FROM THE JOURNAL OF THE NATIONAL CANCER INSTITUTE MONOGRAPHS

Meditation, yoga, and relaxation with imagery can be recommended as evidence-based supportive care options during breast cancer treatment, according to a data review published in the Journal of the National Cancer Institute Monographs.

A review of randomized controlled clinical trials has provided researchers with strong evidence that certain behavioral therapies for mood improvement, depression, and anxiety can be useful as supportive care in women receiving standard breast cancer treatment (J. Natl. Cancer Inst. Monogr. 2014;50:346-58).

To determine which therapies had an effect during breast cancer treatment, the researchers organized a review of randomized controlled trials designed to assess the safety and effectiveness of more than 80 different intervention/modality combinations.

The investigators, led by Heather Greenlee, Ph.D., used a set of nine biomedical publication databases to find 203 randomized controlled clinical trials among breast cancer patients that tested complementary therapies together with standard cancer care – defined as surgery, chemotherapy, radiation therapy, and hormonal therapy.

A modified version of the U.S. Preventive Services Task Force grading system was used to develop and evaluate the effectiveness of the therapies, which were ranked into A, B, C, D, and H grades based on their evidence of benefit.

‘A’ grades were given to meditation, yoga, and relaxation with imagery, which were associated with mood improvement in the context of depression and anxiety during treatment for breast cancer. Music therapy was given a B grade for stress reduction.

C grades were assigned to 32 treatments that had weaker evidence of benefit, and 138 therapies were deemed to have insufficient evidence to form recommendations. Nine therapies were given a D grade, meaning they did not appear to have any effect on cancer treatment.

Only one intervention was given an H grade, meaning it was identified as potentially harmful: acetyl-L-carnitine, used for the prevention of taxane-induced neuropathy,was found to increase neuropathy.

Though the recommended therapies will not work for everyone, the guidelines should at least help clinicians and patients create a dialogue about treatment options, regardless of what the patient ultimately chooses, wrote Dr. Greenlee of Columbia University’s Mailman School of Public Health, together with colleagues at the Herbert Irving Comprehensive Cancer Center, the M.D. Anderson Cancer Center, the University of Michigan, the Memorial Sloan Kettering Cancer Center, and other U.S. and Canadian institutions.

Although A and B grade treatments will be recommended by the Society for Integrative Oncology as secondary therapies for breast cancer patients, the authors stressed that more research will be needed to identify and improve newer therapy options for breast cancer patients.

“Given the limited number of Grade A and Grade B recommendations, clinicians should engage patients in shared decision making using evidence-based projected benefits and harms that reflect patient values and preferences, as well as acknowledge their clinical prognosis,” the researchers wrote.

The authors had no relevant financial conflicts of interest to disclose.

mbock@frontlinemedcom.com

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