Breast cancer patients who used only alternative medicine died more often

Overview

Ayoade OF et al.. JAMA Netw Open 2026 · PMID 41770560 · DOI 10.1001/jamanetworkopen.2026.0337

Using alternative medicine instead of standard treatment was linked to a 3.7-fold higher risk of death; skipping parts of treatment also raised risk.

Does the study support the specific claim? No · Methodological quality: moderate

Original publication

Plain-language summary

Scientific in-depth review

1. Full reference

Authors

Ayoade OF et al.

Journal

JAMA Netw Open

Year

2026

Identifier

PMID 41770560 DOI 10.1001/jamanetworkopen.2026.0337

Verification

verified – PubMed efetch 2026-10-26 + Crossref

Retracted

no

Corrections

none

Extent checked

full text

Conflicts of interest and funding

No conflicts of interest reported (full text); no specific funding statement found.

2. Research question

Is the use of complementary and alternative medicine (CAM), alone or combined with conventional therapy, associated with survival in women with breast cancer?

3. Study design and population

Study design

Cohort study – Retrospective registry cohort (US National Cancer Database), Cox regression with landmark sensitivity analysis

Population

Women with stage I-IV breast cancer in the NCDB (about 70% of new US cancer diagnoses)

Country

USA

Period

Diagnoses 2011-2021

Sample size

2,157,219 analysed; 273 CAM only, 568 CAM plus traditional, 49,713 no treatment, 2,106,665 traditional only

Inclusion and exclusion criteria

Female breast cancer 2011-2021; 11,983 with missing treatment information excluded

4. Methods and endpoints

Exposure / intervention

CAM only (treatment by non-medical personnel, NCDB definition); CAM combined with traditional therapy; no treatment

Comparator

Traditional therapy only (surgery, chemotherapy, radiation, endocrine therapy, immunotherapy)

Endpoints

5-year overall survival

Statistical methods

Kaplan-Meier, log-rank; Cox model adjusted for age, race/ethnicity, Charlson index, insurance, facility type, region, year, stage, income; landmark at 3 months for immortal-time bias

5. Actual results

Results

Adjusted HR for death vs traditional therapy: CAM alone 3.67 (95% CI 3.03-4.44); no treatment 3.53 (3.48-3.58); CAM plus traditional 1.45 (1.22-1.72). Unadjusted 5-year OS: traditional 85.4%, combination 81.2%, CAM only 60.1%, no treatment 47.8%. Combination patients less often received radiation (stage II 36.6% vs 59.5%) and endocrine therapy (stage II 40.7% vs 65.2%).

Absolute risks

Unadjusted 5-year OS 85.4% vs 60.1% (difference 25.3 percentage points, not adjusted for stage); adjusted absolute differences not reported

Authors' conclusion

Use of CAM instead of traditional therapies was uncommon but associated with reduced survival; combining CAM with traditional therapy was linked to skipping some treatments and higher mortality.

6. Strengths

• Very large national registry
• Adjustment for stage and socioeconomic factors
• Landmark analysis for immortal-time bias
• Full text read

7. Weaknesses

• Observational; residual confounding (no adjustment for receptor/HER2 status or grade; criticised in I-CAN-128)
• NCDB captures only registry-coded treatment by non-medical personnel (construct narrower than CAM in general; I-CAN-128)
• Handling of immortal time in the adjusted Cox model not clearly described (only unadjusted landmark analysis; I-CAN-128)
• Stage missing in 34-44%
• Type of alternative treatment (e.g., diet) not specified

8. Risk of bias

Orienting tool

ROBINS-E

Type of assessment

simplified assessment (abstract only)

Full formal assessment

no

Overall risk of bias

some concerns

Rationale

Confounding by indication and misclassification possible; effect large and consistent with earlier NCDB analysis (I-CHM-03).

9. Assessment of the statistical interpretation

Hazard ratios with log-symmetric CIs (recalculated). The 25-point unadjusted survival gap is partly confounded by stage (31.8% vs 18.1% stage III-IV among known stage), but the adjusted HR remains 3.67.

10. Relevance to the specific claim

Direct evidence on survival when non-medical approaches replace or partly replace standard breast cancer treatment.

11. Independent contrary findings

The study cannot judge CAM used strictly as an adjunct while all recommended treatment is completed (authors).

12. Transferability to Germany and Europe

Moderate: US registry, but the mechanism (forgoing effective treatment) applies everywhere.

13. Overall methodological judgement

Strong recent confirmation that replacing standard cancer treatment with alternatives is associated with markedly higher mortality.

14. Open questions

Outcomes of specific diet-only approaches; patients who add CAM while completing all standard treatment.

15. Linked fact checks

• Cancer will respond to the Tayebat system; a patient with a malignant tumour should start the system now (diet as cancer treatment). – Studies contradicting or limiting the claim
• The body heals itself if left alone: the human body was created healthy and has an unlimited capacity for self-healing unless burdened by harmful inputs. – Studies contradicting or limiting the claim
• The system's life method is 'zero medicine': a life without any medicines at all. – Studies contradicting or limiting the claim