Integrative medicine in breast cancer survivorship care

Introduction

Cancer survivors may continue to experience a range of symptoms—such as fatigue, pain, and anxiety—even years after completing active treatment. These ongoing challenges often require additional interventions to effectively support their long-term well-being. Integrative medicine is a healthcare approach that incorporates evidence-based complementary therapies into conventional medicine to treat the whole person, not just the disease, by addressing physical, emotional, mental, social, spiritual, and environmental factors that may impact health. Integrative medicine focuses on prevention, wellness, and patient empowerment, often using a personalized treatment plan tailored to the individual’s needs. Integrative oncology is a “patient-centered, evidence-informed field that utilizes mind-body practices, natural products, and lifestyle modifications alongside conventional cancer treatments to help address patients’ unmet needs, relieve symptoms, and improve quality of life” (1). More and more breast cancer survivors are turning to integrative medicine approaches during their anti-cancer journey (2). Increasing research has been conducted on if and how integrative medicine approaches may help improve cancer survivors’ symptoms and quality of life (QoL). Oncology professionals should be aware of the evidence supporting the use of integrative medicine among cancer survivors and be prepared to guide them in effectively using these approaches to promote adherence to prescribed treatments and follow-up plans, ultimately leading to better outcomes.

Cancer treatments can lead to challenging physical and emotional symptoms, often resulting in long-term side effects. Integrative medicine employs nonpharmacologic therapies alongside conventional treatments to manage symptoms, enhance QoL, and promote healthy lifestyle changes. Integrative therapies can effectively address a range of symptoms, such as pain, anxiety, depression, fatigue, hot flashes, and nausea/vomiting. Breast cancer survivorship is a complex experience that includes the physical challenges of diagnosis and treatment as well as the emotional, psychological, and spiritual aspects of recovery. As survivors aim for optimal well-being post-treatment, integrative medicine has become increasingly important. This approach blends conventional medical treatments with evidence-based complementary therapies to holistically address the diverse needs of breast cancer survivors.

Three main types of integrative approaches are clinically employed to assist breast cancer patients in managing symptoms associated with the disease and its treatment, as well as improving their lifestyle:

• Diet and exercise recommendations.
• Mind-body therapies such as meditation, yoga, acupuncture, and massage.
• The use of dietary supplements, which is often discussed during integrative medicine consultations for breast cancer survivors.

This review provides an overview of these integrative medicine modalities used for consulting breast cancer survivors.

Diet

Cancer survivors are interested in how their diet may affect their risk of recurrence. Evidence from population studies points to possible links between diet and cancer risk.

The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) suggested that diets associated with increased cancer risk include high intake of red and/or processed meats, drinks containing alcohol, and foods containing refined sugars (3). Diets associated with decreased cancer risk include foods rich in dietary fiber, such as fruits and non-starchy vegetables, as well as those rich in vitamin D, like salmon, sardines, and fortified foods. We also encourage breast cancer survivors to maintain a diverse diet, including plant-based proteins such as peas, beans, lentils, and nuts, as well as animal proteins like fatty fish such as salmon and sardines, lean poultry, and low-fat dairy. Indeed, several prospective observational studies found that better adherence to the WCRF/AICR recommendations may play a significant role in reducing the risk of developing cancer (4,5).

Many lifestyle factors may contribute to the development of breast cancer. The typical Western diet, high in refined carbohydrates and fat but low in fiber, is associated with metabolic complications such as obesity, insulin resistance, and inflammation—all of which increase the risk of postmenopausal breast cancer (6). Research shows that excess body weight is linked to a higher risk of developing breast cancer and increased mortality rates among survivors (7). Counselling patients on the benefits of multimodal lifestyle interventions—including dietary changes, physical activity, and psychological support—is crucial for maintaining a healthy body weight and improving outcomes.

Research suggests that a high intake of saturated and trans fats may increase the risk of hormone receptor-positive breast cancer and negatively impact outcomes for premenopausal survivors. Additionally, high consumption of saturated fats and processed meats has been associated with an increased risk of mortality in patients with a history of breast cancer. Conversely, adherence to diets such as the Mediterranean diet, which is rich in fruits, vegetables, and omega-3 fatty acids, has shown promising benefits for breast cancer survivors, including improved well-being and reduced recurrence rates (8). A randomized controlled trial (RCT) called PREDIMED investigated the potential of a Mediterranean diet, a diet characterized by a variety of fruits, vegetables, cereals, legumes, poultry, fish, nuts, seeds, olive oil and low consumption of meat and dairy products, to reduce breast cancer risk in 4,282 women aged 60–80 years who were at high risk for cardiovascular disease. Participants were divided into three groups: a Mediterranean diet supplemented with extra-virgin olive oil (EVOO), a Mediterranean diet supplemented with mixed nuts, and a low-fat diet serving as the control group. After a median follow-up of 4.8 years, the Mediterranean diet/EVOO group had the lowest incidence of breast cancer (1.1 per 1,000 person-years) compared to the nut-supplemented Mediterranean diet (1.8 per 1,000 person-years) and the low-fat control group (2.9 per 1,000 person-years). This study suggests that a Mediterranean diet may have a beneficial effect on the primary prevention of breast cancer (9).

Studies examining the relationship between dairy consumption and breast cancer recurrence have yielded mixed results. Some suggest a potential link between high dairy intake and an increased risk of recurrence, while others find no significant association. This variability may depend on factors such as the type and amount of dairy consumed, the fat content of the products, and individual patient characteristics. While dairy is a valuable source of protein and calcium, its role in breast cancer recurrence remains unclear and warrants further research. For instance, one study found an increased risk in women who consumed milk as a beverage, but no similar trend was observed in those who consumed cheese or yogurt (10).

Soy consumption has been a topic of interest among breast cancer survivors, with research suggesting potential benefits. Scientific evidence indicates that including soy isoflavones in the diet may improve prognosis for breast cancer survivors, encouraging further exploration in this field. Traditional soy foods, such as edamame, tofu, soymilk, and tempeh, are often recommended for their nutritional value, providing complete protein, fiber, potassium, and magnesium. These foods contain isoflavones—natural plant compounds that have demonstrated promising effects in cancer research, including tumor suppression, induction of apoptosis, and support for DNA repair. Research also suggests a non-linear inverse relationship between isoflavone intake and the risk of recurrence and all-cause mortality (11).

The recent 2023 Pathways Study examined alcohol consumption around the time of diagnosis and during the six months following and its impact on prognosis and survival in breast cancer survivors. The study found that alcohol intake may increase the risk of recurrence in non-obese women. Interestingly, in obese women, alcohol consumption was associated with decreased all-cause mortality (12). Similarly, the 2010 Life After Cancer Epidemiology (LACE) study reported that women who consumed three to four alcoholic beverages per week after a breast cancer diagnosis faced an increased risk of recurrence, particularly among postmenopausal and overweight or obese women. Additionally, daily alcohol intake exceeding 6 grams was linked to a higher risk of breast cancer recurrence [hazard ratio (HR) of 1.35] and disease-related mortality (HR of 1.51) (13).

Overall, diet and lifestyle choices play a critical role in the risk and management of breast cancer. However, the connections between specific dietary factors and health outcomes remain nuanced and complex. Continued research is vital to provide more precise dietary recommendations.

Exercise and physical activity

Integrative oncology professionals routinely recommend exercise as a crucial part of cancer survivorship self-care. A sedentary lifestyle has been shown to increase the risk of many cancers, including colon, endometrium, and lung cancers (14). In addition, sedentary lifestyle contributes to obesity, which is a risk factor for many types of cancer (15). Notably, weight gain and obesity are risk factors for postmenopausal breast cancer development (16). In addition, studies have shown that increased physical activity is associated with improved cancer-related survival (17-19). Post-diagnosis, recreational physical activity can play critical role in improving outcomes for breast cancer survivors. Research shows that engaging in regular, recreational physical activity after a breast cancer diagnosis is associated with a 23% reduction in both recurrence and disease-specific mortality (20). The American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention recommend more than 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity every week (21). Moderate-intensity physical activity raises the heart rate to 64–76% of the maximum (calculated as 220 minus your age). Examples include brisk walking, casual cycling, or playing doubles tennis. Vigorous-intensity exercise raises the heart rate to 77–93% of the maximum, with examples such as running, swimming laps, or playing singles tennis. In a large prospective cohort study of over 10,000 patients with primary breast cancer, postdiagnosis and pretreatment exercise were associated with a lower risk of distant recurrence-free interval (DRFI) events in a nonlinear manner, with benefits leveling off beyond approximately 25 metabolic equivalent of task (MET)-h/wk. The protective effect of exercise varied by breast cancer subtype and menopausal status, with the strongest benefits observed in hormone receptor-negative subtypes and premenopausal women (22). A study of 755,459 participants across nine cohorts found that recommended levels of leisure-time physical activity (7.5–15 MET hours/week) significantly reduced the risk of seven out of 15 cancers, including colon, breast, and liver. Both linear and nonlinear dose-response patterns support maintaining recommended activity levels to lower cancer risk (23).

Cancer survivors may face barriers such as pain and fatigue and would need guidance on how to safely exercise while dealing with cancer-related side effects. Studies have shown that regular physical activity during cancer treatment can reduce pain and fatigue, improve physical functioning, cardiovascular fitness, and QoL, and may lower cancer risk (23-26). Finally, sedentary patients may start with movement meditation like restorative yoga, while those with physical limitations may benefit from supervised exercise to prevent injury. Health care providers and oncology professionals should promote regular physical activity at recommended levels.

Mind-body therapies

Mind-body modalities recognize the link between physical and psychological health, offering significant benefits for improving emotional and psychological well-being in cancer survivors. Mind-body therapies typically fall into two categories: practitioner-led practices such as meditation, yoga, or tai chi; and provider-administered therapies such as acupuncture and massage. These evidence-based therapies are highly effective in enhancing emotional and psychological well-being, and they are also utilized to alleviate various cancer-related symptoms, including pain, anxiety, depression, sleep problems, and balance difficulties. In addition, while initial guidance is necessary, mind-body approaches are predominantly self-directed, cost-effective, efficient, and safe, with minimal or no adverse effects, making them highly advisable for individuals with cancer.

Meditation

Meditation is an ancient practice that enhances present-moment awareness and comes in different forms. Focused attention meditation entails concentrating on a specific object, recognizing distractions, and gently refocusing attention. Open monitoring meditation involves observing experiences without reaction, noting changes from moment to moment (27). Mindfulness-based intervention (MBI) is a meditation approach increasingly integrated into cancer care. There are different forms of MBI, and among them mindfulness-based stress reduction (MBSR) is the original form that combines mindfulness meditation, yoga, and body awareness to cultivate mindfulness and alleviate stress. Mindfulness-based cancer recovery (MBCR) is an eight-session adaptation that blends elements of both MBSR and mindfulness-based cognitive therapy (MBCT) to address the needs of people with cancer. It includes training in mindfulness meditation and Hatha yoga as in MBSR, along with cognitive coping as in MBCT, and specific breathing and sleep exercises as well as content related to management of cancer-related symptoms such as fatigue and pain.

MBSR and MBCR programs have shown significant benefits for breast cancer patients and survivors. Studies indicate that regular practice of these interventions can lead to reduced depression, anxiety, and fear of recurrence (28,29); increased energy and physical functioning; improved psychosocial adjustment, with effects lasting up to 12 months post-intervention (30); alleviation of endocrine-treatment-related side effects (31); enhanced sleep quality (32). MBCR has been found to be more effective than supportive-expressive group therapy for treating distress and stress, and improving QoL in breast cancer survivors (33). It has also shown non-inferiority to cognitive behavioral therapy for treating insomnia in some measures (34). Other type of MBI has also been shown to reduce depressive symptoms, intrusive thoughts and worry, and increase positive affect among young breast cancer survivors (35). In fact, there is a wealth of evidence supporting the use of MBIs in reducing anxiety and depression among cancer survivors during and after active treatment. The Society for Integrative Oncology (SIO)-American Society for Clinical Oncology (ASCO) guidelines strongly recommend offering MBIs to people with cancer both during active treatment and post-treatment for managing symptoms of anxiety and depression (36). In addition, a study of 1,744 midlife women revealed that higher mindfulness and lower stress correlated independently with fewer menopausal symptoms, with mindfulness showing an even stronger association among women experiencing high stress levels. This suggests mindfulness practices may be particularly beneficial for reducing menopausal symptoms, especially psychological ones, in stressed midlife women (37).

Yoga

Yoga is an ancient mind-body practice that integrates holding of physical postures (asanas), breathing exercises (pranayama), meditation, and mindfulness to promote overall well-being and balance. There are different types of yoga, which incorporate varying amounts of physical elements (asanas) and spiritual elements (meditation, pranayama).

Yoga has been shown to improve sleep quality, reduce memory difficulty, stress, and improve QoL in cancer survivors (38-40). A study involving 410 cancer survivors with moderate to severe sleep issues found that a 4-week yoga intervention (including pranayama, gentle asanas, and meditation) significantly improved all aspects of sleep compared to standard care (39). In breast cancer patients, yoga was found to help improve mood, social functioning, QoL, and reduce anxiety, fatigue, joint pain, chemotherapy-induced peripheral neuropathy (CIPN) and hot flashes (41-45). The 2022 SIO-ASCO integrative medicine cancer pain guideline recommended that yoga can be offered to patients with aromatase inhibitor (AI) induced joint muscle pain (46). In addition, two studies found yoga effective for reducing menopausal symptoms, with one meta-analysis (5 RCTs, 582 participants) showing modest improvements in vasomotor and psychological symptoms, while a larger meta-analysis (13 RCTs, 1,306 participants) demonstrated yoga’s effectiveness across all symptom categories (psychological, somatic, vasomotor, and urogenital) compared to no treatment (47,48). Due to its low risks, potential for mild joint and muscle pain, and significant benefits for breast cancer survivors, integrative oncology professionals frequently recommend yoga as a viable intervention for managing symptoms in cancer survivors.

Acupuncture

Acupuncture is a traditional Chinese Medicine technique that involves inserting and manipulating hair-thin needles into specific points on the body to alleviate symptoms. Research suggested that acupuncture works by regulating neurotransmitters, neurohormones and reducing neuroinflammation (49,50). Acupuncture has been used as an integrative therapy for various symptoms affecting breast cancer survivors with increasing evidence indicates its potential benefits in alleviating symptoms induced by cancer treatment, such as musculoskeletal discomfort, hot flashes, peripheral neuropathy, fatigue, anxiety, and depression.

Aromatase inhibitor-induced musculoskeletal symptoms (AIMSS)

AIMSS has been reported in about half of breast cancer survivors taking it, resulting in approximately 13% of users discontinuing the medication (51,52). The greatest benefit is seen with a minimal five-year course of adjuvant endocrine therapy, which is consequently the recommended treatment duration for breast cancer survivors. Acupuncture has been shown to help reduce AIMSS with minimal toxicities. The 2022 SIO-ASCO integrative medicine cancer pain guideline recommended that “Among adult patients, acupuncture should be recommended for aromatase inhibitor-related joint pain” (46). This strong recommendation is based on four systematic reviews and five RCTs investigated the use of acupuncture for AI-related joint and muscle pain in breast cancer survivors. The most robust evidence comes from a large phase III sham-controlled RCT involving 226 patients with moderate to severe AI-related joint pain. After 6 weeks of treatment, true acupuncture significantly reduced pain compared to sham acupuncture and standard of care (pain reduction: 2.05, 1.07, and 0.99 points, respectively, on a 0–10 points numeric rating scale), with a higher proportion of patients in the true acupuncture group experiencing clinically meaningful pain reduction (58%, 33%, and 31% respectively) (53).

Vasomotor symptoms

Hot flashes and night sweats, known as vasomotor symptoms, are common side effects of breast cancer treatments like chemotherapy or endocrine therapy. Hypnotherapy is one of the non-pharmacologic treatments recommended by guidelines for managing vasomotor symptoms (54). Acupuncture appears to be a promising treatment for hot flashes in women with breast cancer, with minimal side effects, as indicated by several RCTs (55-58). A systematic review found that acupuncture significantly improved hot flashes in cancer patients across all eight studies analyzed (59).

Neuropathic pain

The 2022 SIO-ASCO integrative medicine cancer pain guideline recommended that “Acupuncture may be offered to patients experiencing CIPN from cancer treatment” (46). This recommendation was based on two systematic reviews and seven RCTs, with small sample sizes studying the effect of acupuncture on reducing CIPN symptoms. Most studies showed a benefit of acupuncture for CIPN pain, without major toxicities. A phase IIB trial involving 75 cancer survivors experiencing moderate to severe CIPN found that acupuncture significantly reduced pain compared to usual care, with a trend toward reduction compared to sham acupuncture (60). However, the small sample size and potential biases in the studies led to a low level of evidence supporting these findings. An ongoing phase III RCT is comparing acupuncture to sham acupuncture in reducing CIPN pain.

Fatigue

Fatigue is another common side effect of cancer with limited effective treatment options.

In a large RCT with 302 breast cancer patients, acupuncture plus usual care significantly reduced general fatigue scores compared to usual care alone (61).

On the other hand, one large RCT involving 101 patients with post chemotherapy chronic fatigue and showed that both real and sham acupuncture groups had reduction in fatigue without significant difference between the groups (62). These results showed that acupuncture significantly improved fatigue when compared with usual care alone, although whether it is significantly better than placebo control will warrant further study.

Anxiety and depression

Three RCTs suggested that acupuncture may be beneficial for reducing anxiety symptoms in women with breast cancer after acute treatment (36). One trial found that auricular acupuncture significantly improved anxiety scores compared to psychoeducation alone (63). The second RCT showed that acupuncture, compared to usual care, resulted in significant decreases in both anxiety and depression scores (61). However, the acupuncture protocol was tailored more towards alleviating fatigue, and the inclusion of additional anxiety-reducing points might have enhanced its efficacy (61). The third RCT found that, compared to the wait-list control, women in the electro-acupuncture group experienced a significant reduction in anxiety scores over time (64).

In summary, existing research indicates that acupuncture could be a beneficial and safe non-pharmacological approach to managing different symptoms and enhancing the QoL in breast cancer survivors. Health care providers and oncology professionals should promote and offer acupuncture to survivors to alleviate cancer-related symptoms, such as AIMSS.

Massage

Several studies have explored the impact of massage on individuals with cancer. While some studies have been preliminary or varied in quality, common findings include enhanced QoL and significant reductions in pain, anxiety, and stress. A meta-analysis of 18 RCTs including 950 participants suggests that massage may help to reduce anger and fatigue in patients with breast cancer (65). Another meta-analysis of nine studies showed massage was effective in relieving cancer pain when compared with no massage or usual care (66). In addition, studies have shown that massage therapy help reduce pain and improve mood among cancer survivors patients with advanced cancer (67). A recently comparative effectiveness phase III RCT showed that massage was as effective as acupuncture in reducing cancer pain, fatigue, insomnia and improve QoL among patients living with advanced cancer with minimal side effects (68). Massage therapy may be a valuable therapeutic resource for managing cancer related symptoms for cancer survivors.

Dietary supplements and natural products

A significant proportion of cancer survivors use dietary supplements and natural products for symptom relief, cancer prevention, and QoL improvement (69). Most women with a history of breast cancer who use supplements do not disclose their use to their healthcare providers. Furthermore, clinicians often fail to document vitamin and supplement use in the medical record. This is concerning, as supplements may pose risks of toxicity, herb-drug interactions, and interference with the effectiveness of cancer treatments (70,71). Some dietary supplements and natural products may modulate drug metabolism, reduce the effects of cytotoxic therapies, stimulate hormone-sensitive cancers, increase bleeding risk, or alter immunosuppressive therapy efficacy. Additionally, others may cause renal and hepatic injury. Dietary supplements and natural products manufacturers are not required to have standards for safety, content, and quality, and possible side effects may not be included in the labeling (72).

Sleep disruptions are prevalent among individuals who have survived breast cancer, persisting even after the completion of active treatment. Sleep disturbances are common among breast cancer survivors and often persist beyond active treatment. A placebo-controlled trial in this population found that melatonin supplementation improved subjective sleep quality without significant adverse effects (73).

Research suggests that higher vitamin D levels may reduce the risk of breast cancer recurrence and mortality (74,75). Vitamin D supplementation in breast cancer survivors has also shown potential benefits for improving bone density, which is particularly important due to the increased risk of osteopenia and osteoporosis associated with cancer treatments. Research supports that maintaining adequate vitamin D levels may help preserve bone health, though more studies are needed to determine optimal dosage and long-term effects (76).

The use of omega-3 fatty acids in breast cancer survivors has been studied for its potential benefits, particularly in reducing inflammation, improving cardiovascular health, and enhancing overall well-being. Findings also suggest that increased consumption of omega-3 polyunsaturated fatty acids may help reduce physical fatigue symptoms (77). A 2023 systematic review highlighted that omega-3 fatty acids, either alone or in combination with other supplements, were associated with improvements in physical symptoms, mood, and certain inflammatory and metabolic markers in breast cancer patients undergoing or post-treatment (78).

Tart cherry juice has been studied for its potential to alleviate joint pain induced by AIs. Its anti-inflammatory properties are primarily attributed to high levels of anthocyanins, hydroxycinnamates, and flavonoids (Flavin-3-ols). Research suggests that these compounds may help reduce inflammation and oxidative stress, which are likely contributors to joint pain. Although studies specifically focusing on tart cherry juice for AI-induced joint pain are limited, related research indicates promising outcomes. A 2022 double-blind placebo-controlled trial involving patients with a history of hormone-positive breast cancer showed significant benefits from drinking tart cherry juice, with a 34.7% mean decrease in pain compared to just a 1.4% reduction in the placebo group (79).

Clinical practice guidelines found little evidence supporting dietary supplements and natural products use among breast cancer patients (80). Acetyl-L-carnitine may cause harm when used for CIPN prevention. Aloe vera, and hyaluronic acid cream were not recommended for radiation skin reactions (80). Given the potential risks and lack of evidence supporting benefits, it is essential for oncology healthcare providers and patients to discuss the use of dietary supplements and natural products, and to record in the medical chart the supplements that patients report.

The importance of specialized practitioners in integrative medicine

The role of regulated, integrative medicine specialists, such as integrative medicine physicians, naturopathic doctors, and registered acupuncturists is to help navigate the challenges and opportunities of integrating evidence-based complementary therapies into conventional cancer care. These practitioners ensure that these therapies are both safe and effective, without interfering with prescribed medications. By fostering collaboration among patients, oncologists, and integrative healthcare providers, they aim to optimize survivorship outcomes and empower individuals to take an active role in their healing journey.

Many patients are interested in health promotion and improving their QoL through non-pharmacologic approaches. All healthcare providers must work to bridge the gap, recognizing integrative practices as essential partners in survivorship care. A recent 2023 multi-institutional analysis revealed that the majority of patients (91.2%) disclosed using complementary and alternative medicine (CAM) alongside conventional treatments. However, 27.1% of these individuals did not disclose their CAM usage to their oncologist (81).

With the rapidly increasing prevalence and interest in CAM, its relevance in oncology has grown significantly. Eight studies found that many healthcare providers felt unprepared to offer adequate guidance on CAM use or to initiate discussions about CAM options, highlighting the need for additional training in this field (82). Future research should explore cancer patients’ perspectives and provide evidence on the use of CAM in oncology settings.

Conclusions

Breast cancer survivors often face complex physical, emotional and psychospiritual challenges. They increasingly turn to evidence-informed integrative medicine for support with long-term side effects, QoL, and adopting healthy lifestyle changes. This review summarizes the use of three main types of integrative approaches in breast cancer survivorship: diet and exercise recommendations, mind-body therapies, and dietary supplements.

Diet and exercise modifications can significantly impact outcomes (e.g., risks of recurrence and mortality) as well as QoL (e.g., pain, fatigue, physical functioning) in breast cancer survivors. Mind-body therapies including acupuncture, massage, meditation, and yoga offer significant benefits for physical psychological well-being in cancer survivors. These therapies can address a wide range of symptoms, including pain (e.g., neuropathic pain, AI-induced joint pain), anxiety, stress, depression, fatigue, insomnia, vasomotor symptoms, memory issues, and balance difficulties. These symptoms often contribute to poor medication compliance.

Breast cancer survivors may also use dietary supplements such as melatonin, vitamin D, and omega-3 fatty acids to support their well-being or potentially reduce recurrence risk. However, they often do not disclose supplement use to their healthcare providers, and such use is frequently absent from medical records.

Healthcare professionals should proactively discuss the potential benefits and risks of these interventions with patients. It is important to recommend modalities that are evidence-based, cost-effective, and have minimal side effects. Integrative medicine specialists are essential partners in survivorship care. Programs that incorporate integrative therapies within cancer care institutions can offer structure, guidance, and support to help patients safely integrate these approaches into their treatment and recovery plans.

Future research should explore cancer patients’ perspectives and provide robust evidence on the use of CAM in oncology settings.

Acknowledgments

None.

Footnote

Provenance and Peer Review: This article was commissioned by Guest Editors (Muna Al-Khaifi, Charles B. Simone, Maryam Lustberg, Isabelle Choi, Henry Wong and Elwyn Zhang) for the series “Supportive Care After Breast Cancer: Challenges and Opportunities” published in Annals of Palliative Medicine. The article has undergone external peer review.

Peer Review File: Available at https://apm.amegroups.com/article/view/10.21037/apm-24-176/prf

Funding: This work was supported by National Institutes of Health Grants (NIH) (No. CA248563 to T.B. and No. CA251470 to T.B.).

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-24-176/coif). The series “Supportive Care After Breast Cancer: Challenges and Opportunities” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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