BCAC’s Marion Barnett recently attended ABC7 online, an international conference on advanced breast cancer. Here is her report on a talk about integrative medicine given by German breast cancer researcher Rachel Würstlein. Integrative medicine is the combination of medical treatments for cancer and complementary therapies to cope with symptoms and side effects.  

Integrative Medicine in Advanced Breast Cancer Treatment. The Actual Panorama and how it can be improved. Rachel Würstlein, Munich, Germany

Quality of life and toxicity management
Dr Würstlein reviewed recent literature on some of the most common types of complementary therapies used by patients to improve quality of life, including addressing side effects of treatment.

Mindfulness and exercise
In terms of evidence-based integrative oncology, there are two stand-out actions that people can take - mindfulness-based stress reduction and exercise. We hear a lot about mind-body techniques including yoga, but the literature shows that while yoga does improve quality of life, physical activity is better. 1

The recommended amount of exercise to improve symptoms such as fatigue is 150–300 minutes of moderate exercise per week or 75 minutes of vigorous exercise per week. However, exercise in cancer is an individual thing and this may be too much exercise for some patients with advanced breast cancer.

A large sample of 35,000 patients from various trials looked at acupuncture – it does no harm and improves quality of life but there’s no clear evidence that it’s superior to other methods and more evidence is needed.2

Supplements and diets
In terms of supplements and diets, one study looked at exercise + diet, exercise + supplements, or exercise alone. All three options improved quality of life – but neither of the combination arms worked better than exercise alone.3

There is also little evidence on the use of nutraceuticals. Importantly, a large recent review of the use of nutraceuticals could not conclude whether any specific substances – including Chinese medicines, vitamins, and other commonly used supplements – were beneficial or harmful.4

Dr Würstlein presented the results of the only trial that addressed complementary medicines and survival in cancer, including breast cancer.5 This showed high use of complementary medicine in patients with advanced breast cancer (35%), involving 651 different kinds of medications. Use of complementary medicine did improve quality of life and reduced adverse effects but there was no effect on progression-free survival or overall survival. Some complementary medicines use the same metabolic pathways in the body as conventional medicines and there is a risk that some could interfere with the action of the conventional cancer therapies.  The authors concluded that patients should be screened for complementary medicine use to identify and prohibit use of complementary medicines in trials with shared metabolic pathways.

The way forward
More research is needed to look at complementary medicines and survival given the clear interest in complementary medicine use and the lack of information on complementary medicine and drug interactions.

Report by Marion Barnett
19 November 2023

1.    O’Neill M.  The Effect of Yoga Interventions on Cancer-Related Fatigue and Quality of Life for Women with Breast Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Integr Cancer Ther. 2020 Jan-Dec:19:1534735420959882. doi: 10.1177/1534735420959882.
2.    Li H, et al. Acupuncture Improves Multiple Treatment-Related Symptoms in Breast Cancer Survivors: A Systematic Review and Meta-Analysis. J Altern Complement Med. 2021 Dec;27(12):1084-1097. doi: 10.1089/acm.2021.0133.  
3.    Pérez-Bilbao T, et al. Effects of Combined Interventions of Exercise and Diet or Exercise and Supplementation on Breast Cancer Patients: A Systematic Review. Nutrients. 2023 Feb 17;15(4):1013.  doi: 10.3390/nu15041013
4.    di Napoli R, et al. What Is the Role of Nutraceutical Products in Cancer Patients? A Systematic Review of Randomized Clinical Trials. Nutrients 2023, 15(14), 3249; https://doi.org/10.3390/nu15143249
5.    Wells JC, et al. Complementary Medicine Use Amongst Patients with Metastatic Cancer Enrolled in Phase III Clinical Trials. Oncologist. 2022 Mar 11;27(3):e286-e293.  doi: 10.1093/oncolo/oyac020.

Further reading
Society of Integrative Oncology (SIO) guidelines: https://integrativeonc.org

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