Complementary therapies increasingly play a role, and breast cancer patients in particular are frequent users of complementary therapies as part of their care.
What information is available to help in selecting complementary therapies that have been shown to be effective?
A study reported late last year in the Journal of the National Cancer Institute Monographs evaluated the evidence currently available from randomized, controlled clinical trials on the effectiveness of complementary therapies that are used as supportive care for breast cancer patients.
The authors defined complementary and alternative therapies as “any medical system, practice, or product that is not part of conventional medical care.” Complementary therapies are used along with conventional medical treatments for breast cancer to help manage a variety of physical and emotional issues that develop either as side effects of treatment or from the cancer itself. When evidence-based complementary therapies are used along with conventional medical treatment, the practice is often referred to as integrative oncology and the therapies may be referred to as integrative therapies.
The evidence is the key, but unfortunately there has not been a great deal of evidence to go on because there have been relatively few clinical trials testing complementary or integrative therapies.
How the study was done
In this study, researchers from several major cancer centers conducted a systematic review of the randomized, controlled trials over the last two decades that evaluated the use of integrative therapies for supportive care of patients who were receiving breast cancer treatment. The authors then distilled that information–from a total of 203 articles published between 1990 and 2013–into a set of guidelines to help patients and doctors select integrative therapies.
The authors did not include some interventions, such as diet and exercise, because the evidence on those therapies was considered to be well-summarized and available elsewhere. And certain other interventions including counseling and support groups weren’t included because they have become “mainstream.”
Therapies receiving Grade A or B ratings were those for which the evidence suggested a high degree of certainty that there was at least moderate benefit from the intervention. Grade C ratings were assigned when the evidence pointed to a small net benefit, but many of these therapies were recommended for consideration depending upon an individual’s specific circumstances.
Findings and recommendations
These are the overall findings from the study:
- The therapies receiving Grade A ratings were meditation, yoga and relaxation with imagery when used for help in addressing depressive symptoms and mood problems.
- Grade B ratings were assigned for stress management, massage, music therapy and energy conservation when used to aid with stress reduction, anxiety, depression and fatigue.
- Therapies that received Grade C ratings for some uses included acupuncture, relaxation, healing touch and qigong.
- The majority of interventions reviewed did not have enough evidence to support they’re being recommended, and a few were deemed unlikely to provide any benefit. One intervention, acetyl-L-carnitine for the prevention of taxane-induced neuropathy, was found to actually increase neuropathy.
These are the study’s conclusions for several specific conditions for which there was at least one Grade A or B complementary therapy recommended, along with some Grade C therapies that could be considered:
- Anxiety and stress: Music therapy was recommended for short-term relief of anxiety during chemotherapy and radiation therapy. To reduce longer-term anxiety both during and after treatment, meditation, yoga and stress management programs were recommended. In addition, it was noted that relaxation and massage therapy can be considered for short-term relief of anxiety during treatment, and acupuncture can be considered for treating anxiety concurrent with fatigue.
- Depression and mood: Several therapies were recommended for depression and mood. Mediation, particularly mindfulness-based stress reduction, was recommended both during radiation therapy and post-treatment. Yoga and relaxation were also recommended during both chemotherapy and radiation therapy. For newly diagnosed patients, music therapy was recommended to improve mood and depressive symptoms, and massage was recommended for post-treatment survivors. Other therapies that could be considered included stress management, healing touch and acupuncture (for women suffering from hot flashes.)
- Fatigue: A therapy referred to as “energy conservation/activity management” was recommended for fatigue management. Other therapies that could be considered to manage fatigue include qigong, acupuncture and 2,000 mg daily of American ginseng root powder.
- Chemotherapy-induced nausea and vomiting: Along with antiemetics (drugs to control nausea and vomiting) therapies that could be considered included electroacupuncture, acupressure and progressive muscle relaxation.
Importance of personalized choices
The study’s authors stressed that the guidelines are intended to be a reference for both physicians and patients as they discuss together plans for treatment and management of toxicities. Treatment plans need to be personalized based on a patient’s preferences and their specific condition.
The researchers also noted that, similar to most therapies, the effectiveness of different approaches varies among patients so it’s important to track outcomes carefully, including any adverse effects.
Future research needs
The article identified several conditions for which future research is needed to identify appropriate complementary therapies. These included peripheral neuropathy, joint pain, mucositis, fatigue and cognitive dysfunction. In addition, promising evidence on several therapies including acupuncture needs to be followed up in further studies.
It was also noted that some botanical products studied in clinical trials had strong evidence on short-term effects, but lacked data on long-term safety and toxicity outcomes, and that future studies need to address this. An example in this category was the use of mistletoe for “improving quality of life.”
Some practical strategies were suggested to aid future research efforts. One was the use of electronic medical records and established research networks as a way to obtain high quality data on clinical outcomes. The authors also recommended that researchers consider including assessments of the use of complementary therapies in conventional treatment trials.
For More Information
If you’re interested in learning more about complementary therapies for breast cancer, one good place to start is the website of the Office of Cancer Complementary and Alternative Medicine (OCCAM), which is part of the National Cancer Institute. Their patient information resources includes tips for talking with health care providers about complementary and alternative medicine (CAM) and information on many specific CAM therapies used by cancer patients. You can also get information on CAM clinical trials by cancer type through the OCCAM website.
Breastcancer.org is another helpful website for information on the use of complementary medicine in breast cancer care.
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