You expect your oncologist to talk about chemotherapy regimens and surgical options to treat your breast cancer, but can you imagine discussing the use of meditation and hypnosis to help ease the cancer symptoms and side effects of the treatment?
The American Society of Clinical Oncology (ASCO) has recently endorsed new guidelines on complementary therapies like these, encouraging breast cancer patients and their health care teams to consider using such approaches which have been shown to improve patient outcomes.
For years, ASCO, the organization that creates clinical guidelines for oncologists, stayed away from evaluating complementary therapies. These new guidelines for breast cancer care, published in June 2018, represent the group’s first venture into the field. So why now?
Because patients are using complementary therapies even without their doctor’s recommendation.
“We know this is a multibillion-dollar industry in the U.S., particularly with supplements,” Gary Lyman, M.D., co-chair of the ASCO panel that reviewed the guidelines, co-director of the Hutchinson Institute for Cancer Outcomes Research at Fred Hutchinson, and Professor of Medicine at the University of Washington said in a phone call with HealthCentral.
“Patients are spending a huge amount of money on these therapies. Some may be helpful but many will not be. They deserve to know what the best science has to say about these options so they can make informed decisions.”
The guidelines were originally established by the Society for Integrative Oncology (SIO), an organization that works to promote the use of evidence-based complementary treatments in combination with conventional cancer care.
“These guidelines were created after a systematic review,” said SIO President Lynda Balneaves, Ph.D., in a phone interview with HealthCentral. “We went through thousands of research articles from all around the world. These articles were reviewed by an international group of experts and graded in terms of the quality of the research. For each study, we determined if it was a therapy that should be recommended, that may be helpful, that we didn’t have evidence for, or that could do harm and should not be recommended.”
Then a panel of ASCO experts reviewed the SIO guidelines and endorsed most, although not all, of the recommendations. Here are several symptoms and side effects of breast cancer and its treatments, and complementary approaches recommended or discouraged by the guidelines:
- Anxiety - Meditation, music therapy, yoga, and group stress management programs were all recommended to reduce anxiety.
- Nausea - Acupressure, electro-acupuncture, ginger, and relaxation could be offered to certain patients along with medications to reduce nausea. Glutamine use was discouraged due to inadequate results.
- Depression and moodiness - Meditation, relaxation, yoga, massage, and music therapy were all recommended to treat depression and mood disturbances.
- Fatigue - Hypnosis, ginseng, acupuncture, and yoga could be offered to certain patients to help with treatment-related fatigue. However, ASCO advised patients to seek guidance from their health care team before using ginseng or any dietary supplement because ginseng may mimic estrogen, which could harm certain breast cancer patients. ASCO also discouraged the use of acetyl-L-carnitine and guarana for fatigue.
- Lymphedema - Low-level laser therapy, manual lymphatic drainage, and compression bandaging can be offered to certain patients to relieve lymphedema related to breast cancer treatment.
- Pain management - Acupuncture, healing touch, hypnosis, and music therapy can be offered to patients to treat pain.
- Quality of life - Meditation and yoga were widely recommended to improve quality of life, while acupuncture, mistletoe, qigong, reflexology, and stress management could be offered, with caveats, to certain patients.
You can find the complete guidelines in the Journal of Clinical Oncology.
Like Dr. Lyman, Dr. Balneaves agrees that ASCO’s endorsements will help doctors and patients make informed decisions.
“This is important because clinicians are incredibly busy,” Dr. Balneaves said. “Often they don’t receive training in integrative medicine or complementary therapies during medical school. Having guidelines increases the knowledge of these therapies at point of care. I think it’s vital clinicians expand their toolbox and not just focus on pharmaceuticals and conventional treatments. If there are other therapies that are shown to be safe and effective, we need to make sure the patients have the knowledge and access to that information as well.”
While these guidelines are specifically designed for breast cancer patients, Dr. Lyman says individuals at ASCO have talked about pursuing more collaborations with SIO. In the future, they may create guidelines for a particular side effect, like fatigue or pain, or another type of cancer.
“It’s an issue we can’t ignore,” Dr. Lyman said. “We’d rather it be discussed so patients and doctors can share the evidence and together make the best decisions.”