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"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.

Therapy-based complementary/integrative medicine in breast cancer therapy encompasses a wide range of practices and approaches to support patients physically, emotionally, and mentally -- all used alongside conventional medical treatments.

Although some complementary approaches have evidence supporting their efficacy in improving quality of life (QoL), reducing symptoms such as pain and nausea, and managing stress, others lack robust scientific evidence.

Healthcare providers should be aware of the evidence base for different complementary therapies and discuss this with their patients.

Integrative therapies should not replace conventional medical treatments for breast cancer, but can be used as adjuncts to standard care to help manage symptoms, improve quality of life, and support overall well-being.

The has a comprehensive guideline on complementary therapy, and endorsed the guideline and included a helpful list of such treatments.

Note that these therapies do not include naturopathic or homeopathic interventions, most of which are taken orally. Certain herbs and supplements can interfere with chemotherapy or radiation therapy and may cause or exacerbate adverse side effects related to other forms of breast cancer therapy. Counseling patients on the importance of disclosing any additional supplements they may be considering or have begun taking during treatment should be emphasized in a non-judgmental manner at each follow-up visit.

Otherwise, if patients express an interest in therapy-based complementary approaches, providers should emphasize the importance of integrating complementary therapies into a comprehensive treatment plan.

Discussing a patient's preferences and goals for complementary therapy as an adjunct to their treatment – including potential risks, benefits, and limitations – will empower patients to make informed decisions about their care. This may lead to better outcomes and improved QoL.

As with all aspects of breast cancer care, collaboration among all healthcare providers is crucial to delivering optimal therapeutic care. A multidisciplinary approach ensures that patients receive the most appropriate and effective treatments – including complementary therapies.

Lastly, complementary/integrative medicine continues to evolve, with new research and evidence emerging on an ongoing basis.

Healthcare providers should endeavor, through continuing education and engagement with reputable sources of information, to stay updated on the latest developments.

Acupuncture

Acupuncture is the insertion of sterile, extremely thin needles into specific points of the skin. These acupuncture points are thought to connect pathways of energy through a person's body. A 2018 found that among postmenopausal women with early-stage breast cancer and aromatase inhibitor-related arthralgias, acupuncture compared with sham acupuncture or with a control group resulted in a statistically significant reduction in joint pain at 6 weeks (although the observed improvement was of uncertain clinical importance).

In a , acupuncture significantly reduced multiple treatment-related symptoms compared with usual care. The authors noted that on the basis of available data, acupuncture appears to be generally a safe treatment with some mild adverse events (for example, bruising, pain, and swelling at needle insertion sites).

Compared with control groups, the acupuncture groups had significant reductions in pain intensity, fatigue, depression, hot flash severity, and neuropathy.

Exercise

Although not really a complementary/integrative therapy, it's worth emphasizing that exercise can help relieve symptoms and fatigue in breast cancer patients and help with chemotherapy dose tolerance and completion. In addition, the (Lifestyle, Exercise, and Nutrition Early After Diagnosis) trial found an association between a diet and exercise intervention and a higher pathologic complete response in patients with hormone receptor–positive/human epidermal growth factor receptor 2–negative and triple-negative breast cancer undergoing neoadjuvant chemotherapy.

Aromatherapy and Music Therapy

Aromatherapy is a technique where scented oils are inhaled through the nostrils or rubbed on the body during the course of a massage. Music therapy is the utilization of live or recorded music to promote relaxation.

In a that used usual care as a comparator, a perioperative combination of music therapy and aromatherapy achieved greater pain improvement and anxiety reductions in patients with breast cancer, as well as a less marked increase in interleukin-6 and high mobility group box 1 levels as measured by enzyme-linked immunosorbent assay.

A of aromatherapy with single essential oils found a substantial effect on the sleep quality of cancer patients, with researchers concluding that the method could be recommended as a beneficial complementary therapy to promote sleep quality.

A of the effect of a music therapy intervention found it can "effectively relieve anxiety and depression symptoms in patients with breast cancer, and reduce the degree of pain, but demonstration of its ability to improve the quality of life of patients requires additional research."

Guided Imagery and Progressive Muscle Relaxation

Guided imagery, also known as visualization, is a practice where a person imagines being in a certain environment or situation via thinking of pictures, sounds, smells, or other sensations associated with reaching a goal.

Progressive muscle relaxation involves tensing and releasing the muscles, one body part at a time, to induce physical relaxation.

A reported that both methods reduced anxiety in breast and prostate cancer patients undergoing chemotherapy, with a decrease in cortisol and amylase levels in the intervention group versus controls. The researchers concluded that these therapies could be of benefit in reducing anxiety and depression.

A of these therapies done in breast cancer found the practice to be effective for stress and anxiety reduction, with a positive QoL improvement, although there was no significant improvement in chemotherapy-related adverse events.

Hypnosis

Hypnosis may help patients experience a state of calm, alert awareness, which is believed to help a person relax deeply and focus on a specific idea, sensation, or memory.

A designed to assess the feasibility of self-hypnosis in breast cancer patients undergoing chemotherapy found that approximately two-thirds continued the practice from the beginning to the end of chemo.

And a found "sparse but promising evidence" for the effectiveness of the practice among patients with breast cancer, with the researchers concluding that hypnosis can be considered as an ancillary intervention for breast cancer symptom management.

Meditation

Meditation is a mind-focusing practice that endeavors to suspend the normal stream of thoughts occupying a person's conscious mind. There are different types of meditation approaches including:

• Tibetan-medicine meditation, which involves visualizing beneficial energy in the shape of a sphere of white light, with a goal of providing positive benefits to specific areas of a person's body or entire being. A found that five sessions of Tibetan-medicine mediation in patients with breast cancer led to significant decreases in scores between baseline and follow-up in anxiety-tension, depression-dejection, anger-hostility, fatigue, and confusion.

• Buddhist walking meditation involves mindfulness walking exercises at moderate intensity for 30 minutes. A showed that the method may improve cardiovascular fitness among on-treatment patients with breast cancer. In a , a South Korean form of meditation based on this method seemed to reduce anxiety and fatigue in breast cancer patients undergoing radiation therapy.

Movement-Based Therapies

These therapies often involve a physical practice with a spiritual component and include:

• Tai chi, an exercise comprised of a choreographed series of slow movements in concert with meditation and breathing techniques. It is conducted by a teacher, and most often takes place in a group setting. A of tai chi in breast cancer found no differences from conventional supportive care interventions for improving fatigue, sleep quality, depression, or body mass index at 3 months or 6 months, although the authors reported that there was a boost in QoL at 3 months.

• Yoga, from the Sanskrit "yuj" or union, is a more than 5,000-year-old tradition of principles and practices originating in India. Most styles of yoga practiced in the Western world focus on movement and breathing, with a multitude of variations available – some slow, some gentle, some active, and some fast-moving. It is perhaps the most studied form of complementary therapy for cancer care, with a plethora of evidence-based material supporting its use among patients with breast cancer. Multiple studies have tied yoga therapy to improvements in ; improvements in ; and .

Spirituality and Prayer

Spirituality, being concerned with the human spirit or soul, is most often expressed via religion and prayer, although there are many other means of expressing it. Various studies have supported the , when appropriate, to help patients cope with , as well as .

Hands-On Therapies

There is less evidence for the benefits of these treatments, which are rendered primarily through direct touch between the practitioner and the patient:

• Reiki, or "universal life force energy," is a form of therapy developed in Japan that is delivered via a practitioner's hands. The practitioner attempts to balance the flow of energy believed to move through the body in order to stimulate its healing capabilities. A had patients receiving chemotherapy undergo 6 Reiki therapy sessions, which led to reductions in fatigue versus controls, who experienced an increase in fatigue.

• Massage is a technique of manipulating the soft tissues of the body, most commonly by using the hands, fingertips, and fists. Shiatsu is a Japanese massage technique that uses acupressure through a practitioner's fingers. A of such manipulative and body-based practices (massage, acupressure, and reflexology) in an oncological setting showed positive effects on pain and fatigue symptoms, with mixed outcomes for QoL and patient mood.

Read the rest of the installments in this series:

Part 1: Breast Cancer -- The Basics of Diagnosis, Staging, and Treatment

Part 2: Breast Cancer: Making the Diagnosis With Breast Biopsy

Part 3: What to Know About Management of Early-Stage Breast Cancer

Part 4: New Treatment Options for Locally Advanced and Metastatic Breast Cancer

Part 5: Genetic Testing in Breast Cancer: Mutations, Multigene Panels, and More

Part 6: Case Study: Older Male With Rash, Chest Swelling, and Mysterious Skin Issues

Part 7: Breast Cancer Palliative Care and Metastatic Disease: Looking Beyond End of Life

Part 8: Breast Cancer and Post-Surgical Screening: Advising Patients on Appropriate Imaging

Part 9: The Key Role of Primary Care Providers in Managing Breast Cancer Tx-Related AEs

Part 10: Case Study: Patient with Rare Breast Cancer Has Surprising Response to NAC

Part 11: The Long View on the Long-Term Impact of Breast Cancer Treatment