Table 1.
Summary of systematic review of randomized controlled trials on the use of integrative therapies during breast cancer treatment*
| Clinical population | BC patients during treatment, including surgery, CT, hormonal/biological therapy, and RT | |
| Clinical question | What integrative therapies can be used to prevent, treat, and manage symptoms and side effects encountered during breast cancer treatment? | |
| Clinical applications | Recommendations | Strength of evidence |
| Anxiety/stress reduction | Music therapy is recommended for reducing anxiety during RT and CT sessions | B |
| Meditation is recommended for reducing anxiety in BC patients and those undergoing RT | B | |
| Stress management is recommended for reducing anxiety during treatment, but longer group programs are likely better than self-administered home programs or shorter programs | B | |
| Yoga is recommended for reducing anxiety in BC patients undergoing RT +/− CT and suggested for fatigued patients | B | |
| Acupuncture can be considered for reducing anxiety in fatigued BC patients | C | |
| Massage can be considered for short-term reduction of anxiety in BC patients | C | |
| Relaxation can be considered for treating anxiety during treatment | C | |
| Depression/mood | Meditation, particularly MBSR, is recommended for treating mood disturbance and depressive symptoms in BC patients undergoing RT | A |
| Relaxation is recommended for improving mood and depressive symptoms when added to SC | A | |
| Yoga is recommended for improving mood in women undergoing RT +/− CT and for fatigued BC patients in addition to SC | A | |
| Massage is recommended for improving mood disturbance in posttreatment BC patients | B | |
| Music therapy is recommended for improving mood in newly diagnosed BC patients | B | |
| Acupuncture can be considered for improving mood in postmenopausal women experiencing hot flashes or fatigue | C | |
| Healing touch can be considered for improving mood in BC patients undergoing CT | C | |
| Stress management interventions with or without exercise can be considered for improving mood in BC patients | C | |
| Fatigue | Energy conservation counseling is recommended for the treatment of fatigue | B |
| American ginseng can be considered as an herbal approach for the treatment of fatigue in BC patients | C | |
| Acupuncture can be considered for the treatment of fatigue after the completion of cancer treatments | C | |
| Modified qigong can be considered for the treatment of fatigue in BC patients | C | |
| Acetyl-l-carnitine is not recommended for the treatment of fatigue due to lack of effect | D | |
| Guarana is not recommended as an herbal for the treatment of fatigue due to lack of effect | D | |
| Sleep | Stress management techniques can be considered for the treatment of sleep disruption | C |
| Gentle yoga can be considered for the treatment of sleep disruption | C | |
| Quality of life and physical functioning | Meditation is recommended for improving quality of life among BC patients | A |
| Acupuncture can be considered for improving quality of life among cancer patients | C | |
| Guided imagery can be considered for improving quality of life among BC patients | C | |
| Mistletoe can be considered for improving quality of life among BC patients | C | |
| Qigong can be considered for improving quality of life in cancer patients | C | |
| Reflexology can be considered for improving quality of life among BC patients | C | |
| Stress management can be considered for improving quality of life among BC patients | C | |
| Yoga can be considered for improving quality of life among BC patients | C | |
| Exercise/awareness can be considered for improving functioning among BC patients | C | |
| Energy conservation is not recommended for improving functioning among BC cancer patients due to lack of effect | D | |
| CINV | Acupressure can be considered for BC patients receiving CT as an addition to antiemetics to help control nausea and vomiting during CT | B |
| Electroacupuncture can be considered for BC patients as an addition to antiemetics to control vomiting during CT | B | |
| Ginger can be considered for BC patients receiving CT, without concurrent RT as an addition to antiemetics for the control of acute nausea | C | |
| PMR can be considered for BC patients receiving CT as an addition to antiemetics to help control nausea and vomiting during CT | C | |
| Glutamine is not recommended for use by BC patients receiving CT for the treatment of CINV due to lack of effect | D | |
| Pain | EASE can be considered for pain associated with CT among unemployed individuals | C |
| Massage and healing touch can be considered for pain associated with CT | C | |
| Music therapy can be considered to relieve pain associated with surgery | C | |
| A physical training program that includes a mind–body modality can be considered for relieving pain associated with surgery among BC patients | C | |
| Hypnosis can be considered for relief of associated with surgery in BC patients | C | |
| Acupuncture can be considered as a nonpharmacologic approach to the short-term treatment of AIMSS | C | |
| Electroacupuncture can be considered as a nonpharmacologic approach to the short-term treatment of AIMSS | C | |
| Neuropathy | Acetyl-l-carnitine is not recommended for prevention of neuropathy in BC patients due to harm | H |
| Lymphedema | Laser therapy can be considered as a treatment for lymphedema in BC patients | C |
| MLD and compression bandaging have been shown to be equivalent. MLD can be considered for treatment of lymphedema in BC patients who have sensitivity to bandaging | C | |
| Hot flashes | Acupuncture can be considered for decreasing the number of hot flashes in BC patients | C |
| Electroacupuncture can be considered for decreasing the number of hot flashes in BC patients | C | |
| Soy is not recommended for the treatment of hot flashes in BC patients due to lack of effect | D | |
| Acute radiation skin reaction | Aloe vera is not recommended as a standard therapy to prevent or treat acute radiation skin reaction due to lack of effect | D |
| Hyaluronic acid cream is not recommended as a standard therapy to prevent or treat acute radiation skin reaction due to lack of effect | D |
* AIMSS = aromatase inhibitor-associated musculoskeletal symptoms; BC = breast cancer; CINV = chemotherapy-induced nausea vomiting; CT = chemotherapy; EASE = energy and sleep enhancement; MBSR = mindfulness-based stress reduction; MLD = manual lymphatic drainage; PMR = progressive muscle relaxation; RT = radiation therapy; SC = standard care.