A new report card on complementary therapies for breast cancer patients gives an “A” to yoga, meditation and guided imagery for anxiety and low mood.
The analysis led by a Bastyr University alumna provides a new ranking of therapies that are widely used but often lacking in science-based research. More than 80 percent of breast cancer patients in the United States use some form of complementary therapies, according to the authors. The new analysis provides a set of guidelines for evaluating their effectiveness.
The report is a collaboration of naturopathic doctors, conventional cancer doctors and others, including Heather Greenlee, ND (’01), PhD, immediate past president of the Society for Integrative Oncology and assistant professor of Epidemiology at Columbia University’s Mailman School of Public Health. The guidelines are available online through the Journal of the National Cancer Institute Monograph.
“Most breast cancer patients have experimented with integrative therapies to manage symptoms and 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,” Dr. Greenlee said in a news release.
The authors reviewed randomized controlled clinical trials that tested complementary therapies together with standard breast cancer care. They considered 4,900 research articles and selected 203 that met their criteria for analysis.
More from the authors:
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 …
Acupuncture received a “B” grade for controlling chemotherapy induced nausea and vomiting and can be recommended to most patients. More than 30 interventions, including some natural products and acupuncture for other conditions, had weaker evidence of benefit due to either small study sizes or conflicting study results, and received a “C” grade.
“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,” said Dr. Greenlee. “The vast majority of therapies require further investigation through well-designed controlled clinical trials.”
Dr. Greenlee has helped lead just that sort of rigorous research at Columbia University and the Society for Integrative Oncology (SIO), where she became the first ND elected president in 2013. SIO received mainstream medical attention last year when the American Society of Clinical Oncology devoted a newsletter to highlights from SIO’s annual conference.
In 2013, investigators from the Bastyr Integrative Oncology Research Center presented promising preliminary findings at the annual conference of the Society for Integrative Oncology in Vancouver, British Columbia.
One of Greenlee’s coauthors, Dugald Seely, ND, MS, FABNO, director of research at the Canadian College of Naturopathic Medicine, recently received a $3.4 million grant to study the effectiveness of naturopathic cancer therapies. He will team up with his brother, a medical doctor (MD), to conduct a randomized controlled trial over 11 years.
Dr. Seely also collaborated with Bastyr researchers on a study of Canadian postal workers that found naturopathic care led to a significant drop in their risk of heart disease, leading to publication in the Canadian Medical Association Journal, a top 10-ranked medical research journal.
These studies contribute to a growing evidence base suggesting the effectiveness of complementary therapies — knowledge that MDs and NDs alike can use in guiding their patients.
While the new breast cancer guidelines provided much-needed analysis of clinical data, Dr. Greenlee says doctors must continue to make decisions together with their patients, an emphasis of naturopathic medicine.
“The guidelines clearly demonstrate that clinicians and patients should adopt shared decision-making approaches when assessing the risk-benefit ratio for each therapy,” she said. “It is important to personalize the recommendations based upon patients’ clinical characteristics and values.”
The breast cancer clinical practice guidelines were also presented at the International Conference of the Society for Integrative Oncology in Houston in October.
Read the full analysis: Clinical Practice Guidelines on the Use of Integrative Therapies as Supportive Care in Patients Treated for Breast Cancer