Complementary Therapy. Hormonal Treatment and Alternatives in Breast Cancer Survivors
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1 Diagnosis and Treatment of Patients with Primary and Metastatic Breast Cancer Complementary Therapy Hormonal Treatment and Alternatives in Breast Cancer Survivors Survivorship
2 Complementary Therapy Hormonal Treatment and Alternatives in Breast Cancer Survivors Survivorship Version 2002: Hanf / Göhring Versions : Bauerfeind / Blohmer / Gerber / Hanf / Janni / Kümmel / von Minckwitz / Oberhoff / Scharl / Thomssen Version 2012: Hanf / Schmidt
3 Alternative Therapies CAM Complementary + alternative medicine UCT Unconventional Thx Complementary Alternative Unconventional In addition to scientifically based medicine Instead of scientifically based medicine Unproven outsider methods
4 Complementary Therapy Pre- and Postoperative Oxford AGO Preoperative: Hypnosis (reduces anxiety) 1b B +/- Postoperative: Acupuncture (pain relief) 2b B +/- Acupuncture (nausea, vomiting) 2b B + Early postop. exercise reduces upper-limb 1a A + dysfunction (beware: increased wound drainage) Prophylactic lymph drainage 1b B -
5 Complementary Treatment Impact on Toxicity While on cancer treatment: beware of drug interactions! Oxford / AGO High dose vitamine C 1b C - Proteolytic enzymes in order to reduce chemotherapy-induced toxicity 3b B - Mistletoe (Viscum album) in order to reduce side 1a B +/- effects of therapy (influence on efficacy of antitumortherapy unknown) Thymic peptides (lowered the risk of severe infections) 2a B +/- (influence on efficacy of antitumortherapy unknown) Oxygen- and ozone therapy 5 D - - Antioxidant supplements 1b B - Co-Enzyme Q 10 4 D - Selenium for alleviating side effects of therapy 1b D - Vitamine E 2b D - Ginseng (in order to reduce cancer rel. fatigue) HR- 3b C +/- HR+ - Chinese herbal medicine improves 1b B -*inf wound healing after mastectomy * Substances (infusion) in Germany not approved
6 Additional Complementary Therapy Side Effects Related to Cancer Treatments e.g. Chemotherapy Oxford Chinese medicinal herbs to treat the side effects of 1b B - chemotherapy in breast cancer patients AGO May offer some benefit to breast cancer patients in terms of bone marrow improvement and quality of life Homoeopathic medicines for adverse effects of cancer 1b B +/- treatments Topical calendula (>= 20% Calendula Anteil) for prophylaxis of acute dermatitis during radiotherapy Traumeel S mouthwash to treat chemotherapy-induced stomatitis Acupuncture in order to improve on Chemotherapy-induced >=nausea and vomiting 1b B + Cognitive dysfunction 5 D +/- Fatigue 2b B +/- Pain 1b D +/- Leucopenia 2b B -
7 Modifiable Lifestyle Factors Nutrition after Breast Cancer Diagnosis Prevention of Recurrence Oxford /AGO Adherence to normal BMI 2b B ++ (improves prognosis DFS/OS) Low fat diet 1b (-) B + (improves prognosis DFS - esp. postmenopausal, ER neg.; <20% fat calories, only with dietary counseling!) Flaxseed 2a D +/- Adherence to general nutrition guidelines 2a B + Dietary extremes 1b B - - (are associated with less favourable outcomes)
8 Modifiable Lifestyle Factors Prevention of Recurrence Oxford / AGO Physical exercise 2a B ++ (Equivalents to 3 5 hrs moderate walking per week improves DFS and OS, cardiorespiratory fitness, physical functioning) Improves quality of life, cancer (-treatment) related fatigue 1a A ++ Smoking 2b B - Reg. alcohol consumption (>6 g/die) 2b(-) D +/-
9 Complementary Treatment Prevention of Recurrence While on anti-cancer treatment: beware of drug interactions Oxford AGO Orthomolecular substances 5 D - (Selenium, Zinc...) Selenium for alleviating side effects of therapy 1b D - Vitamines (in pts. on a balanced diet) 2b B - Proteolytic enzymes 3b B - (Papain, Trypsin, Chymotrypsin) Soy (phytoestrogenes) 2b B +/- In receptor-positive tumors - Black Cohosh (Cimicifuga racemosa) 2b C +/- Mistletoe (Viscum album) 1b C - Thymic peptides (impact on OS) 2a B - Oxygen- and ozone therapy 5 D - - Antioxidant supplements (after end of radiotherapy) 2b B +/- Laetrile 1c D -- Cancer bush (Sutherlandia frutescens), Devil's claw (Harpagophytum procumbens), Rooibos tea (Aspalathus linearis), Bambara groundnut (Vignea subterranean) 5 D -
10 Complementary Treatment Mind-Body Medicine Oxford / AGO MBSR (Mindfulness-Based Stress Reduction) Program improves quality of life, coping, reduces stress and depression 2b B + Yoga Improves Sleep, quality of life, stress, anxiety, depression 2b B + Qi Gong May improve quality of life, fatigue, mood 2b D +/-
11 Complementary Treatment Cancer pain reduction Oxford / AGO Acupuncture for cancer pain in adults Transcutaneous electric nerve stimulation (TENS) for cancer pain in adults 2b D +/- 2b D +/- Cave: No delay in diagnostics
12 Hormone (Replacement) Therapy (HT) of Estrogen Deficiency after Diagnosis of Breast Cancer Oxford / AGO Endocrine responsive disease (HT may increase risk) 1b B - Endocrine non-responsive disease (apparently no risk increase) 2a B +/- Endocrine responsive disease: combined treatment TAM plus low-dose-ht 2b B +/-* Tibolone 1b A - - Topical vaginal application of Estriol 5 D +/- Estradiol during AI therapy 4 C - *Study participation recommended
13 Alternatives to Reduce Menopausal Symptoms after BC I General approaches: Oxford / AGO Physical exercise 2b D + Mind Body-medicine (yoga, hypnosis, education, counseling) 2b C + Vaginal lubricants and moisturizers 4 C + Acupuncture 1b B +/-
14 Alternatives to Reduce Menopausal Symptoms after BC II Medical approaches: Selective serotonin reuptake inhibitors and serotonin-(noradrenalin) reuptake inhibitors (SSRI-SNRI): reduce hot flashes in BC patients Oxford / 1 st choice: venlafaxine 1a A + 2 nd choice: desvenlafaxine 1b A +/- 3 rd choice: sertraline, escitalopram 1b A +/- Gabapentin (BC and TAM-use) 1a A + Pregabalin 1b A +/- Clonidin (BC and TAM-use) 1a A + MPA (i.m. 500 mg single shot) (most potent, but endocrine agent!) 1b A +/- Vitamine E 1b A - Stellate ganglion block (SGB) 3a B +/- AGO
15 Herbal Approaches to Reduce Menopausal Symptoms While anti-cancer treatment: Beware of drug interactions! Oxford AGO Soy-derived phytoestrogens isoflavonoids 1b A - (might stimulate BC especially in endocrine responsive disease) Flaxseed-supplementation (40 g/d) (in HR+ 10g/d) 3 D +/- Black Cohosh for hot flushes 1b A +/- (effectiveness could not be clearly shown) St. Johns Wort in combination-therapy (pharmacokinetic interference with endocrine therapy, cyctotoxic drugs and tyrosinkinase inhibitors) 1b A -- Kava-Kava (Piper methysticum) 5 D -- Red Clover leaf (Trifolium pratense) 5 D -- Dong Quai root (Angelica sinensis) 5 D -- Ginseng root (Panax ginseng or P. quinquefolius) 5 D - Bromelain + Papain + Selen + Lektin (vs. AI induced 3b B +/- joint symptoms)
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