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4 February, 2020

Integrative cancer treatments: options to consider


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Receiving a cancer diagnosis is a life-changing event, which people often receive with feelings of shock, fear and confusion.

The next step is working out what treatment options exist, which can generate further confusion and anxiety about what treatments to choose and their side effects.

Many people with cancer often turn to traditional and complementary medicine (T&CM) treatments and/or products to help support their health, as well as to assist recovery from surgery and help mitigate the side effects of chemo- and radiotherapy.

It is estimated that up to 80% of patients with cancer utilise some form of T&CM, but only 14% communicate this to their medical providers.

‘Best of both worlds’

Cancer is a serious and often aggressive disease that requires appropriate treatment.

The good news is that a growing body of research indicates that people often achieve improved outcomes by adopting a holistic approach, where T&CM is used alongside conventional medical care, as part of an integrative, evidence-informed approach.

T&CM can play a role in helping people cope with signs and symptoms caused by cancer and cancer treatments. T&CM interventions may help lessen common signs and symptoms such as anxiety, fatigue, nausea and vomiting, pain, difficulty sleeping, and stress.

Integrative oncology

Integrative oncology is a relatively new and growing field. It encompasses a patient-centered, evidence-informed field of holistic cancer care that uses mind-body practices, complementary and traditional therapies/ products, and lifestyle modifications from different traditions, alongside conventional cancer treatments.

A ‘best of both worlds’ approach.

Integrative oncology seeks to engage patients and families as active participants in their own care, from prevention throughout treatment and survivorship. This principle optimises health promotion and proactively addresses symptoms and adverse effects that arise from cancer or its treatment.

The goal is to prioritise safety and best available evidence to offer appropriate therapeutic interventions alongside conventional care. This optimises health outcomes for patients and addresses symptoms and adverse effects that arise from cancer or its treatment, such as insomnia, pain, fatigue, and anxiety, which may persist despite standard medical interventions.

International best practice

Internationally, complementary therapies have been established at many major cancer centres to help manage both immediate and delayed cancer-related symptoms, support lifestyle changes, and improve quality of life for patients. This is increasingly being regarded as best-practice.

In Australia, integrative medical practitioners operate within a conservative medical culture that regards innovative treatments as ‘unconventional’. However, patients can still access the services of integrative doctors, services that are growing in demand.

Which complementary treatments are commonly used?

The current evidence is strongest for the following interventions to offer physical, emotional and spiritual support, help reduce side effects from medical treatment, improve quality of life and clinical outcomes. This list is not exhaustive but represents growing best practice:

Lifestyle modification

Modifiable lifestyle factors including diet, exercise, sleep hygiene, stress management, social environment and avoidance of risky behaviour have been shown to play a major role in lifetime risk in people developing and/or recovering from cancer.

After treatment is over, lifestyle modification can greatly impact the likelihood of a person’s cancer recurring and is an important area where a person can self-empower their ongoing recovery.

Exercise and physical activity

Regular physical activity during cancer treatment can help with fatigue and improve physical functioning and cardiovascular fitness. In addition, there are documented benefits on patient-reported outcomes including self-esteem, sleep and quality of life.

For patients with physical limitations, resulting from surgery or other factors, supervised exercise can help prevent injury and decline in health, as well as improve quality of life and build self-confidence for sustained health improvement.

This may include ‘movement meditation’ exercises such as yoga and tai chi, which can help rebuild strength and reduce stress, as well as being highly enjoyable.

Diet

A growing body of evidence links obesity and other modifiable lifestyle behaviors (including physical inactivity and diet) to cancer development. There is also evidence supporting the role of nutrition for improving quality of life before and after cancer care, decreasing the risk of cancer recurrence and promoting survival time.

Sleep

Insomnia and sleep disturbance are common among people with cancer, both during and after treatment, which can hamper recovery. Causes of insomnia are often multifactorial, including drug side-effects, treatment-related fatigue, and psychological factors.

Recent randomised controlled trials assessing non-drug treatment options including acupuncture, tai chi and mindfulness-based stress reduction have demonstrated positive and sustained results for cancer patients with insomnia.

Stress management

A cancer diagnosis is invariably experienced as physically, emotionally and socially stressful.

In practice, most relaxation and mindfulness-based therapies are found to be useful in dealing with the stress, including meditation, tai chi, yoga, acupuncture, aromatherapy, hypnosis, massage, music therapy, amongst others.

Mind-body interventions

“Mind-body therapies include instructor-guided movement practices such as tai chi or yoga or contemplative and relaxation practices such as meditation or guided imagery, as well as provider-dependent interventions such as massage therapy and acupuncture. The practices and their applications harness the intricate relationship between psychological and physical well-being.” (Latte-Naor et al 2019)

Acupuncture

Studies show acupuncture may be helpful in relieving nausea caused by chemotherapy and may also help relieve certain types of pain in people with cancer.

The US National Comprehensive Cancer Network Guidelines recommend acupuncture for pain, fatigue, nausea, vomiting, and hot flushes, and in palliative care and survivorship settings. More than 80% of National Cancer Institute-designated comprehensive cancer centres recommend acupuncture for symptom management.

Acupuncture may be contraindicated where people are taking blood-thinners or have low blood counts, which should be medically checked.

Massage

Studies have shown massage in an oncology setting can be effective in relieving pain in people with cancer, as well as help relieve anxiety, fatigue and stress. Clinical guidelines in the US recommend massage to help reduce cancer-related fatigue, pain, mood disturbance and lymphedema.

It is best to work with an experienced massage therapist trained to work with cancer patients.

Yoga

Yoga is an ancient meditative movement practice with its origins in Ayurvedic medicine. Yoga involves stretching exercises with breathing techniques.

A number of large studies have demonstrated the benefits of yoga on quality of life and emotional health in cancer patients and cancer survivors, including improvement in fatigue and sleep, with corresponding reduction in the use of sleep medication.

It is important to work with a yoga instructor that is experienced in working with health concerns, who will know which movements are safe and those that should be avoided to prevent pain.

Tai chi

Tai chi is a gentle form of exercise that has its origins in Chinese martial arts. It is another form of meditative movement practice that incorporates slow, focussed movement and deep breathing, designed to strengthen the body from the inside. It can easily be modified to suit people’s abilities, and is best done under the guidance of an experienced instructor.

A significant body of research has shown tai chi to help relieve stress, improve balance and reduce falls in the elderly. It is particularly helpful in encouraging elderly and debilitated patients to re-engage in exercise.

Tai chi has been shown to assist with cancer-related fatigue and insomnia.

Herbal medicine

Herbal medicine is one of the most used traditional and complementary therapies by cancer patients alongside conventional cancer treatments.

Herbal medicine can be helpful in mitigating fatigue and other side-effects of chemo- and radiotherapy, as well as offering safe alternatives to assist with symptoms such as insomnia, gastrointestinal symptoms, and psychological impacts (including stress and depression).

It is important when using herbal medicine in a cancer setting that patients seek the advice of a qualified practitioner, and that it is used as part of an integrative approach. Inappropriate use of herbs may interfere with, or reduce the effectiveness of, conventional treatment.

However used appropriately, herbal therapy can greatly augment conventional treatment, as well as assist with post-treatment recovery.

Aromatherapy

Aromatherapy uses scents from fragrant oils (such as lavender, neroli, clary sage), that may help in alleviating nausea, pain and stress. They can also be added to bathwater and massage oils to impart their effect.

Aromatherapy practitioners can best advise which oils are best suited to your needs and how to use them safely.

 
If you’re experiencing:Then consider trying:
AnxietyHypnosis, massage, meditation, relaxation techniques, herbal medicine
FatigueExercise, massage, relaxation techniques, yoga, herbal medicine
Nausea and vomitingAcupuncture, aromatherapy, hypnosis, music therapy, herbal medicine
PainAcupuncture, aromatherapy, hypnosis, massage, music therapy, herbal medicine
Sleep problemsExercise, relaxation techniques, yoga, herbal medicine
StressAromatherapy, exercise, hypnosis, massage, meditation, tai chi, yoga, herbal medicine

 

Sources:

https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/cancer-treatment/art-20047246

Putting Integrative Oncology Into Practice: Concepts and Approaches. Shelly Latte-Naor and Jun J. Mao. Journal of Oncology Practice 2019 15:17-14
Zia FZOlaku OBao T, et al: The National Cancer Institute’s conference on acupuncture for symptom management in oncology: State of the science, evidence, and research gaps. J Natl Cancer Inst Monogr 2017:68732017

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