Key points
- Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects.
- Evidence supporting the use of such therapies in the oncology setting is limited.
- No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects.
- There is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment.
Content:
Terminology
- Complementary and alternative therapies are generally defined as any medical system, practice, or product that is not part of conventional medical care.
- Complementary medicine comprises therapies used as a complement alongside conventional medicine.
- Alternative medicine comprises therapies used in place of conventional medicine.
- Integrative medicine is the coordinated use of evidence-based complementary practices and conventional care.
- Integrative oncology refers to the use of complementary and integrative therapies in collaboration with conventional oncology care.
What are integrative therapies?
Integrative therapies, also known as complementary therapies, include a wide range of therapies that can be used alongside recommended conventional breast cancer treatments (such as endocrine therapy, chemotherapy, biological/targeted therapy, and radiation therapy).
While scientific research and studies on integrative therapies is limited, there is a growing number of well conducted randomised trials that suggest some may help management of physical and emotional symptoms and adverse effects of treatments in people with breast cancer.
Selecting an integrative health practitioner – What to tell your patient
- Find potential practitioners who have experience working with people with breast cancer. If your patient has private medical insurance check with the provider to see which integrative medical practitioners are recommended.
- Find out whether the practitioner is willing to work together with conventional health care providers.
- Explain all health conditions to the practitioner, which could affect the safety of integrative approaches. For example, it may not be safe for patients with osteoporosis to do certain yoga poses and it is also not recommended that patients on chemotherapy or having radiation take high dose anti-oxidants.
Benefits of integrative therapies alongside conventional treatment for breast cancer
Integrative therapies are thought to have a wide range of benefits for people before, during, and after treatment for breast cancer. These include:
- Improving physical wellbeing (e.g. build strength and endurance, relaxation)
- Improving emotional wellbeing (e.g. reduce stress and anxiety, relieve depression)
- Reducing disease symptoms and side effects of breast cancer treatment (e.g. relieve pain, fatigue, hot flushes)
Based on a systematic review of the literature, the Society for Integrative Oncology makes the following recommendations:
- Use of music therapy, meditation, stress management and yoga for anxiety/stress reduction.
- Use of meditation, relaxation, yoga, massage and music therapy for depression/mood disorders.
- Use of meditation and yoga to improve quality of life.
- Use of acupressure and acupuncture for reducing CINV.
- There is a lack of strong evidence supporting the use of ingested dietary supplements or botanical agents as supportive care and/or to manage breast cancer treatment-related side effects.
Types of integrative therapies
Listed below are the most common integrative therapies that have been reported to help with physical and emotional wellbeing. As complementary therapies work on different symptoms, the possible benefits of each complementary therapy are outlined in the second column.
| Complementary therapy technique | Possible benefits (based on evidence and research) |
| Acupuncture A traditional form of Chinese medicine. Involves the use of tiny needles and/or pressure to stimulate points on the body. Research shows that acupuncture releases chemicals, such as beta-endorphin and serotonin. | Found to help with some side effects of chemotherapy, such as nausea and sickness, when given alongside conventional anti-emetic drugs. May also help reduce pain and menopausal symptoms (e.g. hot flushes, night sweats), improve mood and reduce anxiety. |
| Aromatherapy The use of essential plant oils for therapeutic purposes. The most common forms of aromatherapy include body massage (massaged and absorbed by the skin), and the use of diffusers or devices to inhale the scent. | Shown to reduce anxiety and ease depression. Also found to help with sleeplessness, menopausal symptoms, pain, respiratory congestion and nausea (e.g. anticipatory nausea and vomiting with chemotherapy). |
| Massage A hands-on approach, working on the body’s muscles and joints to stretch and apply pressure. Soothes stiffness and muscle tension. | Found to help reduce pain, decrease tension and stress, ease anxiety and depression, and help sleep quality and fatigue |
| Meditation and Mindfulness Techniques to help develop awareness of thoughts and feelings to achieve inner calmness / balance and relaxation. | Shown to help people to cope better with stress, anxiety and depression. May also help some people with physical side effects such as fatigue. |
| Yoga and Tai Chi Movement based mind-body therapy. Uses breathing exercises combined with a series of movement: yoga – stretch and flex different muscle groups; Tai Chi – slow fluid movements. | Found to help reduce fatigue, stress; improve ability to cope and general wellbeing. |
| Other Mind-Body Therapies Art Therapy: Use of art for communication and emotional therapeutic use. May be used with other psychological methods. Music Therapy: Communicating through music | Found to help with expression of feelings (awareness of difficult feelings and how to let go of them) and general wellbeing. |
Graded integrative therapies for use in patients with breast cancer according to clinical outcomes
| Clinical outcomes | Recommended therapy | Strength of evidence grade |
| Acute radiation skin reaction | Aloe vera and Hyaluronic acid cream should not be recommended for improving acute radiation skin reaction. | D |
| Anxiety/Stress reduction | 1. Meditation is recommended for reducing anxiety. 2. Music therapy is recommended for reducing anxiety.
4. Yoga is recommended for reducing anxiety. | 1. A
2. B 3. B 4. B 5. C |
| Chemotherapy induced nausea and vomiting | 1. Acupressure can be considered as an addition to anti-emetics drugs to control nausea and vomiting during CT. 2. Acupuncture can be considered as an addition to anti-emetics drugs to control vomiting during CT. 3. Ginger, relaxation can be considered as an addition to anti-emetics drugs to control nausea and vomiting during CT. 4. Glutamine, should not be recommended for improving nausea and vomiting during CT. | 1. B 2. B 3. C
|
| Depression/Mood disturbance | 1. Meditation, particularly MBSR, is recommended for treating mood disturbance and depressive symptoms. 2. Relaxation is recommended for improving mood disturbance and depressive symptoms
4. Massage is recommended for improving mood disturbance 5. Music therapy is recommended for improving mood. 6. Acupuncture, healing touch, stress management can be considered for improving mood disturbance and depressive symptoms. | 1. A 2. A 3. B 4. B 5. B 6. C |
| Fatigue | 1. Hypnosis and ginseng can be considered for improving fatigue during treatment. 2. Acupuncture and yoga can be considered for improving fatigue post treatment. 3. Acetyl-L-carnitine and Guarana should not be recommended for improving fatigue during treatment. | 1. C 2. C 3. D |
| Lymphoedema | Laser therapy, manual lymphatic drainage and compression bandaging can be considered for improving lymphedema. | C |
Neuropathy | Acetyl-L-carnitine is not recommended for prevention of neuropathy in breast cancer patients due to harm. | H |
| Pain | Acupuncture, healing touch, hypnosis, music therapy can be considered for the management of pain. | C |
| Quality of life | 1. Meditation is recommended for improving quality of life 2. Yoga is recommended for improving quality of life 3. Acupuncture, mistletoe, Qigong, reflexology, stress management can be considered for improving quality of life | 1. A 2. B
|
| Sleep disturbance | Gentle yoga can be considered for improving sleep. | C |
| Vasomotor/Hot flashes | 1. Acupuncture can be considered for improving hot flashes. 2. Soy is not recommended for hot flashes in BC patients due to lack of effect. | 1. C 2. D |
