“Up to 60 percent of cancer patients and survivors try at least one type of integrative medical approach for cancer care, whether they tell their doctors or not,” says Heather Greenlee, ND, PhD, MPH, an associate professor at the Fred Hutchinson Cancer Center in Seattle, and co-chair of the SIO Clinical Practice Guideline Committee. “Having this report now presents clear guidelines for them.” The practice guidelines, issued by the Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO), were published in the September 19, 2022, issue of the Journal of Clinical Oncology. The recommendations acknowledge the growing popularity of nondrug approaches to cancer pain management, as well as the established dangers of opioid pain relievers, which in the United States claimed 75,673 overdose victims in the 12 months preceding April 2021, up from 56,064 a year earlier, according to the Centers for Disease Control and Prevention (CDC). The experts who wrote the guidelines found reasonably strong evidence that acupuncture “should be offered” to help dampen joint pain caused by aromatase inhibitors used for some breast cancers. Based on well-designed studies, they also advised that acupuncture, acupressure (pressure targeting specific bodily points), and reflexology (a form of foot massage) “may be offered” to people experiencing cancer-related general or musculoskeletal pain. They deemed hypnosis appropriate for people experiencing pain from diagnostic or treatment procedures. Therapeutic massage is listed as an option for cancer patients experiencing pain during palliative or hospice care and, to a lesser extent, in alleviating chronic pain after breast cancer treatment. The report notes that other complementary pain-relief strategies, including yoga, music therapy, guided imagery with progressive muscle relaxation, and certain nutrients or supplements, haven’t been adequately studied to yield reliable effectiveness data. “Cancer is a very expensive disease that can even bankrupt some people,” says Jun J. Mao, MD, chief of integrative medicine at Memorial Sloan Kettering Cancer Center in New York City and the SIO chair of the joint effort. “It’s our hope that where the evidence is clear, these guidelines will allow patients from all socio-economic levels to access these therapies as part of their comprehensive pain management.” The new recommendations may also encourage healthcare systems to hire more practitioners of complementary pain management, says Dr. Mao’s co-chair for ASCO, Eduardo Bruera, MD, who heads the palliative, rehabilitation, and integrative medicine department at The University of Texas MD Anderson Cancer Center in Houston.
