You’ve probably seen their commercials spread over all of the major TV networks. Beautiful scenes. Well-kept hospitals which often to appear to be near empty. And an anecdote or two or three from presumably real patients who describe their experience at Cancer Treatment Centers of America (CTCA), a private, for-profit operator of cancer treatment hospitals and outpatient clinics which provide both conventional and alternative medical treatments. Included in their treatment plans are chiropractic and naturopathy, neither of which have any evidence whatsoever in providing any healthcare benefit to patients, let alone those suffering from cancer.
Reuters recently published an in-depth report on the validity of the claims that are made by CTCA in its advertising. Here are some of the ones specifically mentioned:
- For breast cancer, CTCA claims that its survival rate after 3.5 years post-diagnosis is about 42%, compared to the National Cancer Institute’s SEER (Surveillance Epidemiology and End Results) Program result (more or less a nationwide average) of about 29%. That’s a 13% improvement.
- For prostate cancer, CTCA claims that its 4 year survival rate is 20 points higher.
- For advanced colon cancer, CTCA claims that its 1.5 year survival rate is 11 points higher.
Reuters reviewed this data with nine experts in cancer epidemiology and statistics, and concluded that:
The experts were unanimous that CTCA’s patients are different from the patients the company compares them to, in a way that skews their survival data. It has relatively few elderly patients, even though cancer is a disease of the aged. It has almost none who are uninsured or covered by Medicaid – patients who tend to die sooner if they develop cancer and who are comparatively numerous in national statistics.
CTCA does not generally treat patients on Medicare or Medicaid, who are often in poorer health, because CTCA prefers privately insured patients who are generally wealthier and in better health. Reuters reported that “a former CTCA oncology information specialist in Tulsa, Oklahoma, said she and others routinely tried to turn away people who ‘were the wrong demographic’ because they were less likely to have an insurance policy that CTCA preferred. Holmes said she would try to “let those people down easy.” Lots of hospitals do turn down patients without insurance, although eventually most can get appropriate treatment.
Just as important, CTCA only includes data from patients who received treatment at one of their locations for the full duration of their illness. Because CTCA only has a few locations (Philadelphia, PA; Zion, IL; Goodyear, AZ; Tulsa, OK; and Newman, GA), this means that only patients who have the wherewithal to travel to one of those cities, and basically return for any follow-up treatments. This represents a huge selection bias because CTCA only accepts a very small subset of cancer patients, and even then, calculates survival outcomes on a subset of that subset.
According to Reuters, the raw numbers of patients included in its statistics isn’t even close to the total number of patients that enter the facility.
CTCA also appears to exclude the vast majority of its patients when it calculates survival data. In survival results from 2004 to 2008 posted on its website, CTCA reported 61 patients with advanced prostate cancer, 97 with advanced breast cancer, 434 with advanced lung cancer, and 165 with advanced colon or rectal cancer. These are the four most common solid tumors. In the same period, CTCA treated thousands of patients at its Zion facility alone, according to filings with state regulators.
Another issue with their data is that most of it stops at random time periods (1.5 years for colon cancer and 4 years for prostate cancer). The reason they do this is that the 5 year survival rate, the most common measurement of survival, of CTCA appears to be statistically equivalent to SEER data. In other words, if the time period is sufficient, going to a local medical center, even for the self-selected wealthier, better insured individuals, provides the same results.
And if their results are so great, and their treatment protocols are so advanced over other cancer centers, where is this published? By the way, in a peer-reviewed, high impact journal.
CTCA has gotten into trouble with Federal regulators several times in the past:
- In 1996, CTCA was cited by the Federal Trade Commission for ” false and unsubstantiated claims in advertising and promoting their cancer treatments.”
- In 2002, the FDA told CTCA that “based on information obtained during the investigation, we have determined that you violated regulations governing the proper conduct of clinical studies involving investigational new drugs.” Allegedly, CTCA failed to follow investigational plans, maintain proper records, and maintain records on use and disposal of investigational drugs. These are not trivial complaints and can effect the approval (or denial) of a new drug application to the FDA.
What is also troubling, other than the biased statistics, is that CTCA advertises using anecdotes, stories from patients where treatment is successful. And let it be widely known, that cancer is treatable, and there is evidence that survival rates are increasing for many cancers, even when they don’t go to CTCA.
And let’s not forget that CTCA also focuses on alternative medicine therapies, like:
- Nutritional supplements, including vitamins, minerals and amino acids
- Botanical medicine (the use of herbs)
- Homeopathic medicine
There is just no evidence that nutritional supplements are useful treating (or preventing) cancer. And homeopathic medicine? How on earth is water going to treat cancer? The rest of the naturopathy page of the CTCA website is filled with woo and pseudoscience. Is there any evidence that any of this junk medicine works? No.
They even go off the deep end by claiming that ⅓ of cancer patients die of malnutrition. On the surface that might be true, but it’s not because other doctors ignore proper nutrition, but because of cachexia, which is loss of weight, muscle atrophy, fatigue, weakness, and significant loss of appetite and cannot be reversed nutritionally. Unless CTCA has some miracle method to prevent this (and publish it), this is a nonsense comparison.
I’m sure that CTCA is a nicer experience than some oncology centers. Because they are selecting for wealthier patients, I’m sure the rooms are private and nice. There’s probably a nice HDTV with all your favorite channels. But will there be a better outcome, even if you’re one of those wealthy, privately-insured patients that they want? Probably not. Unless you think homeopathy works, then there is nothing to say. But if you’re making a decision about CTCA because you believe that the results are fundamentally better than your local medical center, the evidence just isn’t there. Save your money.
- Begley S, Respaut B. Special Report: Behind a cancer-treatment firm’s rosy survival claims. Reuters. 2013 March 6.
- Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Dörig S, Sterne JA, Pewsner D, Egger M. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet. 2005 Aug 27-Sep 2;366(9487):726-32. PubMed PMID: 16125589.
- Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012 Jan-Feb;62(1):10-29. doi: 10.3322/caac.20138. Epub 2012 Jan 4. PubMed PMID: 22237781.