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Integrative therapies in breast cancer

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photo of woman meditating on a beach, waves crashing in background

In many of my conversations with patients, the use of complementary therapies (e.g., yoga, meditation, and acupressure) comes up. Breast cancer patients want to know what they can do, other than exercise training, to improve their health and reduce side-effects of cancer treatment. The Society of Integrative Oncology (SIO) provides guidance on this topic in an article published last year in the Journal of Clinical Oncology (Lyman, JCO 2018).

The document provides the evidence base for its recommendation based on a grade of A (recommends, high certainty for net benefit), B (recommends, moderate certainty of net benefit), C (recommends selectively based on professional judgement, moderate certainty for small benefit in select patients). In certain cases, integrative therapies was also discouraged (Grade D or H).

Below is a summary from the SIO on integrative therapies recommended based on symptoms:

Anxiety Reduction

  • Meditation (Grade A)
  • Music therapy (Grade B)
  • Yoga (Grade B)
  • Acupuncture, massage (Grade C)

Chemotherapy-Induced Nausea and Vomiting (in addition to antiemetic drugs)

  • Acupressure (Grade B)
  • Electroacupuncture (Grade B)
  • Ginger and relaxation (Grade C)

Depression and Mood Disturbance

  • Mediation, particularly mindfulness-based stress reduction (Grade A)
  • Yoga (Grade B)
  • Massage (Grade B)
  • Music Therapy (Grade B)
  • Acupuncture, healing touch, and stress management (Grade C)

Fatigue

  • Hypnosis during treatment (Grade C)
  • Acupuncture and yoga post treatment (Grade C)

Lymphedema

  • Low-level laser therapy, manual lymphatic drainage, compression bandaging (Grade C)

Pain

  • Acupuncture, healing touch, hypnosis, and music therapy (Grade C)

Sleep Disturbance

  • Gentle yoga (Grade C)

Vasomotor/Hot Flashes

  • Acupuncture (Grade C)


In addition to the general recommendations above, there was a discussion on the use of EEG neurofeedback for those with chemotherapy-induced peripheral neuropathy (Prinsloo, Cancer, 2017) and acupuncture for aromatase inhibitor-induced arthralgias (Hershman, San Antonio Breast Cancer Symposium 2017). Lastly, the SIO provided more details on many medications and herbal remedies that have insufficient evidence for a clinical recommendation. Please see the document for full details.

We would love to hear your opinion on the use of integrative therapies in breast cancer and whether you think it would be helpful to have integrative therapy offerings (yoga videos, etc) within the Outcomes4Me app.

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