Mind-Body Therapies in Cancer: What Is the Latest Evidence?

Abstract

Purpose of Review

Many people living with cancer use complementary therapies, and some of the most popular are mind-body therapies (MBTs), including relaxation and imagery, hypnosis, yoga, meditation, tai chi and qigong, and art therapies. The efficacy of these modalities was reviewed by assessing recent findings in the context of cancer care.

Recent Findings

These therapies show efficacy in treating common cancer-related side effects, including nausea and vomiting, pain, fatigue, anxiety, depressive symptoms and improving overall quality of life. Some also have effects on biomarkers such as immune function and stress hormones. Overall studies lack large sample sizes and active comparison groups. Common issues around clearly defining treatments including standardizing treatment components, dose, intensity, duration and training of providers make generalization across studies difficult.

Summary

MBTs in cancer care show great promise and evidence of efficacy for treating many common symptoms. Future studies should investigate more diverse cancer populations using standardized treatment protocols and directly compare various MBTs to one another.

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Methodological Considerations for Disentangling a Risk Factor's Influence on Disease Incidence versus Post-Diagnosis Survival: The Example of Obesity and Breast and Colorectal Cancer Mortality in the Women's Health Initiative

ABSTRACT

Often, studies modeling an exposure's influence on time to disease-specific death from study enrollment are incorrectly interpreted as if based on time to death from disease diagnosis. We studied 151,996 post-menopausal women without breast or colorectal cancer in the Women's Health Initiative with weight and height measured at enrollment (1993-1998). Using Cox regression models, we contrast hazard ratios (HR) from two time-scales and corresponding study subpopulations: time to cancer death after enrollment among all women and time to cancer death after diagnosis among only cancer survivors. Median follow-up from enrollment to diagnosis/censoring was 13-years for both breast (7633 cases) and colorectal cancer (2290 cases). Follow-up from diagnosis to death/censoring was 7-years for breast and 5-years for colorectal cancer. In analyses of time from enrollment to death, body mass index (BMI)≥35-kg/m² versus 18.5-<25-kg/m² was associated with higher rates of cancer mortality: HR=1.99; 95%CI: 1.54, 2.56 for breast cancer (p-trend <0.001) and HR=1.40; 95%CI: 1.04, 1.88 for colorectal cancer (p-trend=0.05). However, in analyses of time from diagnosis to cancer death, trends indicated no significant association (for BMI≥35-kg/m², HR=1.25; 95%CI: 0.94, 1.67 for breast [p-trend=0.33] and HR=1.18; 95%CI: 0.84, 1.86 for colorectal cancer [p-trend=0.39]). We conclude that a risk factor that increases disease incidence will increase disease-specific mortality. Yet, its influence on post-diagnosis survival can vary, and requires consideration of additional design and analysis issues such as selection bias. Quantitative tools allow joint modeling to compare an exposure's influence on time from enrollment to disease incidence and time from diagnosis to death. This article is protected by copyright. All rights reserved.

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Blood and tissue-based tumor genomics: a battle royale or match made in heaven?

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Inguinal canal spermatic cord leiomyoma presenting as an incarcerated inguinal hernia

Leiomyoma is a benign neoplasm originating from smooth muscle cells and is most commonly seen in the uterus, followed by the small bowel and oesophagus. We report a rare case of a 41-year-old male patient with a spermatic cord leiomyoma that presented as an inguinal canal mass mimicking an irreducible inguinal hernia without scrotal involvement. This report highlights the rare presentation and workup of an inguinal mass, importance of intraoperative decision making based on operative findings and the significance of postoperative pathology findings.

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Hypersegmented neutrophils and oval macrocytes in the setting of B12 deficiency and pancytopaenia

Vitamin B₁₂ deficiency is a recognised pathology in several populations, with a particular prevalence in an older adult population. We present two cases whereby vitamin B₁₂ deficiency is the causative factor in marked pancytopaenia. Oval macrocytosis and hypersegmented neutrophils were noted on both peripheral blood samples, which are a characteristic finding in macrocytic anaemia due to B₁₂ deficiency. Distinct underlying pathologies were identified in both cases; food-cobalamin malabsorption and pernicious anaemia. Parenteral vitamin B₁₂ supplementation resulted in a marked reticulocytosis and rapid improvement of haematological indices in both cases. We present this series to serve as a reminder that B₁₂ deficiency can present as life-threatening pancytopaenia.It has has multiple underlying pathologies,defined risk populations and has characteristic blood film findings which can guide investigations, diagnosis and treatment.

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Mega-giant coronary aneurysm: antithrombotic therapy is an option

A 69-year-old man with a history of hypercholesterolaemia presented to the emergency department with atypical chest pain. Physical examination was normal and ECG showed no evidence of ischaemic changes. Laboratory studies were notable for a D-dimer level of 1842 ng/mL (reference value <500 ng/mL) and the troponin I level was normal.

Chest X-ray was normal. Chest CT angiography ruled out a pulmonary embolism but showed a giant and extensive aneurysm of the right coronary artery (RCA) up to 45 mm in diameter with a partly thrombosed lumen and evidence of right ventricle compression on four-chamber view (figures 1 and 2). The volume of the aorta and the RCA appeared similar (figure 3). Doppler echocardiography did not demonstrate right or left heart haemodynamic abnormalities.

Figure 1

Coronary CT angiography in four-chamber view, evidence of external diameter with arrow and coronary lumen with head arrow.

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Prognostic implication of the primary tumor location in early-stage breast cancer: focus on lower inner zone

Abstract

Background

The aim of this study was to investigate the prognostic significance of tumor location of lower inner zone (LIZ) on the survival of patients with early-stage breast cancer.

Methods

We retrospectively identified 961 breast cancer patients from Jan 2000 to Apr 2016 from hospital database. We evaluated overall survival (OS) and disease-free survival (DFS) in patients with tumors in and outside LIZ. Subgroup analyses were performed according to clinicopathological characteristics and treatment strategies.

Results

A total of 838 cases were finally included. Patients with tumor location of LIZ showed significantly lower survival rates than tumors in other sites in terms of DFS (p = 0.028) but not OS (p = 0.106). When stratified into subgroups, tumors in LIZ retained a significant worse prognosis in DFS in patients with HER-2-negative, high ki-67 expression breast cancers, those who received neoadjuvant chemotherapy, axillary nodal negative patients, and patients with lymphovascular invasion. Univariate and multivariate analyses suggested that tumor location of LIZ was an independent prognostic factor for DFS (p = 0.022).

Conclusions

Our results suggested that tumor location of LIZ was an independent adverse prognostic factor for DFS in patients with early-stage breast cancer. Multicenter studies with larger sample size are needed to confirm the conclusion and anatomical experiments are desired to elaborate the mechanism.

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