The Journal of Alternative and Complementary Medicine
Vol. 24, No. 9-10
Dawn Lemanne, and Victoria Maizes
Published Online:24 Sep 2018
https://doi.org/10.1089/acm.2018.0150
Abstract
A majority of women undergoing conventional treatment for breast cancer also undertake complementary and integrative approaches. Practitioners knowledgeable about the evidence base behind common integrative approaches can help patients attain improved quality of life, and at times, improved survival. Evidence-based recommendations include the following: a plant-based diet for general health after diagnosis, and carbohydrate restriction for patients with estrogen receptor-positive postmenopausal breast cancer may be prudent. Other dietary recommendations include a 13-h daily overnight fast. Carefully selected patients may choose to fast the day before and the day of chemotherapy to decrease side effects. Specific food recommendations include avoidance or limitation of alcohol, and liberal culinary use of cruciferous vegetables, coffee, green tea, soy, and flaxseed. Promising supplements include diindolylmethane and melatonin. Omega 3 fatty acids may help with bone density in patients on aromatase inhibitors, but may increase chemotherapy resistance. Findings regarding the usefulness of multivitamins, vitamin D, vitamin C, and vitamin E are weak and/or mixed different exercise modalities may have different effects and thus play different roles in breast cancer therapy. Aerobic and resistance training combined during breast cancer chemotherapy may confer a survival benefit, while yoga may improve outcome in lymphedema patients. Current evidence suggests that meditation, yoga, breathing, music therapy, guided imagery, and hypnosis may improve mood and quality of life during breast cancer treatment. Acupuncture is useful for treating side effects of breast cancer therapies, including hot flushes, aromatase inhibitor-induced joint pain, chemotherapy-induced peripheral neuropathy, and vulvodynia. Vaginal moisturizers and vaginal rings supplying low-dose estrogen can be useful in the treatment of symptoms of estrogen-deprivation states caused by breast cancer treatments; such symptoms include vaginal dryness, dyspareunia, and sexual dysfunction. Carbon dioxide laser technology can rejuvenate atrophied vaginal mucosa and relieve dyspareunia, allowing avoidance of estrogen therapy. Tertiary sexual health centers are available for referral.
Breast cancer is common. Lifetime risk of a breast cancer diagnosis is 12.4% for women living in the United States, and the disease accounts for 15% of new cancer diagnoses annually.1 Use of integrative approaches as adjuncts to conventional care is extremely common, with as many as 84% of breast cancer patients using diet, supplements, exercise, and stress control interventions in hopes of improving survival and decreasing the side effects of conventional treatment.2 Providers able to guide these patients toward evidence-based choices can be pivotal in helping them achieve their goals of improved physical and emotional well-being.3 It has been the authors’ experience that women respond with relief and gratitude at being able to discuss openly the use of integrative modalities during cancer therapy, with a knowledgeable health professional.
Providers can be confident that complementary interventions are effective adjuncts to conventional therapy. A trial of 275 breast cancer patients demonstrated that those randomized to a personalized complementary program along with conventional care enjoyed a higher quality of life compared with similar patients given usual care only.4
In this article, the authors address many evidence-based integrative strategies that can enhance quality of life, and some that may extend life. What follows are the approaches they recommend most in their practices for patients on active conventional treatment for breast cancer.