The late effects of cancer are not only painful and debilitating in their own right, but also act as constant reminders of all we’ve endured. Shouldn’t we be moving forward after cancer and trying to put the whole experience behind us?
Sadly, it doesn’t always work out like that. There’s a wide and varied list of late effects, including anxiety, depression, PTSD, lymphedema, early menopause, insomnia, bowel disease, fatigue, teeth issues, loss of taste, chemo fog… to name a few.
What’s more, there’s very little research into what actually helps address these issues. Mainstream medicine might offer sleeping pills for insomnia, or some parts of the country (with shorter waiting lists!) might offer access to CBT for fatigue, but generally, there’s been limited clinical trials in this area with few interventions that actually help. After all, most of the research money goes on saving lives, rather than improving them.
So is it any wonder that we turn to complementary therapy in search of answers - a way to try to ease the pain and stress, and take control of our own health? Over in North America in 2012 it was estimated that 80% of breast cancer survivors explored some type of complementary therapy (found in the Women’s Healthy Eating and Living Study).
Complementary therapy – a holistic approach
Complementary therapy approaches health and illness holistically, through four areas: physical, psychosocial, emotional, and spiritual (study by Light, 1997). It is believed that “whole person” care should be applied to cancer patients, because their needs are “numerous, unique, multidimensional, interrelated, under explored, generally unmet, and require a holistic approach to be adequately met” (book by Haylock, 2010).
Sounds about right to me!
What is deemed ‘safe’?
Conventional medics seem to encourage exploration of complementary therapy, as long as it doesn’t make your late effects worse. The best advice (obvs) is to consult your GP before departing on any holistic wellness journey. If they give the go ahead, there’s little to lose beyond the hit to the wallet – most of these treatments aren’t available on the NHS. In terms of results, at the very worse there’s the hope that a placebo effect might help alleviate symptoms.
The most popular CAM therapies are acupuncture, reflexology, massage, biofield therapies – like reiki, qigong, yoga, deep breathing, and osteopathic treatment. I outline each therapy below, along with a quick research study or link to how they might help.
Acupuncture is a mind/ body therapy that involves needles being inserted into ‘specific acupoints that run along the body’s meridians.’ Electro-acupuncture needles might also be attached to a device that generates continuous electric pulses. The Cochrane review on how acupuncture might help depression isn’t exactly glowing, but perhaps it might help other issues.
And actually, some physio departments do offer acupuncture on the NHS to alleviate pain, so perhaps that’s something to explore?
Reflexology has been promoted in the western world for the last century. The therapy is based on the belief that the whole body is represented on the foot and internal organs can be stimulated by pressing particular parts of it. It is supposed to facilitate blood and lymph circulation, accelerate the excretion of waste; improve proper functioning of muscles, joints, and tendons; and improve relaxation. The good news is that it is free from side effects.
Massage is the most popular complementary therapy, involving the moving of soft tissue to promote healing. Techniques include kneading, stroking, rubbing, and tapping and it’s based on the belief that massage cleanses the body and improves tissue oxygenation.
The evidence for massage supporting cancer patients is promising but very limited. As this breast cancer meta analysis discovered, ‘our review shows that few rigorous trials have tested the effectiveness of massage for breast cancer care. (But) the evidence indicates that massage therapy is useful as a supportive measure for treating symptoms of breast cancer.’
This explores ‘energy medicine’ and is based on the belief that an energy field exists beyond the physical body and can be manipulated by another person! Practitioners sense energetic imbalances that exist when there’s disease or pain and ‘work to “unruffle” or “smooth” out the person’s energetic field.’ Types of biofield therapy include Qigong, Reiki, therapeutic touch, and healing touch.
Qigong for example, ‘can be performed internally (a person channels his or her own energy) or externally (a person interacts and balances another’s energy field)’. It also explores how ‘gentle movements integrate the mind and body… (and) balance a person’s energy, thereby improving overall well-being’.
There is evidence that biofield therapies reduces stress and increases relaxation in breast cancer survivors. This study explores how therapeutic touch increases relaxation – I wonder how the study might show similar results if exploring the therapeutic effect of a simple hug though?
Yoga is a mind and body therapy which includes physical postures, breath control, and meditation. There’s quite a bit of research into how yoga can have a positive impact on anxiety and depression.
If you don’t have the flexibility or strength to embrace a full yoga class, you can also explore chair yoga, or even bed yoga!
Like yoga, mindfulness has existed for thousands of years in an effort to quiet the mind and be present. It encourages you to live moment-to-moment, be present-centered, purposeful and non-judgmental. It guides participants to achieve greater awareness.
Some research suggests relaxation techniques might decrease the occurrence of menopausal hot flashes. Preliminary research on therapies such as deep breathing, guided imagery, meditation, muscle relaxation, and mindful stretching have supported not only claims of a decreased frequency of hot flashes but also claims of overall improved quality of life (a study by Fisher & Chervenak, 2012).
Osteopathic manipulative treatment
This therapy manipulates the body using various techniques such as high velocity low amplitude, muscle energy, myofacial release, craniofacial and lymphatic pumping or drainage. It is part of osteopathic medicine and delivered by osteopathic doctor. The ‘goal is to treat somatic dysfunction and facilitate physiological functioning.’
There is limited evidence of OMT interventions helping lymphedema, with one case study suggesting it is promising, though access to the full report isn’t available!
And this is the theme of all the research – you encounter the same repeated refrains. A small number of people are involved in the trials. Results are biased. And negative findings, i.e. if studies do not show evidence that an intervention has benefited patients, are frequently unreported, so we only ever hear about the positive stories.
The other issue is that many of these therapies are bloomin’ expensive and aren’t provided on the NHS. So, as a patient, what do you do?
If you’ve explored complementary therapies, let us know below. Did you find them helpful and if so, how?
Special thanks to Professor Ashley Hennegan and her paper on 'Complementary and Alternative Medicine
Therapies as Symptom Management Strategies for the Late Effects of Breast Cancer Treatment' which helped guide this post. All quotes come from this paper unless otherwise indicated.