Complementary Psychological and/or Physical Approaches for Cancer Symptoms and Treatment Side Effects: What the Science Says

Acupuncture

Available data suggest that acupuncture may help reduce cancer pain, manage treatment-related nausea and vomiting in people with cancer, and relieve cancer-related fatigue. Research on the effects of acupuncture on cancer-related hot flashes is limited.

What Does the Research Show?

Several clinical practice guidelines from the Society for Integrative Oncology based on systematic reviews of many randomized controlled trials, as well as guidelines from the American College of Chest Physicians, report there is some demonstrated efficacy for acupuncture for relief of some cancer-related symptoms and treatment side effects.

• Clinical practice guidelines issued in 2009 by the Society for Integrative Oncology recommend acupuncture as a complementary therapy when pain is poorly controlled, when side effects associated with other treatments are significant, when nausea and vomiting associated with chemotherapy or surgical anesthesia are poorly controlled, or when reducing the amount of pain medicine becomes a clinical goal. The benefits of acupuncture for other symptoms, including fatigue or hot flashes, have not been established.
• In 2017, the Society for Integrative Oncology issued guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment, recommending the use of acupressure and acupuncture for reducing chemotherapy-induced nausea and vomiting.
• In a 2017 monograph of the Journal of the National Cancer Institute, the authors state that although there is general consensus that acupuncture is useful for chemotherapy-induced nausea and vomiting, this is primarily based on studies that predate current antiemetic guidelines. Whether acupuncture has benefits above current standard treatments is unknown. However, a 2015 reported randomized trial of 70 participants found comparable efficacy between acupuncture and ondansetron in the prevention of delayed chemotherapy-induced nausea and vomiting. Participants in the acupuncture group appeared to have fewer adverse events and improved quality of life.
• Guidelines on complementary therapies and integrative medicine for lung cancer patients issued in 2013 by the American College of Chest Physicians suggest acupuncture as an adjunct treatment option for nausea or vomiting from either chemotherapy or radiation therapy. The guidelines also suggest acupuncture as an adjunct option in patients with cancer-related pain and peripheral neuropathy with inadequate control of these symptoms.
• A 2020 systematic review and meta-analysis (17 randomized controlled trials involving 1,111 participants were included in the systematic review, and data from 14 randomized controlled trials involving 920 participants were used in the meta-analysis) found that acupuncture and/or acupressure was significantly associated with reduced cancer pain and decreased use of analgesics; however, the evidence level was moderate. The reviewers noted that more rigorous trials are needed to identify the association of acupuncture and acupressure with specific types of cancer pain and to integrate such evidence into clinical care to reduce opioid use.
• A 2018 meta-analysis of 10 studies involving 1,327 participants showed that acupuncture may be more helpful than sham acupuncture or usual care in relieving cancer-related fatigue.
• A 2017 systematic review and meta-analysis of 13 randomized controlled trials involving 844 breast cancer patients found that acupuncture significantly alleviated menopause symptoms but had no effect on hot flashes.

Safety

• Complications from acupuncture are rare, as long as the acupuncturist uses sterile needles and proper procedures. Chemotherapy and radiation therapy weaken the immune system, so it’s especially important for acupuncturists to follow strict clean-needle procedures to reduce the risk of infection when treating people with cancer.

Hypnosis

Hypnosis may be helpful for pain caused by cancer itself or by procedures used in cancer care, for nausea and vomiting in people with breast cancer, and for anxiety and distress around surgical and medical procedures in both adults and children. It may also be helpful for hot flashes in women with breast cancer.

What Does the Research Show?

• A 2018 review found that hypnosis may help treat symptoms of nausea and vomiting in people with breast cancer, manage pain in a variety of contexts, and also reduce levels of anxiety and overall distress around surgical and medical procedures.
• In 2017 the Society for Integrative Oncology issued guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment and suggested that hypnosis (based on two trials from a single research group) can be considered for use for fatigue during treatment (Grade C). These guidelines also indicate that hypnosis can be recommended as a therapy for pain (Grade C).

Safety

• Hypnosis is a safe technique when practiced by a trained, experienced, licensed health care provider.

Massage Therapy

Massage therapy, with or without aromatherapy (the use of essential oils), has been used to attempt to relieve pain, anxiety, and other symptoms in people with cancer. However, there is only limited evidence on whether it is beneficial.

What Does the Research Show?

• A 2021 systematic review and meta-analysis of 13 studies involving 1,100 participants of various manual therapies, including but not limited to massage therapy, provided evidence for benefits on pain, physical function, and global well-being but not fatigue, nausea, anxiety, or depression. These results should be interpreted cautiously because a variety of different manual therapies and measurement techniques were included and because some studies included small numbers of participants or were of low quality.
• A 2016 Cochrane review of 19 studies involving more than 1,200 participants found that there was a lack of evidence on the clinical effectiveness of massage for symptom relief in people with cancer. Most studies were too small to be reliable and key outcomes were not reported.
• Clinical practice guidelines issued in 2009 by the Society for Integrative Oncology recommend considering massage therapy delivered by an oncology-trained massage therapist as part of a multimodality treatment approach in patients experiencing anxiety or pain.
• In 2017 the Society for Integrative Oncology issued guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment, recommending the use of massage therapy to improve mood disturbance in breast cancer survivors after active treatment (grade B). This recommendation is based on results from six trials.
• In clinical practice guidelines issued by the American College of Chest Physicians in 2013, massage therapy is suggested as part of a multimodality supportive care program for lung cancer patients whose anxiety or pain is not adequately controlled by usual care.

Safety

• Massage therapists may need to modify their usual techniques when working with people with cancer; for example, they may have to use less pressure than usual in areas that are sensitive because of cancer or cancer treatments.

Mindfulness-Based Stress Reduction

There is evidence that mindfulness-based stress reduction, a type of meditation training, can help cancer patients cope with stress, anxiety, and depression and can help reduce fatigue and improve quality of life.

What Does the Research Show?

• A 2020 systematic review and meta-analysis of 26 studies involving 3,476 participants  with various types of cancer showed that those who participated in mindfulness-based interventions had less anxiety, depression, fatigue, and stress and a better quality of life than those who did not participate in mindfulness-based interventions.
• 2009 reported clinical practice guidelines from the Society for Integrative Oncology recommend mind and body modalities, including mindfulness-based stress reduction, as part of a multidisciplinary approach to reduce anxiety, mood disturbance, and chronic pain and improve quality of life.
• Clinical practice guidelines issued in 2017 by the Society for Integrative Oncology on the evidence-based use of integrative therapies during and after breast cancer treatment recommend meditation for anxiety/stress reduction (Grade A), depression/mood disorders (Grade A), and to improve quality of life (Grade A).

Safety

• Mindfulness and other forms of meditation are generally considered to be safe for healthy people. However, they may need to be modified to make them safe and comfortable for people with some health conditions.

Tai Chi and Qigong

There is some limited evidence that tai chi may improve fatigue in people with cancer when used as an addition to conventional care but not when used as an alternative to conventional care. Tai chi or qigong may also help improve sleep quality in people with cancer.

What Does the Research Show?

• A 2020 systematic review and meta-analysis analyzed 16 studies (1,268 participants) of tai chi in women with breast cancer. Some of the studies evaluated tai chi as an alternative to conventional supportive care interventions such as aerobic exercise and cognitive behavioral therapy, and others evaluated it as an addition to conventional care. Tai chi improved fatigue when used as an addition to conventional care (two studies) but not when used as an alternative to conventional care (two studies). Tai chi improved overall quality of life when used either as an addition to conventional care (four studies) or as an alternative to conventional care (two studies).
• A 2019 systematic review and meta-analysis of 12 recent studies (915 participants) of qigong or tai chi for patients with various types of cancer found favorable effects on symptoms of fatigue and sleep quality that were large enough to be meaningful to patients.

Safety

• Tai chi and qigong are generally considered to be safe practices.

Yoga

Studies in women with breast cancer show that yoga may provide a modest improvement in fatigue and sleep disturbances, depression and anxiety, and quality of life. Most yoga studies have focused on women with breast cancer; much less is known about yoga for people with other types of cancer.

What Does the Research Show?

• A 2020 systematic review and meta-analysis of 24 studies of yoga for women with breast cancer, involving a total of more than 1,600 participants, concluded that yoga provides small-to-moderate improvements in cancer-related fatigue and quality of life compared to interventions not involving physical activity. Therefore, it could be a supportive intervention for women with breast cancer, as an addition to standard treatment.
• A 2021 systematic review and meta-analysis of 26 studies of yoga-based interventions for depressive symptoms (1,486 participants) and 16 studies of yoga-based interventions for anxiety symptoms (977 participants) in people with various types of cancer found evidence that the interventions were helpful for both types of symptoms. The majority of the studies involved women with breast cancer.
• In 2013 guidelines from the American College of Chest Physicians, yoga is suggested as part of a multidisciplinary approach to reduce fatigue and sleep disturbance while improving mood and quality of life in patients with lung cancer.
• 2009 clinical practice guidelines from the Society for Integrative Oncology recommend mind and body modalities, including yoga, as part of a multidisciplinary approach to reduce anxiety, mood disturbance, and chronic pain and improve quality of life.
• In 2017 the Society for Integrative Oncology issued guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment, recommending the use of yoga for reducing anxiety in breast cancer patients (Grade B), for improving mood disturbances and depressive symptoms in women with breast cancer (Grade B), and for improving the quality of life in breast cancer patients (Grade B).
• A 2017 Cochrane review of 24 studies involving 2,166 women with breast cancer concluded that moderate-quality evidence supports the recommendation of yoga as a supportive intervention for improving health-related quality of life and reducing fatigue and sleep disturbances when compared with no therapy, as well as for reducing depression, anxiety, and fatigue, when compared with psychosocial/educational interventions.

Safety

• Yoga is generally considered a safe form of physical activity for healthy people when performed properly under the guidance of a qualified instructor. However, as with other forms of physical activity, injuries can occur. The most common injuries are sprains and strains. Serious injuries are rare. In studies of yoga in people with cancer, adverse events have mostly been minor. However, having an ongoing health problem such as cancer may increase the risks of doing yoga.

References