Integrative approaches can be valuable allies in oncology

Evidence-based recommendations show, with caveats, the benefits of practices such as acupuncture, reflexology, hypnosis, and massage for patients undergoing cancer treatment

Reinaldo José Lopes

In early 2024, researchers from the MD Anderson Cancer Center, in Texas, published a review study in the journal Current Oncology Reports regarding the efficacy of integrative approaches in cancer treatment. The study analyzed healthy eating habits, physical activity, stress management and social support, sleep hygiene, as well as natural products and supplements.

The authors note that, apart from Vitamin D, especially for those who are deficient, and occasionally high-quality adjuvant melatonin, there are no natural products or supplements recommended to reduce cancer recurrence and prolong survival.

The study concludes by stating that the authors support “an integrative approach to healthcare,” to “offer patients a comprehensive treatment plan that leads to optimal health, quality of life, and improved cancer survival.” The authors also add several important caveats, such as that integrative healthcare should not replace conventional treatment. They also recognize the need for more studies on integrative approaches.

The review study references a set of recommendations published in 2022 and 2023, drafted with input from the American Society of Clinical Oncology (ASCO), which establishes evidence-based guidelines for the use of integrative medicine in cancer patients.

One such guideline, published in September 2022 in partnership with the Society for Integrative Oncology (SIO), suggests that practices such as acupuncture, reflexology, hypnosis, and massage could be used to alleviate pain in cancer patients, considering the scientific literature already available on the practices.

Other approaches, such as music therapy, cause no harm to patients, but currently have less empirical support, according to the publication.

The guidelines for the joint ASCO and SIO working group, coordinated by Jun J. Mao, from the Memorial Sloan Kettering Cancer Center, in New York, were published in the Journal of Clinical Oncology. As part of their research, Mao and his colleagues reviewed 227 previous studies in an attempt to estimate the quality of the evidence they contained.

In addition to the experts, the panel included a representative for cancer patients who use this type of therapy. The team searched the PubMed and Cochrane Library databases for studies published between 1990 and 2021, including randomized controlled trials, systematic reviews, and meta-analyses on the topic.

The studies had to include adult or pediatric patients who suffered from pain during any stage of cancer treatment and received integrative interventions to minimize the problem (pain prevention techniques were not included). The primary outcome should be a reduction in pain frequency or intensity, and at least 20 participants should be included in each study.

Based on these criteria, the initial 1,346 scientific articles analyzed dropped to 227. Even for the studies that met the inclusion criteria, the team highlights that there is considerable variability in methodology and primary outcome.

“This disparity precluded a quantitative analysis, so we only carried out a descriptive review,” write the authors.

In the paper, Mao and his colleagues highlight that, in addition to the pain caused by the tumor itself or its effect on bones, nerve tissue, and muscles, patients often have to deal with pain triggered by conventional cancer treatments, such as joint pain caused by aromatase inhibitors, commonly used against breast cancer, and pain associated with chemotherapy-induced peripheral neuropathy.

Faced with these and other issues, the authors concluded that some integrative practices achieved a quality of evidence considered intermediate. These are moderately recommended for cancer patients.

This is the case with acupuncture, which is indicated to treat joint and muscle pain caused by aromatase inhibitors in breast cancer patients.

Acupuncture

In this case, a phase III clinical trial (which evaluates efficacy) with 226 patients showed, for example, that acupuncture is more effective at reducing pain than using needles at “fake” acupuncture points (not traditionally stimulated by acupuncturists) or standard treatment (solely pharmacological).

Very similar conclusions were reached for reflexology and hypnosis in those undergoing systemic cancer treatment, or for massage in those receiving palliative care.

As for approaches such as music therapy, a review of the medical literature indicates that these practices tend to be more beneficial than harmful for patients. However, the quality of the evidence is considered low and, therefore, the guidelines only “tentatively” recommend its use.

The most solid evidence, for the time being, comes from studies performed on adult patients. According to the research, data on the use of integrative practices to minimize pain in pediatric cancer patients has not yet reached sufficient critical mass to make recommendations.

Biologist Elisa Harumi Kozasa, a researcher at Hospital Israelita Albert Einstein, in Brazil, highlights the need for more studies. “As of yet, very few integrative treatments have scientific backing,” says Kozasa, who works with studies on mind-body practices, such as meditation and yoga, which, according to her, have extensive literature backing them up.

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