Positive Health Online

Abstract

GREENLEE and COLLEAGUES, Department of Epidemiology, Mailman School of Public Health, Columbia University, 722W. 168th Street, 7th Floor, New York, NY 10032. hg2120@columbia.edu reviewed the published literature about integrative therapies supportive care during breast cancer treatment.

Background

The majority of breast cancer patients use complementary and/or integrative therapies during and beyond cancer treatment to manage symptoms, prevent toxicities, and improve quality of life. Practice guidelines are needed to inform clinicians and patients about safe and effective therapies.

Methodology

Following the Institute of Medicine’s guideline development process, a systematic review identified randomized controlled trials testing the use of integrative therapies for supportive care in patients receiving breast cancer treatment. Trials were included if the majority of participants had breast cancer and/or breast cancer patient results were reported separately, and outcomes were clinically relevant. Recommendations were organized by outcome and graded based upon a modified version of the US Preventive Services Task Force grading system.

Results

The search (January 1, 1990–December 31, 2013) identified 4900 articles, of which 203 were eligible for analysis. Meditation, yoga, and relaxation with imagery are recommended for routine use for common conditions, including anxiety and mood disorders (Grade A). Stress management, yoga, massage, music therapy, energy conservation, and meditation are recommended for stress reduction, anxiety, depression, fatigue, and quality of life (Grade B). Many interventions (n = 32) had weaker evidence of benefit (Grade C). Some interventions (n = 7) were deemed unlikely to provide any benefit (Grade D). Notably, only one intervention, acetyl-l-carnitine for the prevention of taxane-induced neuropathy, was identified as likely harmful (Grade H) as it was found to increase neuropathy. The majority of intervention/modality combinations (n = 138) did not have sufficient evidence to form specific recommendations (Grade I).

Conclusion

Specific integrative therapies can be recommended as evidence-based supportive care options during breast cancer treatment. Most integrative therapies require further investigation via well-designed controlled trials with meaningful outcomes.

References

Heather Greenlee, Lynda G. Balneaves, Linda E. Carlson, Misha Cohen, Gary Deng, Dawn Hershman,  Matthew Mumber, Jane Perlmutter, Dugald Seely, Ananda Sen, Suzanna M. Zick,  and Debu Tripathy. Clinical Practice Guidelines on the Use of Integrative Therapies as Supportive Care in Patients Treated for Breast Cancer.  Natl Cancer Inst Monogr (50): 346-358. doi: 10.1093/jncimonographs/lgu041. http://jncimono.oxfordjournals.org/content/2014/50/346 . 2014.

 

FRISK and COLLEAGUES, Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden evaluated the long-term effects on vasomotor symptoms after treatment with acupuncture in women with breast cancer and men with  prostate cancer.

BACKGROUND: Acupuncture has been suggested as therapy for hot flashes in women with breast cancer and men with prostate cancer. In this systematic review, the authors sought to evaluate the long-term effects on vasomotor symptoms after the end of a defined treatment period of acupuncture in women with breast cancer and men with  prostate cancer.

METHODS: A literature search revealed 222 articles within the field. With defined exclusion criteria, we identified 17 studies. We also used the Jadad quality score and identified seven studies with a score of at least 3.

RESULTS: Six of seven identified studies qualified for inclusion in an analysis that measured frequency of hot flashes weighted in relation to number of patients (n=172). The average reduction from baseline to end of acupuncture (ranging between 5 and 12 weeks of treatment) showed 43.2 % reduction of hot flashes. At the last follow-up (mean 5.8 months, range 3-9 months) after the end of therapy,  the weighted reduction from baseline was sustained at 45.6 % in the 153 of 172 patients (89 %) who were followed up.

CONCLUSIONS: Data from six prospective analyzed studies indicate at least 3-month effects after the end of acupuncture treatment for flashes in women with breast cancer and men with prostate cancer. However, larger randomized trials with long-term follow-up will be needed to confirm these preliminary findings.

Frisk JW, Hammar ML, Ingvar M and Spetz Holm AC. How long do the effects of acupuncture on hot flashes persist in cancer patients? Support Care Cancer. 22(5):1409-15. May 2014  doi: 10.1007/s00520-014-2126-2. Epub. PMID: 24477325. Jan 30 2014.

 

VALENTI and COLLEAGUES, Department of Medicine, Clinic of Internal Medicine, section D, University of Verona, Piazzale Scuro, 10, 37134 Verona, Italy luca.dallecarbonare@univr.it investigated the effect of ascorbic acid (AsA - vitamin C) on osteogenic differentiation and apoptosis of the MG-63 osteosarcoma cell line.

BACKGROUND: Osteosarcoma originates from mesenchymal stem cells with impaired bone differentiation. In the present study the authors investigated the effect of ascorbic acid (AsA – vitamin C) on osteogenic differentiation and apoptosis of the MG-63 osteosarcoma  cell line.

METHODOLOGY: The authors evaluated the expression of runt-related transcription factor-2 (RUNX2) and secreted phosphoprotein 1 (SPP1) genes by real-time Polymerase Chain Reaction (PCR) and of endogenous bone morphogenetic protein-2 (BMP2) and osteocalcin proteins by immunohistochemistry. They analyzed osteoblast maturation by phosphatase alkaline synthesis and calcium deposition, and apoptosis by (TUNEL) test and Annexin staining.

RESULTS: The results showed that RUNX2 and SPP1 gene expression was increased in cells treated with low concentrations of AsA with respect to untreated cells. At  higher concentrations, AsA induced apoptosis of osteosarcoma cells, possibly with the involvement of p21.

CONCLUSION: Our findings support the ability of AsA - vitamin C to induce both differentiation, by affecting the target involved in early and late phases of osteogenic maturation, and apoptosis in poorly-differentiated osteosarcoma cells.

Valenti MT, Zanatta M, Donatelli L, Viviano G, Cavallini C, Scupoli MT, Dalle  Carbonare L. Ascorbic acid induces either differentiation or apoptosis in MG-63 osteosarcoma lineage. Anticancer Res. 34(4):1617-27. PMID: 24692690.  April 2014.

Comments: The above research demonstrates, at the molecular level, the ability of ascorbic acid - Vitamin C to induce apoptosis of osteosarcoma cancer cells, possibly via p21 action.

 

MIN and MIN, Department of Occupational and Environmental Medicine, Ajou University School of  Medicine, Suwon, Korea investigated - by stratifying the risk by current smoking status - whether serum carotenoid levels were associated with the mortality risk of lung cancer.

BACKGROUND: Lung cancer is one of the most common cancers worldwide and is the leading cause of cancer-induced death in the USA. Although much attention has been focused on the anti-carcinogenic effect of consuming carotenoid-containing food or supplements, the results have been inconsistent.

METHODOLOGY: The authors investigated whether serum carotenoid levels were associated with the mortality risk of lung cancer in US adults using data from a nationally representative sample. The data were obtained from the Third Nutrition and Health Examination Survey (NHANES III) database and  the NHANES III Linked Mortality File.

RESULTS: A total of 10,382 participants aged over 20,years with available serum carotenoid levels and no other missing information  on questionnaires and biomarkers at baseline (NHANES III) were included in the present study. Of the 10,382 participants, 161 subjects died due to lung cancer. The authors found that high serum levels of alpha-carotene and beta-cryptoxanthin at baseline were significantly associated with a lower risk of lung cancer death. When the authors stratified the risk by current smoking status, the risk of death of current smokers was significantly decreased to 46% (95% confidence interval, 31-94%) for alpha-carotene and 61% (95% confidence interval, 19-80%) for beta-cryptoxanthin. By contrast, no association was observed among never/former smokers at baseline.

CONCLUSIONS: High serum levels of alpha-carotene and beta-cryptoxanthin are associated with a lower risk of lung cancer death in US adults.

Min KB and Min JY. Serum carotenoid levels and risk of lung cancer death in US adults. Cancer Sci. 105(6):736-43. June 2014. PMID: 24673770.  doi: 10.1111/cas.12405. Epub  May 6. 2014.

Comments: The above large study with >10,000 participants demonstrated that high serum levels of alpha-carotene and beta-cryptoxanthin – carotenoids - were associated with significantly reduced lung cancer death risk.