Greenlee, H., Balneaves, L.G., Carlson, L.E., Cohen, M., Deng, G., Hershman, D., . . . Society for Integrative Oncology. (2014). Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. Journal of the National Cancer Institute.Monographs, 2014, 346–358.

DOI Link

Purpose & Patient Population

PURPOSE: To inform clinicians and patients about evidence regarding complementary and integrative therapy use to manage symptoms and side effects

TYPES OF PATIENTS ADDRESSED: Women with breast cancer during and beyond treatment

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Evidence-based guideline

PROCESS OF DEVELOPMENT: A literature search was done, and study quality was evaluated using the Jadad scale and an adapted Delphi scale. A modified version of the U.S. Preventive Services Task Force scale was used for grading the evidence. A panel of experts compiled results and drafted recommendations, which were reviewed by clinicians, researchers, patient advocates, and other stakeholders. Feedback was incorporated into the final recommendations.

SEARCH STRATEGY:

DATABASES USED: Medline, EMBASE, CINAHL, SCOPUS, AMED, PubMed, PsychINFO, and Web of Science

KEYWORDS: Not stated

INCLUSION CRITERIA: Randomized, controlled trials; at least 50% of patients had breast cancer; breast cancer results separately reported an outcome of interest; used an integrative intervention

EXCLUSION CRITERIA: Systematic review or meta-analysis

Phase of Care and Clinical Applications

PHASE OF CARE: Multiple phases of care

APPLICATIONS: Palliative care

Results Provided in the Reference

4,900 references were identified that were published between January 1, 1990 and December 31, 2013. 203 articles were included in the final review although only 174 were referenced. Grades used and reported here were A: recommended, high certainty of benefit, B: recommended, high certainty of moderate to substantial benefit, D: recommends against use, moderate to high certainty of no net benefit, and H: recommends against use, moderate to high certainty that harms outweigh benefits.

Guidelines & Recommendations

Interventions for specific symptoms that had strong recommendations for or against use were:

Anxiety: Music therapy during RT and chemotherapy sessions, meditation, and yoga for patients undergoing therapy (B-level recommendation)
Depression: Mindfulness-based stress reduction for patients undergoing radiotherapy, relaxation, and yoga (level A recommendation); massage and music therapy (level B)
Fatigue: Energy conservation (level B)
CINV: Acupressure and electroacupuncture in addition to antiemetics (B level)
Neuropathy: Acetyl L carnitine was not recommended because of harm (H level).
Radiodermatitis: Aloe vera and hyaluronic acid cream were not recommended as standard therapy because of lack of effect (D level).

Limitations

It appears that only specific types of interventions were included, and there are numerous types of integrative or complementary interventions that were not considered in this review. The findings considered were limited to women with breast cancer. Quality rating of evidence was not discussed individually.

Nursing Implications

These guidelines provided an evidence-based evaluation of various integrative therapies in women with breast cancer. This set of interventions is not all-inclusive; however, it does provide some guidance to clinicians and others regarding evidence strength in these areas as assessed by this specific study group.