A Model of an Integrative Approach to Breast Cancer Patients

Abstract

Background: Breast cancer (BC) survivors have physical and psychological needs that require convincing responses by health care providers. The quality of life issue and clinical unmet needs are among the main reasons pushing a number of patients toward “natural” therapies that are often misleading and alternative to mainstream cancer care. Integrative Oncology (IO) tries to respond to many of those needs, by combining lifestyle counseling, body-mind activities, and complementary evidence-informed therapies with anticancer standard treatments. Methods: In our model at Fondazione Policlinico Gemelli (FPG), every woman diagnosed with a BC waiting for surgery or candidate to neoadjuvant chemotherapy undergoes a preliminary psycho-oncological distress evaluation and a brief lifestyle interview. Anthropometric measurements, body composition analysis, and individual levels of physical activity are recorded. Patients are given evidence based recommendations about the advisable diet and physical activity in a prehabilitation setting. A physician provides patients with information about integrative care plans to treat symptoms related to the disease or its treatments. Therapeutic approaches include acupuncture, mindfulness-based protocols, qigong, massage therapy, and classes of music/art therapy. Results: Between September 2018 and February 2020, the Center for Integrative Oncology at FPG has carried out 1249 lifestyle counseling sessions, 1780 acupuncture treatments, 1340 physiotherapy sessions, 3261 psycho-oncological consultations, 218 herbal medicine counseling sessions. Moreover, 90 BC patients completed the mindfulness based stress reduction (MBSR) protocol and 970 patients participated in qigong, art therapy, and music therapy classes. Conclusions: Our integrative approach aims to achieve a person-centered medicine by improving symptoms management, adherence to oncological protocols, and eventually overall quality of life.

Impact of acupuncture and integrative therapies on chemotherapy‐induced peripheral neuropathy: A multicentered, randomized controlled trial

“…The present study examined two CIM intervention groups, treated with either acupuncture alone (group A) or a multimodal regimen combining acupuncture with other CIM therapies (group B). Although others, such as Bao et al, 29,30 compared true vs placebo/sham acupuncture for CIPN‐related symptoms, the present study compared two true interventions, an approach more reflective of real‐life clinical IO practice 31,32 . Although the findings do not suggest a significant difference between the two intervention subgroups, several differences are worth noting.…”

“…Although others, such as Bao et al, 29,30 compared true vs placebo/sham acupuncture for CIPN-related symptoms, the present study compared two true interventions, an approach more reflective of real-life clinical IO practice. 31,32 Although the findings do not suggest a significant difference between the two intervention subgroups, several differences are worth noting. In group A, for example, a greater improvement was found with the TaxS subscale, most specifically for "feeling discomfort in Cancer October 15, 2022 the feet" at 6 weeks.…”

Feasibility study of a multimodal prehabilitation programme in women receiving neoadjuvant therapy for breast cancer in a major cancer hospital: a protocol

“…Benefits of neoadjuvant therapy include downstaging to potentially allow less extensive surgery in the breast and/or axilla, as well as permitting evaluation of response to guide the choice of adjuvant therapies and for prognostication. However, side effects include fatigue, cardiotoxicity, neurotoxicity, anxiety, insomnia, vasomotor symptoms, gastrointestinal disturbance as well as a raft of immune-related AEs, which may impact treatment tolerance, long-term outcomes and quality of life 3–7. Providing early supportive care prior to surgery (typically termed ‘prehabilitation’) may mitigate these side effects and improve quality of life 8…”

Effect of music therapy combined with aerobic exercise on sleep quality among breast cancer patients undergoing chemotherapy after a radical mastectomy: A randomized controlled trial

“…Because cancer survivors generally face various cancer-related complications that are in uenced by a number of factors, the combination of different therapy approaches is gaining interest [19]. It was found that music therapy combined with other rehabilitation strategies is an effective modality for improving physiological stability, and aerobic exercise combined with music therapy is more effective in improving depression and general discomfort in individuals with bromyalgia than aerobic exercise along [20].…”