Clinical Practice Guidelines on the Use of Integrative Therapies as Supportive Care in Patients Treated for Breast Cancer
Clinical Practice Guidelines on the Use of Integrative Therapies as Supportive Care in Patients Treated for Breast Cancer
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DOI：
10.1093/jncimonographs/lgu041
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发表时间：
2014-11-01
期刊：
影响因子：
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通讯作者：
Tripathy, Debu
中科院分区：
文献类型：
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作者：
Greenlee, Heather;Balneaves, Lynda G.;Tripathy, Debu
背景：大多数乳腺癌患者在癌症治疗期间和治疗之外使用补充和/或综合治疗来控制症状、预防毒性反应和提高生活质量。需要实践指南来告知临床医生和患者安全有效的治疗方法。方法根据医学研究所的指南制定过程，系统回顾确定了随机对照试验，测试综合疗法在接受乳腺癌治疗的患者中的支持性护理的使用。如果大多数参与者患有乳腺癌和/或乳腺癌患者的结果单独报告，并且结果与临床相关，则包括试验。结果检索(1990年1月1日-2013年12月31日)共鉴定出4900篇文献，其中203篇符合分析条件。对于包括焦虑和情绪障碍(A级)在内的常见疾病，建议常规使用冥想、瑜伽和放松和想象。压力管理、瑜伽、按摩、音乐疗法、能量节约和冥想被推荐用于缓解压力、焦虑、抑郁、疲劳和生活质量(B级)。许多干预措施(n=32)的受益证据较弱(C级)。一些干预措施(n=7)被认为不太可能提供任何好处(D级)。值得注意的是，只有一种干预措施，用于预防紫杉烷诱导的神经病变的乙酰基-L-肉碱，被确定为可能有害的(H级)，因为它被发现增加了神经病变。大多数干预/模式组合(n=138)没有足够的证据来形成特定的建议(I级)。结论特定的综合治疗可以作为乳腺癌治疗期间的循证支持护理选择。大多数综合疗法需要通过设计良好的对照试验进行进一步研究，并取得有意义的结果。
Background The majority of breast cancer patients use complementary and/or integrative therapies during and beyond cancer treatment to manage symptoms, prevent toxicities, and improve quality of life. Practice guidelines are needed to inform clinicians and patients about safe and effective therapies.Methods Following the Institute of Medicine's guideline development process, a systematic review identified randomized controlled trials testing the use of integrative therapies for supportive care in patients receiving breast cancer treatment. Trials were included if the majority of participants had breast cancer and/or breast cancer patient results were reported separately, and outcomes were clinically relevant. Recommendations were organized by outcome and graded based upon a modified version of the US Preventive Services Task Force grading system.Results The search (January 1, 1990-December 31, 2013) identified 4900 articles, of which 203 were eligible for analysis. Meditation, yoga, and relaxation with imagery are recommended for routine use for common conditions, including anxiety and mood disorders (Grade A). Stress management, yoga, massage, music therapy, energy conservation, and meditation are recommended for stress reduction, anxiety, depression, fatigue, and quality of life (Grade B). Many interventions (n = 32) had weaker evidence of benefit (Grade C). Some interventions (n = 7) were deemed unlikely to provide any benefit (Grade D). Notably, only one intervention, acetyl-l-carnitine for the prevention of taxane-induced neuropathy, was identified as likely harmful (Grade H) as it was found to increase neuropathy. The majority of intervention/modality combinations (n = 138) did not have sufficient evidence to form specific recommendations (Grade I).Conclusions Specific integrative therapies can be recommended as evidence-based supportive care options during breast cancer treatment. Most integrative therapies require further investigation via well-designed controlled trials with meaningful outcomes.