Exact details of the alternative natural and traditional therapies tried by Steve Jobs before he underwent surgery in 2004 and eventually died of pancreatic cancer earlier this month have not been disclosed. (A representative from Apple declined to comment on any aspect of the Apple co-founder's illness.) He reportedly restricted his diet to just fruits or just fruits and vegetables, tried out something called hydrotherapy and consulted psychics. In any case, a mounting body of scientific and anecdotal reports provides compelling evidence about the potential impact, both positive and negative, of so-called complementary practices on the health and longevity of cancer patients following their diagnosis. And, although Jobs's unconventional early-treatment choices may not have done much to stave off the spread of deadly cancer cells in his case, they provide an opportunity to discuss what makes cancer grow and how to stop it.
Jobs had a rare form of pancreatic cancer known as pancreatic neuroendocrine tumor (pNET). Accounting for about 1 percent of all pancreatic cancers, pNET is a cancer of the endocrine cells, known clinically as the islets of Langerhans, which exist in small clusters throughout the pancreas. These cells produce hormones such as insulin, which lowers blood sugar, and glucagon, which increases it.
Unlike the vast majority of pancreatic cancers (known as pancreatic adenocarcinomas) of the ductal part of the pancreas, pNET is not always deadly. These cancer cells tend to be slow growing, and so the cancer does not spread to other sites in the body as quickly. That means surgical removal of the tumor can sometimes be curative. For patients whose disease is detected while it's still confined to the pancreas, the five-year survival rate is 87 percent—in other words, the majority of patients live for quite a while.
For patients in whom this cancer has spread outside the pancreas, the median survival is 27 months. "That said, there are groups of patients with metastatic disease who can live much longer," says James Yao, associate professor and deputy chairman in gastrointestinal medical oncology at the University of Texas M. D. Anderson Cancer Center, "some even up to 5 to 10 years."
It's impossible to know whether surgery would have been curative if Jobs had undergone the procedure at the time of his diagnosis. But what about the role of acupuncture and other naturopathic approaches he tried? Could they have extended his life and improved his health or had the opposite effect?
Acupuncture has gained traction in Western medicine as a helpful complementary component to cancer care. Some clinical studies have confirmed the efficacy of this traditional Chinese medicine approach, in which needles are shallowly inserted at different points on the body, in diminishing the nausea, pain and fatigue that often follow chemotherapy, radiation and surgery, the mainstays of modern cancer treatment.
But although it may have contributed to overall well-being, acupuncture is unlikely to have had an impact on the tumor itself. "It is not enough to change the course of the disease," says Lowell Kobrin, a medical doctor who now focuses on acupuncture and herbal medicine at Northbend Medical Center in Coos Bay, Ore. "It could not affect the cancer itself."
As Tim Birdsall, vice president of integrative medicine at the Cancer Treatment Centers of America, explains it, cancer is a disease in which the cells become less and less responsive to their external environment. Multiple mutations in DNA—specifically, abnormalities in the p21 and p53 genes, among other changes—stop the process of apoptosis, or programmed cell death, that normal cells undergo. In addition to becoming immortal, cancer cells invade the surrounding tissue, rendering it nonfunctional.