Complementary Therapies and Breast Cancer

Part II of a Series

April 1999; Volume 1: 36-38

By Adriane Fugh-Berman, MD

More than 50% of cancer patients commonly use unconventional therapies;1 a U.S telephone survey found that cancer was one of the top five reasons for using alternative medicine.2 Several studies have looked at the prevalence of alternative medicine use specifically among women with breast cancer.

An Italian study of 242 women who had undergone surgery for breast cancer in the preceding year found that 16% used complementary therapies after cancer diagnosis and 8.7% before diagnosis.3 Homeopathy, manual healing methods, herbalism, and acupuncture were the most commonly used complementary therapies, and the majority of women reported that they used the therapies in an attempt to alleviate physical rather than psychological distress. The only variable that independently predicted the probability of using alternative therapies after diagnosis was use of alternative therapies prior to diagnosis.

An interview survey of 80 San Francisco residents (representing Chinese-American, African-American, Latino, and white populations) diagnosed with non-recurrent breast cancer within the past four months found that use of complementary therapies was quite high both before and after diagnosis.4 In this multi-ethnic population, 69% of study participants reported using complementary treatments before diagnosis. In the first two to four months after diagnosis, 70% reported using complementary treatments specifically targeted toward breast cancer.

One U.S. survey of 201 postmenopausal women, 48 (24%) of whom were breast cancer survivors, examined the use of complementary therapies for menopausal symptoms.5 Non-medical traditional therapies—including acupuncture, chiropractic, massage, spiritual healing, and meditation—were practiced by 35% of women with and without breast cancer. Twenty-three percent of women with breast cancer and 12% of women without breast cancer used herbal therapies including ginseng, dong quai, evening primrose, and black cohosh. Antioxidants, including vitamin C, vitamin E, and beta-carotene, were used in 65% of women with breast cancer and 38% of women without breast cancer. Menopausal symptoms were relieved in 74% of women using herbal therapies and 96% of women using non-medical traditional therapies.

A small qualitative study of 20 women with breast cancer—nine of whom had used alternative therapies with conventional therapies, while the rest had used only conventional therapies—found that beliefs about the cause of illness were similar in both groups, but beliefs about recovery differed between the groups.6 Patients in the unconventional group perceived their beliefs to be formed chiefly by their cancer experiences while patients who had only used conventional therapies felt their beliefs were lifelong and influenced primarily by upbringing.

Dietary Supplements for Treatment or Prophylaxis

Coenzyme Q10: Several reports claim a beneficial response of breast cancer patients to Coenzyme Q10.7,8 Patients also had received conventional treatment. These case series are not well reported and lack crucial information about cases. Coenzyme Q10 is a harmless but very expensive supplement, especially in doses used for cancer treatment (usually 390 mg/d). However, there are some interesting case reports; further research should be done on this supplement.

Vitamin E: Epidemiological studies of dietary intake of vitamin E and breast cancer risk are mixed. None of the three prospective observational studies show an effect, and only three of seven case control studies show a decreased risk. Seven of eight studies (three case control and five prospective studies) of serum levels of vitamin E found no connection between serum vitamin E levels and breast cancer. The only statistically significant study (a case control study of 658 women in Italy and France) found an increased risk in those with the highest levels of serum vitamin E.9

About half of the animal studies that examined the effect of dietary intake of vitamin E on mammary cancer found a decreased rate of mammary cancer with vitamin E intake.9 Half found no effect.

In cell culture, dl-alpha-tocopherol (vitamin E) exhibits a dose-dependent inhibition of cell growth, with MCF-7 breast cancer cell lines and CRL-1740 prostate cancer cell lines showing much more sensitivity to this intervention than two erythroleukemia cell lines.10 The growth of breast and prostate cancer cell lines was markedly inhibited at 0.1 mM, while 25 times that dose was necessary to achieve inhibition in the erythroleukemia cell lines.

Phytoestrogens: Althougth there is epidemiological evidence showing some reduction in risk of premenopausal breast cancer with high soybean intake, there is little evidence for an effect in postmenopausal women. There are no long-term safety data on the use of purified isoflavone supplements in humans.11

Group Therapy and Self-hypnosis: Effect on Mortality

In a randomized, controlled trial of 86 women with metastatic breast cancer, 50 women were assigned to weekly supportive group therapy and were taught self-hypnosis for pain.12 Thirty-six women in the control group received conventional care (as did all women in the treatment group). Women in the treatment group attended weekly meetings for one year. Follow-up showed that women in the treatment group lived an average of 36.6 months after randomization, compared to controls who lived an average of 18.9 months. Divergence in survival was seen beginning eight months after the intervention ended.

Adjunctive Complementary Therapies

Massage for Lymphedema: Massage reduces edema. In one study of 60 post-mastectomy subjects with arm edema, getting lymphatic massages three times a week for four weeks resulted in a significant reduction in edema that lasted at least three months. A pneumatic device used for six hours a day was also effective when used in such a way as to exert constant pressure, but not when it applied variable pressure.13

Therapeutic Touch for Mood and Pain: The effect of therapeutic touch and dialogue (compared to quiet time and dialogue) on anxiety, mood, and pain was tested in 31 women with breast cancer within a week prior to surgery and 24 hours after hospital discharge. The therapeutic touch group had significantly lower preoperative state anxiety than the control group; no differences were found in preoperative mood or any postoperative measure.14

Relaxation and Imagery for Mood: A six-week study of 154 women with breast cancer receiving radiotherapy divided women into three groups.15 In weekly sessions, controls were encouraged to talk about themselves; the relaxation group was taught relaxation exercises; and the relaxation plus imagery group received instruction in relaxation with imagery of peaceful scenes. The two treatment groups were given taped instruction and asked to practice 15 minutes daily. At six weeks, total mood disturbance scores were significantly less in the intervention groups, while moods in the control groups were worse. No difference was seen among the three groups in terms of Leeds scores for depression and anxiety.

Pain and Nausea: For the pain of breast cancer, hypnosis has been found more effective than a support group or no treatment.16 Fifty-four women with metastatic breast cancer were divided into three groups; 20 control patients received conventional treatment and 34 patients participated in one of two weekly cancer support group meetings. In one of the support groups, self-hypnosis techniques were taught. Both treatment groups reported significantly less pain sensation and suffering than the control group. The group that was taught self-hypnosis reported significantly less pain sensation than the other treatment group.

Another study of 67 cancer patients undergoing bone marrow transplants compared hypnosis, cognitive behavioral skills, contact with a psychologist, and no treatment for pain and nausea. Hypnosis proved to be effective in reducing oral pain, but none of the treatments seemed to help nausea, vomiting, or the need to use painkillers.17 References..

1. Hauser SP. Unproven methods in cancer treatment. Curr Opin Oncol 1993;5:646-654.

2. Eisenberg DM, et al. Unconventional medicine in the United States. N Engl J Med 1993;328:246-252.

3. Crocetti E, et al. The use of complementary therapies by breast cancer patients attending conventional treatment. Eur J Cancer 1998;34:324-328.

4. Adler SR. Women’s breast cancer treatment strategies: Integrating complementary/alternative and biomedical approaches (abstract). Alt Ther Health Med 1998;4:89.

5. Duda RE. The use of herbal remedies and alternative therapies by breast cancer patients (abstract). Proceedings of ASCO, 1995;14:93.

6. Brown PJ, Carney PA. Health beliefs and alternative medicine: A qualitative study of breast cancer patients. J Cancer Educ 1996;11:226-229.

7. Lockwood K, et al. Partial and complete regression of breast cancer in patients in relation to dosage of coenzyme Q10. Biochem Biophys Res Commun 1994;199:1504-1508.

8. Lockwood K, et al. Progress on therapy of breast cancer with vitamin Q10 and the regression of metastases. Biochem Biophys Res Commun 1995;212: 172-177.

9. Kimmick GG, et al. Vitamin E and breast cancer: A review. Nutr Cancer 1997;27:109-117.

10. Sigounas G, et al. dl-alpha-tocopherol induces apoptosis in erythroleukemia, prostate, and breast cancer cells. Nutr Cancer 1997;28:30-35.

11. Fugh-Berman A. Soybeans and breast cancer. Alt Ther Women’s Health 1999;2:12-14.

12. Spiegel D, et al. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 1989;2:888-891.

13. Zanolla R, et al. Evaluation of the results of three different methods of postmastectomy lymphedema treatment. J Surg Oncol 1984;26:210-213.

14. Samarel N, et al. Effects of dialogue and therapeutic touch on preoperative and postoperative experiences of breast cancer surgery: An exploratory study. Oncol Nurs Forum 1998;25:1369-1376.

15. Bridge LR, et al. Relaxation and imagery in the treatment of breast cancer. BMJ 1988;297:1169-1172.

16. Spiegel D, Bloom JR. Group therapy and hypnosis reduce metastatic breast carcinoma pain. Psychosom Med 1983;45:333-339.

17. Syrjala KL, et al. Hypnosis or cognitive behavioral training for the reduction of pain and nausea during cancer treatment: A controlled clinical trial. Pain 1992:48:137-146.