Integrative Oncology in Breast Cancer Care

Introduction
The Global Breast Cancer Crisis
	Global Breast Cancer Impact
	Challenges and Opportunities
Integrative Oncology
	Definitions of Integrative Oncology
	International Professional Associations in Integrative Oncology
	Global Models of Care
	Integrative Oncology Addressing Public Health Challenges
	Clinical Evidence Supporting IO Use in Practice and Professional Guidelines
	Professional Training Initiatives
	Success Through Collaboration
Contents
Part I: Breast Cancer Prevention and Diagnosis
	1: Prevention Is Better Than Treatment
		1.1	 Primary Prevention
		1.2	 Secondary Prevention
		1.3	 Tertiary Prevention
		1.4	 Diet
		1.5	 Obesity
		1.6	 Alcohol
		1.7	 Physical Activity
		1.8	 Environmental Toxins
		1.9	 Summary
		References
	2: Personalised Breast Screening: A Mammogram for All?
		2.1	 How Effective Is Mammography as a Screening Modality
		2.2	 What Is the Level of Need When It Comes to Screening
		2.3	 Individualised Breast Screening
		2.4	 Breast Cancer Surveillance
		2.5	 Breast Ultrasound as a Screening Modality
		2.6	 Magnetic Resonance Imaging as a Screening Modality
		2.7	 Pros and Cons of Personalised Screening
		2.8	 Summary
		References
	3: The Diagnosis Dilemma: Do We Know the Why
		3.1	 Breast Cancer Is a Complex Disease to Diagnose and Treat
		3.2	 Global Inequities in Diagnosis and Treatment of Breast Cancer
		3.3	 Summary
		References
	4: Integrative Oncology Matters: Building the Foundations
		4.1	 Building the Foundations
		4.2	 Nutrition in Integrative Breast Cancer Care
		4.3	 Physical Activity Before, During and After Breast Cancer Treatment
		4.4	 Why Sleep Matters
		4.5	 Psycho-Emotional Support Throughout the Breast Cancer Care Continuum
		4.6	 Integrating Complementary Modalities and Natural Products into Breast Cancer Care Safely
		4.7	 Creating a Personalised Integrative Oncology Plan
		4.8	 Change Is the Only Constant: Dynamic Care Planning
		4.9	 The Patient Perspective
		References
Part II: Early Breast Cancer
	5: Before and After Breast Surgery
		5.1	 What Type of Breast Surgery
		5.2	 Lymphoedema and Breast Surgery
		5.3	 Risk Assessments After Breast Surgery
		5.4	 Lifestyle Interventions Before and After Breast Surgery
		5.5	 Summary
		References
	6: Living with, Not Just Surviving Chemotherapy
		6.1	 Acupuncture
		6.2	 Reiki
		6.3	 Guided Imagery
		6.4	 Reflexology
		6.5	 Yoga and Yoga Therapy
		6.6	 Exercise
		6.7	 Anthroposophic Medicine
		6.8	 Mindfulness
		6.9	 Personalised Integrative Medicine
		6.10	 Integrative Breast Cancer Guidelines
			6.10.1	 Acute Radiation Skin Reaction
			6.10.2	 Anxiety and Stress Reduction
			6.10.3	 Chemotherapy-Induced Nausea and Vomiting
			6.10.4	 Depression and Mood Disturbance
			6.10.5	 Fatigue
			6.10.6	 Lymphedema
			6.10.7	 Neuropathy
			6.10.8	 Pain
			6.10.9	 Quality of Life
			6.10.10 Sleep Disturbance
			6.10.11 Vasomotor/Hot Flashes
		6.11	 Summary
		References
	7: Radiotherapy, When, What and How
		7.1	 Radiotherapy and Reconstruction
		7.2	 Radiation-Induced Fibrosis
		7.3	 Reflexology for Radiotherapy-Induced Fatigue and Anxiety
		7.4	 Integrative Oncology Interventions During Radiotherapy
			7.4.1	 Guided Imagery
			7.4.2	 Mindfullness
			7.4.3	 Yoga
			7.4.4	 Music Therapy
			7.4.5	 Healing Touch
			7.4.6	 Qigong
			7.4.7	 Polarity Therapy
		7.5	 Summary
		References
	8: Managing the Impact of Hormone Therapy
		8.1	 Brief Overview of Current Hormone (Endocrine) Therapy Options in ER+ Breast Cancer
		8.2	 Side Effects of Endocrine Therapy (ET)
			8.2.1	 Patient Voice from Qualitative Studies [24]
		8.3	 Understanding Tamoxifen Metabolism
		8.4	 Aromatase Inhibitors: Additional Challenges
		8.5	 Integrative Oncology Support for Menopausal Symptoms in ER+ Breast Cancer
		8.6	 Summary
		References
	9: Targeted Therapies and Immunotherapy
		9.1	 The Gut Microbiome
		9.2	 Probiotics: One Size Does Not Fit All
		9.3	 Cancer-Induced Cardiotoxicity Management
		9.4	 Key Recommendation of Exercise Prescription in Cancer Patients [24]
			9.4.1	 General Principles [24]
			9.4.2	 Frequency and Duration [24]
			9.4.3	 Intensity [24]
			9.4.4	 Progression [24]
		9.5	 Multidisciplinary Approach to Cardio-Oncology Care [25]
		9.6	 Summary
		References
Part III: Living Well with Advanced Breast Cancer
	10: No Cure Versus Chronic Illness: Shifting the Paradigm
		10.1	 Cancer as a Chronic Illness
		10.2	 Chronic Cancer Burden
		10.3	 Pain in Chronic Breast Cancer
		10.4	 Mindfulness Practices in Chronic Breast Cancer
		10.5	 Anxiety in Chronic Breast Cancer and Access to Integrative Oncology Services
		10.6	 Summary
		References
	11: Integrating Therapies: A Rational, Personalised Approach to Metastatic Disease
		11.1	 Aiming for Best as the Default Goal: No Patient Left Behind
		11.2	 Beyond Side Effects: Dynamic Assessment of Needs and Quality of Life
		11.3	 Monitoring and Management: Testing Considerations
		11.4	 Foundational Support
		11.5	 Oral Natural Products: Nutritional Supplements
			11.5.1	 Nutrient Supplementation
				11.5.1.1	 Vitamin D
				11.5.1.2	 Omega-3
				11.5.1.3	 Antioxidants, Iron and Glutamine
			11.5.2	 Medicinal Mushrooms or Mycotherapy
			11.5.3	 Curcumin and Other Common Anti-Inflammatory Supplements
			11.5.4	 Probiotics, Prebiotics, Synbiotics and Postbiotics
			11.5.5	 Oral Natural Products: Herbal Medicine
			11.5.6	 Injectable Natural Products
				11.5.6.1	 Mistletoe
				11.5.6.2	 IV Vitamin C
				11.5.6.3	 IV Curcumin
		11.6	 Medical Cannabis
		11.7	 Building a Rational, Personalised Approach to Metastatic Breast Cancer Support
		11.8	Summary
		References
	12: Symptomatic Care Is a Whole Team Approach
		12.1	 Supportive Oncology
		12.2	 Key Recommendations from the ASCO Guidelines on Supportive Oncology
			12.2.1	 General Recommendations
			12.2.2	 Specific Recommendations
		12.3	 Summary
		References
	13: Experiencing the End-of-Life
		13.1	 Integration Between Oncology and Palliative Care
		13.2	 Summary
		References
Part IV: Survivorship
	14: Early Survivorship: Rehabilitation and Reintegration
		14.1	 Why the End of Active Treatment Is Just the Beginning
		14.2	 Supporting Psychological Wellbeing: Coping, Managing Fear and Sexual Wellness
		14.3	 Dealing with Lingering Symptoms
		14.4	 Physical Rehabilitation and Health and Wellbeing Promotion
		14.5	 Multimodal Breast Cancer Survivorship Care: Proposed Approach
		14.6	 Summary
		References
	15: Managing Long-Term Health Risks for Breast Cancer Survivors
		15.1	 Beyond Recurrence: Looking at the Bigger Picture
		15.2	 Optimising Long-Term Health: Metabolic Syndrome (MetS) and Cardiovascular Disease (CVD)
		15.3	 Optimising Long-Term Health: Addressing the Hormone Environment
		15.4	 Environmental Exposures
		15.5	 Summary
		References
Appendix
	Levels of Evidence
	Grades of Recommendation