Integrative oncology therapy for adverse treatment effects in young women with breast cancer.
Authors: Warren Yancey , Hecksher Anna , Trufan Sally , Greiner Rebecca Sheaff , Yaguda Susan , Gentile Danielle , Bailey-Dorton Chasse Margot , Fisher Julie , Hadzikadic-Gusic Lejla 
Published: June 2021

e12504

Background: Breast cancer in young women portends a poorer prognosis and often results in more aggressive treatments, placing patients at a higher risk of adverse treatment effects. Small studies suggest that the use of integrative oncology (IO) as a complementary therapy during standard of care cancer treatment may help reduce adverse treatment effects, improve treatment compliance, and enhance patient well-being. However, the timing of therapies and usage patterns relative to standard treatment are unknown. We sought to offer young women with breast cancer a referral to IO physicians, describe timing of consultation, and identify recommended IO therapies. Methods: Retrospective review of women < 40 years with breast cancer from 2014-2019 in a young women’s breast cancer program at a large, single-institution, tertiary care center. Patients were referred to a fellowship-trained physician in the Department of IO who recommended various integrative therapies as adjunctive treatment to standard of care based on patient-reported concerns. Patient demographics, tumor characteristics, operative procedures, adjunctive medical treatments, reasons for seeking IO consultation, timing of consultation, and IO therapies were analyzed using descriptive statistics. Results: 64 young women (median age 39 years) received an IO consultation: 48 (75%) after starting standard care treatment, 16 (25%) before. Clinical stages Ia, IIa, or IIb, node negative, without metastatic disease were common. Hormone-positive, poorly differentiated, invasive ductal carcinoma was the most observed histology. 42 (65%) patients underwent mastectomy; 18 (29%) underwent breast conservation surgery. 91% of patients received chemotherapy as part of standard care; 70% of patients received chemotherapy prior to their IO consultation. Primary reasons women sought an integrative oncology consultation were cancer risk reduction (63%) and adverse treatment effects (54%). For the latter, patients reported vasomotor concerns (43%), insomnia (34%), weight gain/loss (29%), nutrition (25%), and gastrointestinal problems including chemotherapy-induced nausea/vomiting (20%). Recommended IO therapies were as follows: acupuncture (34%), massage (29%), and healing touch (28%). Conclusions: Breast cancer in young women tends to be more advanced and more aggressive; these patients are at a higher risk of adverse treatment effects. Our study suggests that young women who receive a consultation by an IO physician express concerns for adverse treatment effects and desire to decrease their future cancer risk. Although the extent to which IO therapies may effect a clinically relevant change in adverse effects or future cancer risk remains unknown, this study serves as preliminary data for more rigorous studies examining the optimal timing of IO therapies as well as specific therapies that may be associated with improved outcomes.