What You Need to Know: The Society for Integrative Oncology (SIO) has now published the first clinical practice guidelines on integrative therapy in breast cancer, which allow specific therapies to be recommended as evidence-based supportive care options.
Background: Even though the majority of breast cancer patients in the United States use complementary therapies, there has been a lack of evidence-based resources to help guide both clinicians and patients about their safety and effectiveness.
The Study: The multidisciplinary team of authors evaluated more than 80 different types of therapies and 30 interventions for safety and efficacy, including acupuncture, food supplements, yoga, and meditation. A modified version of the US Preventive Services Task Force (USPSTF) grading system was used to develop and grade recommendations.
“This allowed us to use a standard tool to measure the strength of the data,” said guideline first author Heather Greenlee, ND, PhD, assistant professor of epidemiology at Columbia’s Mailman School of Public Health in New York City and president of the Society for Integrative Oncology.
Few Score Grade A or B
- Only meditation, yoga, and relaxation with imagery got top marks with grade A recommendations for routine use for common conditions such as anxiety and mood disorders.
- These therapies also received a B grade for reducing stress, depression, and fatigue, as did acupuncture for controlling chemotherapy-induced nausea and vomiting. Music therapy and massage also got B recommendations for reducing anxiety and mood disturbances.
- Many of the interventions (n = 32), including laser therapy for lymphedema, acupuncture for hot flashes, and Qigong for improving quality of life, had weaker evidence of benefit (grade C), primarily owing to small study sizes or conflicting evidence in the literature.
- A few interventions (n = 7), such as aloe vera gel to prevent or treat acute skin reaction to radiation and guarana as an herbal for the treatment of fatigue, were deemed unlikely to provide any benefit and received a grade of D and are not recommended.
- In addition, one therapy was found to be harmful and was given a grade H. “We found that acetyl-l-carnitine, which is marketed to prevent chemotherapy-related neuropathy, was shown to actually increase the risk,” Dr Greenlee told Medscape Medical News.
A number of interventions did not have sufficient evidence to support any specific recommendations. They require further investigation through well-designed controlled clinical trials, she explained. “We were also unable to assess most dietary supplements and herbs, as there’s not much evidence available. So we could not make any recommendations on those.”
The only botanicals included in the guideline were ginseng for fatigue, ginger for chemotherapy-related nausea/vomiting, and mistletoe to improve quality of life (all grade C). Even though some of the natural products had sufficient efficacy data, they lacked long-term safety information and could not be given a higher grade.
The authors note that grade C interventions represent areas in which there is a greater need for additional study, and as such, the use of these modalities require “shared decision making between patients and providers, a discussion of the risk-benefit for all available treatments, and monitoring for efficacy, futility, and harm and balanced against the availability of conventional treatments.”
I’m Dr. Michael Hunter.
The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.
Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.
Reference: J Natl Cancer Inst Monogr (2014) 2014 (50): 346-358