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First Guidelines on Use of Complementary Therapies for Breast Cancer
More than 80% of breast cancer patients in the U.S. use complementary therapies after their diagnosis, but there has been little science-based guidance to inform clinicians and patients about the safety and effectiveness of these treatments.
In newly published guidelines from the Society for Integrative Oncology (SIO), researchers at Columbia University, along with colleagues at the MD Anderson Cancer Center, the University of Michigan, the Memorial Sloan Kettering Cancer Center, and other institutions in the U.S. and Canada, analyzed which integrative treatments appear to be most effective and safe for patients. They evaluated more than 80 different therapies.
Meditation, yoga, and relaxation with imagery were found to have the strongest evidence supporting their use. They received an “A” grade and are recommended for routine use for anxiety and other mood disorders common to breast cancer patients. The same practices received a “B” grade for reducing stress, depression, and fatigue, but are endorsed for most breast cancer patients.
Acupuncture received a “B” grade for controlling chemotherapy-induced nausea and vomiting and can be recommended to most patients, the experts say.
More than 30 interventions, including some natural products and acupuncture for other conditions, had weaker evidence of benefit because of either small study sizes or conflicting study results, and received a “C” grade. Seven other therapies were deemed unlikely to provide any benefit and were not recommended. One therapy was found to be harmful: acetyl-l-carnitine, which is marketed to prevent chemotherapy-related neuropathy, but actually increases the risk for the condition.
The results were published online in the Journal of the National Cancer Institute Monograph.
To conduct their analysis, the researchers used nine biomedical publication databases to review randomized controlled clinical trials that tested complementary therapies together with standard cancer care — defined as surgery, chemotherapy, radiation therapy, and hormonal therapy –– in breast cancer patients from 1990 through 2013. Based on a set of guidelines developed by the Institute of Medicine, the authors considered the magnitude and type of benefit and harm along with the trials’ quality and size. Of 4,900 research articles reviewed, 203 met the criteria for the final analysis. The recommendations were organized by clinical outcome and graded using the U.S. Preventive Services Task Force grading system.
“Most breast cancer patients have experimented with integrative therapies to manage symptoms and to improve quality of life. But of the dozens of products and practices marketed to patients, we found evidence that only a handful currently have a strong evidence base,” said Heather Greenlee, ND, PhD, president of the SIO.
A number of interventions did not have sufficient evidence to support specific recommendations. “This does not mean that they don’t work; this means that we don’t yet know if they work, in what form, or what dose is the most effective. The vast majority of therapies require further investigation through well-designed, controlled clinical trials,” Greenlee said.
“These guidelines provide an important tool for breast cancer patients and their clinicians as they make decisions on what integrative therapies to use and not use. The guidelines clearly demonstrate that clinicians and patients should adopt shared decision-making approaches when assessing the risk–benefit ratio for each therapy. It is important to personalize the recommendations based upon patients’ clinical characteristics and values. What’s right for one patient may be wrong for another,” Greenlee remarked.
Source: EurekAlert; November 4, 2014.