Your Breast Cancer Handbook

During breast cancer treatment

At this time, you’ll likely want to focus on allowing your cancer treatments to be as effective as possible while also keeping side effects under control.

Top practices and therapies we have reviewed for improving cancer outcomes during treatment

These practices and therapies have at least modest evidence for the medical benefits listed. We add to this list as we complete new reviews of practices and therapies.

Self-care practices

Moving More ›

Sharing Love and Support ›

Manage your body weight ›

Complementary therapies

Astragalus ›

Melatonin ›

Mistletoe ›

Non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) ›

Reishi Mushroom ›

Turkey tail mushroom ›

On this page

How integrative experts approach care during treatment

Clinical practice guidelines

Specific guidelines for managing symptoms and side effects are listed in handbooks for each side effect. See Managing side effects and improving quality of life › below.

American College of Sports Medicine

Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable ›

Combined moderate-intensity aerobic and resistance exercise performed two to three times per week for at least 12 weeks results in improvements in health-related quality of life both during and after treatment. 

The benefit of combined aerobic plus resistance training programs appears more potent than programs consisting of only aerobic or resistance training

Moderate-intensity aerobic training, resistance training or combined aerobic plus resistance training performed three times weekly for 8 to 12 weeks can significantly improve self-reported physical function.

Supervised exercise appears to be more effective than unsupervised or home-based interventions, although unsupervised programs may be effective in older cancer survivors.

Cancer Australia

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

The full text is available online free of charge.

Cancer Care Ontario and American Society of Clinical Oncology

Use of adjuvant bisphosphonates and other bone-modifying agents in breast cancer: a Cancer Care Ontario and American Society of Clinical Oncology clinical practice guideline ›

It is recommended that, if available, zoledronic acid (4 mg intravenously every 6 months) or clodronate (1,600 mg/d orally) be considered as adjuvant therapy for postmenopausal patients with breast cancer who are deemed candidates for adjuvant systemic therapy. Data for adjuvant denosumab look promising but are currently insufficient to make any recommendation.

Society for Integrative Oncology

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

This 2018 guideline provides recommendations for the use of self-care practices and complementary therapies for managing symptoms and side effects among people with breast cancer. Specific recommendations are listed in handbooks for each side effect (see below).

Published programs and approaches

Lise Alschuler, ND, FABNO, and Karolyn Gazella

• Chapter 8, Immune system (including stress management)
• Chapter 9, Inflammation
• Chapter 11, Insulin resistance

Alschuler and Gazella also devote a portion of chapters 6 and 7 to integrative approaches to preparing for, mitigating side effects from, and enhancing outcomes of cancer surgery.

Keith Block, MD

Gurdev Parmar, ND, FABNO, and Tina Kaczor, ND, FABNO

Traditional medicine approaches

Traditional Chinese medicine (TCM) › uses botanical and animal products, trace elements, diet, and exercise in addition to acupuncture/acupressure.

Traditional Korean medicine has treatment approaches for breast cancer.³Bae K, Kim E, Choi JJ, Kim MK, Yoo HS. The effectiveness of anticancer traditional Korean medicine treatment on the survival in patients with lung, breast, gastric, colorectal, hepatic, uterine, or ovarian cancer: a prospective cohort study protocol. Medicine (Baltimore). 2018 Oct;97(41):e12444.

Examples of integrative approaches

A number of integrative oncology care programs and clinics employ complementary approaches to enhance conventional treatment and/or minimize side effects. Three programs have published studies of their integrative approaches in caring for those with advanced breast cancer. We provide a description of their research, not as endorsements of their programs, but as examples of different integrative approaches to advanced breast cancer care.

Canadian/US Integrative Oncology Study (CUSIOS) study: a naturopathic oncology approach

See the Canadian/US Integrative Oncology Study (CUSIOS) study ›

CancerChoices advisor Leanna Standish, ND, is a Fellow of the American Board of Naturopathic Oncology (FABNO) and works within the research institute of the prestigious naturopathic school Bastyr University. Dr. Standish has been leading research studies looking at integrative therapies that naturopathic oncologists provide, as well as the costs and outcomes of that care.

In one study published in 2017, the Bastyr Integrative Oncology Research Clinic (BIORC), in collaboration with Fred Hutchinson Cancer Research Center, followed 324 women of all stages of breast cancer who received integrative oncology care from board-certified naturopathic oncologists in the Seattle area. The most common integrative therapies prescribed:

The costs ranged from $1594 per year for early stage breast cancer up to $6200 per year for stage 4 breast cancer patients. About 20% of that cost was out-of-pocket, with the remainder paid for by insurance or written off by the university. As the researchers point out, “regardless of the stage of breast cancer, integrative [naturopathic] oncology care is low-cost relative to conventional oncology costs. Standard cancer treatments may cost as much as $10,000 to $40,000 per month.”⁴Standish LJ, Dowd F et al. Breast cancer integrative oncology care and its costs. Integrative Cancer Therapies. 2017 Mar;16(1):85-95. The extra cost of adding complementary therapies to conventional care may be outweighed by the benefits to patients: better quality of life, symptom management and in some cases improved response to conventional treatment.

Since opening in 2009, BIORC has enrolled 704 patients in a separate prospective outcomes study treating breast, lung, colon, pancreatic, brain and skin cancers. One-third are patients with stage 4 cancer. During the study, the natural products used have been intravenous (IV) high-dose vitamin C, IV artesunate, oral curcumin, green tea and Trametes versicolor (turkey tail mushroom). Dr. Standish shared with us: “Our median overall survival was excellent compared to other published phase III clinical trials.”⁵Leanna Standish, ND. Email communication, September 29, 2018.

However, a study published in 2021 found that women with breast cancer who received naturopathic oncology care in addition to conventional carethe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy showed worse disease-free or overall survival compared to women who received conventional care only. Part of this difference may have been due to a lower likelihood of using anti-estrogen therapy among women receiving naturopathic care, but this did not fully explain the difference in outcomes.⁶Standish LJ, Sweet E et al. Recurrence of breast cancer after primary treatment: a matched comparison study of disease-free survival in women who do and do not receive adjunctive naturopathic oncology care. Integrative Cancer Therapies. 2021 Jan-Dec;20:15347354211058404.

Bastyr breast cancer study supplements

No one “Bastyr protocol” exists, as researchers continue to investigate and refine approaches. Supplements used in one Bastyr protocol for breast cancer:⁷McKinney N. Naturopathic Oncology, 3rd Edition. Victoria, BC, Canada: Liaison Press. 2016.

Naturopathic oncology care › is complementary rather than alternative to conventional care, with complementary therapies used in conjunction with conventional treatments. Naturopathic oncologists are oriented to deliver integrative oncology care in tandem with their conventional oncology colleagues. 

UPMC Breast Cancer Integrative Care and Wellness Program

The UPMC Breast Cancer Integrative Care and Wellness Program offers a range of wellness-based and holistic health care both in-house and through referrals to providers in the area. The cancer care team works with integrative medicine experts to look beyond treating breast cancer itself and treat the whole person. The team checks in with patients throughout their treatment, asking especially about how patients are feeling and helping them manage any new concerns.

The UPMC care team includes experts in conventional care specialties.

Integrative offering may include approaches such as these:

Commentary: conventional treatment interactions with drugs and natural products

Tamoxifen interactions

From CancerChoices advisor Jen Green, ND, FABNO, September 1, 2020: Arimidex generally has lower risk of drug interactions as compared to tamoxifen because it is metabolized by p glycoproteins and not CYP pathways in the liver. Tamoxifen, on the other hand, carries greater drug-drug and herb-drug interaction risks because it is extensively metabolized by the CYP2D6 pathway. Tamoxifen shouldn’t be combined with Paxil/paroxetine,⁸Kelly CM, Juurlink DN et al. Selective serotonin reuptake inhibitors and breast cancer mortality in women receiving tamoxifen: a population based cohort study. BMJ. 2010;340:c693. Prozac/fluoxetine,⁹Desmarais JE, Looper KJ. Interactions between tamoxifen and antidepressants via cytochrome P450 2D6. Journal of Clinical Psychiatry. 2009;70(12):1688-1697. Benadryl/diphenhydramine or Tagamet/cimetidine.¹⁰National Cancer Institute. Hormone Therapy for Breast Cancer. National Institutes of Health. February 14, 2017. Viewed September 2, 2020. 

Out of caution, it should also not be combined with these natural substances:

• DIM 300mg¹¹Thomson CA, Chow HHS et al. A randomized, placebo-controlled trial of diindolylmethane for breast cancer biomarker modulation in patients taking tamoxifen. Breast Cancer Research and Treatment. 2017;165(1):97-107.
• 3.6g or more of curcumin (7 capsules daily)¹²Hussaarts KGAM, Hurkmans DP et al. Impact of curcumin (with or without piperine) on the pharmacokinetics of tamoxifen. Cancers (Basel). 2019;11(3):403. (see more below)

• Goldenseal
• St. John’s wort
• Grapefruit

Tamoxifen and curcumin

CancerChoices advisors Gwen Stritter, MD, and Jen Green, ND, FABNO, May 9, 2019: Impact of curcumin on tamoxifen effectiveness

Many are aware that tamoxifen is what we call a pro-drug. A pro-drug is ineffective until specific enzymes in your body activate it. Tamoxifen is metabolized to endoxifen, the effective drug that prevents ER+ breast cancer patients from relapse.

An enzyme called CYP2D6 is responsible for the magic that changes tamoxifen to endoxifen. The activity of this enzyme varies from individual to individual. Part of the variance is due to genetics—some people are born with hyperactive CYP2D6; others have an enzyme that is very sluggish. Many medications—antidepressants like fluoxetine (Prozac), paroxetine (Paxil) and citalopram (Celexa) amongst a host of others—as well as assorted foods and dietary supplements can either activate or slow down CYP2D6.

When this information first started causing a stir in the breast cancer world roughly 10 years ago, researchers hypothesized that taking tamoxifen with a CYP2D6 inhibitor would cause a increase in breast cancer relapse. As it turned out, further clinical research did not bolster this theory,¹³Mayer SE, Weiss NS et al. CYP2D6-inhibiting medication use and inherited CYP2D6 variation in relation to adverse breast cancer outcomes after tamoxifen therapy. Cancer Causes Control. 2019 Jan;30(1):103-112. leading to a new one: genetics, drugs and dietary intake have complex interactions with the body’s enzyme system. They activate some enzymes and inhibit others. This results in a variable net effect on the concentration of important drugs. In a 2016 study, the cause of low endoxifen levels could not be identified over 50% of the time.¹⁴Fox P, Balleine RL et al. Dose escalation of tamoxifen in patients with low endoxifen level: evidence for therapeutic drug monitoring-the TADE study. Clinical Cancer Research. 2016 Jul 1;22(13):3164-71.

Because such a complex system is difficult to study, researchers turned away from looking at just CYP2D6 and are focusing on the endoxifen level itself (ignoring the middleman). In one study, researchers in the Netherlands gave tamoxifen with or without curcumin 1200 mg three times a day. The group taking tamoxifen combined with curcumin had about an 8% decrease in endoxifen levels. If the curcumin was compounded with piperine (often done to substantially improve curcumin absorption), endoxifen levels were further decreased by 12%.¹⁵Hussaarts KGAM, Hurkmans DP et al. Impact of curcumin (with or without piperine) on the pharmacokinetics of tamoxifen. Cancers (Basel). 2019 Mar 22;11(3). pii: E403.

Although an 8 to 12% reduction doesn’t seem like much, if your genetics and/or dietary habits result in levels of endoxifen just barely in the effective range, the addition of curcumin, and especially with piperidine, could tip the scales in favor of breast cancer growth. The authors of this paper conclude: “co-treatment with curcumin could lower endoxifen concentrations below the threshold for efficacy (potentially 20 to 40% of the patients).”

Do keep in mind that this was a very small study, only 16 patients. However, these results are in line with previous lab and animal research so should not be discounted. On the other hand, curcumin supplementation has documented beneficial effects: decreased depression,¹⁶Sanmukhani J, Satodia V et al. Efficacy and safety of curcumin in major depressive disorder: a randomized controlled trial. Phytotherapy Research. 2014 Apr;28(4):579-85. anti-inflammatory effects¹⁷Panahi Y, Saadat A, Beiraghdar F, Sahebkar A. Adjuvant therapy with bioavailability-boosted curcuminoids suppresses systemic inflammation and improves quality of life in patients with solid tumors: a randomized double-blind placebo-controlled trial. Phytotherapy Research. 2014 Oct;28(10):1461-7. and lowered cholesterol,¹⁸Qin S, Huang L et al. Efficacy and safety of turmeric and curcumin in lowering blood lipid levels in patients with cardiovascular risk factors: a meta-analysis of randomized controlled trials. Nutrition Journal. 2017 Oct 11;16(1):68. to name a few.

The bottom line: if you are taking curcumin with tamoxifen, ask your integrative practitioner if s/he could substitute another supplement. If not, then request to have your endoxifen levels checked, both before and a month after starting curcumin. Quest Diagnostics, a very reputable lab, offers a “tamoxifen and metabolites” blood test.

Herbal and botanical therapies in general

CancerChoices advisor Debu Tripathy, MD, writes that “herbal and botanical agents have significant potential as bioactive agents that can affect cellular pathways involved in breast cancer, but may also cause side effects and drug interactions. . . Caution should be exercised when used with other treatments.”¹⁹Tripathy D. Chapter 21: Integrative Medicine and Breast Cancer in Abrams DI, Weil AT. Integrative Oncology, 2nd Edition. New York, NY: Oxford University Press. 2014.

Commentary: medicinal mushrooms in breast cancer care

CancerChoices advisor Lise Alschuler, ND, FABNO, August 9, 2018: There are instances when I use specific mushrooms, for instance: Coriolus (or Trametes) versicolor (turkey tail) for breast cancer, Agaricus blazeii for ovarian cancer and chaga mushroom for melanoma. However, it is a very valuable and reasonable strategy to use a blend that includes mushrooms, each of which is standardized to its polysaccharides and beta-glucans. The key is to use a hot water extract of the fruiting bodies or a full-spectrum extract (includes mycelium) that clearly identifies on its label the quantity of mushroom extract.

Some blends that I often recommend:

Per capsule:

• Trametes versicolor (turkey tail) (40% polysaccharides, 40% beta-glucans)—100mg
• Grifola frondosa (maitake) 40% polysaccharides, 30% beta-glucans—100mg
• Ganoderma lucidum (reishi), 40% polysaccharides, 15% beta-glucans—100mg
• Lentinula edodes (shiitake), 409% polysaccharides, 40% beta-glucans—100mg

I would recommend between 2-3 capsules twice daily.

When recommending single mushrooms, it is important to know how much beta-glucan is in each serving so that I can titrate my dose accordingly. For instance, I often use Grifola frondosa (maitake) mushroom to increase white blood cell counts. One product I use contains:

Per 6 tablets:

• Maitake (Grifola frondosa) Fruiting body powder – 600mg
• Maitake fruiting body extract, standardized to contain 30% D-fraction—240mg (so 72mg D-fraction beta glucan)
• Vitamin C 120mg (supports bioactivity)

Costs permitting, in most clinical studies, the daily dose of mushroom extracts that is correlated with improved survival (especially in breast, colorectal, gastric cancers) is 3000mg/day.

Mushrooms do pack a punch! From a meta-analysis on Coriolus versicolor mushroom extracts in patients diagnosed with cancer:²⁰Eliza WL, Fai CK, Chung LP. Efficacy of Yun Zhi (Coriolus versicolor) on survival in cancer patients: systematic review and meta-analysis. Recent Patents on Inflammation & Allergy Drug Discovery. 2012 Jan;6(1):78-87.

• Over all cancers, there was a 9% absolute reduction in 5-year mortality (one additional patient alive for every 11 patients treated).
• Effects were more evident for breast, gastric or colorectal cancer versus esophageal or nasopharyngeal.

Improving breast cancer surgery outcomes

Reducing risk of complications and infection after surgery

• Before leaving the hospital, be sure you (and anyone who will be assisting you at home) fully understand and follow all wound care instructions carefully. Call your physician immediately if you show any signs of infection—an increase of redness, swelling, pain, or discharge from your wound.
• Avoid contact with soil for two or more weeks after surgery.
• Avoid procedures that might introduce infection to the breast, such as nipple piercing or a tattoo.
• In the weeks following your surgery, if you need a medical procedure that may introduce bacteria to the body, check with your surgeon about using antibiotics to prevent infection.

Infection response

Despite best efforts, people can sometimes still get an infection after breast surgery. Fortunately, it is uncommon for a mild infection to cause a significant worsening of outcomes. But knowing what to do (and what not to do) will help prevent a mild infection from becoming a serious one. 

If you do get an infection:

• Report symptoms of infection immediately to your surgeon and begin treatment promptly. If antibiotics are prescribed, take as directed.
• Eat well to maintain a healthy nutritional state. Consider consulting a board-certified oncology dietician for specific dietary recommendations.
• If antibiotics are prescribed, eat well and follow other practices to restore a healthy microorganism balance. 
• Consider consulting an integrative oncology specialist about additional measures to clear infection, help wound healing, control inflammation, and minimize tissue fibrosis (scarring) from surgical wounds and/or from radiation therapy.

Reducing the risk of chronic pain after mastectomy or breast reconstruction

From medical advocate, breast cancer survivor, and CancerChoices advisor Gwendolyn Stritter, MD

About 15 to 20% of patients have moderate to severe chronic pain after breast cancer surgery.²¹Meretoja TJ, Andersen KG et al. Clinical prediction model and tool for assessing risk of persistent pain after breast cancer surgery. Journal of Clinical Oncology. 2017 May 20;35(15):1660-1667. Regional anesthesia (also known as nerve blocks) has been shown to reduce the risk of persistent pain after breast surgery.²²Levene JL, Weinstein EJ et al. Local anesthetics and regional anesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children: a Cochrane systematic review and meta-analysis update. Journal of Clinical Anesthesia. 2019 Aug;55:116-127; Kairaluoma PM, Bachmann MS, Rosenberg PH, Pere PJ. Preincisional paravertebral block reduces the prevalence of chronic pain after breast surgery. Anesthesia and Analgesia. 2006 Sep;103(3):703-8. Thoracic paravertebral blocks and PECS blocks are the two types of regional anesthesia most widely used.

Performing such nerve blocks before surgical incision allows for “light” general anesthesia (such as primarily using IV propofol instead of inhaled gases). This in turn results in quickly “waking up” from anesthesia without nausea › or prolonged grogginess. Enough evidence shows that regional anesthesia lowers the chance of subsequent relapse and metastasis.²³Kim R. Anesthetic technique and cancer recurrence in oncologic surgery: unraveling the puzzle. Cancer Metastasis Review. 2017 Mar;36(1):159-177.

Not all anesthesiologists have the training or experience to do these blocks well. An appointment with the anesthesia team well in advance of surgery will increase the odds of getting these blocks before mastectomy. I had bilateral paravertebral blocks for my double mastectomy and required only oral anti-inflammatory medication for post-op pain control.

Practices and therapies with good or modest evidence of benefit for improving surgery outcomes

Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) indicates that the practice or therapy is linked to the outcomes described with reasonable certainty. Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) means the practice or therapy may be linked to the outcomes described, but with a lower degree of certainty.

The evidence for these effects is described in the reviews available through the image links.

Manage your body weight: good and modest evidence

Find strategies to manage your body weight in this handbook.

Practices and therapies with preliminary or weak evidence of benefit for improving surgery outcomes

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) typically indicates that not much research has been published so far, although the outcomes may be meaningful. Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) may mean that the effects are small or that only very preliminary research has been published.

Further therapies reported to provide benefit for surgery outcomes

Mind-body therapies › including meditation, music therapy, cognitive-behavioral therapy, and hypnosis

Managing side effects and improving quality of life

Self-care practices as well as supplements, mind-body therapiesapproaches that enhance your mind’s capacity to positively affect your body’s function and symptoms. Some interventions focus on calming your mind, improving focus, enhancing decision-making capacity, managing stress, or resolving conflict. Other interventions have a goal of relaxing both your mind and your body., and other 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 psychosocialtherapy, and acupuncture therapies may reduce symptoms and side effects and enhance your quality of life during cancer treatment. In addition, managing side effects may allow you to complete your cancer treatment, allowing for more benefit from conventional treatments.

Practices and therapies listed here have evidence of managing side effects and symptoms or generally improving quality of life during cancer treatment or surgery. Therapies that can help at any phase of your cancer experience are listed in At any time during your breast cancer experience ›

For some symptoms and side effects, we have complete handbooks, as linked below. For other symptoms and side effects, and for quality of life and physical function as a whole, we list here the effects of complementary therapies and practices we’ve reviewed. Details of the evidence supporting the summary statements are in the linked pages. 

We report the evidence relating to benefits from using these therapies. Please also review the Safety and precautions page within the linked reviews for guidance on safe use. We recommend supervision from a medical professional trained in the use of complementary therapies.  

Quality of life or physical function as a whole

Strong, good, or modest evidence of benefit for quality of life or physical function as a whole

Moving More: strong to modest evidence

Cancer as a whole:

• Better fitness, strength, and quality of life among people participating in exercise during treatment, except not among people with shoulder dysfunction due to treatment for head and neck cancer (good evidence)significant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently)
• Less toxicity during chemotherapy among people with cancer participating in exercise (modest evidence)significant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently)

Guided imagery: modest and preliminary evidence 

• More comfort during radiation therapy among women with early stage breast cancer treated with guided imagery (preliminary evidence)

Cancer as a whole:

• Better quality of life and related measures during chemotherapy among people treated with guided imagery, sometimes with other mind-body therapies (modest evidence)

Reishi mushroom: modest and preliminary evidence

Preliminary or weak evidence of benefit for quality of life or physical function as a whole

No evidence or insufficient evidence of benefit for quality of life or physical function as a whole

Acupressure ›

Cancer as a whole:

• No evidence of an effect on recovery time or return to normal physical activities among people undergoing major laparoscopic procedures treated with acupressure devices in a preliminary study

Further therapies reported to provide benefit for quality of life or physical function

Anxiety

Blood-related side effects

Good or modest evidence of benefit for blood-related side effects

Moxibustion: modest and preliminary evidence

Preliminary or weak evidence of benefit for blood-related side effects

Further therapies reported to provide benefit for blood-related symptoms

Body composition or cachexia

Good or modest evidence of benefit for body composition or cachexia

Further therapies reported to provide benefit for body composition and cachexia

Bone and joint symptoms

Good or modest evidence of benefit for bone and joint symptoms

Preliminary or weak evidence of benefit for bone and joint symptoms

Further therapies reported to provide benefit for bone and joint symptoms

Cardiovascular side effects

Also see Taking care of your heart below.

Good evidence of benefit for cardiovascular side effects

Preliminary or weak evidence of benefit for cardiovascular side effects

Further therapies reported to provide benefit for cardiovascular side effects

Changes in appetite

Modest evidence of benefit for changes in appetite

Preliminary or weak evidence of benefit for changes in appetite

See our handbook on the Beyond Conventional Cancer Therapies website: Changes in appetite ›

Cognitive difficulties

Preliminary or weak evidence of benefit for cognitive difficulties

Gastrointestinal symptoms

Hair loss

Preliminary or weak evidence of benefit for hair loss

Kidney side effects

Preliminary or weak evidence of benefit for kidney side effects

Lymphedema

Preliminary or weak evidence of benefit for lymphedema

Further therapies reported to provide benefit for lymphedema

Selenium

Neuropathy and other neurological symptoms

Oral symptoms

Preliminary or weak evidence of benefit for oral symptoms

Further therapies reported to provide benefit for oral symptoms

Sepsis

Good evidence of benefit for sepsis

Vitamin C: intravenous use: good evidence

Sexual difficulties

Preliminary evidence of benefit for sexual difficulties

See our handbook on the Beyond Conventional Cancer Therapies website: Sexual difficulties ›

Skin and tissue symptoms

Preliminary or weak evidence of benefit for skin and tissue symptoms

Further therapies reported to provide benefit for skin and tissue damage

Wound healing

Insufficient (conflicting) evidence of benefit for wound healing

Therapeutic Touch™ ›

Cancer as a whole:

• Insufficient (conflicting) results of better healing of acute wounds among people with cancer

Taking care of your heart: heart health and breast cancer

With contributions from CancerChoices advisor Jen Green, ND, FABNO

Caring for your heart is an important part of your wellness plan. The relationship between breast cancer and heart health may work both ways:

• After a breast cancer diagnosis, 35% of deaths are related not to breast cancer, but to cardiovascular disease.²⁴Lemanne 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.
• A heart attack raises the risk of death from recurrence.²⁵Koelwyn GJ, Newman AAC et al. Myocardial infarction accelerates breast cancer via innate immune reprogramming. Nature Medicine. 2020;26(9):1452-1458.

As part of your treatment, you may be given toxic drugs and/or radiation therapy to kill cancer cells. The normal cells in and around your heart can also be killed, resulting in cardiac toxicity. Besides cell death, cancer treatment can lead to cardiomyopathy, heart failure, acute coronary syndromes, and other heart-related conditions.²⁶Florescu M, Cinteza M, Vinereanu D. Chemotherapy-induced cardiotoxicity. Maedica (Bucur). 2013 Mar;8(1):59-67.

People with breast cancer who are undergoing chemotherapy such as anthracylines (including Adriamycin/doxorubicin), targeted agents such as Herceptin/trastuzumab, and radiation therapy to the chest are at risk for heart damage. Risk is even higher for those receiving anthracyclines plus Herceptin, or anthracyclines plus chest radiation.

From a conventional treatment standpoint, preventing heart problems from cancer treatment involves a baseline test of heart function, monitoring those at risk for problems, and adjusting drug dosage and/or frequency or even changing to a less cardiotoxic drug. Radiation oncology is becoming more and more adept at targeting the cancerous tissue and shielding the heart and lungs. 

Your doctor should monitor you for early signs of heart disease and manage risk factors—cholesterol levels, blood pressure and lifestyle.²⁷Koelwyn GJ, Newman AAC et al. Myocardial infarction accelerates breast cancer via innate immune reprogramming. Nature Medicine. 2020;26(9):1452-1458. If your doctor hasn’t mentioned cardiovascular care yet, consider bringing it up.

Early treatment of heart problems is more likely to prevent serious damage. The first step is to get a baseline test of heart function (usually an echocardiogram, or ECG), and repeat testing during cancer treatment if you are at risk for heart problems.²⁸Zamorano J-L, Saltijeral A, Perez de Isla L. Cardiac monitoring for patients under chemotherapy. E-Journal of Cardiology Practice. 2008 Nov 25;7(11). 

An echocardiogram should be taken periodically during treatment—every three months during treatment with Herceptin/trastuzumab, according to guidelines from the American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging and European Society for Medical Oncology.²⁹Tan C, Denlinger C. Cardiovascular toxicity in cancer survivors: current guidelines and future directions. American College of Cardiology. June 29, 2018. Viewed April 2, 2019. An “echo” takes pictures of the heart and measures the strength of the heart/ejection fraction. Ejection fraction over 55% is normal, a mildly weak heart is at 45 to 55%, a moderately weak heart is 30 to 45%, and below 30% is considered severely weakened.

After treatment with doxorubicin, repeat testing is recommended at 4 and 10 years after treatment.³⁰Curigliano G, Cardinale D et al. Cardiovascular toxicity induced by chemotherapy, targeted agents and radiotherapy: ESMO Clinical Practice Guidelines. Annals of Oncology. 2012 Oct;23 Suppl 7:vii155-66. Survivors of childhood cancer should have an echocardiogram every one to five years throughout their lives³¹Denlinger CS, Sanft T et al. Survivorship, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network. 2018 Oct;16(10):1216-1247. and during late-stage pregnancy.³²Children’s Oncology Group. Heart Health: Health LinkHealthy living after treatment of childhood cancer. October 2013. Viewed April 2, 2019.

“Heart healthy” lifestyle choices

You can do much more than having diagnostic tests periodically. You can be actively involved in reducing your risk of heart damage and cardiovascular disease. 

Cancer survivors can follow these approaches to reduce risks:

• 7 Lifestyle Practices
• Healthy lifestyle
• Ask your doctor about the supplements and approaches mentioned in this section.

Exercise during treatment—as much as you can tolerate—can be especially beneficial: “Our findings strongly support that tailored exercise training during adjuvanttreatment applied after initial treatment for cancer, especially to suppress secondary tumor formation breast cancer treatment may counteract a decline in cardiovascular function, and in particular among those receiving chemotherapy.”³³Thune I, Husøy A et al. Cardiovascular function and the effect of exercise training during adjuvant breast cancer treatment. Results from The EBBA-II trial. Presentation at the San Antonio Breast Cancer Symposium (SABCS) 2018. December 7, 2018.

Be sure to consult your doctor before starting an exercise program, particularly if you already have heart issues or other problems such as neuropathy that may require adjusting a fitness plan. In this case, a cardiac or cancer rehab program may guide you in choosing safe exercise and movement therapies.

Other foundations for protecting your heart:

Natural therapies protecting your heart during Adriamycin/doxorubicin treatment

Please connect with an integrative oncology professional or naturopathic physician for specific guidance.

Milk thistle ›

Cancer survivors who took milk thistle during doxorubicin treatment had better heart function compared to placebo. The researchers concluded that silymarin “can be recommended as adjuvant drug in patients with ALL under doxorubicin therapy.”³⁵Hagag AA, El Shehaby WA, El-Abasy AI, Mabrouk MM. Protective role of silymarin in early doxorubicin induced cardiac dysfunction in children with acute lymphoblastic leukemia. Infectious Disorders Drug Targets. 2018 Aug 3. An earlier trial showed that milk thistle is safe to combine with chemotherapy.³⁶Ladas EJ, Kroll DJ et al. A randomized, controlled, double-blind, pilot study of milk thistle for the treatment of hepatotoxicity in childhood acute lymphoblastic leukemia (ALL). Cancer. 2010 Jan 15;116(2):506-13. 

Coenzyme Q10 (CoQ10)

CoQ10 use preserved heart function during doxorubicin treatment³⁷Iarussi D, Auricchio U et al. Protective effect of coenzyme Q10 on anthracyclines cardiotoxicity: control study in children with acute lymphoblastic leukemia and non-Hodgkin lymphoma. Molecular Aspects of Medicine. 1994;15 Suppl:s207-12. and radiation treatment.³⁸Takimoto M, Sakurai T et al. [Protective effect of CoQ 10 administration on cardial toxicity in FAC therapy]. [Article in Japanese]. Gan To Kagaku Ryoho. 1982 Jan;9(1):116-21. Researchers hypothesize that CoQ10 prevents doxorubicin from binding to heart muscle cells.³⁹Okuma K, Furuta I, Ota K. [Protective effect of coenzyme Q10 in cardiotoxicity induced by adriamycin]. [Article in Japanese]. Gan To Kagaku Ryoho. 1984 Mar;11(3):502-8.

Before taking CoQ10, consult your doctor. Because CoQ10 is an antioxidant, it may theoretically interfere with some chemotherapy drugs—such as anthracyclines and cyclophosphamide—or radiation therapy. “Recent in-vitro [cell] studies, however, have shown that CoQ10 does not affect the antineoplastic properties of doxorubicin.”⁴⁰The Summaries. Coenzyme Q10. CAM-Cancer. June 21, 2016. Viewed October 8, 2018.

L-carnitine

Many people who have low carnitine from chemotherapy will have weakness in large muscle groups, which can make your legs feel like Jello when walking up stairs. L-carnitine is established for improving heart function following a heart attack. Use of L-carnitine after a heart attack was associated with a 27% lower risk of death and 65% lower risk of irregular heart rate.⁴¹DiNicolantonio JJ, Lavie CJ, Fares H, Menezes AR, O’Keefe JH. L-carnitine in the secondary prevention of cardiovascular disease: systematic review and meta-analysis. Mayo Clinic Proceedings. 2013 Jun;88(6):544-51. 

Among people with cancer, L-carnitine use during doxorubicin treatment improved signs of heart muscle toxicity. Young cancer survivors who received doxorubicin have lower plasma carnitine levels than controls, so L-carnitine has been suggested as a way to prevent heart damage.⁴²Waldner R, Laschan C et al. Effects of doxorubicin-containing chemotherapy and a combination with L-carnitine on oxidative metabolism in patients with non-Hodgkin lymphoma. Journal of Cancer Research and Clinical Oncology. 2006 Feb;132(2):121-8. 

Ginkgo

People who took the ginkgo extract Gingold during doxorubicin treatment had fewer abnormal echocardiograms.⁴³Yi SY, Nan KJ, Chen SJ. [Effect of extract of Ginkgo biloba on doxorubicin-associated cardiotoxicity in patients with breast cancer]. [Article in Chinese]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2008 Jan;28(1):68-70. Because ginkgo does not affect how most medicines are metabolized, it appears to be safe to combine with chemotherapy,⁴⁴Markowitz JS, Donovan JL, Lindsay DeVane C, Sipkes L, Chavin KD. Multiple-dose administration of Ginkgo biloba did not affect cytochrome P-450 2D6 or 3A4 activity in normal volunteers. Journal of Clinical Psychopharmacology. 2003 Dec;23(6):576-81. tamoxifen, anastrozole, or letrozole.⁴⁵Vardy J, Dhillon HM et al. Investigation of herb-drug interactions with ginkgo biloba in women receiving hormonal treatment for early breast cancer. Springerplus. 2013 Mar 22;2(1):126. 

Ginkgo use in addition to aspirin (either 325 mg⁴⁶Gardner CD, Zehnder JL, Rigby AJ, Nicholus JR, Farquhar JW. Effect of Ginkgo biloba (EGb 761) and aspirin on platelet aggregation and platelet function analysis among older adults at risk of cardiovascular disease: a randomized clinical trial. Blood Coagulation and Fibrinolysis. 2007 Dec;18(8):787-93. or 500 mg⁴⁷Wolf HR. Does Ginkgo biloba special extract EGb 761 provide additional effects on coagulation and bleeding when added to acetylsalicylic acid 500 mg daily? Drugs in R&D. 2006;7(3):163-72.) did not increase risk of bleeding.

Arginine

People who took arginine during doxorubicin treatment had less shortness of breath, palpitations, and fewer changes in electrocardiograms.⁴⁸Skrypnyk I, Maslova G, Lymanets T, Gusachenko I. L-arginine is an effective medication for prevention of endothelial dysfunction, a predictor of anthracycline cardiotoxicity in patients with acute leukemia. Experimental Oncology. 2017 Dec;39(4):308-311.

Iodine ›

Women who took iodine during epirubicin chemotherapy for breast cancer had significantly lower levels of heart distress enzymes (creatine kinase-MB) than those taking a placebo.⁴⁹Moreno-Vega A, Vega-Riveroll L et al. Adjuvant effect of molecular iodine in conventional chemotherapy for breast cancer. randomized pilot study. Nutrients. 2019 Jul 17;11(7). pii: E1623.

Natural therapies protecting your heart during treatment with Herceptin/trastuzumab, Perjeta/pertuzumab or Kadcyla/trastuzumab emtansine

Studies of these herbs or natural supplements show improvements in heart strength/ejection fraction. These may be useful if your heart strength is reduced from treatment with Herceptin or Kadcyla. Please connect with an integrative oncology professional or naturopathic physician for specific guidance. 

Hawthorn berry/crataegus

Hawthorne berry improved heart strength/ejection fraction and symptoms among people with congestive heart failure.⁵⁰Pittler MH, Schmidt K, Ernst E. Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials. American Journal of Medicine. 2003 Jun 1;114(8):665-74.

L-carnitine

L-carnitine improved heart strength/ejection fraction and symptoms among people with congestive heart failure.⁵¹Song X, Qu H et al. Efficacy and safety of L-carnitine treatment for chronic heart failure: a meta-analysis of randomized controlled trials. BioMed Research International. 2017;2017:6274854.

Taurine

Taurine has improved heart function and signs of congestive heart failure among people with heart conditions.⁵²Azuma J, Sawamura A et al. Therapeutic effect of taurine in congestive heart failure: a double-blind crossover trial. Clinical Cardiology. 1985 May;8(5):276-82; Ahmadian M, Dabidi Roshan V, Ashourpore E. Taurine supplementation improves functional capacity, myocardial oxygen consumption, and electrical activity in heart failure. Journal of Dietary Supplements. 2017 Jul 4;14(4):422-432.

Combination of taurine, CoQ10 and L-carnitine

People with heart conditions who took 3 g taurine, 3 g carnitine and 150 mg CoQ10 had better heart function.⁵³Jeejeebhoy F, Keith M, et al. Nutritional supplementation with MyoVive repletes essential cardiac myocyte nutrients and reduces left ventricular size in patients with left ventricular dysfunction. American Heart Journal. 2002 Jun;143(6):1092-100.

Astragalus ›

Weak evidence of better heart function, better 6-minute walking distance and better scores on quality of life among people with chronic heart failure treated with astragalus

Berberine ›

Modest evidence of better cardiovascular symptoms among people with cardiovascular conditions treated with berberine

Safety note: Dr. Barbara MacDonald recommends against taking berberine during taxol treatment.⁵⁴MacDonald B. The Breast Cancer Companion: A Complementary Care Manual: Third Edition. 2016.

Magnesium

People with severe congestive heart failure who took magnesium had better symptoms and survival.⁵⁵Stepura OB, Martynow AI. Magnesium orotate in severe congestive heart failure (MACH). International Journal of Cardiology. 2009 May 1;134(1):145-7.

Managing pain after breast cancer surgery

Many options are available for managing pain after surgery. 

Opioids

According to one national report,⁵⁶2018 Exposing a Silent Gateway to Persistent Opioid Use – A Choices Matter Status Report. Pacira BioSciences, Inc. Viewed September 10, 2019. 18% of opioid addicts or persistent users got their first opioid prescription after surgery. Evidence also shows that use may increase your risk of cancer recurrence.⁵⁷Aich A, Gupta P, Gupta K. Could perioperative opioid use increase the risk of cancer progression and metastases? International Anesthesiology Clinics. 2016 Fall;54(4):e1-e16. These are both good reasons to carefully consider whether use is necessary.

Fortunately, some hospitals are now discharging even their post-mastectomy patients without any opioids at all and, despite this, are achieving better pain control than with standard treatment that includes opioids. Maimonides Medical Center in Brooklyn, New York, is on the forefront of this movement, as discussed in their 2019 paper, Mastectomy is no longer an indication for postoperative narcotic.⁵⁸Rojas KE, Fortes TA et al. Mastectomy is no longer an indication for postoperative narcotic. Americal Journal of Surgery. 2019 Jul 18. pii: S0002-9610(19)30177-1. Many other hospitals are instituting their own opioid-avoiding protocols. Dr. Stritter strongly recommends that you ask your surgeon at the pre-op visit whether their hospital has a post-mastectomy opioid-sparing ERAS (Enhanced Recovery After Surgery) protocol. While we are in the throes of an opioid epidemic, it makes a lot of sense to minimize unnecessary opioid prescriptions.

In addition to pain control, some retrospective studies suggest that a single intraoperative dose of NSAIDs such as ketorolac may even reduce the risk of breast cancer recurrence.⁵⁹Retsky M, Demicheli R et al. Reduction of breast cancer relapses with perioperative non-steroidal anti-inflammatory drugs: new findings and a review. Current Medicinal Chemistry. 2013;20(33):4163-76. But a single dose may not be enough. 

Dr. Stritter, once interested in the idea of using such a protocol for breast cancer surgery, has come to a different conclusion. “The initial reports⁶⁰Retsky M, Demicheli R et al. Reduction of breast cancer relapses with perioperative non-steroidal anti-inflammatory drugs: new findings and a review. Current Medicinal Chemistry. 2013;20(33):4163-76. were based on retrospective, observational studies that had no control group.” Dr. Stritter’s confidence in those reports evaporated when Forget published her updated report—“a definitive prospective, randomized trial—at the 2018 San Antonio symposium that showed no effect of a single dose of intraoperative ketorolac on early recurrences.”⁶¹Forget P, Bouche G et al. Intraoperative ketorolac in high-risk breast cancer patients with and without inflammation. A prospective, randomized, placebo-controlled clinical trial. Cancer Research 2019;79(4 Suppl):Abstract # P1-20-01. Dr. Stritter thinks it doesn’t make physiological sense that a single dose of ketorolac would reduce the chance of recurrence or metastasis. “The healing breast would have the epigenetic, genetic and proteonomic changes of wound healing—a well-documented pro-oncogenic environment—for several weeks until the incision has healed.” That is why after her bilateral mastectomy, Dr Stritter used anti-inflammatories (and no opioids) during her entire post-operative period, not only for pain relief but in hopes of creating an anti-oncogenic tumor microenvionment.

A 2018 review of anesthetic interventions in breast cancer concluded that “based on the available evidence, an ideal anesthetic in this patient population would involve a combination of TIVA (propofol), regional anesthesia (paravertebral block), non opioid sedatives (clonidine or dexmedetomidine), and COX-2 inhibition (ketorolac).”⁶²Eden C, Esses G, Katz D, DeMaria S Jr. Effects of anesthetic interventions on breast cancer behavior, cancer-related patient outcomes, and postoperative recovery. Surgical Oncology. 2018 Jun;27(2):266-274.

The overall surgery experience may differ by age. Preliminary evidence shows more severe depressive and anxiety symptoms and sleep disturbance, and subsequent worse pain-related functioning in younger women compared to older women.⁶³Wilson J, Colebaugh C, Flowers K, Schreiber KL. Different than your mother’s pain: postsurgical pain modulation by psychosocial factors among younger and older breast cancer patients. Journal of Pain. 2022;23(5)Supplement:40.

Breast cancer surgery and opioid dependence

Even though addiction is not common overall among opioid users with cancer, a study of women undergoing mastectomy with reconstructive surgery as part of cancer treatment investigated use of opioids and sedative-hypnotic drugs.

These women are at particularly high risk of becoming dependent on opioids following surgery. Among people who had not used an opioid before surgery, about 17% of those filling an opioid prescription after surgery became a chronic user in the year following surgery. More than 17% of women who filled a prescription for a sedative-hypnotic drug became chronic users of these drugs. The researchers recommend women work closely with the prescribing provider to attempt to minimize risk of dependence.⁶⁴The ASCO Post Staff. SABCS 2020: Opioid and sedative-hypnotic use after mastectomy with reconstructive surgery. December 23, 2020. Viewed February 5, 2021; Cogan JC, Raghunathan RR et al. Persistent controlled substance use following mastectomy with reconstruction surgery. Publication Number: GS3-0. 2020 San Antonio Breast Cancer Symposium®. Viewed February 5, 2021.

Dr. Stritter’s approach

Dr. Gwen Stritter, MD, medical advocate and board-certified anesthesiologist, had bilateral mastectomy for breast cancer. She followed this approach, without opioids, to achieve good pain control and speedy recovery after her 2014 surgery:

• Before incision: IV ketorolac, 30 mg; bilateral paravertebral blocks
• During surgery: no opioids; no nitrous oxide; lots of IV propofol 
• After surgery:
  • Ibuprofen 800 mg every 8 hours around the clock
  • Omeprazole 20 mg twice a day to avoid the gastrointestinal issues
  • After about five or six days, started to get a lot of edema from the ibuprofen so stopped ibuprofen and omeprazole; switched to boswellia and curcumin

Helpful links

Lucius K, Trukova K. Integrative therapies and cardiovascular disease in the breast cancer population: a review, part 1. Integrative Medicine (Encinitas). 2015 Aug;14(4):22-9.

Kim E, Andersen MR, Standish LJ. Comparison of health-related quality of life between adjuvant breast cancer treatment groups. Oncology Nursing Forum. 2019 Jan 13;46(1):59-70.

Keep reading about breast cancer

Choose what to read next

• Introduction
• At any time during your breast cancer experience
• Preparing for breast cancer treatment
• During breast cancer treatment
• Surviving and thriving with and beyond breast cancer
• Reducing your risk of breast cancer
• Are you a health professional?

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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