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Complementary Therapies for Breast Cancer: Are They Worth Trying?

Brooke Morgan, Jessica Koches, Regan LaVigna

James and Coralie Centofanti School of Nursing, Youngstown State University

NURS3749 Nursing Research

Ms. Heasley

June 20, 2021

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Abstract

Many alternative and complementary therapies have been discovered to help people with many

illnesses, but more specifically breast cancer. This report discusses 6 different types of

complementary therapies to aid breast cancer patients in managing their disease, along with the

ailments that occur with the vigorous treatment. Traditional treatments for breast cancer include

chemotherapy, radiation, and mastectomies. With these conventional treatments, many unwanted

side effects often occur. Our goal is to find effective interventions that will help relieve these

lasting effects of breast cancer treatment. The therapies that will be covered in this report

include, acupuncture, aromatherapy, massage, cognitive-behavioral therapy, hypnosis, and yoga.

After reviewing literature on each of these therapies, it has been concluded that they are all

effective approaches to improving quality of life in women with breast cancer, and those who

survived breast cancer. Our PICO question that we used to generate this report is, for women

who have or have had breast cancer, how effective are alternative/complementary therapies

combined with chemotherapy and radiation compared to those patients who only receive

chemotherapy and radiation? This report will also review how these different therapies can be

implemented into nursing practice.

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Breast cancer. When women all over the world receive this diagnosis, their worlds are

forever drastically changed. As many people are aware, the most common treatments for breast

cancer include chemotherapy, radiation, and mastectomies, or lumpectomies. As hopeful patients

may be receiving these treatments, there are some undesirable side effects that may occur

alongside them. Some of these troublesome effects that may occur include, but are not limited to,

neuropathy, hair loss, fatigue, digestive problems such as nausea and vomiting, and breast pain.

For many women, the battle of cancer itself is enough to cause severe stress in their lives, let

alone what the treatments can do to their bodies, which is why our group has decided to research

the effectiveness of various complementary therapies. For women who have or have had breast

cancer, how effective are alternative/complementary therapies combined with chemotherapy and

radiation compared to those patients who only receive chemotherapy and radiation? This is the

burning question that will be answered in the following research paper, in hopes of shedding

light on complementary therapies that may make coping with breast cancer easier for women.

Besides eradicating the breast cancer, the second most important goal is to provide the best

quality of life possible given the patients' current health status. There are a number of

complementary therapies to help alleviate some of the side effects of cancer treatments. The ones

that will be the focus of this research paper include, acupuncture, aromatherapy, massage,

cognitive-behavioral therapy, hypnosis, and yoga. All of our sources were found using the

nursing database CINAHL Plus. First we looked at lists of complementary therapies, and chose 6

to focus on. When searching for literature, we used the advanced search tool. The keywords we

used were ‘complementary therapies’, ‘breast cancer’, and then followed by each of the therapies

listed. For example our keywords search included ‘complementary therapies’, ‘breast cancer’,
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and ‘aromatherapy’. Lastly, we narrowed our search to the years 2015-2021 to filter the most

recent publications. The first alternative therapy that will be covered is acupuncture.

Acupuncture is a traditional form of Chinese medicine where tiny needles are inserted

into the body at specific target areas. Acupuncture is used as an alternative treatment for several

health issues, however, one study found that it was useful in treating CIPN,

(chemotherapy-induced peripheral neuropathy) in breast cancer patients. CIPN is one of the most

common side effects of chemotherapy that can last months to years after the conclusion of

treatment. The study, which was a randomized controlled pilot trial, conducted by researchers

from The Oncologist, examined the effects of acupuncture on chemotherapy-induced peripheral

neuropathy. This trial consisted of forty women who were survivors of breast cancer that

experienced mild to moderate CIPN. Twenty women were assigned to a group who received

prompt acupuncture in eighteen sessions in 8 weeks followed by 8 more weeks with no

acupuncture. Whereas the other twenty women received no acupuncture in the first 8 weeks, and

experienced nine sessions of acupuncture in the second 8 week term (Lu et al., 2019 p. 310). The

results were measured using a PNQ (Patient Neurotoxicity Questionnaire) score. The PNQ tool

was used based on its ability to measure not only sensory deficits, but motor changes as well. It

also was able to measure the neuropathy’s effect on activities of daily living (p. 311). The results

revealed significant improvement of CIPN in women who received eighteen sessions of

acupuncture. The researchers who performed this study stated, “Acupuncture also led to

clinically meaningful reductions in pain intensity and pain interference, as well as improvements

in CIPN-specific and general quality of life” (Lu et al., 2019 p. 316). This trial demonstrated just

one of many complementary therapies that can be used to help alleviate some of the pain that
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results from chemotherapy in breast cancer patients. Next, the use of aromatherapy will be

examined, in its attempt to relieve chemo-induced nausea and vomiting.

Nausea and vomiting are very unpleasant symptoms that may occur as a result of

chemotherapy in all cancer patients alike. Although there are medications to help alleviate these

undesirable symptoms, some patients may opt for a non-pharmacological method such as

aromatherapy. Aromatherapy is the use of assorted oils that are inhaled or absorbed into the body

that can be derived from various plants to stimulate the olfactory nerve in the brain to alleviate

health-related problems, such as nausea, vomiting, headaches, motion sickness, and stress. For

the purpose of improving quality of life in breast cancer patients, the focus is on improving

chemotherapy-induced nausea and vomiting. A study conducted by researchers from the Clinical

Journal of Oncology Nursing examined the use of peppermint oil aromatherapy on reducing

nausea and vomiting in cancer patients. They used a sample of seventy-nine patients receiving

chemotherapy in an ambulatory setting (Mapp et al., 2020 p. 160). The participants were divided

into 2 groups; one group received a cool, damp washcloth with no scent to place on their neck,

while the second group was given a cool, damp washcloth with 2 drops of peppermint oil (p.

160). The measurement tool used was the Baxter Retching Faces Pictorial scale (BARF), and

patients were asked to rate the intensity of nausea prior to the intervention, and then again thirty

minutes after the intervention. (p. 160). Before the intervention, all participants had similar

scores on the Baxter Retching scale, with a mean score of 5.52; this scale is a number scale

ranging from 0 to ten, with 0 being no nausea, and ten being severe nausea and/or vomiting (p.

162). The researchers concluded the following results, “Patients who received peppermint oil on

their washcloth had better post intervention BARF scores than patients who received no scent,

with an average decrease of 3.86 (SD = 2.2) points” (Mapp et al., 2020 p. 162). Based on this
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data, peppermint oil appears to be a useful form of aromatherapy for chemotherapy-induced

nausea and vomiting. As a result, patients had fewer troublesome symptoms, which in turn

improves their quality of life in dealing with breast cancer. Another type of alternative therapy

that may benefit breast cancer patient’s well being is massage.

A complementary therapy frequently used for ill patients, including patients with cancer,

is massage. Massage is a type of pressure application to soft tissues of the body. A trained

therapist may use many techniques such as pressing, rolling, kneading, or rubbing of the soft

tissues (Pujol & Monti, 2016, p. 474). The stimulation of the pressure receptors increases vagal

activity and reduces cortisol levels. This means the body is able to relax in an easier and quicker

manner. Many outcomes of massage therapy include promotion of circulation, decreased pain,

elimination of waste products in the body, and relaxation of muscles and nerve tissue (Choi, Lee,

& Ernst, 2012, p. 474). A meta-analysis of 37 studies by Moyer, demonstrated that massage

therapy significantly reduces anxiety and depression. In the oncology community, massage

therapy is gaining popularity due to the increase in symptom management. Massage therapy

alleviates the physical and psychological symptoms caused by the cancer and its treatment.

Because cancer patients are more at risk for blood clots, bruising, osteoporosis, peripheral

neuropathy, and many other side effects, massage therapy should be delivered by trained

professionals. Evidence from 3 studies shows how massage therapy in cancer patients helps

manage symptoms like pain, nausea, depression, anxiety, stress, anger, and fatigue. A

meta-analysis by Lee, specified that surgery-related pain is effectively reduced by massage.

Massage is a sensible and easy intervention that is proven to alleviate the physical and

psychological symptoms that cancer and its treatments may cause. An additional type of
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intervention that is proven to improve the quality of life in cancer patients is called

cognitive-behavioral therapy.

The way someone thinks has a direct effect on that person's feelings, emotions, and

behaviors. Cognitive-behavioral therapy is a therapy based on the concept that to change a

patients’ behavior, their emotions need to be changed (Daniels, 2015, p. 471). For CBT, a trained

therapist assists patients in identifying challenging thoughts, and then altering them to control the

response towards disease symptoms. This is accomplished by using counseling or programmed

education. CBT involves techniques such as autogenic training, biofeedback, imagery,

meditation, problem-solving, and systematic desensitization (2006). According to Role of

Complementary Therapies in Cancer Patients, fourteen out of twenty-one studies reviewed,

Kwekkeboom demonstrated that CBT was effective in improving pain, fatigue, or sleep

disturbances in cancer patients (2010). In a meta-analysis done by Tatrow and Montgomery, the

outcome showed that CBT significantly reduced distress and pain scores of breast cancer

patients. Another study done by Garland, CBT therapy intervention showed a significant

improvement in the patients’ sleep, along with fatigue, mood and insomnia. Mindfulness-based

interventions in an oncology setting are very important in improving patients’ mind and body. By

changing the way a person thinks, their perceptions are changed, which can drastically improve

their health. This is very important in cancer patients who are going through such a drastic

transition in their lives. Hypnosis may also be used for individuals suffering or recovering from

breast cancer.

Hypnosis is defined as ‘the induction of a state of consciousness in which a person

apparently loses the power of voluntary action and is highly responsive to suggestion or

direction’, according to Dictionary.com. It is used in therapy, typically to recover repressed

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memories or to allow modification of behavior’. The beginning period is one of the biggest

challenges someone with breast cancer will go through that can have effects on their

psychological and physical state. One of the most frequent occurring and unmet needs caused by

the anxiety is the fear of recurring cancer after treatment is provided. Hypnosis is being used to

treat these fears, and ultimately mask them. Alternative therapies such as hypnosis, are being

used throughout many medical procedures and even used as an alternative to general anesthesia

in procedures like biopsies, laparoscopies and plastic surgery. According to the article, An RCT

to explore clinical efficacy and cost effects written by Guy Montgomery at the Icahn School of

Medicine at Mount Sinai, New York individuals undergoing breast cancer biopsy in the United

States used hypnosis as a pain reliever (2018). He also found that women who had hypnosis

before breast cancer surgery reported less pain, anxiety, nausea and fatigue afterward. Guy

Montgomery and his team calculated that if ninety percent of individuals undergo hypnosedation

before their breast cancer biopsy, it would save the country more than $135 million a year. In the

experimental study, two-hundred individuals who were scheduled to undergo a breast biopsy or

lumpectomy, were randomly assigned to a fifteen-minute pre surgery hypnosis session with a

psychologist. In The healing power of your mind, Aurore Marcou at the Curie Institute in Paris,

France (2019) explains the process:

“The patient receives a local anaesthetic and mild sedation. We sit beside them and guide

them to concentrate on their inner world, their breathing, and help them bring their

attention to a safe space. We help them relive experiences in the past. All of your brain is

focused on those memories" (p.6).

The patient's pain was recorded by using a visual analog scale (0-100). To prevent bias, the

hypnosis intervention was performed away from the clinical setting in a private room away from
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anesthesiologists, doctors, etc. The treatment consisted of fifteen minutes the morning of the

surgery, approximately 1 hour before surgery and the interventionists were four PhD-level

clinical psychologists with advanced training in hypnosis. The measurement tool that the

researchers used to determine certain effects was multivariate analysis of variance (MANOVA)

and ANOVA tests (p.6). Patients were assessed at discharge according to their subjective

experiences of pain intensity, pain unpleasantness, fatigue, nausea, physical discomfort, and

emotional upset. In conclusion, it was found in the study that a brief pre surgery hypnosis

treatment reduces medication use, pain, fatigue, nausea, discomfort, and emotional upset in

women undergoing breast cancer surgery. The mean pain intensity on a 0-100 scale post surgery

recorded from the hypnosis group was twenty-two while the attention control group recorded

forty-seven (p.1). Emotional upset was also recorded for the hypnosis group and control group.

The mean average for the same scale for the hypnosis group was an 8 and the control group was

thirty-three. One of the other ways the researchers conducted this study was by comparing if the

hypnosis intervention would reduce time spent in the operating room compared to patients in the

attention control group. It was concluded that patients in the hypnosis group spent 10.60 fewer

minutes than those in the control group. Our final topic that we will be looking at is how yoga is

used as an alternative therapy in patients with breast cancer and lymphoedema.

Yoga has gained a lot of popularity over the years that gives people control over their

inner thoughts and physical strength, but recently people suffering from breast cancer have

sought out yoga to heal their inner fears and illness, and empower them to share their

experiences. In the background of the article, Yoga, breast cancer-related lymphoedema and

well-being, it is stated that roughly twenty percent of women will experience lymphoedema as a

consequence of breast cancer treatment. Lymphoedema is described as a blockage of the

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lymphatic vessels which leads to fluid retention commonly found in the lower extremities like

the calves. The experimental study found in the article written by the Wiley Journal of Clinical

Nursing, was conducted with fifteen women with stage one breast cancer related lymphoedema.

These women had completed 8 weeks of a yoga intervention consisting of 1.5 hours of yoga

class weekly and daily home practice using a forty-five minute DVD. Each week, patients

self-reported their lymphoedema using their QOL (quality of life), using a validated instrument.

The results after this 8 week period, not only benefited them physically, but 9 women reported

feeling empowered to share their experiences. A person from the study decided to share how

they were affected by the clinical trial:

My underarm area, which a build-up of fluid usually makes tight and sore, has been a lot

more flexible. (#8) My breast is not swollen in the way it used to be. There’s a lot less

fluid there, because I was retaining a lot of fluid. Where the scar is on my breast –

because of all the yoga and the DVD I am doing at home – my scar is a lot softer.

(#2)When you go through the yoga, if you can just lie there at the end, there’s no

heaviness, no pain, the lightness is just absolutely wonderful. . . (#12)

In conclusion, the individuals in this trial stated that they clearly saw a difference in their

physical, mental, and social functioning and believed they benefited and contributed significantly

from participating in the trial.

These 6 complementary therapies can all easily be implemented into nursing practice to

assist breast cancer patients in achieving their highest quality of life. Registered nurses can

continue their education and become registered nurse acupuncturists, which would greatly

increase the convenience for patients to receive acupuncture. The use of aromatherapy can be an
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easy intervention for nurses to provide to patients. Essential oils such as peppermint oil can be

stocked in supply rooms throughout hospitals to help relieve nausea in various types of patients.

Massage is already a common practice throughout hospitals, however it is often overlooked as a

useful tool in helping patients’ physically and psychologically. Nurses can provide patients with

proper pressure over soft tissue to promote better health and reduce pain. Nurses can acquire

additional training in hypnosis, which can also increase patient satisfaction and outcomes in

treating effects from breast cancer treatment. Similarly, nurses can also be educated on different

types of cognitive behavioral therapy approaches to heal the minds of cancer patients. Yoga is a

very common practice in several areas of holistic medicine. If nurses gain knowledge about

various yoga techniques and positions, they can educate their patients on which techniques will

be best for that individual. Nursing is a very dynamic field; this allows nurses to be skilled in

several areas of medicine. This ultimately improves the quality of life in all patients.

Upon final analysis, after conducting our review of literature regarding complementary

therapies for breast cancer, there is staggering evidence demonstrating their effectiveness.

Acupuncture, aromatherapy, massage, cognitive-behavioral therapy, hypnosis, and yoga are all

excellent options for breast cancer patients to consider when battling this deadly disease to help

alleviate some of the additional symptoms that occur. Each of these interventions all work in

their own unique way, allowing women to have several choices when assessing which treatment

is right for them. Breast cancer is a diagnosis that no patient ever wants to hear, however, it is

important for patients to be aware of all the complementary therapies that are available to help

them effectively manage their disease.

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References

Behzadmehr, R., Dastyar, N., Moghadam, M. P., Abavisani, M., & Moradi, M. (2020). Effect of

complementary and alternative medicine interventions on cancer related pain among

breast cancer patients: A systematic review. Complementary Therapies in Medicine, 49,

102318. https://doi.org/10.1016/j.ctim.2020.102318

Leggett, S., Koczwara, B., & Miller, M. (2015, April). The Impact of Complementary and

Alternative Medicines on Cancer Symptoms, Treatment Side Effects, Quality of Life, and

Survival in Women With Breast Cancer—A Systematic Review. Youngstown.

https://web-a-ebscohost-com.eps.cc.ysu.edu/ehost/pdfviewer/pdfviewer?vid=4&sid=a5e2

a1da-3e66-449d-9cb7-c82669100f8a%40sdc-v-sessmgr03.

Loudon, A., Barnett, T., & Williams, A. (2017, December). Yoga, breast cancer-related

lymphoedema and well-being: A descriptive report of women's participation in a clinical

trial. Youngstown.

https://onlinelibrary-wiley-com.eps.cc.ysu.edu/doi/pdfdirect/10.1111/jocn.13819.

Lu, W., Giobbie-Hurder, A., Freedman, R. A., Shin, I. H., Lin, N. U., Partridge, A. H.,

Rosenthal, D. S., & Ligibel, J. A. (2019, October 14). Acupuncture for

Chemotherapy-Induced Peripheral Neuropathy in Breast Cancer Survivors: A

Randomized Controlled Pilot Trial. Youngstown.

https://web-b-ebscohost-com.eps.cc.ysu.edu/ehost/pdfviewer/pdfviewer?vid=3&sid=e0dc

1ca1-a1ae-469d-bd99-e4ee171428bf%40pdc-v-sessmgr01.
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Mapp, C. P., Hostetler, D., Sable, J. F., Parker, C., Gouge, E., Masterson, M., Willis-Styles, M.,

Fortner, C., & Higgins, M. (2020, April). Peppermint Oil: Evaluating efficacy on nausea

in patients receiving chemotherapy in the ambulatory setting. Youngstown.

https://web-a-ebscohost-com.eps.cc.ysu.edu/ehost/pdfviewer/pdfviewer?vid=3&sid=a513

daf5-51ad-4791-a4a7-1ea7b4148896%40sessionmgr4007.

Montgomery, G. (2018, June 1). Hypnosis to reduce aromatase inhibitor (AI)-associated

musculoskeletal pain and to improve AI adherence: An RCT to explore clinical efficacy

and cost effects. Grantome. https://grantome.com/grant/NIH/R01-AT008762-04.

Satija, A., & Bhatnagar, S. (2017, December). Complementary Therapies for Symptom

Management in Cancer Patients. Youngstown.

https://web-b-ebscohost-com.eps.cc.ysu.edu/ehost/pdfviewer/pdfviewer?vid=3&sid=83b

dc0e9-5f64-410a-8f79-d8b4c97c58ae%40pdc-v-sessmgr03.

Thomson, H. (2019, November 9). The Healing Power of Your Mind. Youngstown.

https://web-b-ebscohost-com.eps.cc.ysu.edu/ehost/detail/detail?vid=2&sid=aca2960c-c3c

5-4c7c-a43c-ff00e3cf54b6%40pdc-v-sessmgr03&bdata=JkF1dGhUeXBlPWlwLHVpZC

ZzaXRlPWVob3N0LWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=139788124&db=rzh.