Guidelines on the best complementary therapies for breast cancer patients

New guidelines have been published to give breast cancer patients evidence-based advice on the most worthwhile and helpful complementary therapies.

Complementary medicine is intended to be used in conjunction with (not instead of) standard medical cancer treatments and includes techniques such as meditation, acupuncture, herbal medicine, massage, support groups, and yoga.  Research shows that up to 80 per cent of breast cancer patients use some form of complementary therapy.

The guidelines by the Society for Integrative Oncology, have been published in A Cancer Journal for Clinicians and are based on an analysis of more than 80 different complementary therapies used to treat breast cancer patients.

The Society believes the analysis is needed to help doctors and patients understand which therapies are safe and effective for people diagnosed with breast cancer.

The guidelines give each complementary therapy a letter grade with “A” meaning the therapy is recommended because there is strong evidence it offers benefits, “B”, “C” and “D” for those with progressively weaker evidence of benefit, while “H” means the therapy is not recommended because research shows that it does more harm than good.

Based on those findings, the Society for Integrative Oncology makes the following recommendations:

  • Meditation, music therapy, stress management and yoga for anxiety and stress reduction
  • Meditation, relaxation, yoga, massage and music therapy for depression and mood disorders
  • Meditation and yoga to improve quality of life
  • Acupressure and acupuncture for reducing chemotherapy-induced nausea and vomiting

The society advises that there is a lack of strong evidence supporting the use of ingested dietary supplements or botanical natural products to manage breast cancer treatment-related side effects.

Four other therapies were deemed unlikely to provide any benefit and are not recommended. One therapy was found to be harmful: acetyl-L-carnitine, which is marketed to prevent chemotherapy-related neuropathy, actually increased the risk of neuropathy.

The guidelines list specific conditions and breast cancer treatment side-effects and recommends complementary therapies to help ease them.   These include:

Anxiety and stress

  • Grade A:
    • Meditation, including mindfulness-based stress reduction
    • Yoga.
  • Grade B: 
    • Music therapy
    • Stress management programs.
  • Grade C:
    • Acupuncture
    • Relaxation

Depression and mood

  • Grade A:
    • Meditation, particularly mindfulness-based stress reduction, is recommended for improving mood and easing depression
    • Relaxation.
  • Grade B:
    • Yoga (grade B)
    • Music therapy
    • Massage
  • Grade C:
    • Acupuncture
    • Healing touch
    • Stress management.

Fatigue

  • Grade C:
    • Hypnosis
    • Ginseng
    • Acupuncture
    • Yoga
  • Grade D (not recommended)
    • Acetyl-L-carnitine
    • Guarana

Sleep problems

  • Grade C:
    • Gentle yoga.

Quality of life

  • Grade A:
    • Meditation
  • Grade B:
    • Yoga
  • Grade C (could be considered):
    • Acupuncture
    • Mistletoe
    • Qigong
    • Reflexology
    • Stress management

Nausea/vomiting caused by chemotherapy

  • Grade B:
  • Acupressure
  • Electroacupuncture
  • Grade C: (could be considered)
    • Ginger (should not be taken with Emend)
    • Relaxation
  • Grade D (not recommended)
    • Glutamine.

Pain

  • Grade C (could be considered);
    • Acupuncture
    • Healing touch
    • Hypnosis
    • Music therapy.

Neuropathy

  • Grade H (Definitely not recommended)
    • Acetyl-L-carnitine is NOT recommended to prevent neuropathy; one large study showed that acetyl-L-carnitine actually increased neuropathy.

Lymphoedema

  • Grade C:
    • Manual lymph drainage
    • Low-frequency laser therapy
    • Compression bandaging

Hot flashes

  • Grade C”
    • Acupuncture.
       
  • Grade D (not recommended):
    • Soy products.

Skin irritation from radiation therapy

  • Grade D (not recommended):
    • Aloe vera
    • Hyaluronic acid cream

BCAC chairperson Libby Burgess says the new guidelines offer useful advice to patients and clinicians alike.

“We know that many women pursue complementary therapies so it’s really important that they are making informed decisions based on rigorous scientific evidence.  These guidelines will help women to make better decisions about the options they pursue.

“It’s also important to stress that no patient should pursue any complementary therapy without first discussing it with their medical team.  It’s vital that complementary therapies do not interfere negatively with conventional medical treatments,” Libby says.

You can find more information about complementary therapies on BCAC’s website here.  You might also like to seek out this New Zealand book by Professor Shaun Holt Complementary Therapies for Cancer - What works, what doesn't ... and how to tell the difference .

 

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