Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment

Heather Greenlee; Melissa J DuPont-Reyes; Lynda G Balneaves; Linda E Carlson; Misha R Cohen; Gary Deng; Jillian A Johnson; Matthew Mumber; Dugald Seely; Suzanna M Zick; Lindsay M Boyce; Debu Tripathy

doi:10.3322/caac.21397

Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment

CA Cancer J Clin. 2017 May 6;67(3):194-232. doi: 10.3322/caac.21397. Epub 2017 Apr 24.

Authors

Heather Greenlee^{1

2}, Melissa J DuPont-Reyes³, Lynda G Balneaves⁴, Linda E Carlson⁵, Misha R Cohen^{6

7}, Gary Deng⁸, Jillian A Johnson⁹, Matthew Mumber¹⁰, Dugald Seely^{11

12}, Suzanna M Zick^{13

14}, Lindsay M Boyce¹⁵, Debu Tripathy¹⁶

Affiliations

¹ Assistant Professor, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
² Member, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY.
³ Doctoral Fellow, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
⁴ Associate Professor, College of Nursing, Rady Faculty of Health Sciences, Winnipeg, MB, Canada.
⁵ Professor, Department of Oncology, University of Calgary, Calgary, AB, Canada.
⁶ Adjunct Professor, American College of Traditional Chinese Medicine at California Institute of Integral Studies, San Francisco, CA.
⁷ Clinic Director, Chicken Soup Chinese Medicine, San Francisco, CA.
⁸ Medical Director, Integrative Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
⁹ Post-Doctoral Scholar, Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA.
¹⁰ Radiation Oncologist, Harbin Clinic, Rome, GA.
¹¹ Executive Director, Ottawa Integrative Cancer Center, Ottawa, ON, Canada.
¹² Executive Director of Research, Canadian College of Naturopathic Medicine, Toronto, ON, Canada.
¹³ Research Associate Professor, Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI.
¹⁴ Research Associate Professor, Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI.
¹⁵ Research Informationist, Memorial Sloan Kettering Library, Memorial Sloan Kettering Cancer Center, New York, NY.
¹⁶ Professor, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.

Abstract

Answer questions and earn CME/CNE Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, 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. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. CA Cancer J Clin 2017;67:194-232. © 2017 American Cancer Society.

Keywords: acupressure; acupuncture; breast cancer; complementary therapies; integrative medicine; integrative oncology; massage; meditation; music therapy; stress management; yoga.

Publication types

Practice Guideline
Review
Systematic Review

MeSH terms

Anxiety / therapy
Breast Neoplasms / complications*
Breast Neoplasms / psychology
Breast Neoplasms / therapy*
Complementary Therapies*
Depression / therapy
Fatigue / therapy
Female
Humans
Lymphedema / therapy
Mood Disorders / therapy
Nausea / therapy
Peripheral Nervous System Diseases / therapy
Quality of Life
Sleep Wake Disorders / therapy
Stress, Psychological / therapy
Vomiting / therapy

Grants and funding

P30 CA016672/CA/NCI NIH HHS/United States