Anxiety and Stress Reduction
• Meditation is recommended for reducing anxiety. (Grade A)
• Music therapy is recommended for reducing anxiety. (Grade B)
• Stress management is recommended for reducing anxiety during treatment, but longer group programs are likely better than self-administered home programs or shorter programs. (Grade B)
• Yoga is recommended for reducing anxiety. (Grade B)
• Acupuncture, massage, and relaxation can be considered for reducing anxiety. (Grade C)
Chemotherapy-Induced Nausea and Vomiting
• Acupressure can be considered as an addition to antiemetic drugs to control nausea and vomiting during chemotherapy. (Grade B)
• Electroacupuncture can be considered as an addition to antiemetic drugs to control vomiting during chemotherapy. (Grade B)
• Ginger and relaxation can be considered as additions to antiemetic drugs to control nausea and vomiting during chemotherapy. (Grade C)
• Glutamine should not be recommended for improving nausea and vomiting during chemotherapy. (Grade D)
Depression and Mood Disturbance
• Meditation, particularly mindfulness-based stress reduction, is recommended for treating mood disturbance and depressive symptoms. (Grade A)
• Relaxation is recommended for improving mood disturbance and depressive symptoms. (Grade A)
• Yoga is recommended for improving mood disturbance and depressive symptoms. (Grade B)
• Massage is recommended for improving mood disturbance. (Grade B)
• Music therapy is recommended for improving mood disturbance. (Grade B)
• Acupuncture, healing touch, and stress management can be considered for improving mood disturbance and depressive symptoms. (Grade C)
Fatigue
• Hypnosis and ginseng can be considered for improving fatigue during treatment. (Grade C)
• Acupuncture and yoga can be considered for improving post-treatment fatigue. (Grade C)
• Acetyl-L-carnitine and guarana should not be recommended for improving fatigue during treatment. (Grade D)
Lymphedema
• Low-level laser therapy, manual lymphatic drainage, and compression bandaging can be considered for improving lymphedema. (Grade C)
Neuropathy
• Acetyl-L-carnitine is not recommended for the prevention of chemotherapy-induced peripheral neuropathy in patients with breast cancer due to potential harm. (Grade H)
Pain
• Acupuncture, healing touch, hypnosis, and music therapy can be considered for the management of pain. (Grade C)
Quality of Life
• Meditation is recommended for improving quality of life. (Grade A)
• Yoga is recommended for improving quality of life. (Grade B)
• Acupuncture, mistletoe, qigong, reflexology, and stress management can be considered for improving quality of life. (Grade C)
Sleep Disturbance
• Gentle yoga can be considered for improving sleep. (Grade C)
Vasomotor/Hot Flashes
• Acupuncture can be considered for improving hot flashes. (Grade C)
• Soy is not recommended for hot flashes in patients with breast cancer due to lack of effect. (Grade D)
**Grade A indicates there is high certainty that the net benefit is substantial. Grade B indicates there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. Grade C indicates that the evidence is equivocal or that there is at least moderate certainty that the net benefit is small. The lowest grades (D, H, and I) indicate no demonstrated effect, suggest harm, or indicate that the current evidence is inconclusive, respectively.