ASOI:::Association for Integrative Oncology

Evidence-based Therapies

	Nutritional Supplements, Herbs and Vitamins A nutritional supplement (also called dietary supplement) is a product that contains vitamins, minerals, herbs or other botanicals, amino acids, enzymes, and/or other ingredients intended to supplement the diet. Although these are usually products of natural origin, they are not always innocuous. In fact, many of them can interfere with specific cancer treatments such as chemotherapy. Hence the importance of integrative oncology in assuring the rational, responsible and effective use of these products.
	Mind-Body Techniques (Mind-Body Medicine) The mind-body approach and its techniques can transform the meaning of cancer and mitigate the stress it brings. The use of these techniques reduces psychological vulnerability to stress and its physiological consequences. Awareness of the mind-body connection is a fundamental tool to help patients cope with cancer-related or treatment-related psychological and emotional stress. These mind-body techniques, such as meditation and yoga, imagery, tai-chi, as well as hypnosis, self-expression, and exercise, provide specific psychological and physiologic benefits, that is, improvements in sleep and mood; alleviation of pain; a decrease in stress hormones; and improvement in immunity. Each time patients feel the benefit of a technique they are using, they reinforce a sense of control over their own lives and counter feelings of hopelessness and helplessness. 1 *Meditation* focuses attention on increasing mental awareness and clarity of mind (concentrative meditation) or opens attention to whatever goes through the mind and to the flow of sensations experienced from moment to moment (mindfulness meditation), thus the patients are able to observe what happens in a clearer and more adaptive way. Meditation is today one of the complementary medicines most widely used given its well-known physical, psychological and emotional benefits, and the absence of adverse effects. 2 *Tai chi* incorporates in its practice physical movement, breath control, and meditation. It has been associated with increased aerobic capacity, muscular strength and flexibility, and improved quality of life.
	Music Therapy Music therapy employs music to produce psychological, physiologic, and social changes in people undergoing cancer treatment. The form that music therapy takes depends on the individual and the circumstances. A music therapist undergoes specialized, rigorous training in using music as a therapeutic tool. Because music therapy is geared to the patient’s situation and experience with music, the therapy can vary from listening to music to actively creating music with instruments, talking about music, and lyric writing, among others. Several quantitative studies have established the impact of music on pain reduction, anxiety and nausea. Music therapy has also been successful in mitigating mood and side effects of treatment.
	Manipulative and Body-Based Practices (Medical massage) The many types of body-based practices share in the manipulation or movement of parts of the body to achieve health benefits. Massage therapists apply pressure to muscle and connective tissue to reduce tension and pain, improve circulation an encourage relaxation. Massage modalities most commonly used in oncology include Swedish massage, aromatherapy massage, reflexology, and acupressure. All involve manual manipulation of soft tissues of the body for the purpose of enhancing well-being. Massage therapy helps relieve symptoms commonly experienced by cancer patients. It reduces anxiety and pain, as well as fatigue and distres.
	Exercise and Physical Activity Regular physical activity and exercise improve quality of life, physical functioning, and emotional well-being and relieve fatigue. Health-related benefits include cardiovascular fitness, muscular strength, body composition, and physical functioning. The benefits of exercise in cancer patients are well-known, especially during cancer treatment.
	Energy Therapies Energy therapies are based on a theory that manipulation of a patient’s “bioenergy” has therapeutic value. These therapies exert their effects through light touch, mind-body interaction, or positive expectation. Therapies that are intended to work exclusively with biofields, such as Reiki, Therapeutic Touch, are known to be safe, but there is limited evidence for efficacy. The relationship with the energy therapist may alleviate stress, enhance relaxation, and enable a sense of protection or feeling safe. Some limited clinical trials show that these interventions can improve symptoms, quality of life, and a sense of control and hope. The most common effects are relaxation and calm .
	Acupunture Acupuncture is a therapeutic modality originating from traditional Chinese medicine. It is theoretically based on the regulation of the flow of “qi” (vital energy) by stimulation with needles, heat or pressure on certain points of the body (acupressure). Acupuncture can relieve both acute (e.g., postoperative dental pain) and chronic (e.g., headache) pain, the most common and best studied indications for its use. Acupuncture is recommended as a complementary therapy when pain is poorly controlled, when the side effects from other modalities are clinically significant, when chemotherapy-induced nausea and vomiting are poorly controlled, or when reducing the amount of pain medicine becomes a clinical goal.