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NCCIH Clinical Digest

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Complementary and Integrative Approaches for Cancer Symptoms and Treatment Side Effects:
What the Science Says

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October 2018
Cancer woman child

   

Clinical Guidelines, Scientific Literature, Info for Patients: 

There is evidence that suggest some mind and body approaches, such as acupuncture, massage therapy, music therapy, meditation and mindfulness-based stress reduction, and yoga may help to manage some symptoms of cancer and side effects of treatment. The Society for Integrative Oncology 2009 clinical practice guidelines for the use of complementary therapies and botanicals in integrative oncology, recommends mind and body modalities as part of a multidisciplinary approach for reducing anxiety, mood disturbance, and chronic pain and for improving quality of life in people with cancer. 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 music therapy, meditation, stress management and yoga for anxiety/stress reduction; use of meditation, relaxation, yoga, massage and music therapy for depression/mood disorders; use of meditation and yoga to improve quality of life, and use of acupressure and acupuncture for reducing chemotherapy-induced nausea and vomiting. The guidelines also state that no strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. The American College of Chest Physicians issued guidelines in 2013 on complementary therapies and integrative medicine in lung cancer. Specific recommendations from these guidelines are noted below.

Acupuncture

Available data suggest that for people undergoing cancer treatment, acupuncture can help to manage chemotherapeutic-induced nausea and vomiting. There isn’t enough evidence to determine whether acupuncture relieves cancer pain or other symptoms such as treatment-related hot flashes or xerostomia.

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 recommends 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 has 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 suggests 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 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.
  • A 2015 Cochrane review of five studies involving 285 participants concluded that there is insufficient evidence to determine whether acupuncture is effective in relieving cancer pain in adults. 
  • A 2013 Cochrane review of nine studies of participants with xerostomia, including four studies of participants undergoing radiotherapy for oral cancers, concluded that there is some low quality evidence that acupuncture results in a small increase in saliva production in patients with dry mouth following radiotherapy. A 2018 systematic review found insufficient evidence to concluded whether acupuncture is an evidence-based treatment option for xerostomia/hyposalivation.

Safety

  • Complications from acupuncture are rare, as long as the acupuncturist uses sterile needles and proper procedures. Because chemotherapy and radiation therapy can induce immunosuppression, acupuncturists should follow strict clean-needle procedures when treating these patients.

 

Massage Therapy

Some studies suggest that massage therapy might help with pain and anxiety in people with cancer. However, research findings have not been consistent.

What Does the Research Show?

  • Clinical practice guidelines issued in 2009 by the Society for Integrative Oncology recommends 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 multi-modality cancer supportive care program for lung cancer patients whose anxiety or pain is not adequately controlled by usual care.
  • 2016 Cochrane review of 19 small studies involving 1,274 participants found some studies suggesting that massage with or without aromatherapy may help relieve pain and anxiety in people with cancer; however, the quality of the evidence was very low and results were not consistent. 
  • Another 2016 systematic review and meta-analysis of 16 studies concluded that based on the available evidence, weak recommendations are suggested for massage therapy, compared to an active comparator, for the treatment of pain, fatigue, and anxiety. 

Safety

  • To avoid possible adverse effects, the massage therapist should not use deep or intense pressure without the health care providers’ approval and may need to avoid certain sites, such as areas directly over a tumor or a known thrombus, or areas where the skin may be sensitive following radiation therapy.

 

Mindfulness-Based Stress Reduction

There is evidence that mindfulness-based stress reduction, a type of meditation training, can help cancer patients cope with stress.

What Does the Research Show?

  • 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, 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 recommends meditation for anxiety/stress reduction (Grade A), depression/mood disorders (Grade A), and to improve quality of life (Grade A).

Safety

  • Meditation is generally considered to be safe for healthy people. However, people with physical limitations may not be able to participate in certain meditative practices involving movement.
  • There have been rare reports that meditation could cause or worsen symptoms in people with certain psychiatric condition such as anxiety disorders and depression.

 

Yoga

Studies in women with breast cancer show that yoga may reduce fatigue and sleep disturbances, reduce depression and anxiety, and improve the 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?

  • 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, 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.
  • A 2015 reported secondary analysis on data from a randomized controlled trial assessed the effects of a 4-week yoga intervention on overall cancer-related fatigue in 97 cancer survivors 60 years of age, or older. Participants in the yoga intervention reported significantly lower cancer-related fatigue, physical fatigue, mental fatigue, and global side-effect burden than participants receiving standard care.

Safety

  • Because yoga involves physical activities, before they start it’s important for cancer patients to speak with their health care providers about  whether any aspects of yoga might be unsafe.  

 

Hypnosis

Results of some studies suggest that hypnosis may help manage pain, anxiety, and distress in patients who are having cancer-related procedures such as biopsies or surgery.

What Does the Research Show?

  • In 2017 the Society for Integrative Oncology issued guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment and suggest 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 considered safe when performed by a health professional trained in hypnotherapy.
  • Self-hypnosis also appears to be safe for most people. There are no reported cases of injury resulting from self-hypnosis.

 

References

NCCIH Clinical Digest is a service of the National Center for Complementary and Integrative Health, NIH, DHHS. NCCIH Clinical Digest, a monthly e-newsletter, offers evidence-based information on complementary health approaches, including scientific literature searches, summaries of NCCIH-funded research, fact sheets for patients, and more.

The National Center for Complementary and Integrative Health is dedicated to exploring complementary health products and practices in the context of rigorous science, training complementary health researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCIH's Clearinghouse toll-free at 1-888-644-6226, or visit the NCCIH Web site at nccih.nih.gov. NCCIH is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.

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This page last modified October 31, 2018