A new study published in The Lancet, the ATLAS trial (Adjuvant Tamoxifen: Longer Against Shorter) found that women with breast cancer treated for ten years with the anti-estrogen drug Tamoxifen had reduced rate of recurrence and greater survivorship at 15 years than women who were treated for the standard five years. Researchers concluded that extending the duration Tamoxifen treatment to ten years halved the incidence of mortality from breast cancer in the second decade following diagnosis. While the clinical implications of this study are yet to be determined, this is promising news in breast cancer research.
As we await further trials to determine whether doubling the duration of Tamoxifen treatment will become the new standard of care, it is timely to review the many integrative therapeutics for managing the side effects of this drug. The most common side effects of Tamoxifen are hot flashes, night sweats, and joint or muscle aches. Fortunately there are many natural medicine options for reducing these side effects.
A very effective nutrient to reduce the frequency and severity of hot flashes is hesperidin methyl chalcone[i]. Hesperidin is a bioflavonoid that has been shown to stabilize capillaries by increasing capillary resistance and reduce permeability. It is a non-phytoestrogen useful for providing relief of menopausal hot flashes and those induced by medical and surgical interventions. Because it does not affect estrogen levels, it is appropriate for use in breast cancer patients and survivors.
Another wonderful option for hot flashes is acupuncture. In one landmark study, acupuncture was found to be as effective as the pharmaceutical treatment of choice, venlafaxine (Effexor).[ii] In this randomized clinical trial, the subjects receiving acupuncture experienced relief of their hot flashes, and also reported secondary benefits such as better sleep, improved energy, and overall sense of well-being. Additionally, these benefits all persisted beyond the course of treatment, and unlike the drug treatment, the acupuncture treatment carried no adverse effects.
Finally, vitamin D is a very important nutrient for reducing the joint and muscle aches common with Tamoxifen. One study demonstrated that maintaing a baseline 25-hydroxyvitamin D level of at least 40 helped prevent these side effects.[ii] Optimal levels of vitamin D are between 50-100, and it can require high dose supplementation to achieve this, especially if one is initially deficient. Maintenance doses of vitamin D are between 2000-4000 IU, but between 6000-8000 IU daily may be needed to address a deficiency, with periodic testing to ensure safe blood levels.
At Hygeia Center for Healing Arts, acupuncture and naturopathic medicine provide adjunct support for cancer patients undergoing conventional treatment, to optimize the patient’s overall health, enhance immune function, and help reduce adverse effects of treatment. For more information or to make an appointment, please call (734) 769-6100 or visit http://www.hygeiacenter.org.
[i] Prieto-Alhambra D et al. Vitamin D threshold to prevent aromatase inhibor-induced arthralgia: a prospective cohort study. Breast Cancer Res Treat 2011 Feb;125(3):869-78.
[ii] Walker et al. Acupncture versus velnafaxine for the management of vasomotor symptoms in patients with hormone-receptor-positive breast cancer: a randomized clinical trial. J Clin Oncol 28:634-640.
[iii] Bouskela E, Cyrino FZGA, Marcelon G, et al. Inhibitory effect of the Ruscus Extract and of the flavonoid hesperidin methylchalcone on increased microvascular permeability. J Cardiovasc Pharmacol 1993;22:225-230.
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