Therapies in Symptom
Management for Breast Cancer Survivors
Anne H. Blaes,
Mary Jo Kreitzer,
and Tuﬁa Haddad
The request and use of nonpharmacologic interventions and complementary and alternative
medicine (CAM) in cancer survivors is increasing. Given the large number of breast cancer
survivors and the multiple treatment-related symptoms they endure, it is important for physicians
to be aware of the evidence supporting nonpharmacologic therapies. Several studies evaluating
such interventions have demonstrated improved overall quality of life (QOL). For other symptoms,
the literature is limited but growing. We summarize the evidence to support complementary and
alternative therapies for the major symptoms in breast cancer survivors.
Semin Oncol 38:394-402 © 2011 Elsevier Inc. All rights reserved.
n 2005, the Institute of Medicine stated there were
more than 10 million cancer survivors with roughly
one in 30 being a breast cancer survivor. For breast
cancer, between 1996 and 2006, the US incidence
increased 19% and the breast cancer–speciﬁc mortality
As a result, the number of breast
cancer survivors is increasing, and represents more
than 40% of all female cancer survivors.
Many breast cancer survivors endure a multitude of
symptoms after treatment. These symptoms and late
effects from therapy may include fatigue, hot ﬂashes,
insomnia, musculoskeletal disturbances, neurocogni-
tive changes, neuropathy, weight gain, sexual dysfunc-
tion, and anxiety and depression (Table 1). In the
Women’s Healthy Eating and Living Study, breast can-
cer survivors treated between 1995 and 2000 com-
pleted a survey about complementary and alternative
medicines (CAM) to improve symptom and quality of
life (QOL) measures. Of 2,527 individuals, 2,017 (80%)
reported use of CAM.
The highest disclosure rates
were for naturopathy (85%), homeopathy (74%), acu-
puncture (71%). and chiropractic medicine (47%). In
another study in 1,904 cancer survivors, 40% reported
using CAM within the prior year. Of the CAM therapies,
64% used prayer for healing. Compared to the general
population, cancer survivors were 36% more likely to
have used CAM. These results were conﬁrmed in both
recent and long term (Ͼ10 years) cancer survivors.
Often, cancer survivors do not disclose this information
to their physicians.
With the high use of CAM therapies, there is a need
to better understand what CAM therapies are available,
and the evidence to support their use. Dietary modiﬁ-
cations and physical activity are key components in the
overall health of breast cancer survivors. This report
summarizes the evidence to support CAM therapies for
the major symptoms, including hot ﬂashes, fatigue,
arthralgias, neuropathy, insomnia, cognitive deﬁcits, and
QOL (Table 2).
Hot ﬂashes are extremely common and can cause
signiﬁcant physical and emotional distress. There are
several reasons for the high frequency.
diagnosed with breast cancer are postmenopausal and
some abruptly discontinue hormone replacement ther-
apy at diagnosis. Chemotherapy-induced ovarian dys-
function and therapeutic ovarian suppression or oo-
phorectomy may induce premature menopause. These
vasomotor symptoms are also common side effects of
endocrine therapy with tamoxifen or an aromatase
inhibitor (AI). The frequency and intensity of hot
ﬂashes is greater than those experienced by healthy
women during spontaneous menopause, and contrib-
Department of Medicine, Division of Hematology/Oncology/Transplan-
tation, University of Minnesota, Minneapolis, MN.
Center for Spirituality and Healing, University of Minnesota, Minneap-
Department of Family Medicine and Community Health, University of
Minnesota, Minneapolis, MN.
Financial disclosures: none.
Address correspondence to Tuﬁa Haddad, MD, University of Minnesota,
420 Delaware St, SE, MMC 480, Minneapolis, MN 55455. E-mail:
0270-9295/ - see front matter
© 2011 Elsevier Inc. All rights reserved.
Seminars in Oncology, Vol 38, No 3, June 2011, pp 394-402