Integrative Therapies for Breast Cancer Treatment: Clinical Practice Guideline

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The new guideline is intended to provide clinicians and patients with practical information and tools.
The new guideline is intended to provide clinicians and patients with practical information and tools.

The Society for Integrative Oncology (SIO) has issued an updated clinical practice guideline regarding the use of integrative therapies for specific clinical indications during and after breast cancer treatment, as published in CA: A Cancer Journal for Clinicians.1

The new guideline is intended to provide clinicians and patients with practical information and tools to evaluate whether there is an evidence base to support the use of a defined integrative therapy for a specific clinical application in the context of breast cancer.

“Of note, it is important to define the use of the term recommendation in these clinical practice guidelines,” stated the authors. “In many settings, a clinical guideline recommendation suggests that it should be used as the standard of care and is favorable or equal compared with all other options based on best clinical evidence for benefit/risk ratio. Here, in the setting of integrative oncology, we use the term recommendation to conclude that the therapy should be considered as a viable but not singular option for the management of a specific symptom or side effect.

The guideline does not address breast cancer recurrence or survival end points, because few adequately powered randomized controlled trials have examined the effect of integrative therapies on these outcomes.

The authors developed the following graded integrative therapies for clinicians to use in patients with breast cancer according to clinical outcomes.

Acute radiation skin reaction

Aloe vera and hyaluronic acid cream should not be recommended for improving acute radiation skin reaction. Grade D

Anxiety/stress reduction

Meditation is recommended for reducing anxiety. Grade A
Music therapy is recommended for reducing anxiety. Grade B
Stress management is recommended for reducing anxiety during treatment, but longer group programs are likely better than self-administered home programs or shorter programs. Grade B
Yoga is recommended for reducing anxiety. Grade B
Acupuncture, massage, and relaxation can be considered for reducing anxiety. Grade C

Chemotherapy-induced nausea and vomiting

Acupressure can be considered as an addition to antiemetics drugs to control nausea and vomiting during chemotherapy. Grade B
Electroacupuncture can be considered as an addition to antiemetics drugs to control vomiting during chemotherapy. Grade B
Ginger and relaxation can be considered as additions to antiemetic drugs to control nausea and vomiting during chemotherapy. Grade C
Glutamine should not be recommended for improving nausea and vomiting during chemotherapy. Grade D

Depression/mood disturbance

Meditation, particularly mindfulness-based stress reduction, is recommended for treating mood disturbance and depressive symptoms. Grade A
Relaxation is recommended for improving mood disturbance and depressive symptoms. Grade A
Yoga is recommended for improving mood and depressive symptoms. Grade B
Massage is recommended for improving mood disturbance. Grade B
Music therapy is recommended for improving mood. Grade B
Acupuncture, healing touch, and stress management can be considered for improving mood disturbance and depressive symptoms. Grade C

Fatigue

Hypnosis and ginseng can be considered for improving fatigue during treatment. Grade C
Acupuncture and yoga can be considered for improving post-treatment fatigue. Grade C
Acetyl-L-carnitine and guarana should not be recommended for improving fatigue during treatment. Grade D

Lymphedema

Low-level laser therapy, manual lymphatic drainage, and compression bandaging can be considered for improving lymphedema. Grade C

Neuropathy

Acetyl-L-carnitine is not recommended for the prevention of chemotherapy-induced peripheral neuropathy in patients with breast cancer due to potential harm. Grade H

Pain

Acupuncture, healing touch, hypnosis, and music therapy can be considered for the management of pain. Grade C

Quality of life

Meditation is recommended for improving quality of life. Grade A
Yoga is recommended for improving quality of life. Grade B
Acupuncture, mistletoe, qigong, reflexology, and stress management can be considered for improving quality of life. Grade C

Sleep disturbance

Gentle yoga can be considered for improving sleep. Grade C

Vasomotor/hot flashes

Acupuncture can be considered for improving hot flashes. Grade C
Soy is not recommended for hot flashes in patients with breast cancer due to lack of effect. Grade D

Reference

  1. Greenlee H, DuPont-Reyes MJ, Balneaves LG,  et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin. 2017 Apr 24. doi: 10.3322/caac.21397

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