12 May 2015

Compelling cancer research

Lets be really clear about this. What someone with cancer does to help themselves is therapeutic. It makes a difference to their disease as well as to how they feel. People with cancer who are not encouraged and helped to help themselves may well be shortening their lives.

A really effective self-help program is not just designed to help people to feel better, although it is highly likely to do this and of itself, this outcome is very worthwhile. But there is more to it. A really effective self-help program is also designed to improve survival. As such, an effective self-help program is as important in cancer medicine as surgery. Or chemotherapy. Or radiotherapy. Or any natural therapy.

In some situations what a person with cancer does to help themselves is actually even more therapeutic than these other treatments. Just as one example, the evidence shows that for a woman with early breast cancer, regular exercise increases her chances of long-term survival twice as much as chemotherapy.

This week, as Ruth and I have just completed the most recent of the series of follow-up programs called Cancer and Beyond that we present regularly, let us go Out on a Limb once again and examine findings from a major, systematic review of 4,900 published research articles. The researchers went on to identify and analyse 203 randomised controlled trials testing the use of integrative therapies for supportive care in patients receiving breast cancer treatment.

Given there still seem to be people claiming there is little or no research validation for the self-help interventions covered below, this is information that warrants being widely shared, but first,

   Thought for the day

Ten thousand flowers in spring, 
The moon in autumn, 

A cool breeze in summer, 
Snow in winter.

If your mind isn't clouded by unnecessary things,

This is the best season of your life.

   Wu-men - Zen master of the 12th/13th century

Nice title this one: The Society for Integrative Oncology Guidelines Working Group. They commissioned the development of Clinical Practice Guidelines on the Use of Integrative Therapies as Supportive Care in Patients Treated for Breast Cancer.

Practice guidelines are intended to inform clinicians and patients about safe and effective therapies.

These specific breast cancer guidelines have been developed in response to the well know fact that the majority of women affected by breast cancer do use complementary and/or integrative therapies during and beyond cancer treatment to manage symptoms, prevent toxicities, and improve quality of life.

The guidelines are based on the results of a literature search that reviewed relevant published data from January 1, 1990 to December 31, 2013. This search identified 4900 articles, of which 203 were eligible for analysis.

In short, the conclusion reached was that “specific integrative therapies can be recommended as evidence-based supportive care options during breast cancer treatment”.

Meditation, yoga, and relaxation with imagery are recommended for routine use for common conditions, including anxiety and mood disorders (Grade A)   A – is the highest level of evidence-based recommendation, and reducing through B, C and so on.

Stress management, yoga, massage, music therapy, energy conservation, and meditation are recommended for stress reduction, anxiety, depression, fatigue, and quality of life (Grade B).

Many interventions, 32 in all, had weaker evidence of benefit (Grade C).

Seven interventions were deemed unlikely to provide any benefit (Grade D).

Notably, from all these studies examining a wide range of lifestyle/integrative interventions, only one, acetyl-L-carnitine for the prevention of taxane-induced neuropathy, was identified as likely harmful (Grade H) as it was found to increase neuropathy.

Wouldn’t you love it if the side-effect profile of chemotherapy or radiotherapy was this small?


Sadly, combined self-help programs like the ones we present, are not well researched as yet. Given that there are more variables to take into account – like the combined benefits of exercise, and meditation, and exercise, and… and… ; that type of research is far more complex and far more expensive to conduct, so we will need to wait for that data.

At present, all that can be said is that the majority of intervention/modality combinations (n = 138) did not have sufficient evidence to form specific recommendations (Grade I).


Meditation [Grade B evidence found] including mindfulness-based stress reduction, yoga [Grade B], and stress management programs [Grade B] are recommended to reduce longer term anxiety both during and after treatment.

Longer stress management groups are likely more effective than short home study programs.

Meditation [Grade A) particularly mindfulness-based stress reduction, is recommended for improving mood and depression during radiation therapy and post treatment.

Yoga alone [Grade A)and relaxation [Grade A) are also recommended for improving mood and depressive symptoms during radiation therapy and chemotherapy and in the presence of fatigue.

Massage [Grade B) is recommended for improving mood disturbance in post treatment survivors.

Healing touch [Grade C) can be considered for improving mood in patients undergoing chemotherapy.

Meditation [Grade A) is recommended for improving quality of life, while relaxation and guided imagery [Grade C), qigong [Grade C], reflexology [Grade C], stress management [Grade C], and yoga [Grade C] can also be considered.

There are insufficient data from existing trials to make guideline-level recommendations on interventions to prevent and/or treat side effects and symptoms related to cognition, anaemia, neutropenia/leukopenia, alopecia, cardiomyopathy and adherence to standard treatment.

Many trials available for review shared common limitations, including small study sizes, poorly reported or unstated delineation of outcomes (ie primary, secondary, or exploratory outcomes), lack of standardised outcome measures, use of surrogate measures with limited clinical relevance, omission of toxicity and adverse event data, inadequate statistical methods, and lack of blinding and/or appropriate control groups.

The researchers commented that to improve the validity of future studies, it is critical that trials measure clinically relevant and standardised outcomes using validated tools and that they are analysed with accepted and appropriately chosen statistical methods to better allow for pooled analyses.

This major review investigated the role Integrative Therapies play in supportive care for people affected by cancer. In the result there is very useful information that clearly validates that the self-help approach makes a significant contribution to quality of life and general care of women affected by breast cancer. On e could imagine that the evidence for that is strong enough to suggest that a well run program teaching and supporting these modalities needs to be a part of standard care..

Notably, most of the modalities recommended come under the banner of what we would call Lifestyle Medicine.

Meditation has the best level of evidence for the widest number of benefits.

Take up on these self-help principles generally and you are highly likely to have a better experience when diagnosed, treated and recovering from cancer.

What we need urgently now is for the focus of future research to hone in on the potential benefits Lifestyle Medicine offers to actual recovery. There is already a good body of evidence for the therapeutic benefits of some Lifestyle – based therapies such as nutrition and exercise, but it would be good to see all of that evidence collated and evaluated clearly.

And equally as clearly, more research is needed.


But the big question remains.

With so many people affected by cancer meditating, why no outcome studies?

Come on Cancer Council.
Breast Cancer Network.
You have the research funds. Lets find out just how beneficial to survival meditation may be ….

Many, many people would welcome and support that research.


Clinical Practice Guidelines on the Use of Integrative Therapies as Supportive Care in Patients Treated for Breast Cancer , Greenlee H et al. J Natl Cancer Inst Monogr 2014 (50): 346-358.

To read the full reference CLICK HERE

The Cancer Council, the survivors and the book


We head to New Zealand again this week to present the 8 day cancer self-help program Cancer, Healing and Wellbeing in the beautiful southern island town of Wanaka.

What an environment for healing!

For the next post, that will come in 10 days, I will report on this program and the one we have just completed at the Foundation, Cancer and Beyond.



Meditation and the Inner Journey        8th  – 12th  June     Yarra Valley

This retreat brings together 2 powerful experiences - the deep natural peace of meditation, and a gentle process of introspection that will help you reconnect with your own inner wisdom.

For thousands of years, people have removed themselves from the busyness of daily life and entered into a retreat situation to meditate. Come, join like-minded people, be inspired, be renewed. Immerse yourself in meditation.

Be guided, be nurtured. Take the opportunity to reconnect with your own inner wisdom and natural great peace.

FULL DETAILS  -  Click here

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