Position Paper| Volume 42, ISSUE 12, P1702-1710, August 2006

Role of complementary and alternative medicine in the care of patients with breast cancer: Report of the European Society of Mastology (EUSOMA) Workshop, Florence, Italy, December 2004


      The aim of the European Society of Mastology (EUSOMA) Workshop, Florence, Italy, December 2004, was to produce guidelines on the use of complementary and alternative medicine (CAM) for breast cancer. The widespread use of CAM has to be acknowledged and the reasons for this understood. Deficiencies in the practice of conventional medicine that lead to the adoption of CAM need to be addressed. At the same time, CAM use for breast cancer should be quality controlled, avoiding double standards in evaluation, whilst recognising the problems of CAM research. These guidelines, which appear in an accompanying paper, aim to help oncologists and cancer patients alike.


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        • McGrath P.
        Creating a language for ‘spiritual pain’ through research: a beginning.
        Support Care Cancer. 2002; 10: 637-646
        • Tatsumura Y.
        • Maskarinec G.
        • Shumay D.M.
        • Kakai H.
        Religious and spiritual resources, CAM, and conventional treatment in the lives of cancer patients.
        Altern Ther Health Med. 2003; 9: 64-71
        • Newell S.A.
        • Sanson-Fisher R.W.
        • Savolainen N.J.
        Systematic review of psychological therapies for cancer patients: overview and recommendations for future research.
        J Natl Cancer Inst. 2002; 94: 558-584
        • Peto R.
        • Boreham J.
        • Clarke M.
        • Davies C.
        • Beral V.
        UK and USA breast cancer deaths down 25% in year 2000 at ages 20–69 years.
        Lancet. 2000; 355: 1822
        • Humphrys J.
        Lost for words. The mangling and manipulating of the English language. Hodder & Stoughton, London2004
      1. Shorter Oxford English dictionary, third ed. Oxford: Oxford University Press; 1944.

        • Koestler A.
        Janus: a summing up.
        Picador, London1978
        • Turner-Cobb J.
        • Sephton S.E.
        • Speigel D.
        Psycho-social effect on immune function and disease progression in cancer: human studies.
        in: Ader C. Felton D. Cohen C. Psychoneuroimmunology. Academic Press, New York2001
      2. American Cancer Society I. An overview of complementary and alternative therapies. Available from:

      3. Cochrane Complementary Medicine Field CAM definition. 2004. Available from:

      4. Horneber MA, Büschel G, Less DB, Ritter E, Dennert G. The prevalence of unconventional methods in cancer patients: a systematic review. 2006 (in press).

        • Labriola D.
        • Livingston R.
        Possible interactions between dietary antioxidants and chemotherapy.
        Oncology (Huntingt). 1999; 13 (see comments): 1003-1008
        • McCune J.S.
        • Hatfield A.J.
        • Blackburn A.A.
        • Leith P.O.
        • Livingston R.B.
        • Ellis G.K.
        Potential of chemotherapy-herb interactions in adult cancer patients.
        Support Care Cancer. 2004; 12: 454-462
        • Sparreboom A.
        • Cox M.C.
        • Acharya M.R.
        • Figg W.D.
        Herbal remedies in the United States: potential adverse interactions with anticancer agents.
        J Clin Oncol. 2004; 22: 2489-2503
        • Werneke U.
        • Earl J.
        • Seydel C.
        • Horn O.
        • Crichton P.
        • Fannon D.
        Potential health risks of complementary alternative medicines in cancer patients.
        Br J Cancer. 2004; 90: 408-413
        • Mills E.
        • Ernst E.
        • Singh R.
        • Ross C.
        • Wilson K.
        Health food store recommendations: implications for breast cancer patients.
        Breast Cancer Res. 2003; 5: R170-R174
        • Kumar N.B.
        • Hopkins K.
        • Allen K.
        • Riccardi D.
        • Besterman-Dahan K.
        • Moyers S.
        Use of complementary/integrative nutritional therapies during cancer treatment: implications in clinical practice.
        Cancer Control. 2002; 9: 236-243
        • Izzo A.A.
        • Ernst E.
        Interactions between herbal medicines and prescribed drugs: a systematic review.
        Drugs. 2001; 61: 2163-2175
        • Balneaves L.G.
        • Kristjanson L.J.
        • Tataryn D.
        Beyond convention: describing complementary therapy use by women living with breast cancer.
        Patient Educ Couns. 1999; 38: 143-153
        • Tasaki K.
        • Maskarinec G.
        • Shumay D.M.
        • Tatsumura Y.
        • Kakai H.
        Communication between physicians and cancer patients about complementary and alternative medicine: exploring patients’ perspectives.
        Psycho Oncology. 2002; 11: 212-220
        • Söllner W.
        • Maislinger S.
        • Kappauf H.
        How to improve communication between physicians and cancer patients about use of complementary and alternative medicine?.
        Psycho Oncology. 2003; 12: 203-204
        • Horneber M.
        • Büschel G.
        • Kaiser G.
        • Kappauf H.
        • Wilhelm M.
        • Gallmeier W.M.
        Unkonventionelle Verfahren – Chancen für die Arzt-Patient-Beziehung (Unconventional methods. Chances for the physician-patient relationship).
        Onkologe. 2003; 9: 1335-1342
        • Weiger W.A.
        • Smith M.
        • Boon H.
        • Richardson M.A.
        • Kaptchuk T.J.
        • Eisenberg D.M.
        Advising patients who seek complementary and alternative medical therapies for cancer.
        Ann Intern Med. 2002; 137: 889-903
        • Horneber M.A.
        • Büschel G.
        • Kappauf H.
        • Kaiser G.
        • Gallmeier W.M.
        Advising inquirers about unconventional cancer therapies.
        Onkologie. 1999; 22: 238
        • Shilling V.
        • Jenkins V.
        • Fallowfield L.
        Factors affecting patient and clinician satisfaction with the clinical consulation: can communication skills training for clinicians improve satisfaction?.
        Psycho Oncology. 2003; 12: 599-611
        • Fallowfield L.
        • Jenkins V.
        • Farewell V.
        • Solis-Trapala I.
        Enduring impact of communication skills training: results of a 12-month follow-up.
        Br J Cancer. 2003; 89: 1445-1449
        • Priestman T.J.
        • Baum M.
        Evaluation of quality of life in patients receiving treatment for advanced breast cancer.
        Lancet. 1976; 1: 899-900
        • Münstedt K.
        • Entezami A.
        • Wartenberg A.
        • Kullmer U.
        The attitudes of physicians and oncologists towards unconventional cancer therapies (UCT).
        Eur J Cancer. 2000; 36: 2090-2095
        • Rose A.
        A comparison of conventional and alternative practitioners’ views of the communication process in cancer care.
        Psycho Oncology. 1999; 8: 11
        • Gray R.E.
        • Greenberg M.
        • Fitch M.
        • et al.
        A strategy for informing patients and health professionals about unconventional cancer therapies.
        J Cancer Educ. 1998; 13: 31-38
        • Sirois F.M.
        Treatment seeking and experience with complementary/alternative medicine: a continuum of choice.
        J Altern Complement Med. 2002; 8: 127-134
        • Sirois F.M.
        • Gick M.L.
        An investigation of the health beliefs and motivations of complementary medicine clients.
        Soc Sci Med. 2002; 55: 1025-1037
        • Ritvo P.
        • Irvine J.
        • Katz J.
        • Matthew A.
        • Sacamano J.
        • Shaw B.F.
        The patient’s motivation in seeking complementary therapies.
        Patient Educ Couns. 1999; 38: 161-165
        • Truant T.
        • Bottorff J.L.
        Decision making related to complementary therapies: a process of regaining control.
        Patient Educ Couns. 1999; 38: 131-142
        • Brown P.J.
        • Carney P.A.
        Health beliefs and alternative medicine: a qualitative study of breast cancer patients.
        J Cancer Educ. 1996; 11: 226-229
        • Vincent C.
        • Furnham A.
        Why do patients turn to complementary medicine? An empirical study.
        Br J Clin Psychol. 1996; 35: 37-48
        • Daugherty C.K.
        • Fitchett G.
        • Murphy P.E.
        • et al.
        Trusting God and medicine: spirituality in advanced cancer patients volunteering for clinical trials of experimental agents.
        Psychooncology. 2005; 14: 135-146
        • de Moulin D.
        A short history of breast cancer.
        Springer, Dordrecht1989
        • Lewison E.F.
        Spontaneous regression of breast cancer.
        Natl Cancer Inst Monogr. 1976; 44: 23-26
        • Ross M.B.
        • Buzdar A.U.
        • Hortobagyi G.N.
        • Lukeman J.M.
        Spontaneous regression of breast carcinoma: follow-up report and literature review.
        J Surg Oncol. 1982; 19: 22-24
        • Brady M.J.
        • Peterman A.H.
        • Fitchett G.
        • Cella D.
        The expanded version of the Functional Assessment of Chronic Illness Therapy – Spiritual Well-Being Scale (FACIT-Sp-Ex): Initial report of psychometric properties.
        Ann Behav Med. 1999; 21: 129
        • Steer C.J.
        • Lee C.
        Addressing spiritual care: calling for help.
        J Clin Oncol. 2004; 22: 4856-4858
        • Sollner W.
        • DeVries A.
        • Steixner E.
        • et al.
        How successful are oncologists in identifying patient distress, perceived social support, and need for psychosocial counselling?.
        Br J Cancer. 2001; 84: 179-185
        • Matthews D.A.
        • McCullough M.E.
        • Larson D.B.
        • Koenig H.G.
        • Swyers J.P.
        • Milano M.G.
        Religious commitment and health status: a review of the research and implications for family medicine.
        Arch Fam Med. 1998; 7: 118-124
      5. The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med 1995;41(10):1403–1409.

        • Canter P.H.
        • Thompson Coon J.
        • Ernst E.
        Cost effectiveness of complementary treatments in the United Kingdom: systematic review.
        Br Med J. 2005; 331: 880-881
      6. Ernst E, Schmidt K, Baum M. Complementary/alternative therapies for the treatment of breast cancer. A systematic review of randomised clinical trials and critique of current terminology. 2005 (in press).

        • Rainer H.
        • Moser K.
        • Bettelheim P.
        [Randomized study: chemotherapy versus chemotherapy plus transfer factor in metastasized breast neoplasm].
        Verh Dtsch Ges Inn Med. 1978; 84: 604-606
        • Ost B.
        Remissionserhaltung nicht-metastasierter Mammakarzinome unter Factor AF2.
        Dtsch Zschr Onkol. 1989; 21: 102-104
        • Spiegel D.
        • Kraemer H.C.
        • Bloom J.R.
        • Gottheil E.
        Effect of Psychosocial Treatment on Survival of Patients with Metastatic Breast Cancer.
        Lancet. 1989; 14: 888-891
        • Adachi I.
        Supporting therapy with Shi Quan Da Bu Tang in advanced breast cancer patients.
        Biomed Res. 1990; 11: 25-32
        • Pavesi L.
        Fluorouracil (F), with and without high-dose folinic acid (HDFA) plus Epirubicin (E) and Cyclophosphamide (C): FEC versus HDFA-FEC plus or minus Thymostimulin (TS) in metastatic breast cancer: results of a multicenter study.
        Eur J Cancer. 1993; 29 A: S77
        • Lissoni P.
        • Barni S.
        • Tancini G.
        • et al.
        A randomised study with subcutaneous low-dose interleukin 2 alone vs interleukin 2 plus the pineal neurohormone melatonin in advanced solid neoplasms other than renal cancer and melanoma.
        Br J Cancer. 1994; 69: 196-199
        • Ilnyckyj A.
        • Farber J.
        • Cheang M.C.
        • Weinerman B.H.
        A randomised controlled trial of psychotherapeutic intervention in cancer patients.
        Ann RCPSC. 1994; 27: 93-96
        • Cunningham A.J.
        • Edmonds C.V.
        • Jenkins G.P.
        • Pollack H.
        • Lockwood G.A.
        • Warr D.
        A randomized controlled trial of the effects of group psychological therapy on survival in women with metastatic breast cancer.
        Psycho Oncology. 1998; 7: 508-517
        • Edelman S.
        • Lemon J.
        • Bell D.R.
        • Kidman A.D.
        Effects of group CBT on the survival time of patients with metastatic breast cancer.
        Psychooncology. 1999; 8: 474-481
        • Lissoni P.
        • Barni S.
        • Mandala M.
        • et al.
        Decreased toxicity and increased efficacy of cancer chemotherapy using the pineal hormone melatonin in metastatic solid tumour patients with poor clinical status.
        Eur J Cancer. 1999; 35: 1688-1692
        • Walker L.G.
        • Walker M.B.
        • Ogston K.
        • et al.
        Psychological, clinical and pathological effects of relaxation training and guided imagery during primary chemotherapy.
        Br J Cancer. 1999; 80: 262-268
        • Goodwin P.J.
        • Leszcz M.
        • Ennis M.
        • et al.
        The effect of group psychosocial support on survival in metastatic breast cancer.
        N Engl J Med. 2001; 345: 1719-1726
        • Kissane D.W.
        • Love A.
        • Hatton A.
        • et al.
        Effect of cognitive-existential group therapy on survival in early-stage breast cancer.
        J Clin Oncol. 2004; 22: 4255-4260
        • Jadad A.R.
        • Moore R.A.
        • Carroll D.
        • et al.
        Assessing the quality of reports of randomized clinical trials: is blinding necessary?.
        Control Clin Trials. 1996; 17: 1-12
        • Vickers A.J.
        Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials.
        J R Soc Med. 1996; 89: 303-311
        • Molassiotis A.
        • Yung H.P.
        • Yam B.M.
        • Chan F.Y.
        • Mok T.S.
        The effectiveness of progressive muscle relaxation training in managing chemotherapy-induced nausea and vomiting in Chinese breast cancer patients: a randomised controlled trial.
        Support Care Cancer. 2002; 10: 237-246
        • Wong R.K.
        • Jones G.W.
        • Sagar S.M.
        • Babjak A.F.
        • Whelan T.
        A Phase I–II study in the use of acupuncture-like transcutaneous nerve stimulation in the treatment of radiation-induced xerostomia in head-and-neck cancer patients treated with radical radiotherapy.
        Int J Radiat Oncol Biol Phys. 2003; 57: 472-480
        • Wilkinson S.
        • Aldridge J.
        • Salmon I.
        • Cain E.
        • Wilson B.
        An evaluation of aromatherapy massage in palliative care.
        Palliat Med. 1999; 13: 409-417
        • Hadfield N.
        The role of aromatherapy massage in reducing anxiety in patients with malignant brain tumours.
        Int J Palliat Nurs. 2001; 7: 279-285
        • Roffe L.
        • Schmidt K.
        • Ernst E.
        A systematic review of guided imagery as an adjuvant cancer therapy.
        Psychooncology. 2005; 14: 607-617
        • Ernst E.
        • Eisenburg D.
        • Pittler M.
        The desktop guide to complementary and alternative medicine an evidence-based approach.
        C.V. Mosby, Edinburgh2001
        • Yoo H.J.
        • Ahn S.H.
        • Kim S.B.
        • Kim W.K.
        • Han O.S.
        Efficacy of progressive muscle relaxation training and guided imagery in reducing chemotherapy side effects in patients with breast cancer and in improving their quality of life.
        Support Care Cancer. 2005; 13: 826-833
        • Mock V.
        • Frangakis C.
        • Davidson N.E.
        • et al.
        Exercise manages fatigue during breast cancer treatment: A randomized controlled trial.
        Psychooncology. 2005; 14: 464-477
        • Pommier P.
        • Gomez F.
        • Sunyach M.P.
        • D’Hombres A.
        • Carrie C.
        • Montbarbon X.
        Phase III randomized trial of Calendula officinalis compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer.
        J Clin Oncol. 2004; 22: 1447-1453
        • Semiglasov V.F.
        • Stepula V.V.
        • Dudov A.
        • Lehmacher W.
        • Mengs U.
        The standardised mistletoe extract PS76A2 improves QoL in patients with breast cancer receiving adjuvant CMF chemotherapy: a randomised, placebo-controlled, double-blind, multicentre clinical trial.
        Anticancer Res. 2004; 24: 1293-1302