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Clinical Practice Guidelines

SIO is pleased to provide its updated clinical practice guidelines for breast cancer, published in April 2017. Researchers analyzed which integrative treatments are most effective and safe for patients with breast cancer. The guidelines are a resource for clinicians and patients to inform evidence-based decisions on the use of integrative therapies during breast cancer treatment. Researchers at US and Canadian institutions evaluated the efficacy and safety of more than 80 therapies.

The Journal of the National Cancer Institute Monograph has  published a special issue co-sponsored by SIO, "Advancing the Global Impact of Integrative Oncology"; including a comprehensive definition for integrative oncology. The articles in the special Monograph were all peer-reviewed.

Scottsdale AZ
Photo courtesy of Scottsdale Convention & Visitors Bureau

Conference

2018 conference: Mark your calendar for SIO's 2018 conference to be held October 27-29 in Scottsdale, Arizona. The theme will be "Integrative Oncology: From Research to Practical Applications." The conference will be held jointly with Banner MD Anderson Cancer Center and Arizona Center for Integrative Medicine-University of Arizona. Visit our conference website for more information.

Call for Abstracts  - Submission Deadline:  May 08, 2018

SIO is accepting abstract submissions for the 15th International Conference: Integrative Oncology: From Research to Practical Applicationswhich will be held in Scottsdale, Arizona, on October 27-29, 2018. The submission deadline is May 08, 2018.  For more information on abstract guidelines or submissions please visit the Call for Abstracts webpage to submit an abstract please visit the SIO2018 submission portal.  

 

 

One of the main goals of SIO’s research committee is to disseminate updated research to our members.  As such, we recently started a Research Update program.  We will provide bi-monthly updates of relevant literature by selecting a number of recent papers to be listed on the SIO website, based on search criteria that focus on original clinical research in human populations spanning a full range of complementary therapy modalities.  For chosen papers we will include the abstract and link to the journal cite for downloads.  We hope you enjoy this new feature and appreciate your comments and feedback! 

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Archive

March 2018

Authors:

Abrams D, McCulloch M, Cohen M, Liaw M, Silverman D, Wilson C.

Title:

A Survey of Licensed Acupuncturists in the San Francisco Bay Area: Prevalence of Treating Oncology Patients.

Source:

Integr Cancer Ther 2018 Mar;17(1):92-98 PMID 28056563

BACKGROUND: Many cancer patients seek traditional Chinese medicine (TCM), the prevalence varying with diagnosis, comorbidities, and demographics. Interventions sought include acupuncture, massage, herbs, diet, and exercise, usually combined with conventional therapies. It is not known what proportion of TCM practitioners care for cancer patients, their cancer specific training or caseload, what interventions they employ, their outcomes, and their communication patterns with conventional oncologists.

METHODS: A survey was mailed to all 2213 licensed acupuncturists in the 9-county San Francisco Bay Area gathering descriptive statistics.

RESULTS: A total of 472 (21%) responded by mail or web-based Research Electronic Data Capture (REDCap) tool. Most respondents (77%) reported caring for patients with cancer, with 29% reporting having 6 to 10 years of practice experience, and 44.2% having 0 to 20 hours of training specific to the needs of patients with cancer. Improving quality of life was reported by 94% as what their treatment offered cancer patients as well as the area where treatment was felt to have the greatest impact. The most useful TCM modalities were acupuncture (98%), herbs (79%), diet (72%), moxibustion (46%), and meditation instruction (44%). Absence of adverse reactions was noted by 95%. Ninety-one percent reported "never" or "hardly ever" having been contacted by patients' oncologists to discuss treatment.

CONCLUSIONS: Many acupuncturists seeing cancer patients have significant clinical experience and have sought specialized training. Improved communication is needed between TCM practitioners and oncologists sharing care of cancer patients.

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Authors:

Garcia MK, Cohen L, Spano M, Spelman A, Hashmi Y, Chaoul A, et al.

Title:

Inpatient Acupuncture at a Major Cancer Center.

Source: Integr Cancer Ther 2018 Mar;17(1):148-152 PMID 28050924


BACKGROUND: Use of complementary and integrative therapies is increasing among cancer patients, but data regarding the impact treatments such as acupuncture have in an inpatient oncology setting are limited.

METHODS: Patients who received acupuncture in an inpatient hospital environment between December 2014 and December 2015 were asked to complete a modified Edmonton Symptom Assessment Scale (ESAS; 0-10 scale) before and after each visit. Pre- and post-treatment scores were examined for each symptom using paired t tests.

RESULTS: A total of 172 inpatients were treated with acupuncture in their hospital beds (257 visits). Thirty percent (n = 51) received at least one additional follow-up treatment (mean visits/patient = 1.5). Completion rate of the modified ESAS after acupuncture was 42%. The most common reasons for not completing the post-treatment ESAS were "patient too drowsy" or "patient fell asleep" (72%). For patients who reported a baseline symptom score >/=1, the greatest improvements (mean change +/- SD) after acupuncture on the initial visit were found for pain (-1.8 +/- 2.2; n = 69; P < .0001), nausea (-1.2 +/- 1.9; n = 30; P < .001), anxiety (-0.8 +/- 1.8; n = 36; P = .01), drowsiness (-0.6 +/- 1.8; n = 57; P = .02), and fatigue (-0.4 +/- 1.1; n = 67; P = .008). For patients who received at least one follow-up visit, significant improvement from baseline was found for sleep disturbance (-2.5 +/- 4.4; n = 17; P = .03), anxiety (-2.4 +/- 1.7; n = 9; P = .002), pain (-2.3 +/- 2.7; n = 20; P = .001), and drowsiness (-2.0 +/- 2.6; n = 16; P = .008).

CONCLUSIONS: Patients who received inpatient acupuncture at a major cancer center experienced significant improvement after treatment for pain, sleep disturbance, anxiety, drowsiness, nausea, and fatigue.

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Authors:

Lengacher CA, Reich RR, Ramesar S, Alinat CB, Moscoso M, Cousin L, et al.

Title:

Feasibility of the mobile mindfulness-based stress reduction for breast cancer (mMBSR(BC)) program for symptom improvement among breast cancer survivors.

Source: Psychooncology 2018 Feb;27(2):524-531 PMID 28665541

OBJECTIVE: The purpose of this pilot study was to test the feasibility of delivering the mobile mindfulness-based stress reduction for breast cancer (mMBSR(BC)) program using an iPad and to evaluate its impact on symptom improvement.

METHODS: A single group, pre-posttest design was implemented among female stages 0-III breast cancer survivors (BCS) who completed treatment. Data were collected at baseline and week 6 on measures of psychological and physical symptoms and quality of life. The mMBSR(BC) program is a standardized, stress-reducing intervention that combines sitting and walking meditation, body scan, and yoga and is designed to deliver weekly 2-hour sessions for 6 weeks using an iPad.

RESULTS: The mean age of the 15 enrolled BCS was 57 years; one participant was non-Hispanic black, and 14 were non-Hispanic white. Of the 13 who completed the study, there were significant improvements from baseline to 6 weeks post-mMBSR(BC) in psychological and physical symptoms of depression, state anxiety, stress, fear of recurrence, sleep quality, fatigue, and quality of life (P's < .05). Effect sizes for improvements of multiple symptoms ranged from medium to large.

CONCLUSIONS: These results provide preliminary support that the mMBSR(BC) program may be feasible and acceptable, showing a clinical impact on decreasing psychological and physical symptoms. This mobile-based program offers a delivery of a standardized MBSR(BC) intervention to BCS that is convenient for their own schedule while decreasing symptom burden in the survivorship phase after treatment for breast cancer.

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Authors:

Lin PJ, Peppone LJ, Janelsins MC, Mohile SG, Kamen CS, Kleckner IR, et al.

Title:

Yoga for the Management of Cancer Treatment-Related Toxicities.

Source:

Curr Oncol Rep 2018 Feb 1;20(1):5-018-0657-2 PMID 29388071

PURPOSE OF REVIEW: To (1) explain what yoga is, (2) summarize published literature on the efficacy of yoga for managing cancer treatment-related toxicities, (3) provide clinical recommendations on the use of yoga for oncology professionals, and (4) suggest promising areas for future research.

RECENT FINDINGS: Based on a total of 24 phase II and one phase III clinical trials, low-intensity forms of yoga, specifically gentle hatha and restorative, are feasible, safe, and effective for treating sleep disruption, cancer-related fatigue, cognitive impairment, psychosocial distress, and musculoskeletal symptoms in cancer patients receiving chemotherapy and radiation and cancer survivors. Clinicians should consider prescribing yoga for their patients suffering with these toxicities by referring them to qualified yoga professionals. More definitive phase III clinical trials are needed to confirm these findings and to investigate other types, doses, and delivery modes of yoga for treating cancer-related toxicities in patients and survivors.

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Authors:  

Lopez G, Liu W, Madden K, Fellman B, Li Y, Bruera E.

Title:

Adolescent-young adults (AYA) with cancer seeking integrative oncology consultations: demographics, characteristics, and self-reported outcomes.

Source:

Support Care Cancer 2018 Apr;26(4):1161-1167 PMID 29082436

PURPOSE: Integrative Oncology (IO) consultations offer cancer patients counseling regarding complementary integrative medicine (CIM). We explored the CIM interests and symptom burden of AYA cancer patients presenting for an IO consultation.

METHODS: Patients referred for an IO physician consultation at an academic medical center from September 1, 2009 to December 31, 2013 completed an assessment on presentation: MYCaW, ESAS (10 symptoms, 0-10, 10 worst possible), CIM use survey, and SF-12 QOL survey. We compared findings of AYA patients (ages 15-39) with a control sample of adult patients (age >/= 40).

RESULTS: Of the total 2474 consecutive patients, 286 (12%) were AYA, 73.1% female, with the most common diagnosis of breast cancer (30%). Areas of greatest interest for both AYA and adult patients included developing a holistic approach, herbals, and diet, with no significant difference between groups. Comparing groups, AYA patients had significantly higher anxiety (3.4 vs 3.1, p = 0.042). AYA physical health was significantly higher (37.5 vs 35, p = 0.001), with no significant between group differences in mental health. AYA patients were more likely to have participated in yoga (22 vs 11%, p = 0.001) and pilates (9.2 vs 4.5%, p = 0.04), with no significant difference regarding overall CIM use. Differences persisted after correcting for stage.

CONCLUSION: AYA patients make up a small number of overall referrals to an IO consultation, presenting with a low to moderate symptom burden. Physical CIM interventions such as yoga and pilates are of greater interest to the AYA population, suggesting the importance of making such interventions available in cancer programs serving this population.

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Authors:

Lucas AR, Klepin HD, Porges SW, Rejeski WJ.

Title:

Mindfulness-Based Movement: A Polyvagal Perspective.

Source:

Integr Cancer Ther 2018 Mar;17(1):5-15 PMID 28345362

Abstract:

Compelling evidence suggests that physical activity is an effective intervention for cancer survivors, including for those undergoing active cancer treatments. However, to date most evidence has emerged from interventions that have promoted moderate to vigorous physical activity. In this conceptual review, we argue that attention should be given to the entire continuum of physical activity from reducing sedentary behavior to increasing higher levels of physical activity when possible. In addition, considerable evidence in the cancer literature supports the value of mindfulness-based interventions as a means of helping patients and survivors cope with the variety of threats that accompany this disease. Based on the success of these two areas of research, we argue for conceptualizing and promoting physical activity as Mindfulness-Based Movement, using Polyvagal Theory as a theoretical framework to understand the role and value of Mindfulness-Based Movement as a potential intervention for cancer care and control.

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Authors:  

Mazor M, Lee JQ, Peled A, Zerzan S, Irwin C, Chesney MA, et al.

Title:

The Effect of Yoga on Arm Volume, Strength, and Range of Motion in Women at Risk for Breast Cancer-Related Lymphedema.

Source:

J Altern Complement Med 2018 Feb;24(2):154-160 PMID 29064279

OBJECTIVES: To assess the feasibility, safety, and initial estimates of efficacy of a yoga program in postoperative care for women at high risk for breast cancer-related lymphedema (BCRL). DESIGN: Single-group pretest-post-test design.

SETTINGS/LOCATION: Patients were recruited from the University of California, San Francisco Carol Franc Buck Breast Care Center.

SUBJECTS: Twenty-one women were enrolled in the study. Women were >18 years of age, had undergone surgical treatment for breast cancer, and were at high risk for BCRL. INTERVENTION: The women participated in an Ashtanga yoga intervention for 8 weeks. Sessions consisted of once/week instructor-led practice and once/week home practice. Particular attention was given to poses that emphasized upper body strength and flexibility, while avoiding significant time with the upper extremity (UE) in a dependent position.

OUTCOME MEASURES: UE volume was assessed through circumferential forearm measurement, which was converted to volume using the formula for a truncated cone. Range of motion (ROM) was assessed for the shoulders, elbows, and wrists, using a standard goniometer. UE strength was assessed for shoulder abduction, elbow flexion, wrist flexion, and grip using a dynamometer.

RESULTS: Twenty women completed the yoga intervention, with 17 returning for final assessment. Mean age was 52 (+/-9.1) years and body mass index was 24.8 (+/-5.1) kg/m(2). Postintervention, mean volume in the at-risk UE was slightly reduced (p = 0.397). ROM for shoulder flexion (p < 0.01) and external rotation (p < 0.05) significantly increased bilaterally. Shoulder abduction ROM significantly improved for the unaffected limb (p = 0.001). Following intervention, strength improved on the affected side for shoulder abduction and grip strength, and bilaterally for elbow flexion (p < 0.05 for all).

CONCLUSIONS: These preliminary findings suggest that yoga is feasible and safe for women who are at risk for BCRL and may result in small improvements in shoulder ROM and UE strength.

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Authors:

Taylor TR, Barrow J, Makambi K, Sheppard V, Wallington SF, Martin C, et al.

Title:

A Restorative Yoga Intervention for African-American Breast Cancer Survivors: a Pilot Study.

Source:

J Racial Ethn Health Disparities 2018 Feb;5(1):62-72 PMID 28411330

BACKGROUND: Data show that yoga is effective for improving health-related outcomes in breast cancer survivors. While breast cancer is the most commonly diagnosed cancer among African-American women (AAW), AAW are less likely to engage in yoga compared to other ethnic groups. The goals of the current study were to assess the feasibility of an 8-week restorative yoga program among African-American breast cancer survivors (AA BCS). Specifically, study aims were to (1) measure changes in study outcomes in a restorative yoga (RY) group compared to a wait list control group, (2) assess adherence to the RY program, and (3) assess program satisfaction among study participants.

METHODS: Thirty-three AA BCS were randomly assigned to either the RY intervention (n = 18) or wait list control group (n = 15). RY classes met once per week for 8 weeks. Pre- and post-testing assessments were measured at 0 and 8 weeks (immediately post-intervention).

RESULTS: Depression scores at follow-up were significantly lower in the yoga group (M = 4.78, SD = 3.56) compared to the control group (M = 6.91, SD = 5.86). No significant group differences were observed for sleep quality, fatigue, or perceived stress. Yoga program participants completing baseline assessments demonstrated 61% adherence to the yoga classes. Average rating of the yoga program was "very useful." Recommendations for future yoga programs were provided.

CONCLUSIONS: This study suggests that yoga has a beneficial effect on depression in AA BCS. There is, however, a need to further explore the benefits of yoga among minority breast cancer survivors using a study with larger sample sizes.

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Authors:

Winters-Stone KM, Moe EL, Perry CK, Medysky M, Pommier R, Vetto J, et al.

Title:

Enhancing an oncologist's recommendation to exercise to manage fatigue levels in breast cancer patients: a randomized controlled trial.

Source:

Support Care Cancer 2018 Mar;26(3):905-912 PMID 28965138

PURPOSE: Fatigue is a troublesome symptom for breast cancer patients, which might be mitigated with exercise. Cancer patients often prefer their oncologist recommend an exercise program, yet a recommendation alone may not be enough to change behavior. Our study determined whether adding an exercise DVD to an oncologist's recommendation to exercise led to better outcomes than a recommendation alone.

METHODS: Ninety breast cancer patients, at varying phases of treatment and stages of disease, were randomized to receive the following: an oncologist verbal recommendation to exercise (REC; n = 43) or REC plus a cancer-specific yoga DVD (REC + DVD; n = 47). Fatigue, vigor, and depression subscales of the Profile of Mood States, and physical activity levels (MET-min/week), exercise readiness, and self-efficacy were assessed at baseline, 4, and 8 weeks. Analyses controlled for age, time since diagnosis, and metastatic disease.

RESULTS: Over 8 weeks, women in REC + DVD used the DVD an average of twice per week. The REC + DVD group had greater reductions in fatigue (- 1.9 +/- 5.0 vs. - 1.0 +/- 3.5, p = 0.02), maintained exercise readiness (- 0.1 +/- 1.1 vs. - 0.3 +/- 1.3; p = 0.03), and reported less of a decrease in physical activity (- 420 +/- 3075 vs. - 427 +/- 5060 MET-min/week, p = 0.06) compared to REC only.

CONCLUSIONS: A low-cost, easily distributed, and scalable yoga-based DVD could be a simple booster to an oncologist's advice that motivates breast cancer patients, even those with advanced disease and/or in treatment, to engage in self-care, e.g., exercise, to manage fatigue. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03120819.

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