Frequency of use of complementary and alternative medicine in women with breast cancer

An Integrative Medicine Educational Program for Radiation Oncology Patients: Patient-Reported Outcomes

Purpose

Complementary health approaches (CHAs) equip patients to self-manage radiation therapy (RT)-related symptoms and fulfill unmet needs, but few disclose CHA use to their radiation oncologist. An integrative medicine educational program (IMEP) was developed to assess its ability to improve patient self-efficacy for symptom management and CHA use disclosure.

Methods and Materials

The IMEP included 4 1-hour sessions covering topics of (1) meditation, (2) yoga, (3) massage therapy, and (4) nutrition. Individuals over age 18 years and actively receiving RT were administered presession and postsession surveys. The primary outcomes were intention to disclose CHA use and self-efficacy. Qualitative data were assessed with a thematic approach.

Results

Overall, 23 patients attended 1 or more sessions, yielding 43 completed surveys. Compared with 35.9% of participants who had disclosed CHA use before the session, 67.4% intended to disclose after the session. Of the 5 self-efficacy statements, there were significant improvements in "I have ownership over my health" (increase of 0.42; 95% CI, 0.07-0.77; P = .01), "I have tools to manage my disease on my own" (1.14; 95% CI, 0.42-1.87; P = .001), and "I have control over my cancer" (0.96; 95% CI, 0.39-1.53; P < .001). Barriers to involvement included transportation, timing relative to RT appointment, and poor performance status.

Conclusions

A radiation-specific IMEP resulted in a high rate of intention to disclose CHA use and improvements in patients' reported self-efficacy to manage radiation-related symptoms. However, substantial resources were needed to deliver the IMEP. Future work must focus on increasing accessibility through telehealth and flexible timing.

Complementary and Alternative Medicine Use in Patients With Cancer and Immigration Background

PURPOSE

Studies have shown that patients with cancer are more likely to use complementary and alternative medicine (CAM) than noncancer patients for symptom relief and hope. We aimed to evaluate factors of race, ethnic groups, and immigration status in attitude of patients with cancer in seeking out CAM.

PATIENTS AND METHODS

This is a prospective questionnaire study where information on demographics, cancer information, race/ethnicity, immigration duration, and psychosocial factors was correlated with the CAM use in a community cancer center located in the borough of Brooklyn, at New York City.

RESULTS

Among 658 patients, the prevalence of CAM use was 66.11%. CAM use was 71.98% in females and 54.34% in males (P = .113 × 10-4). Patients of African descent had higher CAM use (72.73%) than the White patients (63.53%; P = .0371). There was no difference of CAM use between the US born (68.77%) and the immigrants (63.98%, P = .199) as a whole; however, comparing with the US born (66.50%), Asian-born immigrants had lower CAM use (53.77%, P = .0161), whereas Latin-American born had a numerical trend toward higher CAM use (74.83%, P = .0608). The number of years of living in the United States was not associated with more CAM use. Prayer and spirituality was the most common CAM subtype used (25.91%). There was no difference in CAM use in the respective non-White ethnic groups whether they were US born or non-US born.

CONCLUSION

In this cohort of patients with cancer enriched with immigration background, CAM use was the highest in African American patients. The use of CAM in the non-White patients was associated with their ethnic background, regardless whether they were US born or not. Cultural roots appeared to be a strong influencing factor for the usage of CAM.

Osteopathy as a complementary/alternative medicine for breast cancer: a Canadian case study and comprehensive review

Aim: In Canada, osteopathic medicine, a well-known branch of complementary/alternative medicine, has received minimal attention for pain management within oncology. Purpose: This review reports both the existing literature and patient experience surrounding the application of osteopathy as an effective treatment for pain in breast cancer patients. Results: Both the literature and this case study support, to some degree, the benefits of osteopathy as pain management for breast cancer patients. Conclusion: Due to contradictory reported findings, more studies would be required to make firm conclusions, especially within a Canadian context. However, a lack of standardization of osteopathic procedures and collaboration between osteopaths and traditional healthcare professionals are challenges in including osteopathy as a standard service offered to breast cancer patients.

Expectancy and Utilisation of Reflexology among Women with Advanced Breast Cancer

OBJECTIVE

Little is understood about patient expectations and use of complementary therapies (CT) during cancer treatment. A secondary analysis of an 11-week reflexology trial among women with breast cancer was conducted. We examined factors that predicted women's expectations about reflexology for symptom relief, factors that predicted utilisation of reflexology, and whether by the end of the trial they believed that reflexology had helped with symptom management.

METHODS

Women (N = 256) were interviewed at baseline and week 11. Friend or family caregivers in the reflexology group were trained to deliver standardised sessions to patients at least once a week for 4 weeks. Baseline and week-11 reflexology expectations were analysed using general linear models. Reflexology utilisation was analysed with generalised linear mixed effects models.

RESULTS

Patients who expected benefits from reflexology ("higher expectancy") at baseline were younger, had lower anxiety, higher education, higher spirituality, and greater CT use. Worsening symptoms over time were associated with greater utilisation of reflexology, but only when baseline expectancy was low. At week 11, expectancy was higher for those with greater symptom improvement.

CONCLUSIONS

Assessing patterns of patient factors, expectancy, and change in symptoms can help determine who is likely to use reflexology, and when.

Intercessory Prayer on Spiritual Distress, Spiritual Coping, Anxiety, Depression and Salivary Amylase in Breast Cancer Patients During Radiotherapy: Randomized Clinical Trial

The goal of this study was to assess the effect of intercessory prayer in the psychological, spiritual and biological scores of breast cancer patients who are undergoing radiotherapy. Double-blind RCT comprising a sample of 31 participants (15 in the Control Group and 16 in the Intervention Group). Data collection was performed in three time points (T₀, T₁ and T₂). Significant changes have been identified in the intra-group analysis, concerning the decrease in spiritual distress score; negative religious/spiritual coping prevailed, while the total religious/spiritual coping increased between the posttest T₂ to T₀. Intercessory prayer was effective in religious and spiritual scores.

Older Adults' Awareness and Knowledge of Beans in Relation to Their Nutrient Content and Role in Chronic Disease Risk

Awareness and knowledge of nutrient-dense foods are important for older adults to help them make dietary choices that support a food-first approach to healthy aging. This is especially important since age is a major risk factor for chronic disease and the proportion of older adults in North America is increasing. Beans can contribute to a food-first approach to healthy aging as they are nutrient-dense and can reduce the risk of chronic diseases. However, studies exploring awareness and knowledge of beans in older adults are lacking. Therefore, the aim of this study was to explore older adults' awareness of beans in relation to their nutrient content and role in chronic disease risk. Community-dwelling older adults (≥65 years old) were recruited and completed a validated researcher-administered questionnaire (n = 250), which was followed by 10 focus groups (n = 49). Results showed that the majority of older adults considered beans as a healthy food and thought consuming them could improve their health (99.2% and 98.0%, respectively); however, only 51.2% were bean consumers. While the majority (83.6%) of older adults were aware that a serving of beans is high in dietary fibre, bean consumers were significantly more likely to think that consuming beans could improve health areas related to dietary fibre including body weight management and constipation. Furthermore, most (84.8%) older adults thought consuming beans could improve heart health; however, bean consumers were significantly more likely to be aware that one serving of beans is low in nutrients relevant to heart health including total fat, saturated and trans fat as well as cholesterol. This research can help to inform healthcare professionals and public health agencies to create specific dietary strategies focusing on increasing older adults' awareness and knowledge of beans in relation to their nutrient profile and role in promoting health.

Motivators, Barriers and Other Factors Related to Bean Consumption in Older Adults

Beans are nutrient-dense and can reduce risk of chronic diseases. This is relevant to older adults who can benefit from consuming beans to reduce their elevated chronic disease risk. This study explored bean consumption in older adults (≥65 years) using mixed-methods including a researcher-administered questionnaire (n = 250) and focus groups (n = 49). Prevalence of bean consumption (daily or weekly) was 51.2%. Motivators to bean consumption were significantly more likely among bean consumers with the top three including nutritional value, taste/texture and versatility, which were also predictors of consuming beans (OR = 3.54, 2.72, and 4.24, respectively). Conversely, barriers to bean consumption were significantly more likely among bean non-consumers with the top three including not part of traditional diet/do not think to include beans in meals, flatulence/abdominal discomfort and lack of knowledge about preparation/cooking, which were also predictors of not consuming beans (OR = 3.85, 2.26, and 5.08, respectively). This research will inform dietary strategies to increase bean consumption.

Effects of laughter therapy on quality of life in patients with cancer: An open-label, randomized controlled trial

Background

Few randomized controlled trials have assessed the effects of laughter therapy on health-related quality of life (QOL) in cancer patients. This study aimed to evaluate these effects as an exploratory endpoint in cancer patients as part of a randomized controlled trial conducted at a single institution in Japan.

Methods

The Initiative On Smile And CAncer (iOSACA) study was an open-label randomized controlled trial conducted in 2017 in which participants aged 40–64 years with cancer were randomly assigned to either an intervention group (laughter therapy) or control group (no laughter therapy). Each participant in the intervention group underwent a laughter therapy session once every two weeks for seven weeks (total of four sessions). Each session involved a laughter yoga routine followed by Rakugo or Manzai traditional Japanese verbal comedy performances. We assessed QOL as a secondary endpoint in this intention-to-treat population using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). The questionnaire was completed at baseline (Week 0) and at Weeks 3 and 7. Mixed-effects models for repeated measures were developed to compare time-dependent changes in each QOL domain from baseline between the intervention and control groups.

Results

Four participants retracted consent and one participant was retrospectively excluded from analysis due to unmet inclusion criteria. The analysis was conducted using 56 participants, with 26 in the intervention group and 30 in the control group. Questionnaire completion rates were high (>90%), with similar QOL scores reported at baseline in both groups. The mixed-effects models showed that the intervention group had significantly better cognitive function and less pain than the control group for a short period.

Conclusion

Laughter therapy may represent a beneficial, noninvasive complementary intervention in the clinical setting. Further studies are needed to verify the hypotheses generated from this exploratory study.

The Potential Influence of Dietary Counseling on Nutritional Status and Dietary Supplement Consumption in Breast Cancer Patients: A Pilot Study

INTRODUCTION

Cancer, in particular breast cancer, is one of the leading causes of death among women. Good nutritional status contributes to the efficacy of treatment and recovery, and nutritional interventions can minimize the adverse effects of cancer therapy.

AIM

The aim of this study was to describe the potential role of dietary counseling in breast cancer patients. The impact of nutritional advice on the nutritional status of patients, the use of dietary supplements, and the knowledge of phytoestrogens were assessed.

MATERIALS AND METHODS

The study was conducted between April and July 2016 in the Lublin Oncology Center on a group of 173 female patients undergoing breast cancer treatment. The patients filled out a questionnaire containing 34 open-ended and closed-ended questions. The collected data were processed in Excel and Statistica 5.0 programs, and the results were regarded as significant at P < 0.05.

RESULTS

The mean age of the evaluated patients was 66.8 ± 11.3 years. The duration of disease was significantly correlated with the patients' nutritional status expressed by the body mass index (P = 0.0368). The main sources of knowledge about nutrition in cancer care were nurses (29.71%), physicians (12.31%), and nutritionists (13.78%). Patients who received nutritional advice had significantly greater knowledge about phytoestrogens (P = 0.0001), and they were of the opinion that a diet rich in phytoestrogens was safe (P = 0.001). More than 85% of the polled subjects used dietary supplements during treatment, and 2/3 of them did so without professional advice. In this study, 73.07% of the respondents regularly monitored their body weight. Patients who did not receive dietary advice less frequently informed their physician about weight changes.

CONCLUSIONS

The nutritional status of patients was correlated with access to nutrition and dietary advice during illness. The risk of malnutrition was minimized when patients received and understood educational materials. The patients who did not receive dietary advice more frequently overdosed on dietary supplements. Phytoestrogens were more widely used by patients who regularly attended a dietitian.

A Randomized Clinical Trial of Caregiver-Delivered Reflexology for Symptom Management During Breast Cancer Treatment

PURPOSE

The objective of this study was to determine the effects of a home-based reflexology intervention delivered by a friend/family caregiver compared with attention control on health-related quality of life of women with advanced breast cancer undergoing chemotherapy, targeted and/or hormonal therapy.

METHODS

Patient-caregiver dyads (N = 256) were randomized to four weekly reflexology sessions or attention control. Caregivers in the intervention group were trained in a 30-minute protocol. During the four weeks, both groups had telephone symptom assessments, and intervention group had fidelity assessments. The intervention effects were assessed using linear mixed-effects models at weeks 5 and 11 for symptom severity and interference with daily activities, functioning, social support, quality of patient-caregiver relationship, and satisfaction with life.

RESULTS

Significant reductions in average symptom severity (P = 0.02) and interference (P < 0.01) over 11 weeks were found in the reflexology group compared with control, with no group differences in functioning, social support, quality of relationship, or satisfaction with life at weeks 5 and 11. Stronger quality of relationship was associated with lower symptom interference in the entire sample (P = 0.02), but controlling for it did not diminish the effect of intervention on symptoms. Significant reductions in symptom severity in the reflexology group compared with attention control were seen during weeks 2-5 but were reduced at Week 11.

DISCUSSION

Efficacy findings of caregiver-delivered reflexology with respect to symptom reduction open a new evidence-based avenue for home-based symptom management.

Safety and Efficacy of Massage Therapy for Patients with Cancer

BACKGROUND

As the popularity of complementary/alternative medicine (CAM) grows, patients are incorporating more CAM therapies into their conventional cancer care. Massage therapy, a CAM therapy known primarily for its use in relaxation, may also benefit patients with cancer in other ways. Massage can also be associated with risks in the oncology population. Risks can be minimized and benefits maximized when the clinician feels comfortable discussing CAM with his or her patients. This article reviews and summarizes the literature on massage and cancer to help provide the clinician with information to help facilitate discussions with patients.

METHODS

MEDLINE and CINAHL databases were searched to identify relevant articles. These were reviewed for content and other pertinent references.

RESULTS

Significant information was extracted from these resources to provide this overview of the use of massage for patients with cancer.

CONCLUSIONS

Conventional care for patients with cancer can safely incorporate massage therapy, although cancer patients may be at higher risk of rare adverse events. The strongest evidence for benefits of massage is for stress and anxiety reduction, although research for pain control and management of other symptoms common to patients with cancer, including pain, is promising. The oncologist should feel comfortable discussing massage therapy with patients and be able to refer patients to a qualified massage therapist as appropriate.

A Methodology for Cancer Therapeutics by Systems Pharmacology-Based Analysis: A Case Study on Breast Cancer-Related Traditional Chinese Medicines

Breast cancer is the most common carcinoma in women. Comprehensive therapy on breast cancer including surgical operation, chemotherapy, radiotherapy, endocrinotherapy, etc. could help, but still has serious side effect and resistance against anticancer drugs. Complementary and alternative medicine (CAM) may avoid these problems, in which traditional Chinese medicine (TCM) has been highlighted. In this section, to analyze the mechanism through which TCM act on breast cancer, we have built a virtual model consisting of the construction of database, oral bioavailability prediction, drug-likeness evaluation, target prediction, network construction. The 20 commonly employed herbs for the treatment of breast cancer were used as a database to carry out research. As a result, 150 ingredient compounds were screened out as active molecules for the herbs, with 33 target proteins predicted. Our analysis indicates that these herbs 1) takes a 'Jun-Chen-Zuo-Shi" as rule of prescription, 2) which function mainly through perturbing three pathways involving the epidermal growth factor receptor, estrogen receptor, and inflammatory pathways, to 3) display the breast cancer-related anti-estrogen, anti-inflammatory, regulation of cell metabolism and proliferation activities. To sum it up, by providing a novel in silico strategy for investigation of the botanical drugs, this work may be of some help for understanding the action mechanisms of herbal medicines and for discovery of new drugs from plants.

Long-term Breast Cancer Survivors’ Use of Complementary Therapies: Perceived Impact on Recovery and Prevention of Recurrence

Objective:Many cancer survivors use some form of complementary therapy (CT); this is particularly true for women with breast cancer. The majority of reports on CT use in women with breast cancer have focused on CT use during cancer treatment or within a year or two of treatment completion. The purpose of this study was to evaluate longertermbreast cancer survivors’ (average, 8.7 years) frequency of CT use and their beliefs about the role of CT in cancer recovery and the prevention of cancer recurrence, as well as the relationship of CT use with current life satisfaction. Methods: A mail survey was completed by 608 breast cancer survivors a minimum of 2 years after their most recent cancer diagnosis. Participants were contacted through the American Cancer Society Reach to Recovery program in Florida. The self-report questionnaire inquired about the use of various CTs, beliefs about CT, current life satisfaction, demographic characteristics, and cancer treatment history. Results: Most of the respondents were older than 50, were Caucasian, were married, had attended or completed college, and were at least 5 years after breast cancer treatment. The most commonly used CTs included exercise, vitamins, prayer/spiritual practice, support groups, humor, self-help books, and relaxation. These survivors used CT therapies because they wanted to play a more active role in their cancer recovery, to manage stress, and to maintain hope. A majority of them reported that they used CT to reduce the risk of cancer recurrence. Use of CT was not correlated with life satisfaction. Conclusions: Most of the breast cancer survivors in this study had used some form of CT since the time of their most recent cancer diagnosis and believed that such therapies could be of significant benefit, despite a lack of correlation between CT use and current life satisfaction. Many believed that use of CT may prevent cancer recurrence. It is important, therefore, to investigate the efficacy of variousCTs among longer-termcancer survivors, especially with regard to their potential in preventing cancer recurrence.

Use of Complementary Therapies During Chemotherapy: Influence of Patients’ Satisfaction With Treatment Decision Making and the Treating Oncologist

The relationship between the use of complementary therapy (CT) and satisfaction with medical treatment decision making and with the treating oncologist was evaluated in a sample of 166 women who were undergoing an initial course of chemotherapy for early-stage breast cancer. At the beginning of chemotherapy, 39% indicated already trying CT and an additional 13% reported planning to try CT. These women mentioned a variety of vitamin, nutritional, herbal, physical, mental, and spiritual approaches. Four months later, when most patients had completed chemotherapy, more than half (53%) reported using CT, with another 8% planning to try it. Regression analysis controlling for psychosocial and medical variables revealed that women who were younger and less satisfied with their treatment decision-making experience were significantly more likely to use CT. When predicting use of CT at the conclusion of treatment, baseline utilization was the greatest predictor, but dissatisfaction with the oncologist was also a significant predictor. These findings suggest that patients who are dissatisfied with their medical care may be more likely to use CT during treatment. Further research is needed to elucidate the relationship between satisfaction with medical decision making and the patient-physician relationship to CT use among cancer patients. The findings also highlight the importance of good patient-physician communication about CT use throughout the cancer treatment experience.

Lesson From Comparison of CAM Use by Women With Female-Specific Cancers to Others: It's Time to Focus on Interaction Risks With CAM Therapies

There has been no examination as to whether the prevalence of complementary and alternative medicine (CAM) use, as well as personal factors associated with CAM use and predictive of CAM use for women with female-specific cancers, is similar to those in other diagnostic groups. The purpose of this review is to compare CAM use and personal factors associated with and predictive of CAM use by women with female-specific cancers to samples of other diagnostic groups. If it is the case that CAM use is similar across various types of samples, then it may be unnecessary to continue to study detailed CAM use by those in separate diagnostic groups and instead focus energies on the examination of CAM therapies that may have risks for interaction with conventional therapies, such as biologically based therapies. The researcher concludes that we are now in an era in which we need to use our restricted time, human resources, and finances to examine biologically based CAM use that may carry high risks for interactions or toxicities for specific groups under examination, rather than examine global CAM use, unless the situation warrants such all-inclusive study.

Vitamin C in Alternative Cancer Treatment: Historical Background

Ascorbic acid is the single-nutrient supplement most commonly used by cancer patients, although in most cases this takes place without the physician's knowledge or supervision. A comprehensive review of the literature is presented on the impact of ascorbic acid on cancer survival. Findings from 6 uncontrolled studies suggest that ascorbic acid may increase survival, whereas 2 controlled trials have yielded null results. The relative strengths and limitations of these studies are discussed. A turning point occurred with the release of the 2 controlled (null) studies, which influenced many physicians to turn away from nutrition in the care of cancer patients. Controversy about these trials still persists, however, in the alternative cancer community.

A Systematic Review of Spiritually Based Interventions and Psychoneuroimmunological Outcomes in Breast Cancer Survivorship

Objective This is a review of spiritually based interventions (eg, mindfulness-based stress reduction) that utilized psychoneuroimmunological (PNI) outcome measures in breast cancer survivors. Specifically, this review sought to examine the evidence regarding relationships between spiritually based interventions, psychosocial-spiritual outcomes, and biomarker outcomes in breast cancer survivors. Methods A systematic search of 9 online databases was conducted for articles of original research, peer-reviewed, randomized and nonrandomized control trials from 2005-2015. Data were extracted in order to answer selected questions regarding relationships between psychosocial-spiritual and physiological measures utilized in spiritually based interventions. Implications for future spiritually based interventions in breast cancer survivorship are discussed. Results Twenty-two articles were reviewed. Cortisol was the most common PNI biomarker outcome studied. Compared with control groups, intervention groups demonstrated positive mental health outcomes and improved or stable neuroendocrine-immune profiles, although limitations exist. Design methods have improved with regard to increased use of comparison groups compared with previous reviews. There are few spiritually based interventions that specifically measure religious or spiritual constructs. Similarly, there are few existing studies that utilize standardized religious or spiritual measures with PNI outcome measures. Findings suggest that a body of knowledge now exists in support of interventions with mindfulness-breathing-stretching components; furthermore, these interventions appear to offer potential improvement or stabilization of neuroendocrine-immune activity in breast cancer survivors compared to control groups. Conclusion From a PNI perspective, future spiritually based interventions should include standardized measures of religiousness and spirituality in order to understand relationships between and among religiousness, spirituality, and neuroendocrine-immune outcomes. Future research should now focus on determining the minimum dose and duration needed to improve or stabilize neuroendocrine-immune function, as well as diverse setting needs, including home-based practice for survivors who are too ill to travel to group sessions or lack economic resources.

Right Place, Right Time: Preferences of Women with Ovarian Cancer for Delivery of CAM Education

The purpose of this pilot study was to assess the feasibility of on-site complementary and alternative medicine (CAM) education sessions to maximize quality of life for women with ovarian cancer. The pilot intervention consisted of four weekly sessions, each focusing the techniques and benefits of a particular CAM topic (e.g., nutrition, massage, relaxation). Participants were recruited from the Center for Women’s Oncology at H. Lee Moffitt Cancer Center from 2010 to 2012. Eligible participants had an ovarian cancer diagnosis with a life expectancy of at least 12 months, and were 18 years or older. The Gynecologic Oncology research nurse invited women in the outpatient clinic who matched the eligibility criteria. The research nurse explained the study and provided an informed consent form and return envelope. Because ovarian cancer is not only a rare cancer but, also, most patients seen at Moffitt have recurrent or advanced disease, many women did not have an adequate ECOG score. Many women who consented had rapid changes in health status, with morbidity and mortality outpacing recruitment of the 20 needed to proceed with the four education sessions. Baseline and follow-up surveys were conducted to assess changes in QOL, knowledge, and satisfaction with the intervention. While 27 women consented and 24 women completed the baseline survey, only five women participated in the intervention. The five women who participated were all white, and at time of consenting had a mean age of 60 (SD 9.08) and an average of 102 months (SD 120.65) since diagnosis, and were all on active treatment, except for one. The intervention pilot did not encounter difficulties with regard to recruitment, but suffered problems in achieving an adequate number of women to launch the on-site sessions because of rapidly changing morbidity and significant mortality. The team recognized that a larger-scaled intervention comprised of on-site sessions was impractical and compared attendance rates with a more convenient format currently underway in the Women’s Oncology program at Moffitt. While low participation prevented an intervention analysis of scientific merit, the study data is informative with regard to barriers, facilitators, and alternative methods for sharing useful information to women with advanced ovarian cancer. The comparison strongly suggested that CAM education for women compromised by the disease and treatment associated with ovarian cancer would best be delivered in the convenient-access format that allowed remote access to live and recorded discussions of specific topics.

Acupuncture in the Postoperative Setting for Breast Cancer Patients: A Feasibility Study

Acupuncture is used to treat a variety of symptoms and conditions associated with cancer and cancer treatments. The present study was performed to evaluate the feasibility of providing acupuncture in the hospital setting for breast cancer patients and to evaluate the short-term effect of acupuncture on stress, anxiety, and pain. This was an open label study conducted at Mayo Clinic Hospital, Methodist and Saint Marys Campus, Rochester, Minnesota. A total of 20 adult breast cancer patients undergoing mastectomy and/or breast reconstruction were recruited and offered daily acupuncture intervention beginning postoperative day 1 and continuing for the duration of the hospital stay. Outcome measures included the Symptom Visual Analog Scale (VAS) and Satisfaction Question and Was-it-Worth-it (WIWI) Questionnaire. It was found that acupuncture is a feasible option for postoperative breast cancer patients. In addition, it can significantly decrease the levels of anxiety (p = 0.0065), tension/muscular discomfort (p < 0.001) and pain (p = 0.023). The association between acupuncture and relaxation was found to be statistically borderline (p = 0.053). This feasibility study showed that acupuncture can be integrated into a busy postsurgical clinical practice. These results also suggest that acupuncture may be an important intervention in the postoperative setting for breast cancer patients.

The effect of laughter therapy on radiation dermatitis in patients with breast cancer: a single-blind prospective pilot study

BACKGROUND

There have not yet been any published studies on the effects of laughter therapy on radiation-induced dermatitis in breast cancer patients treated with radiotherapy (RT). We assessed the effectiveness of laughter therapy in preventing radiation dermatitis in patients with breast cancer.

METHODS

Thirty-seven patients were prospectively enrolled in this study. Eighteen patients were assigned to the experimental group and the other 19 patients were assigned to the control group. The patients who were assigned to the experimental group received laughter therapy during RT. Laughter therapy was started at the onset of RT and was provided twice a week until completion of RT. The patients who were assigned to the control group only received RT without laughter therapy. The grade of radiation dermatitis was scored by a radiation oncologist who was blinded to subject assignment. The patients' evaluation of pain within the RT field was also assessed.

RESULTS

In the experimental group, radiation dermatitis of grade 3, 2, and 1 developed in five (33.3%), five (33.3%), and five patients (33.3%), respectively. In comparison, in the control group, radiation dermatitis of grade 3, 2, 1, and 0 developed in seven (36.8%), nine (47.4%), two (10.5%), and one patient (5.3%), respectively. The experimental group exhibited a lower incidence of grade 2 or worse radiation dermatitis than the control group (33.3% versus 47.4%). The mean maximal pain scores in the experimental and control group were 2.53 and 3.95, respectively. The experimental group complained of less severe pain than the control group during RT. However, these differences were not statistically significant.

CONCLUSION

The results of this study show that laughter therapy can have a beneficial role in preventing radiation dermatitis in patients with breast cancer. To confirm the results of our study, well-designed randomized studies with large sample sizes are required.

Changes in complementary and alternative medicine use across cancer treatment and relationship to stress, mood, and quality of life

OBJECTIVES

Complementary and alternative medicine (CAM) use is prevalent, but specific use of CAM across cancer treatment is underinvestigated. The objectives of this study were to assess changes in CAM use across cancer treatment; specific reasons for and satisfaction with specific types of CAM used; and associations of CAM use with stress, mood, and quality of life (QOL) in women with newly diagnosed breast cancer.

DESIGN AND SETTING

Seventy-seven women with early-stage breast cancer who underwent active cancer treatment participated in the study. Data were collected three times: shortly after cancer diagnosis and 2 months and 6 months after the start of adjuvant cancer therapy.

OUTCOME MEASURES

CAM Questionnaire, Impact of Event Scale (stress), Profile of Mood State (mood), and Functional Assessment of Cancer Therapy-Breast Cancer (QOL).

RESULTS

Mean age was 52.4 years, and 94%-97% of women used on average five to six CAMs across three time points. Women largely started CAM use before cancer diagnosis and continued across cancer treatment. The five most common CAMs were prayer (88.3%), multivitamin use, massage, and vitamins E and C, followed by music, meditation, green tea, chiropractic care, and vitamin A, with little changes in types of CAM use across cancer treatment. Satisfaction was high, and satisfaction with prayer was the highest. Prayer, meditation, and music were used specifically for a feeling of control, whereas vitamins were used to improve the immune system, showing clear patterns. Stress, mood disturbance, and QOL declined significantly over time, p<0.001-0.04, but the number of CAMs used was unrelated to these variables.

CONCLUSIONS

CAM use was highly prevalent with multiple CAMs and continued throughout cancer treatment. Prayer was the most common CAM; it had the highest satisfaction rating and the perception of being most helpful. The effect of long-term CAM use requires further investigation on psychological and biobehavioral outcomes with consideration of demographic and clinical characteristics.

Biofield therapies and cancer-related symptoms: a review

Patients with cancer can experience several treatment-related symptoms, and conventional care focuses primarily on cure and survival without a holistic approach to disease. Subsequently, an increasing number of patients are accustomed to complementary modalities to improve well-being. Biofield therapies (BTs) are complementary and alternative medicine (CAM) modalities based on the philosophy that humans have an energetic dimension. Physical and psychological symptoms may cause imbalance, and BTs are believed to balance disturbance in the energy field. This article provides a study review of the main BTs (i.e., therapeutic touch, healing touch, and Reiki) in the treatment of cancer-related symptoms. Although BTs are among the most ancient healing practices, data on their effectiveness are poor and additional multicenter research with larger samples are necessary. BTs may eventually become an autonomous field of nursing activity and allow professionals to build a relationship with the patient, thereby improving motivation. The idea that this method can be self-managed and may effectively reduce pain for patients with cancer can improve satisfaction challenges experienced by the current healthcare system.

Biologically based therapies are commonly self-prescribed by Brazilian women for the treatment of advanced breast cancer or its symptoms

PURPOSE

Breast cancer (BC) might be associated with loss of function in affected patients, with a direct impact on their quality of life (QOL). Many women with metastatic BC seek relief of symptoms, including the use of complementary and alternative medicine (CAM) to cure cancer. The present study aimed to identify the pattern of CAM used by patients with metastatic BC and to assess the correlation between CAM use and scores on anxiety, depression, and QOL scales.

METHODS

A total of 126 women with metastatic BC were interviewed using four instruments: (1) a questionnaire containing socioeconomic, clinical, and demographic data and CAM use; (2) European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ)-C30; (3) EORTC QLQ-BR23; and (4) the Hospital Anxiety and Depression Scale.

RESULTS

Fifty percent of the participants reported the use of at least one CAM modality. Biologically based practices were the most frequently used to treat BC and/or its symptoms, the most commonly discussed with the oncologists, and one of the CAM categories in which more patients reported a desire to learn more about. The overall use of CAM was not correlated with the scores on the anxiety, depression, and QOL scales. However, analysis of the association of the QOL scores with specific CAM modalities revealed some potential associations (especially for food supplements, art therapy, psychotherapy, and prayer).

CONCLUSIONS

Women with metastatic BC frequently make use of CAM to treat the cancer and/or its symptoms. Biologically based practices seem to be particularly important in Brazil. An association between specific CAM modalities and some QOL domains was suggested, but it needs further confirmation.

Use of the dialectical behavior therapy skills and management of psychosocial stress with newly diagnosed breast cancer patients

Stress-related health concerns have the potential to impact quality of life for patients with breast cancer. National cancer organizations such as the National Cancer Institute, the Institute of Medicine, and the National Comprehensive Cancer Network have acknowledged that all patients with cancer experience some level of distress during the course of illness and treatment. Literature on cancer suggests a range of expected distress from 20% to 50% among all patients diagnosed with cancer. Acknowledging and managing this distress with patients with cancer and providing them behavioral-based Interventions are important parts of cancer research. Dialectical Behavioral Therapy skill is are an empirically proven treatment modality across numerous patient populations. The main objective of this study was to evaluate the utilization and effectiveness of Dialectical Behavior Therapy skills modified for use with patients with breast cancer.

Using a mixed methods research design to investigate complementary alternative medicine (CAM) use among women with breast cancer in Ireland

AIM

To investigate complementary and alternative medicine (CAM) use among women with breast cancer in Ireland using a mixed methods modified sequential explanatory design.

METHODS

Semi-structured interviews were conducted with oncology professionals (n = 20) and CAM practitioners (n = 20) and this was followed by a survey of 406 women with breast cancer using the 'Use of Complementary and Alternative Therapies Survey' questionnaire (UCATS) (Lengacher et al., 2003). Follow up interviews were subsequently undertaken with a subset of this survey sample (n = 31).

RESULTS

Over half of those surveyed (55.7%, n = 226) used some form of CAM since diagnosis. The most frequently used therapies were massage, herbal supplements (including herbs with oestrogenic properties), antioxidants, relaxation, counselling, health supplements, reflexology, reiki and support groups. Dietary interventions were used primarily to reduce symptoms and/or side effects while reduction of psychological stress was the primary reason for use of stress-reducing therapies. Most respondents reported that the CAM therapies they had used were helpful. The qualitative data elaborated on and provided clarification of the survey results.

CONCLUSIONS

Similar to international studies, CAM is popular among women with breast cancer in Ireland. As such, the challenge for Irish oncology professionals is to identify low risk CAM therapies that are likely to benefit patients while educating patients and themselves on therapies which may be of concern. This study clearly illustrates the benefits of using a mixed methods approach to enhance our understanding of a complex clinical issue and thus we recommend that this method should be the method of choice when planning health services research.

Evidence-Based Treatment of Anxiety in Patients With Cancer

Anxiety is a dynamic response to perceived threat that is common among patients with cancer and fluctuates at critical points in the disease trajectory. A substantial minority of patients may experience clinically significant anxiety resulting from a range of potential etiologic factors. This review summarizes evidence-based recommendations for treatment of anxiety in oncology settings. Recommendations are based on the nature and time course of anxiety and the results of meta-analyses, systematic reviews, and individual trials in cancer populations. The evidence-based literature supports the use of psychosocial and psychopharmacologic treatments to prevent or alleviate anxiety symptoms. Conclusions are tempered by study heterogeneity and methodologic limitations and a lack of trials that included patients with clinically significant anxiety. In oncology settings, accessibility and acceptability of evidence-based treatments vary, and patients may seek a variety of resources to manage cancer concerns. Treatment planning should incorporate contributing factors to anxiety and patient preferences for psychiatric care.

Effects of Chan-Chuang Qigong on Improving Symptom and Psychological Distress in Chemotherapy Patients

The purpose of this study was to explore the effect of Chan-Chuang qigong on symptoms distress and psychological distress of breast cancer patients who underwent chemotherapy. A quasi-experimental design was adopted. Subjects were recruited from breast cancer outpatients receiving chemotherapy at an 1800-bed medical center in Taipei, Taiwan. Of these subjects, 35 were assigned to the control group and 32 to the experimental group in which Chan-Chuang qigong was administered. Assignment was not random. The instruments included a 21-item symptom distress scale and psychological distress with the symptom checklist-90-revised. Data of the symptoms and psychological distress were collected on the day before chemotherapy as baseline values, and also collected on days 8, 15 and 22 of chemotherapy. The results showed that the overall severity of symptom distress in the experimental group was significantly lower than the control group on day 22 ( p < 0.05). The symptoms with significant improvement included pain, numbness, heartburn and dizziness ( p < 0.05). With regard to psychological distress, the difference of overall severity between the two groups was not statistically significant ( p > 0.05). However, the items of "unwillingness to live" ( p < 0.05) and "hopelessness about the future" ( p < 0.05) were significantly improved in the experimental group. In conclusion, Chan-Chuang qigong had the effect of attenuating the symptom distress and probably some part of the psychological distress of chemotherapy patients.

How many cancer patients use complementary and alternative medicine: a systematic review and metaanalysis

BACKGROUND

No comprehensive systematic review has been published since 1998 about the frequency with which cancer patients use complementary and alternative medicine (CAM).

METHODS

MEDLINE, AMED, and Embase databases were searched for surveys published until January 2009. Surveys conducted in Australia, Canada, Europe, New Zealand, and the United States with at least 100 adult cancer patients were included. Detailed information on methods and results was independently extracted by 2 reviewers. Methodological quality was assessed using a criteria list developed according to the STROBE guideline. Exploratory random effects metaanalysis and metaregression were applied.

RESULTS

Studies from 18 countries (152; >65 000 cancer patients) were included. Heterogeneity of CAM use was high and to some extent explained by differences in survey methods. The combined prevalence for "current use" of CAM across all studies was 40%. The highest was in the United States and the lowest in Italy and the Netherlands. Metaanalysis suggested an increase in CAM use from an estimated 25% in the 1970s and 1980s to more than 32% in the 1990s and to 49% after 2000.

CONCLUSIONS

The overall prevalence of CAM use found was lower than often claimed. However, there was some evidence that the use has increased considerably over the past years. Therefore, the health care systems ought to implement clear strategies of how to deal with this. To improve the validity and reporting of future surveys, the authors suggest criteria for methodological quality that should be fulfilled and reporting standards that should be required.

Understanding the role of stimulation in reflexology: development and testing of a robotic device

Reflexology is a common choice of women with breast cancer as supportive care during treatment. It involves stimulation of specific locations of the feet called reflexes using a specialised walking motion with the thumb of the reflexologist. Reflexology has shown potential for the successful management of cancer and treatment-related symptoms and improvement in physical functioning; however to date, the mechanism of action for these improvements is unknown. One confounder to the study of reflexology is the 'human factor'. To study the effects of the stimulation of the reflexes independent of the 'human factor', there is a need for an alternative method for the delivery of reflexology. The objective of this work was to design and create a robotic reflexology device that would deliver a breast cancer-specific reflexology protocol to the feet of patients. A prototype robotic reflexology device was developed and tested for feasibility, safety and acceptability with breast cancer survivors (n= 13), and preliminary efficacy in symptom management and enhanced functional status with a sample of women undergoing chemotherapy for breast cancer (n= 13). Safety, feasibility and acceptability were established, and significant improvements from pre- to post-device-delivered reflexology were seen in symptom severity among women on chemotherapy.

Prevalence and predictors of complementary therapy use in advanced-stage breast cancer patients

PURPOSE

Information on the use of complementary therapies in patients with advanced-stage cancer is limited. Given the disease and treatment complexities associated with the care of patients with metastatic cancer, oncology clinicians would benefit from having an appreciation of the extent of usage of unconventional, adjunctive therapies among these patients. This study evaluated the prevalence and demographic predictors of complementary therapy use in a sample of women with metastatic breast cancer.

METHODS

Subjects with stage IV breast cancer were recruited from six treatment facilities in New England. A written, mailed survey assessing complementary therapy use and sociodemographic information was completed by each subject, while disease and treatment information was obtained from medical records. Descriptive statistics and multivariate logistic regression analyses were conducted.

RESULTS

Of the 173 participants, 78% used at least one type of complementary therapy, 43% used two or more types, and 23% used three or more types, excluding spiritual practices and physical exercise. When including spiritual practices and physical exercise, 90% used at least one complementary therapy, 70% used two or more types, and 45% used three or more types. Visits to alternative health practitioners were predicted by younger age (P = .009) and higher education level (P = .002). Younger participants (P = .045) were more likely to use and spend more money on vitamins and herbal products (P = .02).

CONCLUSIONS

Use of unconventional therapies is pervasive among metastatic breast cancer patients, particularly among those who are younger and highly educated. Oncology providers need to assess patients' complementary therapy use and consider potential interactions with prescribed treatment protocols.

Intervention fidelity: aspects of complementary and alternative medicine research

BACKGROUND

The Treatment Fidelity Workgroup (TFW) established by the National Institutes of Health provides a 5-point structure for intervention fidelity: dosing, interventionists' consistency, intervention delivery, receipt, and enactment of the intervention. Using our reflexology trial, we apply the first 3 points.

OBJECTIVES

Study objectives were to (1) evaluate key dosage dimensions associated with complementary and alternative medicine (CAM) research, (2) evaluate approaches to interventionists' consistency of delivery of CAM protocols, and (3) evaluate and discuss data that reflect CAM intervention fidelity.

METHODS

Women with late-stage breast cancer (N = 318) were randomly assigned to either 4 weeks of reflexology, placebo, or standard care.

RESULTS

Dosing consists of 3 dimensions: frequency (4 sessions), duration (30 minutes), and interval between sessions (5-9 days). Interventionist consistency revealed more than a 90% accuracy rate in following the protocol; 84% and 89% completion rate of the 4 sessions in the reflexology and placebo groups, respectively; and no differences in attrition after randomization between reflexology and placebo groups (17% and 15%, respectively). Intervention delivery, examined through debriefing data, indicated a significantly higher rate of correct guesses on group assignment in the reflexology group as compared with the placebo (82% vs 46%, P = .0002).

CONCLUSION

This study points out the relevance of dosing, interventionists' consistency, and delivery data within a CAM clinical trial, as well as the challenges of blinding.

IMPLICATIONS FOR PRACTICE

Monitoring intervention fidelity by using the key areas identified by the TFW ensures that findings from a clinical trial are meaningful and have the potential to be translated to clinical practice.

Use of Chinese medicine by cancer patients: a review of surveys

Chinese medicine has been used to treat a variety of cancer-related conditions. This study aims to examine the prevalence and patterns of Chinese medicine usage by cancer patients. We reviewed articles written in English and found only the Chinese medicine usage from the studies on complementary and alternative medicine (CAM). Seventy four (74) out of 81 articles reported rates of CAM usage ranging from 2.6 to 100%. Acupuncture was reported in 71 out of 81 studies. Other less commonly reported modalities included Qigong (n = 17), Chinese herbal medicine (n = 11), Taichi (n = 10), acupressure (n = 6), moxibustion (n = 2), Chinese dietary therapy (n = 1), Chinese massage (n = 1), cupping (n = 1) and other Chinese medicine modalities (n = 19). This review also found important limitations of the English language articles on CAM usage in cancer patients. Our results show that Chinese medicine, in particular Chinese herbal medicine, is commonly used by cancer patients. Further research is warranted to include studies not written in English.

Predictors of yoga use among patients with breast cancer

OBJECTIVE

Emerging research suggests that yoga may be beneficial for reducing symptoms and improving quality of life among breast cancer patients. However, very little is known about the characteristics of breast cancer patients who use yoga; thus, this study seeks to identify the sociodemographic and clinical characteristics of yoga users among this population.

DESIGN

A cross-sectional survey study was conducted.

SETTING

The study was conducted at an outpatient breast oncology clinic at a large university hospital.

PARTICIPANTS

Three hundred postmenopausal breast cancer patients currently receiving aromatase inhibitors were included in this study.

MAIN OUTCOME MEASUREMENT

Self-reported use of yoga following the cancer diagnosis was collected along with sociodemographic and clinical data. Multivariate logistic regression was used to identify independent predictors of yoga use among breast cancer patients.

RESULTS

Of 300 participants, 53 (17.7%) reported having used yoga following cancer diagnosis. White patients were significantly more likely to use yoga than nonwhite patients (P = .02). Higher education level, lower BMI (body mass index), part-time employment status, previous chemotherapy, and radiation therapy were all associated with greater yoga use (all P < .05). Controlling for other factors, greater yoga use was independently associated with higher education level (adjusted odds ratio [AOR] 2.72, 95% confidence interval [CI], 1.15-6.46), and lower BMI (AOR 0.25, 95% CI, 0.09-0.66).

CONCLUSION

Yoga use following breast cancer diagnosis was substantially higher for white patients and those with lower BMI and higher education levels. Considering its potential benefits for symptom management in cancer, more research is needed to understand the attitudes and barriers to yoga use among individuals with nonwhite race, lower education, and higher BMI level. Such investigation will help design yoga programs that are aligned to the needs of these populations.

The use of complementary and alternative medicines among a sample of Canadian menopausal-aged women

INTRODUCTION

Despite questionable efficacy and safety, many women use a variety of complementary and alternative medicine (CAM) therapies to relieve menopause symptoms.

METHODS

We examined the determinants and use of CAM therapies among a sample of menopausal-aged women in Canada by using a cross-sectional Web-based survey.

RESULTS

Four hundred twenty-three women who were contacted through list serves, e-mail lists, and Internet advertisements provided complete data on demographics, use of CAM, therapies, and menopausal status and symptoms. Ninety-one percent of women reported trying CAM therapies for their symptoms. Women reported using an average of five kinds of CAM therapies. The most common treatments were vitamins (61.5%), relaxation techniques (57.0%), yoga/meditation (37.6%), soy products (37.4%), and prayer (35.7%). The most beneficial CAM therapies reported were prayer/spiritual healing, relaxation techniques, counseling/therapy, and therapeutic touch/Reiki. Demographic factors and menopausal symptoms contributed to 14% of the variance (P < .001) in the number of CAM therapies tried.

DISCUSSION

Results support previous research showing that menopausal women have high user rates of CAM therapy and show that specific demographic factors and somatic symptomatology relate to use of CAM therapies. Health care providers can benefit from understanding the determinants and use of CAM by women during the menopause transition if they are to help and provide quality care for this population.

Biofield therapies: helpful or full of hype? A best evidence synthesis

BACKGROUND

Biofield therapies (such as Reiki, therapeutic touch, and healing touch) are complementary medicine modalities that remain controversial and are utilized by a significant number of patients, with little information regarding their efficacy.

PURPOSE

This systematic review examines 66 clinical studies with a variety of biofield therapies in different patient populations.

METHOD

We conducted a quality assessment as well as a best evidence synthesis approach to examine evidence for biofield therapies in relevant outcomes for different clinical populations.

RESULTS

Studies overall are of medium quality, and generally meet minimum standards for validity of inferences. Biofield therapies show strong evidence for reducing pain intensity in pain populations, and moderate evidence for reducing pain intensity hospitalized and cancer populations. There is moderate evidence for decreasing negative behavioral symptoms in dementia and moderate evidence for decreasing anxiety for hospitalized populations. There is equivocal evidence for biofield therapies' effects on fatigue and quality of life for cancer patients, as well as for comprehensive pain outcomes and affect in pain patients, and for decreasing anxiety in cardiovascular patients.

CONCLUSION

There is a need for further high-quality studies in this area. Implications and future research directions are discussed.

Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer

OBJECTIVES

Considerable morbidity persists among survivors of breast cancer (BC) including high levels of psychological stress, anxiety, depression, fear of recurrence, and physical symptoms including pain, fatigue, and sleep disturbances, and impaired quality of life. Effective interventions are needed during this difficult transitional period.

METHODS

We conducted a randomized controlled trial of 84 female BC survivors (Stages 0-III) recruited from the H. Lee Moffitt Cancer and Research Institute. All subjects were within 18 months of treatment completion with surgery and adjuvant radiation and/or chemotherapy. Subjects were randomly assigned to a 6-week Mindfulness-Based Stress Reduction (MBSR) program designed to self-regulate arousal to stressful circumstances or symptoms (n=41) or to usual care (n=43). Outcome measures compared at 6 weeks by random assignment included validated measures of psychological status (depression, anxiety, perceived stress, fear of recurrence, optimism, social support) and psychological and physical subscales of quality of life (SF-36).

RESULTS

Compared with usual care, subjects assigned to MBSR(BC) had significantly lower (two-sided p<0.05) adjusted mean levels of depression (6.3 vs 9.6), anxiety (28.3 vs 33.0), and fear of recurrence (9.3 vs 11.6) at 6 weeks, along with higher energy (53.5 vs 49.2), physical functioning (50.1 vs 47.0), and physical role functioning (49.1 vs 42.8). In stratified analyses, subjects more compliant with MBSR tended to experience greater improvements in measures of energy and physical functioning.

CONCLUSIONS

Among BC survivors within 18 months of treatment completion, a 6-week MBSR(BC) program resulted in significant improvements in psychological status and quality of life compared with usual care.

Prevalence and predictors of antioxidant supplement use during breast cancer treatment: the Long Island Breast Cancer Study Project

BACKGROUND

Although many patients take antioxidant dietary supplements during breast cancer treatment, the benefits of such supplementation are unproven. The authors of this report analyzed the prevalence of and factors associated with antioxidant supplement use during breast cancer (BC) treatment among women who participated in the Long Island Breast Cancer Study Project.

METHODS

From 2002 through 2004, women with BC who had participated a case-control study from 1996 to 1997 were invited to participate in a follow-up interview. Antioxidant supplement use was defined as any self-reported intake of supplemental vitamin C, vitamin E, beta-carotene, or selenium in individual supplements or multivitamins.

RESULTS

Follow-up interview participants were younger, more predominantly white, and of higher socioeconomic status than women who did not respond. Among 764 participants who completed the follow-up interview, 663 (86.8%) reported receiving adjuvant treatment for their BC. Of those 663 women, 401 (60.5%) reported using antioxidants during adjuvant treatment: One hundred twenty of 310 women (38.7%) used antioxidants during chemotherapy, 196 of 464 women (42.2%) used them during radiation, and 286 of 462 women (61.9%) used them during tamoxifen therapy. Of 401 antioxidant users, 278 women (69.3%) used high doses (doses higher than those contained in a Centrum multivitamin). The factors that were associated with high antioxidant supplement use during treatment were higher fruit and vegetable intake at diagnosis (relative risk [RR], 1.71; 95% confidence interval [CI], 1.13-2.59), tamoxifen use (RR, 3.66; 95% CI, 2.32-5.78), ever using herbal products (RR, 3.49; 95% CI, 2.26-5.38), and ever engaging in mind-body practices (RR, 1.72; 95% CI, 1.13-2.64).

CONCLUSIONS

Given the common use of antioxidant supplements during BC treatment, often at high doses and in conjunction with other complementary therapies, future research should address the effects of antioxidant supplementation on BC outcomes.