Answer questions and earn CME/CNE Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. CA Cancer J Clin 2017;67:194-232. © 2017 American Cancer Society.

Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment.

The effect of guideline-consistent antiemetic therapy on chemotherapy-induced nausea and vomiting (CINV): the Pan European Emesis Registry (PEER)

Chemotherapy-induced nausea and vomiting (CINV) in cancer patients are common symptoms most feared by patients. The aim of this study was to analyze the impact of CINV associated to moderate/highly emetogenous chemotherapy regimens on patients’ quality of life (QoL). Open, multicenter, prospective observational study was performed. Each patient filled out a patient diary for each cycle from the day before chemotherapy and for the next 5 days that included the number of emetic episodes, the intensity of nausea, and QoL evaluation (functional living index-emesis questionnaire). Data from 202 consecutive patients from nine university hospitals were collected, but only data from 160 were analyzed (79.2 %). Most of the participants (70 %) were women with a mean age of 50 years (SD 1.2 years). The most frequent cancer site was breast (44 %) followed by lung (16 %) and 76.3 % were receiving highly emetogenous chemotherapy. Despite the use of antiemetic prophylaxis, patients experienced significant nausea and vomiting during 31 % (3.2 % during acute, 15.0 % during delayed phase, and 13.2 % during both phases) and 45.1 % (5.1 % only during the acute phase, 23.5 % only during the delayed phase and 16.5 % during both phases) of the cycles, respectively, having 44.5 % (nausea) and 39.3 % (emesis) of the cycles an impact on patients’ QoL. The results of the study confirm the detrimental effect of CINV on patients’ QoL despite the use of antiemetic prophylaxis (5HT3 receptor antagonist, steroids, and dopamine receptor antagonists). It is mandatory to intensify the detection of CINV in order to improve the management of these important, albeit frequent, side effects of cancer treatments.

Chemotherapy-induced nausea and vomiting in clinical practice: impact on patients’ quality of life

Goals of work
Certain patient and treatment characteristics are predictive of chemotherapy-induced nausea and vomiting (CINV). Objectives of this analysis were: (1) confirm the importance of several previously reported adverse risk factors for CINV in patients receiving chemotherapy, (2) assess the impact of the NK1 receptor antagonist aprepitant according to these risk factors, and (3) assess the impact of age on antiemetic outcome.

Evaluation of risk factors predictive of nausea and vomiting with current standard-of-care antiemetic treatment: analysis of two phase III trials of aprepitant in patients receiving cisplatin-based chemotherapy

https://www.jpsmjournal.com/article/S0885-3924(13)00397-7/pdf

Evaluation of risk factors predicting chemotherapy-related nausea and vomiting : results from a european prospective observational study

Despite advances in the prevention and treatment of emesis, nausea and vomiting are still considered by patients to be among the most severe and feared adverse effects of chemotherapy for breast cancer. There is, however, a paucity of prospective data documenting the prevalence and severity of emesis in patients with breast cancer in the era of modern antiemetics. This prospective multicenter study evaluated chemotherapy-induced nausea and vomiting (CINV) in patients with breast cancer. Patients were given a daily diary to record the frequency and severity of nausea and vomiting during the first 5 days following chemotherapy. Data were collected until either the cessation of chemotherapy or the administration of a maximum of 6 cycles of treatment. Data are available from 143 patients who received a total of 766 cycles of chemotherapy. Prevalence rates of any nausea or any vomiting were, respectively, 37% and 13% at 24 hours and 70% and 15% during days 2-5. Severe emesis was reported by fewer than 10% of patients. Risk factors associated with CINV included age younger than 40 years, nausea expectation, not eating before treatment, and low alcohol use. The prevalence of severe CINV for breast cancer was relatively low compared with the prevalence reported in the literature. As a result of the observational design of this study, the results may better reflect the "true" prevalence of nausea and vomiting than do estimates from previously reported randomized controlled trials. Several patient characteristics that predict which patients are at increased risk of developing severe symptoms were identified.

Chemotherapy-induced nausea and vomiting in breast cancer patients: a prospective observational study.

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Chemotherapy-induced nausea and vomiting in breast cancer patients: a prospective observational study.