by University of Virginia

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After being diagnosed with breast cancer seven years ago, Elle Macpherson made a controversial choice: She refused chemotherapy, the model has revealed in her new memoir, Elle: Life, Lessons, and Learning to Trust Yourself. Macpherson did undergo a lumpectomy—surgery to remove the malignant breast tissue—but she then went against the advice of 32 doctors and instead followed "an intuitive, heart-led, holistic approach," the 60-year-old told Australian Women's Weekly. Macpherson says she's now considered in remission.

Coming up with a cancer treatment plan is a highly personal process that requires weighing the risks and benefits of treatments. The decision to use alternative or "holistic" therapies worries doctors, but they point out that it's complicated.

On the one hand, these treatments are unproven, and choosing them instead of chemotherapy and other evidence-based therapies could put a patient's life in jeopardy. On the other hand, they say, there are some people who won't get much benefit from chemotherapy, and many at least feel better if they incorporate complementary medicine into their cancer treatment plan, alongside proven therapies.

How often do people decline chemotherapy?

It's rare, but not unheard of—and may be becoming more common. Late Apple CEO Steve Jobs declined standard treatment for pancreatic cancer, choosing dietary supplements, acupuncture and other alternative treatments instead (a decision his biographer, Walter Isaacson, said Jobs later regretted). Actress and singer Suzanne Somers also decided against conventional treatment during her battle with breast cancer; she died from the disease in 2023.

Less than 1% of patients with any type of cancer refuse treatment altogether, according to one study. But somewhere between 3% and 19% refuse some or all chemotherapy, the research found. A 2012 study found that just over 1% of people with advanced (stage III or IV) breast cancer refuse treatment.

"Some people feel very strongly that if there's not a huge benefit, they're not going to take treatment that's going to make them feel bad," including chemotherapy, Dr. Eric Winer, Yale Cancer Center director and president of Smilow Cancer Hospital, tells Yahoo Life. Aside from the side effects, others cite distrust in the treatment and medical system as their reasons for forgoing treatment.

What doctors think about forgoing chemotherapy

That's a really thorny question, oncologists say. "I get nervous that people will read [about decisions like Macpherson's] and assume it applies to their scenario," Dr. Lynn Dengel, a University of Virginia surgical oncologist, tells Yahoo Life.

"Having breast cancer is like having a car: One person has a Mack Truck, and another has a MINI Cooper"—meaning there are many different types and stages of cancers in general, and breast cancers specifically. The appropriate treatment plan is as individual as the person and the cancer, Dengel says.

Broadly speaking, the data is clear: People who choose alternative therapies as their first-line treatments are nearly five times more likely to die within five years than those who undergo standard treatment (often including chemotherapy) immediately, according to a large 2017 study of people with breast, lung and colorectal cancers.

Still, there are some exceptions. "Breast cancer is a disease that can recur many, many years later"—as Somers's did, two decades later—"but chemotherapy only prevents the early recurrences," says Winer. Moreover, some types are more likely to come back than others, so doctors and patients need to weigh the risks and benefits together, he explains.

What's the difference between alternative complementary treatments?

While doctors discourage using alternative treatments such as acupuncture, nutrition and massage in place of standard-of-care chemotherapy, that doesn't mean they're against using these therapies in addition to whatever medical treatment your provider recommends. These are called complementary treatments.

However, natural oils, foods and other treatments commonly referred to as "holistic" have never been proven effective at combating, much less curing, cancer. (You can read about some of these false claims here.) But many holistic treatments can help to reduce symptoms of cancer or side effects of treatments, including chemotherapy.

"I very often have patients using complementary medicine along with standard therapy, and they often have great results with that," Dengel says. "It's a very positive thing when we incorporate non-Western medicine into a treatment plan, but it's rare that we see patients declining standard care."

Why it's important to talk to your doctor about complementary medicine

It's not uncommon for people to use complementary medicine alongside standard medical treatments such as chemotherapy. One study found that a third of cancer patients used at least one form of complementary medicine, with herbal supplements being the most common.

The problem, experts say, is that 29% of these patients, according to the study, don't tell their doctors. That's potentially dangerous, because a patient could be unwittingly taking a supplement that doesn't mix well with their other treatments or has side effects they don't know about.

If you want to try complementary medicines, that's OK, say experts—but keep your doctor in the loop, even if that means you have to find one who won't be judgmental. "When a patient says, "I might not want to do [standard treatment]," as a doctor, you should not turn that person away, but continue to have a conversation and make sure they understand everything" rather than "get on a high horse," says Winer.

Dengel agrees. "Recognize that many of us [doctors] are open-minded and believe complementary medicine has a lot of benefits," she says. "If someone is not going to follow the standard of care, I'm still happy to maintain a relationship with patients and help them make the best decision at each time point" along their cancer journey.

Provided by University of Virginia