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Since green tea has been associated with weight control and cardiovascular disease prevention, its effect on weight gain after breast cancer treatment was also investigated [ ]. A slight reduction in body weight and improved HDL and glucose homeostasis was seen in overweight breast cancer survivors. These clinical findings, together with substantial in vitro and in vivo evidence, suggest that tea polyphenols can be used as chemopreventive agents and as adjuvant treatments for breast cancer [ — ].
Herbal Medicine and Acupuncture for Breast Cancer Palliative Care and Adjuvant Therapy
Mistletoe Viscum album extracts have been used for cancer therapy since the early s, most commonly in central Europe [ , ]. The active compounds in mistletoe treatment are the recently identified mistletoe lectins ML I, II, and III that consist of two polypeptide chains: a carbohydrate-binding B chain that can bind to cell surface receptors enabling the protein to enter the cell, and the catalytic A chain, which can subsequently inhibit protein synthesis, due to its ribosome-inactivating properties [ , ].
Other pharmacologically relevant compounds found in mistletoe are viscotoxins and other low molecular proteins, oligo- and polysaccharides, flavonoids, and triterpene acids, which have been found to act synergistically resulting in the cytotoxic and apoptosis-inducing effects of the whole plant extract [ , ]. These results are attributed to the overregulation of genes responsible for immune defense, stress response, apoptosis, and cell-cell adhesion pathways [ — ]. Rhodiola algida is widely used in TCM to stimulate the immune system.
Oral ulcerative mucositis, a common adverse effect of mainstream cytotoxic drugs, limits the nutritional intake of cancer patients. One clinical study demonstrated the effects of R. While white blood cell WBC levels returned to the normal range a week after every cycle of chemotherapy, WBC count increased faster in patients using R.
Patients also presented fewer and smaller oral ulcers and no liver or renal complications were observed in any of the patients involved in the study. Thus R. Several flavonoids with cytotoxic activity have been isolated from the aqueous extract of the aerial part of Scutellaria barbata. Despite identification of several active chemical compounds, none demonstrated more potent cytotoxic activity than the whole plant extract.
Thus, the whole herb extract is being used and studied clinically [ — ]. In one multicenter, open-label, and dose-escalation phase 1B clinical trial, S. Dose-limiting side effects were decreased including aspartate transferase AST elevation, diarrhea, fatigue, and pain, proving this herb to be effective and safe and thus showing promise in the treatment of side effects related to the treatment of women with MBC [ ]. Most notably, the components of the whole herb extract work in synergy to inhibit cell proliferation, induce cell-cycle arrest, stimulate ROS production and hyperactivation of poly ADP-ribose polymerase PARP , and inhibit glycolysis [ ].
Curcumin, the principal active component of turmeric Curcuma longa , has potential therapeutic activities against breast cancer through multiple signaling pathways [ ]. It has been widely reported to reverse chemoresistance and sensitize cancer cells to chemotherapy and targeted therapy in breast cancer [ , ]. One clinical study reported that when curcumin was used as an adjuvant with docetaxel, dose-limiting toxicity effects were significantly decreased [ ].
Uncaria tomentosa , commonly known as Utor Cat's Claw, is a medicinal herb used in the treatment of different diseases including cancer, arthritis, gout, and epidemic diseases [ ]. Whole plant extracts were reported to have cytostatic and anti-inflammatory activity, and patients who use Cat's Claw along with chemotherapy and radiation report fewer adverse effects [ ].
The use of U. In addition to its antioxidant properties, U. The National Institutes of Health NIH , USA, has defined acupuncture as a family of procedures involving stimulation of anatomical locations on the skin by a variety of techniques. The most studied mechanism of stimulation of acupuncture points uses penetration of the skin by thin, solid, and metallic needles, which are manipulated manually or by electrical stimulation [ ]. Traditional acupuncturists understand qi as circulating between the organs along channels called meridians, which are classified as yin or yang meridians [ ].
Yin meridians include the lung, spleen, heart, kidney, pericardium, and liver, while yang meridians include the stomach, large intestines, small intestines, bladder, triple energizer, and gall bladder [ , ]. Qi energy must flow in the correct strength and quality through each of these meridians and organs for health to be maintained.
Throughout the history of Chinese medicine and descriptions in Huangdi Neijing , the concept of balancing yin and yang had been extensively applied in the application of combination of meridians, corresponding organs, and acupuncture points or acupoints [ , ].
Acupoints are mainly but not always found at specific locations along the meridians which provide one means of altering the flow of qi. Acupuncture points are thought to correspond to conventional Western physiological and anatomical features, such as the peripheral nerve junctions, and are known to stimulate the release of neurotransmitters, partially explaining its effect particularly in pain management [ ]. Acupuncture is aimed at correcting imbalances in the flow of qi by stimulation of acupoints by a variety of techniques which involves the insertion of fine needles into the skin and underlying tissues at specific points, for therapeutic or preventative purposes.
Evidence of the neurophysiological mechanisms underlying acupuncture now exists [ — ]. Moreover, acupuncture can alter gene expression, upregulating opioid production [ , ]. Acupuncture works by modulating noradrenergic and serotonergic pathways to give extra segmental pain relief, that is, analgesia throughout the body [ ]. Acupuncture releases serotonin [ ], oxytocin [ ], and endogenous steroids [ ], which may further contribute to analgesia. In functional MRI studies, acupuncture induced brain activation in the hypothalamus and nucleus accumbens and deactivated areas of the anterior cingulate cortex, amygdala, and hippocampus.
In terms of analgesia, it was suggested that acupuncture modulated the affective-cognitive aspect of pain perception [ ]. Furthermore, correlations between signal intensities and analgesic effects have been reported [ ]. Further work using PET scanning showed that acupuncture induced extra effects in the ipsilateral insula beyond the sham needle, which also had greater effects on activation patterns than the control group [ ].
Recent advances in clinical research on acupuncture suggest that acupuncture provides clinical benefit for breast oncology patients in symptom control and supportive care.
Symptoms that respond to acupuncture treatment include pain, gastrointestinal side effects, hot flushes, fatigue, anxiety, depression, and insomnia. Patients welcome a supportive therapy that can reduce symptoms without the need for long-term medication. The strength of current scientific evidence has made acupuncture more acceptable to Western-trained doctors and given rise to Western medical acupuncture [ ].
Twelve trials explored the effect of acupuncture on vasomotor syndrome summarized in Table 2 [ — , , ], including eight RCTs and four single-group pre-post comparisons. Daily flush frequency was the main outcome measure. All the studies used self-administrated questionnaires to measure this effect. Some trials also used the Kupperman Index KI to score climacteric symptoms. Most studies used six or more acupoints of which SP6 was the most commonly used. A course of acupuncture treatment has been found to reduce hot flushes associated with normal menopause and also from hormonal treatments for cancer.
Those in the acupuncture group additionally reported improved libido, increased energy, and improved clarity of thought and sense of well-being. Furthermore, the acupuncture group reported no adverse side effects. An algorithm has been developed for the long-term treatment of hot flushes, with the observed effects of the initial course of treatment maintained for up to 6 years by weekly self-needling at SP6 or by using semipermanent needles [ ].
For self-needling, patients require clear demonstration of cleansing, insertion, and safe disposal [ ]. Summary of the effectiveness of acupuncture acupoints used in breast cancer patients for cancer-related syndromes or side effects caused by treatments. Ten studies included in Table 2 investigated the antiemetic effect of acupuncture on distress symptoms induced by chemotherapy [ — ]. Participants received intervention over a treatment period of 5 days to 3 weeks.
These studies, including three high quality studies [ , , ], reported that acupuncture could significantly improve emesis caused by breast cancer therapy. Acupuncture stimulation at points PC6 and ST36 has repeatedly been shown to be a clinically useful antiemetic treatment for postoperative nausea and vomiting and chemotherapy-induced emesis. A three-arm RCT comparing conventional antiemetics alone with antiemetics plus either electroacupuncture or minimal acupuncture demonstrated that the electroacupuncture plus antiemetics arm was the most effective for preventing nausea and vomiting associated with high-dose chemotherapy [ ].
Ezzo and colleagues reviewed eleven trials in and concluded that electroacupuncture has demonstrated benefit for chemotherapy-induced acute vomiting, and self-administered acupressure appears to have a protective effect against acute nausea and can readily be taught to patients [ ]. Since then, two multicenter longitudinal RCTs have shown the beneficial effect of acupressure in significantly reducing the severity of both acute and delayed vomiting [ , ].
These studies also demonstrate that acupuncture and acupressure are simple to administer and merit wider consideration. Bone pain is the most common type of cancer-associated pain, and bone metastases are common in advanced breast cancers. Current pain-relieving strategies include the use of opioid-based analgesics, bisphosphonates, and radiotherapy. The pharmacological failure to control pain alone has led to the use of nondrug treatments including acupuncture. The analgesic effects of acupuncture may permit a decrease in the requirement and side effects of pharmaceuticals.
It can also help those who are sensitive to normal doses of analgesics and those who have pain despite analgesic dose titration [ ]. Although acupuncture is used in palliative care settings for all types of cancer pain, the evidence base is still insufficient and inconclusive and there is very little evidence to show its effectiveness in relieving cancer-induced pain [ , ].
Three trials used acupuncture to manage postmastectomy pain Table 2 [ — , , ]. Acupoint L14 was used in all the three trials. Two studies demonstrated a significant effect favoring the acupuncture group [ , ], but one high quality RCT [ ] found no significant difference between the intervention group and the control group. Although reviews vary in their conclusions, acupuncture was found to be superior to no treatment or waiting list control in most studies.
Finally, emerging evidence demonstrates the analgesic effectiveness of both acupuncture and electroacupuncture in breast cancer patients experiencing joint pain as a result of adjuvant aromatase inhibitor treatment. Four trials have included investigation of arthralgia, and all explored the effect of acupuncture therapy on aromatase inhibitor-related joint pain and functional ability Table 2.
Positive results were obtained including enhanced postoperative analgesic efficiency, relief of postoperative pain, and significant improvement in joint and muscle stiffness [ , — , ]. Fatigue is an extremely common symptom in cancer patients [ ]. Fatigue is also an adverse side effect of chemotherapy and radiotherapy, which can persist long after the cessation of treatment.
In a prospective phase II study on patients with persistent fatigue who had previously completed chemotherapy, acupuncture resulted in a significant reduction in baseline fatigue scores [ ]. Further four RCTs showed that acupuncture was associated with a significant improvement in general fatigue scores [ — ]. The two anxiety, sickness, and dyspnoea ASAD points located at the upper left and right sternal regions are used extensively in the UK to control dyspnea and also anxiety.
This method has the added benefit of empowering the patient to control these distressing symptoms in the event of a panic attack. More recent evidence suggests that acupuncture when combined with antidepressant therapy has a faster therapeutic onset rate than pharmacotherapy alone, coupled with a reduction in the side effect profile of the antidepressant medication [ ]. An additional RCT examining the treatment of hot flushes revealed that compared to women taking venlafaxine, those receiving acupuncture felt they had more energy, improved clarity of thought, increased libido, and a greater sense of well-being [ ].
In one study done by Mehling and colleagues, massage and acupuncture in postoperative cancer patients who were also receiving usual care resulted in a significant improvement in their depressed mood with short-lived significant improvement in tension and anxiety when compared to patients receiving usual care alone [ ]. A subsequent meta-analysis revealed that the rate of improvement in insomnia produced by auricular acupuncture was significantly higher than that achieved by taking Diazepam [ ].
Although a Cochrane systematic review of acupuncture for insomnia in concluded that acupuncture or its variants were not more effective than the control groups [ ], five clinical studies showed significant improvement in anxiety and depression over time in patients who underwent acupuncture treatment.
QOL measures of pain severity and interference, physical and psychological distress, life satisfaction, and mood states also showed improved scores after acupuncture treatment [ — ]. Lymphoedema is a distressing problem that affects many women after breast cancer surgery. In the United States, needling and even lifting objects using the affected arm has been prohibited, resulting in a limited number of publications on acupuncture and lymphoedema [ ]. However, recent results of two studies demonstrated that traditional acupuncture after breast cancer surgery was associated with improvements in movement amplitude of the shoulder, symptoms of heaviness and tightness in the arm, and the degree of lymphedema [ , ].
Two trials conducted in China found that dexamethasone injected at the ST36 intra-acupoint was effective in preventing bone marrow suppression-related leukopenia in breast cancer patients undergoing chemotherapy or radiotherapy Table 2 [ , ]. The main body of evidence comes from China where a systematic review of RCTs was positive for increasing WBC in patients undergoing chemotherapy [ ]; however, the quality of trials was considered poor, and the authors suggest that the positive meta-analysis should be considered as exploratory.
With an increasing number of positive evidence-based acupuncture trials, more cancer patients may seek acupuncture treatment. While closely monitored clinical trials often report low incidences of adverse events of acupuncture, many physicians remain concerned about its safety. Serious adverse events are exceedingly rare—roughly five in one million [ ]—and are usually associated with poorly trained, unlicensed acupuncturists [ ]. Serious adverse effects including pneumothorax, spinal lesions, and hepatitis B transmission have been reported in the literature for acupuncture, but these are rare and are generally associated with poorly trained unlicensed acupuncturists [ ].
Acupuncture for oncology should be administered by a suitably qualified practitioner who can maintain a constant dialogue with the oncology team treating the patient. The contraindications and cautions for acupuncture in an oncology setting are outlined in Table 3. In general, acupuncture can be considered a safe method of treatment, with a low side effect profile, which in part adds to its popularity among patients [ — ]. Establishing an eligibility guideline for cancer patients before receiving acupuncture would add another layer of safety.
Guidelines for safe practice within this field have previously been published [ ]. Before the first visit, approval is required from the primary oncologist based upon these guidelines [ ]. This development paves the way toward understanding their efficacy and modes of action in alleviating cancer or cancer treatment-related conditions. Evidence from various in vitro , in vivo studies and RCTs support the use of herbal medicine or acupuncture in boosting the immune system, in relieving pain, fatigue, cyto- and hepatotoxicity, and in inhibiting gastrointestinal toxicity, angiogenesis, and other side effects from chemo- and radiotherapy.
The inclusion of selected herbal medicines from well-designed RCTs in this review provides evidence-based knowledge to strengthen the rationale for the use of herbal medicines in controlling breast cancer in the clinical setting. Although current evidence from basic science and clinical research on herbal medicines or acupuncture is still not sufficient to change oncological practice in general, the quality and design of clinical trials have significantly improved over the last few years which can provide patients with the most effective protocols or treatment types and safety profiles.
Despite all the evidence presented, key challenges still exist including quality control of herbal medicinal materials, standardization of practices and current methodology in acupuncture, and pharmacokinetic interaction between drug components or between chemotherapy and herbal medicine. Further research addressing these challenges in the form of rigorously designed clinical trials accompanied by comprehensive and in-depth laboratory studies is needed to improve the quality of the existing evidence base and support the use of CAM. National Center for Biotechnology Information , U.
Evid Based Complement Alternat Med. Published online Jun Author information Article notes Copyright and License information Disclaimer. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Abstract Breast cancer is a life-threatening disease among women worldwide with annual rates of reported incidence and death increasing alarmingly.
Introduction Breast cancer remains to be the leading cause of cancer death among women worldwide with the rate of reported incidence and mortality increasing annually [ 1 , 2 ]. Results and Discussion 3. Table 1 Summary of major mechanisms of action and common side effects of chemotherapeutic drugs approved for breast cancers. Chemotherapeutic agent Mechanism of action Side effect References Cyclophosphamide Apoptotic cell death Pulmonary toxicities, weight gain [ 50 , 52 ] Cisplatin DNA damage, apoptosis Nephrotoxicity [ 54 ] Doxorubicin DNA damage Impaired cognitive function, anemia [ 55 , 56 ] Docetaxel Mitotic inhibition Pulmonary toxicities, colitis, diarrhea [ 57 ] Epirubicin DNA damage Nausea, cardiotoxicity [ 58 — 60 ] Fluorouracil Thymidylate synthetase inhibition; DNA synthesis inhibition Cardiotoxicity, anemia, GI tract toxicity [ 61 ] Gemcitabine Nucleic acid synthesis inhibition GI tract toxicity [ 62 ] Methotrexate Cell cycle arrest Anemia, weight gain, jaundice, diarrhea, loss of bone density [ 50 ] Mitomycin DNA alkylating agent Myelotoxicity, fatigue, systemic toxicity [ 63 ] Mitoxantrone Topoisomerase inhibition Alopecia, systemic toxicity [ 63 ].
Open in a separate window. Traditional Chinese Medicines Composed of Multiple Herbs In traditional medicinal systems, herbal medicines are used often to treat the symptoms associated with cancer and the side effects of cancer treatment [ 68 ]. Single Herbs and Medicinal Mushrooms Black cohosh Cimicifuga racemosa is known in TCM to reduce hot flushes in menopausal women and to have low toxicity. Use of Acupuncture in Breast Cancer 3.
Definition and Concept of Acupuncture The National Institutes of Health NIH , USA, has defined acupuncture as a family of procedures involving stimulation of anatomical locations on the skin by a variety of techniques. Scientific Exploration into Acupuncture Acupuncture is aimed at correcting imbalances in the flow of qi by stimulation of acupoints by a variety of techniques which involves the insertion of fine needles into the skin and underlying tissues at specific points, for therapeutic or preventative purposes.
Cancer-Related Hot Flushes Twelve trials explored the effect of acupuncture on vasomotor syndrome summarized in Table 2 [ — , , ], including eight RCTs and four single-group pre-post comparisons. Table 2 Summary of the effectiveness of acupuncture acupoints used in breast cancer patients for cancer-related syndromes or side effects caused by treatments.
Nausea and Vomiting Ten studies included in Table 2 investigated the antiemetic effect of acupuncture on distress symptoms induced by chemotherapy [ — ]. Fatigue Fatigue is an extremely common symptom in cancer patients [ ]. Anxiety, Depression, and Insomnia The two anxiety, sickness, and dyspnoea ASAD points located at the upper left and right sternal regions are used extensively in the UK to control dyspnea and also anxiety.
Lymphoedema and Leukopenia Lymphoedema is a distressing problem that affects many women after breast cancer surgery. Safety of Acupuncture With an increasing number of positive evidence-based acupuncture trials, more cancer patients may seek acupuncture treatment. Table 3 Contraindications and cautions for the use of acupuncture in breast cancer patients.
References 1. American Cancer Society. Global cancer statistics. Uncaria tomentosa—adjuvant treatment for Breast Cancer: clinical trial. Evidence-Based Complementary and Alternative Medicine. Screening for Breast Cancer. Screening for breast cancer. Relationship between the expression of various markers and prognostic factors in breast cancer. Acta Histochemica. Dietary supplements and natural products in Breast Cancer trials.
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Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey. Annals of Internal Medicine. Herb-drug interactions: a literature review. A regional survey of health insurance coverage for complementary and alternative medicine: current status and future ramifications. Chemosensitization and radiosensitization of tumors by plant polyphenols. Antioxidants and Redox Signaling. Konkimalla VB, Efferth T. Evidence-based Chinese medicine for cancer therapy.
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Similarly, spiritual healing is provided not only via spiritual interventions but also is experienced along with music interventions, yoga, meditation or energy healing. Therefore, the review performed for this article is based on the available literature which involves a variety of combination of CTs.
All therapies described here have a potential for symptomatic care in cancer patients. However, recognition of effects of these therapies is barricaded by paucity of systematic high-quality research. Poor study designs with small sample size, varied cancer population, different outcome measures; statistically insignificant results and lack of unanimity on the mechanism of actions lead to limited scientific evidence. Despite the lack of strong evidence, the benefits pertained from CTs cannot be contravened. Acknowledging the need of patient-centered care and to address holistic suffering, the limitations of conventional treatments need to be accepted.
It is suggested that high-quality research in this aspect is conducted to provide conclusive findings which will help in collective decision making by both patient and oncologist. National Center for Biotechnology Information , U. Indian J Palliat Care. Aanchal Satija and Sushma Bhatnagar. Author information Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: moc. Abstract Cancer patients are often poly-symptomatic which distressingly affects their quality of lives QOLs. Keywords: Cancer, complementary therapies, mind-body therapies, pain, quality of life.
Open in a separate window. Biofeedback It is a therapeutic tool by which an individual learns to control autonomic physiological activities to improve health. Hypnosis It is a psychotherapeutic practice where a health-care hypnotist induces a highly relaxed mental state whereby patient's mind is receptive for therapeutic suggestions.
Figure 1. Guided imagery It is a psychotherapeutic technique in which an individual creates images to visualize the desired outcome. Music therapy Music has been used extensively since ages for its healing and curative power towards disease or distress. Yoga The origins of yoga can be traced to more than years ago in India. Acupuncture It originated from traditional Chinese medicine over years ago. Figure 2. Trans-cutaneous electrical nerve stimulation and scrambler therapy Trans-cutaneous electrical nerve stimulation TENS is an electro-analgesic technique which reduces pain on the basis of pain gate mechanism.
Massage techniques Ancient scriptures from India, China and Japan, refer to the use of massage. Energy therapies and spiritual interventions Healing can be induced by specific internal intrapersonal and external interpersonal techniques that assert to use subtle energy known as prana, ch'i, qi or spirit for curing self and another individual respectively.
Table 7 Overview of energy therapies. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Moser EC, Meunier F. Cancer survivorship: A positive side-effect of more successful cancer treatment. EJC Suppl. Anderson cancer center: Cancer as a chronic disease.
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A review of smartphone apps for smoking cessation available in portuguese.
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Prev Med. Progressive muscle relaxation: An adjuvant therapy for reducing pain and fatigue among hospitalized cancer patients' receiving radiotherapy. Int J Adv Nurs Stud. Efficacy of progressive muscle relaxation training and guided imagery in reducing chemotherapy side effects in patients with breast cancer and in improving their quality of life. Support Care Cancer. Women are encouraged to talk with their doctors about which surgical option is right for them.
Also, talk with your health care team about the possible side effects from the specific surgery you will have. More aggressive surgery, such as a mastectomy, is not always better and may cause more complications. The combination of lumpectomy and radiation therapy has a slightly higher risk of the cancer coming back in the same breast or the surrounding area. However, the long-term survival of women who choose lumpectomy is exactly the same as those who have a mastectomy.
Even with a mastectomy, not all breast tissue can be removed and there is still a chance of recurrence. Women with a very high risk of developing a new cancer in the other breast may consider a bilateral mastectomy, meaning both breasts are removed.
Although the risk of getting a new cancer in that breast will be lowered, surgery to remove the other breast does not reduce the risk of the original cancer coming back. And more extensive surgery may be linked with a greater risk of problems. Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist.
There are several different types of radiation therapy:. External-beam radiation therapy. This is the most common type of radiation treatment and is given from a machine outside the body. Intra-operative radiation therapy. This is when radiation treatment is given using a probe in the operating room.
This type of radiation therapy is given by placing radioactive sources into the tumor. Although the research results are encouraging, intra-operative radiation therapy and brachytherapy are not widely used. Where available, they may be options for a patient with a small tumor that has not spread to the lymph nodes. Learn more about the basics of radiation therapy. A radiation therapy regimen, or schedule see below , usually consists of a specific number of treatments given over a set period of time. Radiation therapy often helps lower the risk of recurrence in the breast.
If there is cancer in the lymph nodes under the arm, radiation therapy may also be given to the same side of the neck or underarm near the breast or chest wall. Your doctor can recommend topical medication to apply to the skin to treat some of these side effects. Very rarely, a small amount of the lung can be affected by the radiation therapy, causing pneumonitis, a radiation-related swelling of the lung tissue.
This risk depends on the size of the area that received radiation therapy, and this tends to heal with time. In the past, with older equipment and radiation therapy techniques, women who received treatment for breast cancer on the left side of the body had a small increase in the long-term risk of heart disease.
Modern techniques are now able to spare the vast majority of the heart from the effects of radiation therapy. Many types of radiation therapy may be available to you with different schedules see below. Talk with your doctor about the advantages and disadvantages of each option. Even shorter schedules have been studied and are in use in some centers, including accelerated partial breast radiation therapy see below for 5 days. These shorter schedules may not be options for women who need radiation therapy after a mastectomy or radiation therapy to their lymph nodes.
Also, longer schedules of radiation therapy may be needed for some women with very large breasts. More research is being done to find out whether younger patients or those who need radiation therapy after chemotherapy may be able to have these shorter radiation therapy schedules. Recent research studies have looked at the possibility of avoiding radiation therapy for women age 70 or older with an ER-positive, early-stage tumor see Introduction , or for those women with a small tumor. Overall, these studies show that radiation therapy reduces the risk of breast cancer recurrence in the same breast, compared with no radiation therapy.
However, they note that women with special situations or a low-risk tumor could reasonably choose not to have radiation therapy and use only systemic therapy see below after lumpectomy. This includes women age 70 or older and those with other medical conditions that could limit life expectancy within 5 years. People who choose this option must be willing to accept a modest increase in the risk of the cancer coming back in the breast. Systemic therapy is the use of medication to destroy cancer cells. This type of medication is given through the bloodstream to reach cancer cells throughout the body.
Systemic therapies are generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. Common ways to give systemic therapies include an intravenous IV tube placed into a vein using a needle, an injection into a muscle or under the skin, or in a pill or capsule that is swallowed orally.
Each of these therapies are discussed below in more detail. A person may receive 1 type of systemic therapy at a time or a combination of systemic therapies given at the same time. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements.
Herbs, supplements, and other drugs can interact with cancer medications. Learn more about your prescriptions by using searchable drug databases. Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. It may be given before surgery to shrink a large tumor, make surgery easier, and reduce the risk of recurrence, called neoadjuvant chemotherapy.
It may also be given after surgery to reduce the risk of recurrence, called adjuvant chemotherapy. A chemotherapy regimen, or schedule, usually consists of a combination of drugs given in a specific number of cycles over a set period of time. Chemotherapy may be given on many different schedules depending on what worked best in clinical trials for that specific type of regimen. It may be given once a week, once every 2 weeks, once every 3 weeks, or even once every 4 weeks. There are many types of chemotherapy used to treat breast cancer.
Common drugs include:. A patient may receive 1 drug at a time or a combination of different drugs given at the same time. Research has shown that combinations of certain drugs are sometimes more effective than single drugs for adjuvant treatment. The following drugs or combinations of drugs may be used as adjuvant therapy for early-stage and locally advanced breast cancer:.
AC or EC epirubicin and cyclophosphamide followed by T doxorubicin and cyclophosphamide, followed by paclitaxel or docetaxel, or the reverse. An example is the antibody trastuzumab. Combination regimens for early-stage HER2-positive breast cancer may include:. The side effects of chemotherapy depend on the individual, the drug s used, and the schedule and dose used. These side effects can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, diarrhea, constipation, numbness and tingling, early menopause, weight gain, and chemo-brain. These side effects can often be very successfully prevented or managed during treatment with supportive medications, and they usually go away after treatment is finished.
Rarely, long-term side effects may occur, such as heart damage, permanent nerve damage, or secondary cancers such as leukemia and lymphoma. Talk with your health care team about the possible side effects of your specific chemotherapy plan. Hormonal therapy, also called endocrine therapy, is an effective treatment for most tumors that test positive for either estrogen or progesterone receptors called ER positive or PR positive; see Introduction. This type of tumor uses hormones to fuel its growth.
Blocking the hormones can help prevent a cancer recurrence and death from breast cancer when used either by itself or after chemotherapy. Hormonal therapy may be given before surgery to shrink a tumor, make surgery easier, and lower the risk of recurrence. This is called neoadjuvant hormonal therapy. It may also be given after surgery to reduce the risk of recurrence. This is called adjuvant hormonal therapy. Tamoxifen is a drug that blocks estrogen from binding to breast cancer cells. It is effective for lowering the risk of recurrence in the breast that had cancer, the risk of developing cancer in the other breast, and the risk of distant recurrence.
Tamoxifen works well in women who have been through menopause and those who have not. Tamoxifen is a pill that is taken daily by mouth. It is important to discuss any other medications or supplements you take with your doctor, as there are some that may interfere with tamoxifen. Common side effects of tamoxifen include hot flashes as well as vaginal dryness, discharge or bleeding. Very rare risks include a cancer of the lining of the uterus, cataracts, and blood clots. However, tamoxifen may improve bone health and cholesterol levels. Aromatase inhibitors AIs.
AIs decrease the amount of estrogen made in tissues other than the ovaries in postmenopausal women by blocking the aromatase enzyme. This enzyme changes weak male hormones called androgens into estrogen when the ovaries have stopped making estrogen during menopause. These drugs include anastrozole Arimidex , exemestane Aromasin , and letrozole Femara. All of the AIs are pills taken daily by mouth. Only women who have gone through menopause or who take medicines to stop the ovaries from making estrogen see Ovarian suppression, below can take AIs.
Treatment with AIs, either as the first hormonal therapy taken or after treatment with tamoxifen, may be more effective than taking only tamoxifen to reduce the risk of recurrence in post-menopausal women. The side effects of AIs may include muscle and joint pain, hot flashes, vaginal dryness, an increased risk of osteoporosis and broken bones, and increased cholesterol levels. Research shows that all AIs work equally well and have similar side effects. However, women who have undesirable side effects while taking an AI may have fewer side effects with a different AI for unclear reasons.
Women who have not gone through menopause and who are not getting shots to stop the ovaries from working see below should not take AIs, as they do not block the effects of estrogen made by the ovaries. Often, doctors will monitor blood estrogen levels in women whose menstrual cycles have recently stopped, or those whose periods stop with chemotherapy, to be sure that the ovaries are no longer producing estrogen.
Ovarian suppression or ablation. Ovarian suppression is the use of drugs to stop the ovaries from producing estrogen. Ovarian ablation is the use of surgery to remove the ovaries. These options may be used in addition to another type of hormonal therapy for women who have not been through menopause.
For ovarian suppression, gonadotropin or luteinizing releasing hormone GnRH or LHRH drugs are used to stop the ovaries from making estrogen, causing temporary menopause. Goserelin Zoladex and leuprolide Eligard, Lupron are types of these drugs. They are given by injection every 1 to 3 months and stop the ovaries from making estrogen. The effects of GnRH drugs go away if treatment is stopped. For ovarian ablation, surgery to remove the ovaries is used to stop estrogen production.
While this is permanent, it can be a good option for women who are done having children, especially since the cost is typically lower over the long term. Tamoxifen for 5 years, followed by an AI for up to 5 years. This would be a total of 10 years of hormonal therapy. Tamoxifen for 2 to 3 years, followed by 2 to 8 years of an AI for a total of 5 to 10 years of hormonal therapy.
In general, women with stage I cancer should expect to take hormonal therapy for 5 years. As noted above, premenopausal women should not take only AIs, as they will not work. Options for adjuvant hormonal therapy for premenopausal women include the following:. Tamoxifen for 5 years. Then, treatment is based on whether or not they have gone through menopause in those 5 years. If a woman has not gone through menopause after the first 5 years of treatment, she can continue tamoxifen for another 5 years, for a total of 10 years of tamoxifen.
If a woman goes through menopause during the first 5 years of treatment, she can continue tamoxifen for an additional 5 years or switch to an AI for 5 more years. Only women who are clearly postmenopausal should consider taking an AI. For women with stage I or stage II cancer with a higher risk of recurrence who may consider also having chemotherapy. For women who cannot take tamoxifen for other health reasons, such as having a history of blood clots. Ovarian suppression is not recommended in addition to another type of hormonal therapy in the following situations:.
This information is based on ASCO recommendations for adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. Please note this link takes you to another ASCO website. These treatments are very focused and work differently than chemotherapy. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells. Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor.
In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments. The first approved targeted therapies for breast cancer were hormonal therapies. Talk with your doctor about possible side effects of specific medications and how they can be managed. Bone modifying drugs block bone destruction and help strengthen bone. They may be used to prevent cancer from recurring in the bone or to treat cancer that has spread to the bone.
Certain types are also used in low doses to prevent and treat osteoporosis. Osteoporosis is the thinning of the bones. For people with breast cancer that has not spread, receiving bisphosphonates after breast cancer treatment may help to prevent a recurrence. ASCO recommends zoledronic acid Reclast, Zometa or clodronate multiple brand names as options to help prevent a bone recurrence for women who have been through menopause.
Clodronate is only available outside of the United States. Please note that this link takes you to a separate ASCO website. You may have other targeted therapy options for breast cancer treatment, depending on several factors. Many of the following drugs are used for advanced or metastatic breast cancer. Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer.
It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes.
Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy. Age should never be the only factor used to determine treatment options. Systemic treatments, such as chemotherapy, often work as well for older patients as younger patients.
However, older patients may be more likely to have side effects that impact their quality of life.
For example, older patients may have a higher risk of developing heart problems from trastuzumab. This is more common for patients who already have heart disease and for those who receive certain combinations of chemotherapy. They should also ask about potential side effects and how they can be managed. Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care.
It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer. Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy. Research has shown that some integrative or complementary therapies may be helpful to manage symptoms and side effects.
ASCO agrees with recommendations from the Society for Integrative Oncology on several complementary options to help manage side effects during and after breast cancer treatment.