Complementary Therapies Can Boost Survival in Cancer Patients
An evidence review recently published in Current Oncology Reports has found that complementary medicine can have a major impact on cancer survival, comparable to conventional therapies. According to a Medscape article, exercise, relaxation and nutrition are commonly used to help relieve pain and adverse effects of cancer or cancer treatment, but this new review highlights its role in survivorship, a key point that oncologists should emphasize.
A large percent of cancer patients use some form of complementary and alternative medicine (CAM), typically with the goal of relieving pain and controlling the adverse effects of disease or treatment.
A new review of evidence drawn from experimental and epidemiologic studies, as well as a few clinical trials, demonstrates that several of the integrative approaches and lifestyle changes might also influence cancer survivorship.
"At times, these modalities can actually have a survival effect that could be similar to conventional care," said first author Moshe Frenkel, MD, chair of the Israeli Society of Complementary Medicine and founder of the Integrative Oncology Clinic at the University of Texas M.D. Anderson Cancer Center in Houston.
The review was published online March 7 in Current Oncology Reports.
"In the academic arena, complementary therapies are known to be used to reduce symptom intensity and improve quality of life during and after cancer treatments," Dr. Frenkel told Medscape Medical News. In their review, he and his colleagues "wanted to change this view a bit, and increase the awareness that complementary and integrative medicine can affect survival."
This is a point that most integrative oncologists do not emphasize, he added.
"There is actually quite good evidence from multiple studies that suggest that these therapies — including nutrition, certain supplements, physical activity, and stress reduction — actually do have a major effect on survival," he said.
For example, the effect of exercise on the risk for breast cancer recurrence is similar to that seen with the endocrine therapy tamoxifen, he explained.
Tamoxifen can reduce the risk for breast cancer recurrence by about 40%, whereas physical activity at a level of 9 metabolic equivalents of task (METS) per week reduces the risk for recurrence by 50%, he pointed out. This has been observed in long-term studies that are 10 to 15 years in duration.
Although "patients and physicians are aware of the benefit of tamoxifen, they are often not aware of the major survival advantage of physical activity," Dr. Frenkel said.
Survival Benefit Observed
He and his colleagues reviewed evidence from studies that assessed the use of mind–body interventions, nutrition, physical activity, and combined CAM approaches in cancer patients. They compiled data from a collection of studies that suggested an association between survival benefit and these interventions.
Mind–body interventions include approaches such as guided imagery, mindfulness meditation, and yoga, which are commonly used by cancer patients to reduce stress. Some reports have shown prolonged survival in patients who participated in these interventions, the researchers note.
In one study, for instance, women with melanoma who participated in an psychoeducational intervention experienced a 2.5-fold reduction in the risk for recurrence at 5- to 6-year follow-up, and an approximately 7-fold reduction in the risk for death (Arch Gen Psychiatry. 1993;50:681-689).
Nutrition has been widely discussed as a factor in cancer promotion and prevention, and the World Cancer Research Fund and the American Institute for Cancer Research have previously reported that 30% to 40% of cancers can be prevented with proper nutrition, regular physical activity, and the maintenance of a healthy weight (Acta Oncol. 2011;50:167-178).
In addition, the Women's Healthy Eating and Living (WHEL) study revealed a direct relation between vegetable intake and cancer recurrence in more than 3000 breast cancer survivors (Breast Cancer Res Treat. 2011;125:519-527). Baseline vegetable intake in the highest tertile, compared with the lowest tertile, was associated with an overall adjusted hazard ratio for recurrence of 0.69 (95% confidence interval, 0.55 - 0.87).
A number of studies have demonstrated that a combination of alternative therapies could even have greater effect on survival. For example, the combined effect of stress reduction, improved nutrition, physical activity, and smoking-cessation instruction was shown to have a significant effect on survival in women with localized breast cancer (Cancer. 2008;113:3450-3458).
In that study, at a median follow-up of 11 years, patients in the intervention group, compared with those in the observation group, experienced a significant reduction in the risk for breast cancer recurrence (hazard ratio [HR], 0.55; P = .034) and in death from breast cancer (HR, 0.44; P = .016). Risk for death from all causes was also significantly lower in the intervention group (HR, 0.51; P = .028).
"Today, an increased number of physicians and integrative oncology programs are starting to look at these issues and actually add this aspect to counseling, but still the number of patients that actually implement this information is quite low," said Dr. Frenkel.
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