April 24, 2017 — In newly updated clinical guidelines from the Society for Integrative Oncology (SIO), researchers at Columbia University's Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center with an interdisciplinary team of colleagues at MD Anderson Cancer Center, University of Michigan, Memorial Sloan Kettering Cancer Center, and other institutions in the U.S. and Canada, analyzed which integrative treatments are most effective and safe for patients with breast cancer.
This systematic review adds to the growing literature on integrative therapies for patients with breast cancer and other cancer populations. The latest results are published online and in print in CA: A Cancer Journal for Clinicians, a publication of the American Cancer Society.
The researchers evaluated more than 80 different therapies and developed grades of evidence. Based on those findings, the Society for Integrative Oncology makes the following recommendations:
- Use of music therapy, meditation, stress management and yoga for anxiety and stress reduction
- Use of meditation, relaxation, yoga, massage and music therapy for depression and mood disorders
- Use of meditation and yoga to improve quality of life
- Use of acupressure and acupuncture for reducing chemotherapy-induced nausea and vomiting
- A lack of strong evidence supporting the use of ingested dietary supplements or botanical natural products as part of supportive care and/or to manage breast cancer treatment-related side effects
"Studies show that up to 80 percent of people with a history of cancer use one or more complementary and integrative therapies, but until recently, evidence supporting the use of many of these therapies had been limited," said Heather Greenlee, ND, PhD, assistant professor of Epidemiology at Columbia University's Mailman School of Public Health, and past president of SIO. "Our goal is to provide clinicians and patients with practical information and tools to make informed decisions on whether and how to use a specific integrative therapy for a specific clinical application during and after breast cancer treatment," Greenlee continues.
In their systematic evaluation of peer-reviewed randomized clinical trials, the researchers assigned letter grades to therapies based on the strength of evidence. A letter grade of "A" indicates that a specific therapy is recommended for a particular clinical indication, and there is high certainty of substantial benefit for the patient.
Meditation had the strongest evidence supporting its use, and is recommended for reducing anxiety, treating symptoms of depression, and improving quality of life, based on results from five trials. Music therapy, yoga, and massage received a B grade for the same symptoms, as well as for providing benefits to breast cancer patients. Yoga received a B grade for improving quality of life based on two recent trials. Yoga and hypnosis received a C for fatigue.
"The routine use of yoga, meditation, relaxation techniques, and passive music therapy to address common mental health concerns among patients with breast cancer is supported by high levels of evidence," said Debu Tripathy, MD, chair of Breast Oncology at The University of Texas MD Anderson Cancer Center, and a past president of SIO. "Given the indication of benefit coupled with the relatively low level of risk, , these therapies can be offered as a routine part of patient care, especially when symptoms are not well controlled."
Acupressure and acupuncture received a B grade as an addition to drugs used for reducing chemotherapy-induced nausea and vomiting. In general, there was a lack of strong evidence supporting the use of ingested dietary supplements and botanical natural products as part of supportive cancer care and to manage treatment-related side effects.
"Clinicians and patients need to be cautious about using therapies that received a grade of C or D and fully understand the potential risks of not using a conventional therapy that may effectively treat cancer or help manage side effects associated with cancer treatment," warned Lynda Balneaves, RN, PhD, associate professor, College of Nursing, Rady Faculty of Health Sciences, Winnipeg, Canada, and president-elect of SIO.
"Patients are using many forms of integrative therapies with little or no supporting evidence and that remain understudied," noted Dr. Greenlee. "This paper serves as a call for further research to support patients and healthcare providers in making more informed decisions that achieve meaningful clinical results and avoid harm."
Additional co-authors: Melissa J. DuPont-Reyes, Department of Epidemiology, Mailman School of Public Health, Columbia University; Linda Carlson, Department of Oncology, University of Calgary, Calgary, AB, Canada; Misha Cohen, American College of Traditional Chinese Medicine at California Institute of Integral Studies, and Chicken Soup Chinese Medicine, San Francisco; Gary Deng, Integrative Oncology, Memorial Sloan Kettering Cancer Center, New York City; Jillian A. Johnson, Memorial Sloan Kettering Cancer Center, New York City; Matthew Mumber, Department of Biobehavioral Health, Pennsylvania State University, University Park; Dugald Seely, Ottawa Integrative Cancer Center, Ottawa, ON, and Canadian College of Naturopathic Medicine, Toronto, ON; Suzanna M. Zick, Department of Family Medicine, University of Michigan Health System, and Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor; and Lindsay M. Boyce, Memorial Sloan Kettering Library, Memorial Sloan Kettering Cancer Center, New York City.
Columbia University's Mailman School of Public Health
Founded in 1922, Columbia University's Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including ICAP (formerly the International Center for AIDS Care and Treatment Programs) and the Center for Infection and Immunity. For more information, please visit http://www.mailman.columbia.edu.