Conventional treatments for cancer are often described as a large hammer used to hit a small nail. They are effective, but they can also wreak havoc on the body. In addition, every patient experiences slightly different side effects. Not knowing what the side effects will be can be frightening when you are about to start cancer treatment, and often, the fear centers around pain.
Those side effects of cancer treatment—such as nausea, insomnia or pain—are often managed by the use of prescription drugs. And those drugs often come with side effects.
But more and more evidence is pointing to drugless options that will help support cancer patients as they go through their treatment plan.
The Society for Integrative Oncology (SIO) and the American Society for Clinical Oncology (ASCO) recently released a set of guidelines on pain management for people with cancer. These guidelines provide physicians with evidence-based solutions to treating their patients experiencing pain from cancer and treatment.
Integrative, or complementary, treatments are typically used along with conventional medical care to treat a condition. In this case, the ASCO-SIO guidelines address cancer pain relief through drug-free options, including acupuncture, massage therapy, meditation, and yoga.
“You don’t always have to rely on a prescription medication to address cancer pain,” says Richard T. Lee, MD, a clinical professor at City of Hope Comprehensive Cancer Center who helped develop the ASCO-SIO guidelines. “There are effective integrative approaches that help patients manage their pain and potentially use less medication.”
The most effective integrative approaches for cancer pain
The experts who developed the new ASCO-SIO guidelines looked at evidence that integrative treatments were effective at treating cancer pain. They wanted to learn which mind-body approaches and natural products were recommended for pain management for adults and children.
Natural products and treating children’s cancer pain: no good answers yet
To develop the guidelines, experts reviewed the reports of individual research studies and the results of reviews of groups of studies. For each type of integrative treatment, they evaluated how much evidence there was, whether that evidence was reliable, and that the treatment worked for cancer pain.
This approach resulted in a short list of the best integrative treatments for cancer pain in adults. There was not enough evidence to create reliable recommendations for children. In addition, there is not yet enough evidence to recommend for or against any natural products for cancer pain.
Cancer pain in adults: What works?
All integrative treatments included in the guidelines had to meet a specific standard: at least an “intermediate” level of evidence, meaning the treatment’s benefits had to outweigh the risks. The strength of these recommendations is “moderate,” by which experts mean that if the evidence changes, the recommendation may also change.
- For joint pain from aromatase inhibitors.
Aromatase inhibitors are commonly prescribed after breast cancer treatment for people with HR+ breast cancer, but they can lead to joint pain. Acupuncture has been shown to help. - For general pain and muscle and bone pain.
Acupuncture, guided imagery, yoga, and massage all help with general pain and pain that affects muscles and bones. Reflexology and acupressure were in the recommendations for patients experiencing chemotherapy-induced peripheral neuropathy. - For pain after surgery or other procedures.
Acupuncture, acupressure, hypnosis, and music therapy can all help relieve pain. - For pain during care to relieve symptoms (palliative care).
If you are experiencing pain as part of treatment to relieve symptoms, massage may help. It can also help pain for people who do not have cancer. However, the evidence that massage helps with cancer pain was gathered specifically from people receiving palliative care.
Some of the recommendations included were categorized by a “weak” rating, but the panel noted that the benefits outweighed the risks in those cases.
“Not having more evidence now does not mean that integrative treatments do not work,” says Dr. Lee. “Some may work better than current evidence shows because they have not been adequately studied. Integrative therapy clinical trials are more challenging to conduct than clinical trials for conventional therapies.”
What if my insurance does not pay for integrative health care?
There are some free and low-cost options. For example, if you are interested in lower-cost massage, a school of massage may offer lower-cost sessions with advanced students. There are also nonprofit organizations such as Unite for HER that provide coverage of integrative health services. Smith Center for Healing and the Arts offers a number of programs that educate and support people going through cancer treatments with nutrition, stress reduction, webinars on medical cannabis, and more.
Another resource is Inova Life with Cancer. This program of Inova Schar Institute offers free and low-cost services. They are based in Virginia, on the East Coast of the United States, but can help connect you with support and care no matter where you live.
Integrative treatment for other cancer symptoms
“There is growing evidence that integrative therapies can have a real impact on cancer pain,” says Dr. Lee. But you may well be wondering about other integrative approaches. Can they help treat cancer itself, as well as pain? What if you’d like to try a natural product to relieve another symptom, such as nausea, fatigue, or lack of appetite?
The new SIO-ASCO guidelines cover just one aspect of integrative cancer treatment. SIO and ASCO are partnering on further guidelines that will incorporate integrative approaches to helping cancer-related symptoms and address other side effects from cancer treatments. As new guidelines are rolled out, patients can approach cancer treatment with fewer concerns, knowing that integrative approaches offer them more options for managing side effects.
An interview with Dr. Richard T. Lee
I sat down with Dr. Lee to discuss the guidelines. The full interview includes information for both physicians and patients but there is also a video clip specifically discussing how to have a conversation with an oncologist and cancer team.
Starting a Conversation with Your Oncologist & Cancer Team from Wayne Jonas on Vimeo.
Integrative health and cancer
Resources for Cancer Care at the How We Heal Campaign, covering many aspects of integrative health and living with cancer including financial toxicity, sexual health, sleep, nutrition, cannabis, supplements, and others.
Pain management options
Managing Cancer-Related Pain: A Guide for Patients, Families, and Caregivers from the American Society of Clinical Oncology
The Pocket Guide to Cancer Pain
Talking to your health care provider or finding an integrative health provider
How Do I Talk to My Doctor About Complementary and Integrative Methods? Questions to ask your cancer care team from the American Cancer Society.
6 Things to Know When Selecting a Complementary Health Practitioner, from the NIH National Center for Complementary and Integrative Health.
Will My Insurance Cover Complementary and Integrative Therapies? From the American Cancer Society.