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Clinical practice guidelines for professionals

American Cancer Society/American Society of Clinical Oncology

Breast Cancer Survivorship Care Guideline ›

Cancer Australia

Guidance for the management of early breast cancer: recommendations and practice points ›

Management of menopausal symptoms in women with a history of breast cancer ›

National Comprehensive Cancer Network

Professional Guidelines ›

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North American Menopause Society and the International Society for the Study of Women’s Sexual Health

Management of genitourinary syndrome of menopause in women with or at high risk for breast cancer: consensus recommendations ›

Society for Integrative Oncology

Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment (2017) ›

This set of guidelines has been endorsed by the American Society of Clinical Oncology (ASCO).1Lyman GH, Greenlee H et al. Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. Journal of Clinical Oncology. 2018 Sep 1;36(25):2647-2655.

Reducing risk of complications with surgery

Some practices may reduce risk of complications. First, assess all choices and optimize risk factors, including patient characteristics and their status of adjuvant therapy, such as radiotherapy and chemotherapy.2Ooi A, Song DH. Reducing infection risk in implant-based breast-reconstruction surgery: challenges and solutions. Breast Cancer: Targets and Therapies. 2016 Sep 1;8:161-72. Because half of infections occur more than 30 days after a procedure, implement a plan for follow-up care, including appointments and phone calls.

Reduce suppression of the immune system induced by surgery and anesthesia:3Cho JS, Lee MH et al. The effects of perioperative anesthesia and analgesia on immune function in patients undergoing breast cancer resection: a prospective randomized study. International Journal of Medical Sciences. 2017 Aug 18;14(10):970-976.

  • Use regional anesthesia and IV propofol as the primary anesthetic when possible
  • Provide adequate pain control throughout the surgical experience while minimizing the use of opioids such as morphine, oxycodone, or codeine.
  • Avoid or minimize the need for opioids during or after surgery by using an intravenous propacetamol and anti-inflammatories such as ketorolac while in the hospital and then using oral anti-inflammatories such as ibuprofen or naproxen after discharge.
  • Avoid hypothermia by maintaining core body temperature devices such as fluid warmers and external body warmers.

National and regulatory guidelines recommend that patients eligible for reconstruction be counseled on the association of breast implants with subsequent anaplastic large cell lymphoma (ALCL) as part of routine informed consent.4Nationally Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology. breast cancer. June 18, 2022. Viewed December 9, 2022; Food and Drug Administration. Breast implants—certain labeling recommendations to improve patient communication. September 2020. Viewed December 9, 2022. A very large observational study found that “although the relative risk [ALCL] is significantly increased, the absolute risk remains extremely low.” The study found excess risk at 11.6 cases per million persons per year.5Kinslow CJ, DeStephano DM et al. Risk of anaplastic large cell lymphoma following postmastectomy implant reconstruction in women with breast cancer and ductal carcinoma in situ. JAMA Network Open. 2022 Nov 1;5(11):e2243396.

Finally, remove catheters and drains as soon as possible, and use antibiotic prophylaxis.

Helpful links on reducing risk of surgical infection

Racial disparities in breast cancer

Residual tumors from Black patients with estrogen receptor–positive/HER2-negative primary breast cancer treated with neoadjuvant chemotherapy had a higher risk score associated with a biomarker of distant metastatic recurrence compared with tumors from White patients in a mid-sized observational study.6ASCO Post Staff. Study finds racial disparity in prometastatic tumor microenvironment among patients with residual breast cancer after neoadjuvant chemotherapy. ASCO Post. December 6, 2022. Viewed December 9, 2022.

Helpful links for professionals

The Breast Cancer Companion: A Complementary Care Manual: Third Edition (2016) ›

This is an excellent guide for oncology naturopaths caring for people with breast cancer. Dr. Barbara MacDonald provides guidance on natural approaches to consider across the spectrum of breast cancer: reducing inflammation; support through surgery, including wound healing; preventing recurrence and monitoring after conventional treatment is completed. See these sections in particular:

Chapter 1, section 2.1.4, Inflammation

Chapter 2, section 2, Diagnostic Tests and Surveillance Tests

Chapter 4, Preparing for Surgery

Chapter 9:

  • Section 3, Monitoring while in Remission
  • Section 5, Recurrence Prevention Strategies
  • Section 6, Classical Naturopathic Treatment of Breast Cancer Survivors
  • Section 7, Post-treatment Laboratory Testing

Appendix

  • Appendix 1: Genomic Testing for SNPs
  • Appendix 2: Preparing for Surgery Patient Handout
  • Appendix 3: Immune Modulating & Anti-Cancer Agents by Action
  • Appendix 5: Patient Anti-Inflammatory Diet Handout
  • Appendix 6: Patient Handout: Use Foods and Beverages to Heal Your Body
  • Appendix 7: Patient Instructions: Hydrotherapy: Castor Oil Pack
  • Appendix 8: Patient Instructions: Hydrotherapy: Warming Socks Treatment

Follow-Up Care for Early-Stage Breast Cancer ›

Green J. Identifying and treating metabolic syndrome in breast cancer. Natural Medicine Journal. 2014.

Lemanne D, Maizes V. Advising women undergoing treatment for breast cancer: a narrative review. Journal of Alternative and Complementary Medicine. 2018 Sep/Oct;24(9-10):902-909.

Clinical Pearls. Cancer Strategies Journal. 2013 Spring:8-9. See Niacinamide and triple negative breast cancer.

Breast cancer treatment in older women

Decision making regarding cancer treatments

Selected studies regarding de-escalating conventional treatment

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Authors

Laura Pole, MSN, RN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, MSN, RN, OCNS Senior Clinical Consultant

Nancy Hepp, MS

Lead Researcher
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher and writer for CancerChoices and also served as the first program manager. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher

Gwendolyn Stritter, MD

Physician and CancerChoices advisor
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Dr. Stritter is board-certified in anesthesiology. She was also certified in pain medicine from 1996 to 2016 and served as the director of the Kaiser San Jose Pain Medicine Clinic for 10 years. Wishing to pursue a more patient-centered style of practice, Gwen subsequently trained with Dr. Mark Renneker, honing her medical advocacy skills to help those with life-threatening health problems. Her own high risk for breast cancer led her to focus on that area in particular.

During her 13 years of clinical advocacy practice, she appeared on radio, lectured and wrote many articles on medical advocacy. She also coauthored the chapter on clinical advocacy in the textbook Patient Advocacy for Healthcare Quality: Strategies for Achieving Patient-Centered Care (2007).

As fate would have it, Dr. Stritter was diagnosed with breast cancer in 2013. Although side effects of treatment forced closure of her medical advocacy practice, she continues to enjoy attending several breast cancer conferences every year, learning best integrative oncology practices and mentoring the next generation of breast cancer medical advocates.

Gwendolyn Stritter, MD Physician and CancerChoices advisor

Reviewers

Michael Lerner

Co-Founder
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Michael Lerner is co-founder of Commonweal and co-founder of the Commonweal Cancer Help Program, Healing Circles, The New School at Commonweal, and CancerChoices. He has led more than 200 Commonweal Cancer Help Program retreats to date. His book Choices In Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer was the first book on integrative cancer care to be well received by prominent medical journals as well as by the patient and integrative cancer care community.

Michael Lerner Co-Founder

Walter Tsang, MD

Integrative oncologist
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Dr. Walter Tsang is quadruple board-certified in medical oncology, hematology, lifestyle medicine, and internal medicine. In addition to providing cutting-edge treatments for cancer and blood diseases, Dr. Tsang regularly advises his patients on nutrition, physical activity, stress management, and complementary healing methods. He has seen firsthand how this whole-person approach improved his patients’ quality of life and survival.

Outside of his clinical practice, Dr. Tsang teaches integrative oncology at the UCLA Center for East-West Medicine and directs an educational seminar program for cancer survivors in the community. His research interests focus on comparing and integrating the traditional Eastern and modern Western perspectives of cancer care. His fluency in Chinese further allows him to study the enormous integrative medicine literature published in the East that is not easily accessible to the West due to the language barrier.

Dr. Tsang is an active member of the American Society of Clinical Oncology, Society for Integrative Oncology, and American College of Lifestyle Medicine. He currently practices in the Inland Empire region of Southern California.

Walter Tsang, MD Integrative oncologist

Last update: October 16, 2024

Last full literature search: January 2023

CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.

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