Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment
Open accessAbstract
Answer questions and earn CME/CNE Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. CA Cancer J Clin 2017;67:194-232. © 2017 American Cancer Society.
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There is insufficient evidence to support the use of complementary and integrative therapies in oncology, including mindfulness.
“However, the insufficient evidence to support the use of complementary and integrative therapies in oncology, including mindfulness (Greenlee et al., 2017), makes it necessary to conduct controlled and randomized studies, such as the one presented in this article.”
From Improving Psychosocial Functioning in Mastectomized Women Through a Mindfulness-Based Program: Flow Meditation. (2020) · cites this paper as Greenlee et al., 2017
The anxiety/stress-reduction section recommends meditation for breast cancer patients with Grade A evidence, based on five randomized controlled trials, and says there is sound evidence for mindfulness-based therapies to manage anxiety. The Conclusion acknowledges limited evidence for some outcomes, including mixed findings for quality of life, but supports several integrative therapies for psychological outcomes. That is contrary to the claim that evidence is insufficient to support integrative therapies, including mindfulness, in oncology. (LLM, conf=0.92)
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Experimental — accuracy not yet measuredThe positive effects of yoga on patients' psychological well-being have long been known.
“Although the positive effects of yoga on patients’ psychological well-being have long been known [55,56,57,58,59] the study conducted in this project showed that cancer patients could successfully practice vinyasa yoga.”
From The Effect of Vinyasa Yoga Practice on the Well-Being of Breast-Cancer Patients during COVID-19 Pandemic (2023) · cites this paper as [59]
The literature review’s anxiety/stress and depression/mood sections report positive psychological outcomes associated with yoga in cancer patients. But the paper describes the evidence as preliminary and sometimes inconsistent; for breast cancer patients, it says the short-term effects were observed during active treatment, not necessarily afterward. Thus, “have long been known” states the finding more definitively and broadly than this source does. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe SIO 2017 evidence-based guidelines for women with breast cancer supported music therapy, meditation, and yoga for anxiety/stress reduction; meditation, relaxation, yoga, and music therapy for depression/mood disorders; and meditation and yoga to improve QL.
“The SIO reviewed all integrative therapies for women with breast cancer and generated evidence-based guidelines in 2017 (Greenlee et al. 2017).In these, the highest level of evidence (including data from only RCTs) supported music therapy, meditation, and yoga for anxiety/stress reduction; meditation, relaxation, yoga, and music therapy for depression/mood disorders; and meditation and yoga to”
From Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory. (2023) · cites this paper as Greenlee et al. 2017
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- Authors
- Greenlee, H., DuPont‐Reyes, M. J., Balneaves, L. G., Carlson, L. E., Cohen, M. R., Deng, G., Johnson, J. A., Mumber, M., Seely, D., Zick, S. M., Boyce, L. M., & Tripathy, D.
- Affiliations
- Herbert Irving Comprehensive Cancer Center (US)
- Columbia University (US)
- Associate Professor, College of Nursing Rady Faculty of Health Sciences Winnipeg MB Canada
- University of Calgary (CA)
- California Institute of Integral Studies (US)
- Memorial Sloan Kettering Cancer Center (US)
- Pennsylvania State University (US)
- Harbin Clinic (US)
- Canadian College of Naturopathic Medicine (CA)
- University of Michigan (US)
- The University of Texas MD Anderson Cancer Center (US)
- Corresponding author
- Greenlee, Heather
- ORCID
- Venue
- CA A Cancer Journal for Clinicians
- Publisher
- Wiley
- Published
- 2017-04-24
- Volume
- 67
- Issue
- 3
- Pages
- 194-232
- ISSN
- 0007-9235 (ISSN-L)
- 1542-4863
- PMC
- PMC5892208
- OpenAlex
- W2607992798
- Cited by
- 768
- References
- 393
- Citations by year
- 2026: 53 · 2025: 67 · 2024: 93 · 2023: 102 · 2022: 103 · 2021: 102 · 2020: 101 · 2019: 72 · 2018: 58 · 2017: 14 · 2016: 1
- FWCI
- 99.76
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- CA A Cancer Journal for Clinicians (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- University of Southern California
- University of Pennsylvania
- Emory University
- Memorial Sloan-Kettering Cancer Center
- University of Texas MD Anderson Cancer Center
- University of California, San Francisco
- National Cancer Institute (P30CA016672)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Complementary and alternative medicine › Medical Research and Treatments
- Keywords
- breast cancer, integrative therapy, complementary therapy, cancer supportive care, treatment side effects, stress and anxiety, fatigue, quality of life, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, sleep disorders, mind-body interventions, music therapy, meditation, yoga, massage, acupressure, acupuncture, acetyl-L-carnitine, dietary supplements
- MeSH terms
- Complementary Therapies, Anxiety, Breast Neoplasms, Depression, Fatigue, Female, Humans, Lymphedema, Nausea, Peripheral Nervous System Diseases, Quality of Life, Sleep Wake Disorders, Stress, Psychological, Vomiting, Mood Disorders
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