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编者按：整合医学结合了替代医学和循证医学，研究对象是整个人体，以人的健康而不是疾病治疗为中心，强调社会、环境、生理、心理、医患关系的重要性。乳腺癌治疗期间和之后通常使用补充疗法和整合疗法作为支持治疗，并管理治疗相关副作用。不过，肿瘤学科使用这些疗法的支持证据有限。2017年，美国癌症学会《临床医师癌症杂志》发表整合肿瘤学会临床实践指南，更新了乳腺癌治疗期间和之后将整合疗法用于特定临床适应证的推荐意见。该临床实践指南的不少作者，同时也是美国临床肿瘤学会的成员。 2018年6月11日，美国临床肿瘤学会《临床肿瘤学杂志》在线发表西雅图华盛顿大学、弗雷德哈钦森癌症研究中心、美国临床肿瘤学会、纽约纪念医院斯隆凯特林癌症中心、哥伦比亚大学医学中心、罗彻斯特大学医学中心、宾夕法尼亚大学佩雷尔曼医学院、密歇根奥克兰大学、马萨诸塞莱希医院医学中心、癌症健康生活、莎拉坎农癌症研究所、佛罗里达梅奥医学中心、华盛顿特区史密斯康复艺术中心、休斯顿苏珊拉夫特、德克萨斯大学MD安德森癌症中心起草临床实践指南，对整合肿瘤学会乳腺癌治疗期间和之后的整合疗法临床实践指南进行了认可和补充。 整合肿瘤学会指南提出将整合疗法用于症状和不良反应的管理，例如焦虑和压力、情绪障碍、疲劳、生活质量，化疗所致恶心呕吐、淋巴水肿、化疗所致周围神经病变、疼痛、睡眠障碍。相关干预包括心灵和身体修行、天然产品、生活方式改变。整合肿瘤学会的文献系统回顾以1990～2015年发表的随机对照研究为主。美国临床肿瘤学会指南内容专家对整合肿瘤学会指南的临床准确性进行了审核，并且由美国临床肿瘤学会方法学家对其制定的严谨性进行了审核。通过初步审核后，美国临床肿瘤学会指南专家组召开会议对指南的内容和推荐意见进行最终审核。最后，美国临床肿瘤学会专家组确定，2017年发表的整合肿瘤学会指南推荐意见清晰、透彻，并且基于最有意义的科学证据。美国临床肿瘤学会通过一些补充的讨论要点批准了该指南。 关键推荐意见：
相关阅读 J Clin Oncol. 2018 Jun 11. [Epub ahead of print] Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline. Lyman GH, Greenlee H, Bohlke K, Bao T, DeMichele AM, Deng GE, Fouladbakhsh JM, Gil B, Hershman DL, Mansfield S, Mussallem DM, Mustian KM, Price E, Rafte S, Cohen L. Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan Kettering Cancer Center; Columbia University Medical Center, New York; University of Rochester Medical Center, Rochester, NY; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Oakland University, Rochester, MI; Lahey Hospital and Medical Center, Burlington, MA; Cancer Wellness for Life, Shawnee, KS; Sarah Cannon Cancer Institute, Kansas City, MO; The Mayo Clinic, Jacksonville, FL; Smith Center for Healing and the Arts, Washington, DC; Susan Rafte, Houston, TX; The University of Texas MD Anderson Cancer Center, Houston, TX. PURPOSE: The Society for Integrative Oncology (SIO) produced an evidence-based guideline on use of integrative therapies during and after breast cancer treatment that was determined to be relevant to the American Society of Clinical Oncology (ASCO) membership. ASCO considered the guideline for endorsement. METHODS: The SIO guideline addressed the use of integrative therapies for the management of symptoms and adverse effects, such as anxiety and stress, mood disorders, fatigue, quality of life, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Interventions of interest included mind and body practices, natural products, and lifestyle modifications. SIO systematic reviews focused on randomized controlled trials that were published from 1990 through 2015. The SIO guideline was reviewed by ASCO content experts for clinical accuracy and by ASCO methodologists for developmental rigor. On favorable review, an ASCO Expert Panel was convened to review the guideline contents and recommendations. RESULTS: The ASCO Expert Panel determined that the recommendations in the SIO guideline—published in 2017—are clear, thorough, and based on the most relevant scientific evidence. ASCO endorsed the guideline with a few added discussion points. RECOMMENDATIONS: Key recommendations include the following: Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-l-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy because of a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related adverse effects. PMID: 29889605 DOI: 10.1200/JCO.2018.79.2721
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