Breast cancer can severely disrupt patients’ quality of life, and adverse events from breast cancer treatment can significantly reduce quality of life. A systematic review analyzed the impact of treatment on the quality of life of older women with early-stage breast cancer. The article was published in the October 2010 issue of Drugs and Aging. The authors found that breast-conserving surgery improved patients’ quality of life more than mastectomy, and that the absence of anterior lymph node biopsy and axillary surgery improved short-term quality of life. Chemotherapy made patients’ quality of life much lower. However, although there are adverse events associated with each drug, usually aromatase inhibitors or tamoxifen do not reduce quality of life. In addition, a breast cancer diagnosis by itself does not significantly affect the overall emotional well-being of women with the disease. However, the side effects of breast cancer treatment are undeniable, and patients want to find ways to treat them. A new study now shows that 48%-80% of North American women with breast cancer use complementary and combination therapies to treat their breast cancer. The Society of Integrative Oncology (SIO) released its first clinical practice guideline on the combination treatment of breast cancer in November 2014, allowing specific therapies to be recommended as evidence-based supportive treatment options. The guidelines were published in the Journal of the National Cancer Institute Monographs. The full guideline: 2014 SIO Clinical Practice Guideline: Combination Therapy as Supportive Treatment for Patients with Breast Cancer Guideline Highlights ● Treatment recommendations were established by a multidisciplinary panel of experts. ● They prepared the above recommendations by analyzing randomized controlled trials published between 1990 and 2013. They did not look at treatments that had stronger levels of evidence, such as diet, exercise, and cognitive behavioral therapy. ● The researchers graded the strength of the level of evidence for each treatment. level A is high-level evidence that has the potential to help patients beat the disease, while B, C, and D are not as helpful as level A. level I indicates that there is not enough evidence for effectiveness, and level H means that the treatment is harmful. ● Treatment guidelines target the period of active treatment for breast cancer and the stage when side effects occur. For anxiety and stress during treatment, music therapy can be used for short-term symptom relief with a grade of B. Meditation therapy and stress management can appropriately reduce anxiety in the long term with a grade of B. Overall, long-term sustained antidepressant treatment is more effective. Acupuncture for anxiety with fatigue is rated C. ● Meditation, a stress relief based on positive thinking, can improve mood and relieve depression, rated A. Yoga and relaxation therapy can also improve mood and relieve depression during and after radiotherapy, rated A. ● Therapeutic touch can improve mood during chemotherapy, rated C. Acupuncture can relieve depression and hot flashes during chemotherapy, rated A. Acupuncture can relieve depression and hot flashes during chemotherapy with a grade of C. Qigong, acupuncture, and ginseng can relieve fatigue during and after treatment with a grade of C. Acetyl L-carnitine has a grade of D because it lacks evidence of effectiveness. ● Gentle yoga and stress control can help with sleep, with a grade of C. ● Meditation therapy can enhance overall quality of life during treatment, with the highest level of evidence (grade A). Imagery guidance, qigong, stress control, yoga, and acupuncture all contribute to relaxation, with a grade of C. Mistletoe is effective in enhancing short-term life treatment (grade C), but no studies have been reported on its long-term effectiveness or safety. ● Electroacupuncture and acupressure can relieve chemotherapy-induced nausea and vomiting, both with a grade of B. These methods have a higher strength of evidence for treating other cancers than breast cancer. ● Glutamine use during chemotherapy is ineffective in suppressing nausea and vomiting, grade D. ● No combination therapy for analgesia has an evidence grade above C. ● Acetyl L-carnitine exacerbates neuropathy in patients treated with zyrtecan chemotherapy, grade H. ● Electroacupuncture and acupressure are effective in preventing hot flashes, both grade B, but supplementation or consumption of soy isoflavones has no similar effect, grade D. ● Aloe vera gel and hyaluronic acid do not treat acute skin reactions due to radiotherapy, with a grade of evidence of D.