatment, and evidence of complete or
judged to have a complete response and 3 to have a
partial response. These requirements are reasonable
partial response. However, in 1 of the latter (brain
but not easy to fulfill. Old charts and scans are often
cancer case 2), the patient had received radiation
difficult to find. Scans that are not necessary for the
therapy (without evidence of benefit at the time)
patient's treatment might not be covered by
shortly before c o m i n g t o H u f e l a n d a n d w a s t h e r e f o r e n o t categorized as a best case.
insurance. And few CAM practitioners, especially those
Table 4 lists the 15 cases that were excluded from who are not also conventional physicians, require
the best-case series review. Of these, 7 (3 colon cancer patients to document their cancer diagnosis or cases, 1 stage III and 2 stage IV; 2 sarcoma cases; 1 lung
interact routinely with the conventional physicians
Table 1. Cases Reviewed for Best-Case Status
Oct 1987 2 subtotal resections, radi- Second
bladder, right hydronephrosis, dilated right ureter
Melanoma 2 (skin 35/M Apr 1991 Surgery: multiple resections skin,
ec 1982, drainage procedures to Jan 1983
left hand, abnormal reflexes, reduced general condition
Aug 1985 Subtotal resection, radia- RT Sep-
Apr 1996 Surgery, mitomycin, then Aug 1996
Nov 1991 1 cycle epirubicin/cytoxan/ Mar 1992
Unresectable mediastinal 2001 through 1999, expired 2001; no
Oct 1994 Surgery, 1 cycle ifosfamide, Nov 1994
PR = partial response; BCNU = 1,3 bis(2-chloroethyl)-1 -nitrosourea; NA = not applicable; CR = complete response; SQ = subcutaneous; MS = multiple sclerosis; RT = radiation therapy; CT = computed tomgraphy; MRI = magnetic resonance imaging.
Jacobson et al
Table 2. Results of Pathology Review
Adenocarcinoma, poorly differentiated Pilocytic
Adenosquamous carcinoma, poorly differentiated
astrocytoma Anaplastic astrocytoma (grade III)
Anaplastic astrocytoma (grade III) Mucinous
Bronchogenic carcinoma in malignant mixed tumor
Brain cancer cases 1 through 4 were rereviewed by Martha Quezado, MD, National Cancer Institute pathologist. Her diagnoses were brain 1: residual tumor high grade with gemistocytic features; brain 2: pineal parenchymal tumor of intermediate differentiation; brain 3: radiation changes with residual tumor, most likely high grade; brain 4: pilocytic astrocytoma.
Due in part to legal and regulatory constraints on than would be expected for patients with the same
the provision of unconventional cancer treatments in disease and stage. However, they are not the only the United States, many of the clinics that offer such Hufeland patients with better than expected survival, treatments are based elsewhere. Linguistic and and duration of survival is not a criterion for best-case cultural differences add to the difficulty of obtaining status. documentation for a best-case series.
The best-case series methodology came into use as a
Staff and consultants at the NFAM selected the tool for evaluating complex unconventional cancer
Hufeland Klinik for review in part because its medical therapies as candidates for further study. Ideally, such records were far more complete and organized than preliminary reviews should be reasonably quick and those of most clinics they had visited. Dr Woeppel was inexpensive. Our team took more than 2 years to also highly cooperative in providing additional assemble the case records and to complete the records from Hufeland upon request. He obtained imaging and histology review. However, it is difficult authorization from patients for retrieval of additional to imagine how the Hufeland approach and that of documents, histology, and imaging material and other similar cancer clinics could be initially assisted in the retrieval process, which nonetheless evaluated without such a case review. took 2 years.
A strength of the methodology is that it permits the
The most compelling candidates for a best-case evaluation of holistic, multimodality approaches.
series are patients who have survived for many years However, having participated in this best-case series after their initial diagnosis. But for those patients, the review, Dr Woeppel has come to see some merit in documentation trail is often cold; specimens, slides, developing an evidence-based standardized treatment and films may have deteriorated or been lost; and that other cancer facilities could adopt. treating physicians may have retired or relocated. In
Bringing the Hufeland approach in its present
the Hufeland series, many of the computed form to the United States would not be easy. Some tomography scans that were reviewed by our elements of the program are not available in the radiologists came from first-generation scanners and United States because of Food and Drug were of limited quality; the settings of images on Administration regulations, physicians' lack of some magnetic resonance imaging studies posed training in certain methods, and lack of insurance additional challenges for the reviewing radiologists. coverage for them. Some of the digital images derived from
The best-case methodology evaluates the success of
radiographic films for the best-case series review a therapy in inducing a tumor response. But the were also of poor quality.
Hufeland basic treatment program does not target the
Among the cases submitted by Dr Woeppel but tumor and has no specific cytotoxic components.
either not considered best cases or excluded from the Tumor response is, from Hufeland's perspective, review, were many who had arguably longer survival neither necessary nor sufficient; the Klinik's mission is than would be expected given their conventional to help patients to survive with good quality of life, treatment or their status at presentation.22,23 The 5 best and Dr Woeppel selected cases for review with that cases also improved clinically and survived longer
Cancer Outcomes in a Best-Case Series
Table 3. Results of Radiology Review
Right pelvic mass ~5 cm, secondary moderate right hydrouteter and
Ill-defined mass ~2 cm, hydroureter and hydronephrosis unchanged
S/P subtotal resection, cannot exclude residual tumor
Recent, evolving, right MCA infarct on CT; no evidence of tumor but no
5-cm bladder mass, dilated R ureter and R hydronephrosis
R ureter questionably dilated distally, otherwise normal
Soft tissue masses in SQ down to muscle in right medial thigh
Defects same location, postoperative changes, melanoma may still be
No evidence of malignancy chest, abdomen, pelvis; limited lung field
evaluation due to data compression on transfer
Abdominal CT: 3 metastatic foci persist in liver
Abdominal CT: no evidence of metastatic disease
Pineal tumor doubled in size involving adjoining structures, extending
Pineal gland smaller, less enhancement; white matter lesions noted
Minimal rim enhancement, moderate white matter edema
Tumor in lateral thalamus, chiasm, and optic tracts
Residual tumor optic chiasm and tracts but less compared with Jul
No imaging review because of clinical progression in indolent tumor
3-mm round peripheral juxtapleural opacity, not solid; unclear if
Not reviewed here because x-ray reports indicate no PR
Cannot distinguish 3 cm x 2 cm pleural-based mass-like opacity R
New medial pleural mass, 2 right midlung zone masses: progression
CT = computed tomography; S/P = status post; MCA = middle cerebral artery; U/S = ultrasound; MRI = magnetic resonance imaging; SQ ■■
subcutaneous; NA = not applicable; PR = partial response; R = right.
in mind. However, he understood the requirements of Research and Quality did not present response rates the review and accepted them.
but recommended consideration of further study of
The 27 cases that he selected were those in which both modalities. For 1 modality, 9 of 30 cases were
patients survived longer than expected and agreed to judged to meet the criteria; for the other, 3 of 21 were provide access to their conventional medical records. similarly judged. In both reviews, the cases involved The 12 cases that we reviewed were those that cancers of several different organ/sites and a lengthy appeared to meet the NCI best-case series criteria effort to obtain medical records.24 based on the case summary. Where necessary, we then
To calculate a response rate in our study, we would
sought additional documentation. (We excluded only have had to review the charts of all 3000 cancer 1 case for lack of such documentation.)
patients seen at Hufeland since 1985, to eliminate all
Best-case series are not designed to permit those with recent or concurrent potentially curative
calculation of a response rate. A recent report of 2 conventional treatment, to document the status of the best-case series prepared for the Agency for cancer at the time the patient first came to Hufeland, Healthcare
CANCER THERAPIES 4(2); 2005
Table 4. Cases Excluded From Best-Case Series Review
1985 Apr 1985 mastectomy; Sep 1988 and Dec
1988 resection of chest wall recurrences, Sep
1989 resection lymph node metastases; Oct-
Nov 1989 radiation therapy; Oct 1989-Oct
1991 Zoladex; Dec 1991 resection lymph node metastases; Jan-May 1992, cyclophosphamide/methotrexate/5FU (CMF); Jun 1992-Jan 1994 tamoxifen; Feb 1994 radiation therapy; Feb 1995 and Jul 1995 lymph node resection; Sep 1995 skin biopsy, Oct-Nov 1995 RT skin metastases
1991 Oct 1991 left mastectomy, Nov 1991-1995
epirubicin/cyclophosphamide (FEC), velban/
1996 Jun 1996 mastectomy, Jun-Nov 1996 4X EC,
1968 Nov 1968 total abominal hysterectomy and
bilateral salpingo-oophorectomy (TAHBSO),
adriamycin/cyclophosphamide (PAC); Apr 1985 radiation therapy to entire abdomen for tumor cells in peritoneal fluid
1982 Feb 1982 TAHBSO, omentum resection, Mar
1982 chemotherapy; Jan 1989 abdominal wall
cycles; Nov 1991 extirpation of abdominal
1987 Jul 1987 surgery, Jul-Oct 1987 CMF chemo-
therapy, Oct 1987 laparoscopy: biopsy positive
carcinomatosis, Oct 1987 PAC chemotherapy
1989 Nov 1989 left pneumonectomy, Nov 1989-Feb
vincristine (ACO) 3 X, Jul 1990 radiation
1995 Feb-Mar 1996 radiation therapy (60 Gy)
Alive and well May No tumor response after
1988 Apr 1988 sigmoid resection, Oct 1988 liver
Alive and well Feb No evidence of disease
Jan 1991 hemicolectomy and resection liver
No evidence of can- Alive and well Sep No
metastasis; Jan 1993 resection liver, gall
bladder, diaphragm metastasis; Feb-Jul 1993
active-specific-immune therapy; Jan 1995 resection liver and diaphragm metastases
1993 Sep 1993 hemicolectomy, Oct 1993-May 1994
1988 Jun 1988 right pelvic resection and
arthroplasty; Jul 1988-Apr 1999 CESS-86-system chemotherapy; Aug 1995 wedge
resection lung metastases; patient refused
Apr 1992 tumor resection right thigh, Aug 1992 Jun 1993
resection left lung, Mar 1993 resection right lung, Jul-Nov 1992 chemotherapy epirubicin/
1984 Jul 1984 resection SQ tumor left leg, Sep 1984
resection local recurrence, Feb 1986 excision
large left inguinal lymph node metastasis
1996 Dec 1996 radiation therapy to rectal, pelvic
RT = radiation therapy; CT = computed tomography; TAHBSO = total abdominal hysterectomy and bilateral salpingo-oophorectomy; SQ = subcutaneous; PR = partial response.
Jacobson et al
and to identify all the CRs and PRs. To assess survival
who use CAM are a heterogeneous group, and the
as an outcome, we would need a comparison cohort
claims made for treatments vary. Taking those and
of patients similar in cancer organ/site, age, stage,
other relevant factors into account will not be easy, but
gender, date of diagnosis, and status of disease at the
the difficulty should not deter us from trying to
time the treatment group came to Hufeland but
standardize the preliminary evaluation of complex
receiving only conventional treatment. A prospective
CAM treatments alleged to benefit cancer patients.
study that purported to have such a comparison group collected data on the CAM cohort via
interview and chart abstraction but used only chart
We gratefully acknowledge the assistance we received
review of the comparison group and was therefore
from Wendy J. Verret, who served as project
seriously biased.25 Appropriate comparison groups
coordinator in the first year of the study, and from
for prospective studies are hard to find. Most
Martha Quezado, MD, who provided a second opinion
patients who present at an inpatient CAM clinic do
for the pathology review of the brain cancers. Funding
so because they have reason to doubt that
for this study was provided by the National Foundation
conventional treatment will cure them. Even
for Alternative Medicine, 5 Thomas Circle,
matching on stage might not level the playing field
Washington, DC. The contents of the article are solely
unless additional markers and/or perceived risk of an
the responsibility of the authors. The detailed case
reports required by the NCI guidelines are available on
Clinics such as Hufeland clearly seek to provide
comfort and hope to patients with advanced disease who are not ready for exclusively palliative care.
The more established clinics do not guarantee to cure
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Bocconiani ● Newsletter per i laureati dell’Università Bocconi Numero 15 - Settembre 2005 Notiziario in formato elettronico (pdf file), diffuso via e-mail. A cura della Direzione Sviluppo e Relazioni Esterne - Università Bocconi Per segnalazioni, informazioni, suggerimenti: [email protected] - Sito web dei laureati Bocconi: www.bocconiani.net News dalla Bocconi Attiv