Farrah Fawcett turns to alternative medicine for anal cancer

I've had this story sent to me by a few readers over the weekend, and I think it's worth a brief comment.

I'm basically a child of the 1970s. Although I didn't watch it much, if ever, I remember Charlie's Angels when I was in junior high and high school. Like any adolescent who came of age in the late 1970s, I remember the famous and hot-selling poster of Farrah Fawcett, which graced the bedroom of more than one of my friends, although I never actually owned a copy. A while back, I heard that Fawcett had been successfully treated for anal cancer. Now, I hear from my readers that her anal cancer is back and that she is seeking out alternative medical treatments:

Actress Farrah Fawcett and the late Coretta Scott King are among the thousands of people who have turned to alternative approaches to cancer treatment when conventional medicine has failed.

It's often a last-ditch attempt to find a cure, one that brings the patient into a murky world of offshore clinics and unproven courses of treatment that are scorned by the medical establishment.

"I would [tell a patient considering alternative treatment] that they are signing their own death certificate," said Barrie Cassileth, chief of the Integrative Medicine Department at the Memorial Sloan-Kettering Cancer Center. Cassileth has not treated Fawcett. "I would say they are wasting time they could otherwise spend happier and with their families."

So would I, particularly in this case, because from what I can tell reading press reports Fawcett's recurrence is very likely salvageable with conventional therapy. However, as always, it's hard to tell exactly what is going on just from press reports.

Anal cancer is an uncommon cancer arising in the anus, where the mucus membrane of the rectum meets the anoderm, or the skin that runs partway up into the anus. It is different from rectal cancer in that the cell type from which it arises is not the columnar epithelial cell that lines the rectum, but rather squamous epithelial cells similar to the types of cells that line the vagina and urethra. In the "old" days, anal cancer was treated with radical surgery, specifically an operation called an abdominoperineal resection (APR). This operation involves removing the entire anus and rectum, sewing the resulting hole shut, and constructing a permanent colostomy. Not surprisingly, patients really hate having to undergo an operation that leaves them with a permanent colostomy.

Consequently, there was a major reason to look for a treatment regimen that didn't involve an APR. These days, most anal cancer is treated with a chemotherapy and radiation therapy protocol known as the Nigro protocol, which is curative in the majority of cases. My guess is that was probably the treatment therapy that Fawcett underwent: an excisional biopsy to confirm the diagnosis and then treatment with the Nigro protocol. This is how her recurrence was described a few months ago:

Fawcett got the news after a routine three-month checkup in which doctors discovered a malignant polyp, smaller than a pea, says Nevius.

She was still weighing her treatment options when the National Enquirer reported the cancer's return.

"She didn't have a chance to tell some of her family yet," says Nevius. "It is now clear that the tabloids are as invasive and malignant as cancer."

Nevius says Fawcett has been in good health and is "not feeling the effects" of the recurrence. She has not settled on a treatment option, he says, but is considering having a small metalic "seed" placed in the area that will emit radiation.

The placement of such a radioactive seed is known as brachytherapy, which is not standard of care for recurrent rectal cancer. I hope they offered her this as part of a clinical trial, although it is not an unreasonable option to attempt to salvage a recurrence. The definitive salvage therapy for such a recurrence are generally one of two things. Second line therapy of more radiation and chemotherapy can be offered, but the last line of therapy for recurrent anal cancer, unfortunately, is surgical, specifically an APR. My guess--and I emphasize that it is nothing more than an educated guess with a little reading between the lines--is that Fawcett's doctors told her she had to choose between more radiation, with more chances of local complications around the anus or an APR, and, like many patients do when faced with this operation, she freaked. Now she's heading to Germany looking for "alternative" cancer therapies. In one way, I can't blame her, but in another way I can't help but share Dr. Cassileth's fear that she is signing her own death warrant, given that salvage therapy after local recurrence of anal cancer ranges from 30-60%.

One thing that was very refreshing about this news report is that it included a number of quotes that were actually skeptical of alternative medicine, in marked contrast to the usual credulous treatments of alternative medicine claims that I see:

"[Alternative treatment] is a marking term that means anything anybody wants it to mean," said Stephen Barrett, a retired psychiatrist who runs a site called quackwatch.com, which publishes information about alternative clinics. "It indicates it has not been proven, but people use it for different wants, and the implication by promoters is simply that it's a legitimate alternative."

Barrett, who has made it his job to warn cancer patients about the risks of alternative treatments, says he has spoken to people who have visited clinics in other countries and have suffered tremendously from unsanitary IVs and infections.

And:

"I think it's human nature," said Len Lichentheld, deputy chief medical officer for the American Cancer Society. "Human nature is such that we always want to believe there is something else and so people become vulnerable to claims that somebody has something that is going to work."

"There are people who claim they've been helped, but you look at the data and you can't substantiate many of the claims, but still many will spend the money to send their relatives for a 'last try,'" said Lichentheld.

Of course, the article wasn't all perfect. It did have a howler of a quote by Frank Cousineau, President of the Cancer Control Society. Quoth he:

But Cousineau maintains that getting new cancer treatments approved is expensive and time-consuming for these clinics, which is why they choose to keep them under wraps -- not because they don't work.

"I think the [clinics'] reputation is undeserved," said Cousineau, who is not a licensed physician. "The process to get a therapy of any kind approved in the U.S. takes a long time and is extremely costly. Just because they aren't approved doesn't mean they aren't working."

Where have we heard that one before?

That's right: Everywhere in the world of alternative medicine. It's a standard excuse.

Personally, I hope that Fawcett has undergone conventional salvage therapy and is only now seeking out "alternatives." I wouldn't even mind if, as so many cancer patients who seek out alternative therapy after undergoing surgery or a partial course of conventional therapy do, she attributes her survival to the alternative, rather than her conventional therapy.