** Complementary Therapies for People with Cancer

A 'kiddies guide' to complementary Therapies! 

By Caroline Hoofman of The Breast Cancer Haven, London, with additional research by Chris Woollams.

Introduction

In a recent research study of icon readers we found that over 80 per cent were taking a complementary therapy as part of their Integrated Recovery Programme and 40 per cent were using 4 or more such therapies. But the fact is there is a bewildering array to choose from - the list from the research totalled 26 different therapies! Which ones are right for your personal needs - for you and your cancer at this particular time? Are they all safe, or could they do more harm than good? Are there any research studies, or Clinical Trials, or is it all in the mind? And even if it is, is that such a bad thing?

In our magazine and on this web site, we have covered a number of these therapies in some depth, but we realised after conducting our research that our readers needed the definitive overview - a ’Kiddies Guide’!. We have been working with the London Breast Cancer Haven  (there’s one in Hereford and a new one in Leeds too) for several years now on this subject, and so it seemed only natural to start with their thoughts and then add our extra research knowledge on top.Obviously their focus is on women (and men) with breast cance but you will see this is an excellent overview - and contains more therapies than even they offer!

Building an integrated therapy programme.

As you may know, CANCERactive is the UK’s leading Charity in Integrative Therapies. We believe in helping people chose the best of Complementary and Alternative Therapies around their orthodox treatments. Such programmes are thought by US experts to increase survival by 60 per cent.

We have developed our own programme. If you go to ’The Active8 programme’ you will see our approach to building (tailoring) a programme to your personal needs. From time to time we also offer everybody a Personal Prescription service designed to provide all patients with information tailored to their particular cancer and the complementary therapies, supplements, diet and other lifestyle benefits they might best introduce into their personal treatment programme. Several research studies in the USA have shown that those people taking a complementary therapy, for example daily exercise, have 50 per cent lower mortality rates. (Integrative Cancer Therapies Magazine; Philadelphia University and others).

On this web site you will find an ever-increasing list of local Support Groups. And many of the therapies in the guide below, have more detailed explanations and user stories if you follow the links.

Individual Therapies

Acupuncture

Acupuncture  is an ancient system of healing originating from China. The person’s condition is diagnosed by analysing their symptoms, life-style and emotional state, as well as by using tongue and pulse diagnosis. Once this has been understood, specific points located on the energy channels of the body (called meridians) are chosen into which fine needles are carefully inserted to help restore balance to the body. Acupuncture can help to relieve possible side effects of orthodox cancer treatments such as nausea, hot flushes, fatigue or discomfort following surgery. Acupuncture helps balance the body, increases energy levels, relieves pain (1,2), nausea (3) and gives an enhanced sense of well-being.

A course of treatment: 4 - 6 treatments is often given to help alleviate symptoms and rebalance the body. Precautions: Acupuncture needles should not be inserted where lymphoedema is present. Sterile disposable needles are used to prevent infection. Side effects: Sometimes recipients may feel tired following treatment and need to rest.

(Ed: There have been a number of scientific studies on acupuncture, notably in the USA including work at NASA. It is known to affect the brain, hormone levels, and nervous system and can control pain and energy flow. It can be used instead of anaesthetic in operations. As a result of the evidence produced, this therapy which is widely used in parts of South East Asia has been incorporated into normal medical practice in the USA, and now the UK. Two clinical trials, one from Harvard and MIT on how it works in pain relief, and another on reducing side-effects for chemotherapy better than the drugs on offer, can be found in Cancer Watch Febrary 2009 in icon.)

Aromatherapy

Aromatherapy uses essential oils from plants to help with a variety of symptoms and side effects resulting from cancer and its treatments. Generally applied via gentle massage or inhalation, aromatherapy, in the clinical setting, has also been used to help with wound healing and to relieve anxiety, depression, pain, nausea (26) and insomnia. Whilst essential oils are available over the counter, it is recommended that someone affected by cancer should take professional advice regarding oils that are safe to use and that will not show any possible interactions with treatment.

(Ed: Oils used in their concentrated form may be very potent. For centuries certain herbs and natural compounds have been known to have a variety of clear proven beneficial effects)

Bach Flower Remedies

The term ’Flower Remedy’ refers to the products developed by Dr Edward Bach, a London bacteriologist and homoeopath. Dr Bach became disillusioned with the side effects of drug therapies and turned his research to the healing power of nature. Dr Bach believed that harmful emotions contributed to the development of diseases. He believed that illness was a result of mental or emotional balance and that the unique energetic property of a plant could be used to rectify an imbalance and restore the awareness of ’wholeness’.

Referring to the vibrational medicine model provided in homoeopathy, he reasoned that the healing effects of plants might also be contained in the morning dew found on their flowers. In this system, each negative emotion can be helped by a particular flower remedy. The best known remedy is called Rescue Remedy, it is made up of five flowers and can be used in emergency situations or for shock and trauma. Whilst these remedies can be bought over the counter and taken safely, therapists trained in this area can offer a more appropriate prescription.

Counselling

Counselling  provides an opportunity to work with the psychological and emotional issues which may arise as a result of experiencing cancer. Our counsellors work with a wide range of issues that affect women and sometimes men with breast cancer and those who support them. Counselling can help people to understand more about the impact and meaning of diagnosis, treatment and also support recovery. It may help with the adjustment to shock, illness, treatment and the impact on body.

Issues such as those relating to body image, sexual matters, relationships and other life events which have come to the fore through the impact of illness may also be helped by counselling. Counselling is offered to partners and other family members. Haven counsellors may employ a range of techniques including participative sessions and tools for people to try out at home. There has been a lot of research looking into support for people affected by breast cancer. Research shows that people who feel better emotionally and mentally cope better with breast cancer and its treatments (4).

(Ed: One issue that comes up time and time again at icon is the need for people to talk ’with’ someone rather than ’at’ or ’to’ someone about their problems and feelings. Having a discussion with an independent person, especially a qualified professional, can be so helpful)

Craniosacral Therapy

Craniosacral Therapy  is a subtle and profound healing form. It is thought that movement restrictions at the cranial sutures of the skull may negatively affect rhythmic impulses conveyed through the cerebrospinal fluid which surrounds the central nervous system from the cranium to the sacrum. A disturbance of the rhythmic flow of cerebrospinal fluid is believed to adversely affect health. Through light touch, normal function can be restored within the system. This helps increase physical vitality and well being, not only releasing physical tension and disharmony, but also helping to bring psycho-emotional balance and to relieve stress. It can be very relaxing and at the deepest level, truly transformative. Craniosacral has no contraindications for those affected by primary breast cancer. There has been research performed into this therapy (5).

Creating a Healthier Lifestyle

If you think that you would like the opportunity to discuss ways that you can personally develop a healthier lifestyle following the experience of breast cancer, then an appointment can be made to discuss this with one of our Senior Therapists, Counsellors or Life-Work Coach. It may be that you want support in making changes to jobs, relationships, the community or place in which you live or support in developing a regular exercise or meditation routine.

Hands on Healing

Hands on Healing  involves a transfer of energy between the healer and the recipient to promote self-healing. This is done by "focused intent" and holding the hands, at varying distances, electro-magnetic pollution. Through muscle testing, which gathers information directly from the recipient’s conscious and unconscious mind, the practitioner seeks to identify the stress whether on a physical, mental or emotional level. The body is then balanced using techniques that include healing offered with hands on or off the body and the healer may offer suggestions to help the recipient work with issues that arise in the session (6).

Herbal Medicine

Herbal Medicine uses the healing properties of plants, information about which has been gathered over centuries. These are prescribed in the form of pills, juices, teas or tinctures. Medical herbalists combine the wisdom of traditional herbal use with the latest scientific knowledge. As part of the consultation, lifestyle and diet are considered. It may help with headaches, insomnia, nausea, hair loss, fatigue, mood changes and depression, skin, joint and digestive problems. Medical Herbalists prescribe herbs individually and appropriately each person to avoid known and documented drug interactions.

There is currently discussion between oncologists and herbalists regarding possible interactions between herbs and chemotherapy. Some oncologists are advising patients to abstain from taking any herbal medicines during their chemotherapy in the light of inadequate evidence to show if they interact with each other. To balance this rather extreme view, it is worth noting that many herbalists suggest foods e.g. ginger for nausea and herbal teas e.g. peppermint which can be beneficial and given safely during treatment without resorting to potentially higher-dosed herbal medicines. Consulting a qualified medical herbalist is certainly the safest way to take herbs. Buying over the counter preparations is not recommended.

(Ed: We have several articles on Herbs, such as The Power of Herbs by Alan Hopking and on how Astragalus at M.D. Anderson has been shown to double Survival times. Plus Cat’s Claw and Echinacea specifically)

Homeopathy

Homeopathy  is based on the idea that like treats like. This means that a substance, which causes symptoms in a healthy person, given in minute doses, will balance those same symptoms in someone who is unwell. Homeopathy aims to treat the whole person and may also help with the side effects of treatment including wound healing, hot flushes, digestive disorders, depression, mood changes, nausea, bone pain and hair loss. It can be very helpful for fatigue and skin problems following radiotherapy. It is safe to take with other prescribed drug treatments. A detailed medical and psychological history is taken prior to making a decision as to which remedy is given.

As an energetic or vibrational medicine, many people have difficulty understanding its mechanisms of action. However, the benefits of this are that homeopathy does not interact with any conventional medicine so can be taken safely during other cancer treatments. There has been some research into homeopathy that does show benefits in certain conditions including chemotherapy induced stomatitis, radiodermatitis, and general adverse events from radiotherapy (8-13). It is worth noting that the NHS offers a number of homeopathic hospitals around the country offering complementary therapies including homeopathy to patients with cancer including The Royal London Homeopathic Hospital and others in Glasgow, Bristol, Tunbridge Wells and Liverpool.

(Ed: It is important to note that no responsible homeopath would ever claim to ’cure’ cancer or even to help treat the disease directly. But expert homeopaths can provide a great deal of help in controlling and limiting side effects from surgery, radiotherapy or chemotherapy.You might to read the personal story of how  one lady has found Homeopathy extremely helpful in her Therapy programme)

Hypnosis

Some patients find hypnosis very helpful in various aspects on therapy like pain control.

You can find out more by clicking this link.

Qi Gong

Qi Gong  is a self-healing art that combines movement, meditation and visualisation to enhance the mind/body connection and assist healing. Coming from the Chinese medical tradition, the name comes from the word Qi - the life energy source that connects and sustains everything in the universe, and Gong - work or practice. Regular practice can help improve health and wellbeing (14), reduce stress and help develop a more peaceful state. Qi gong is a gentle yet powerful form of exercise that can be adapted to suit the needs of most people affected by cancer. It may be done standing, seated or even lying according to the needs of the individual. Daily practice is recommended as a self-help mechanism.

(Ed: In the 2006 Alberta Conference on Complementary Therapies, there were a number of significant scientific studies presented on the healing benefits of this therapy)

Indian Head Massage

Indian Head Massage uses a combination of techniques to ease tension and invigorate the muscles and soft tissues in the shoulder and scalp area. A face massage is sometimes included. Benefits include reducing stress, relaxation and freeing muscular tension. This technique can be done very gently and is safe with any forms of cancer. As with any other therapy, the therapist would treat each person appropriately to best meet his or her needs.

Kinesiology

Kinesiology is a therapy that uses muscle testing to determine what is wrong with the body and how best to put the problem right. The body can be disturbed by imbalances in virtually any aspect of life - nutrition, emotions, thoughts, relationships, experiences from childhood, fears, environmental chemicals, bacteria and viruses, or through muscle testing, which gathers information directly from the recipient’s conscious and unconscious mind, the practitioner seeks to identify the stress whether on a physical, mental or emotional level. The body is then balanced using techniques that include acupressure, nutritional supplements, hypoallergenic approaches, homeopathic remedies, magnets, specific intentional thoughts, sounds and body positions. Kinesiology can help correct imbalance in physical, mental and emotional patterns in the body.

Reflexology

Reflexology is a holistic healing method that involves pressure and massage of the reflex points on the feet and hands. It teaches that life force or energy moves throughout the body via nerve and meridian (energy) pathways and that, if this is blocked, it can cause imbalance. These blockages can be detected via the reflex points and dissipated by pressure and massage techniques which encourage healing. Reflexology can help alleviate pain and anxiety (15, 16, 17), low mood, hot flushes, nausea, vomiting and fatigue, as well as helping tissue healing. This treatment is considered generally safe for people with cancer, although contra-indicated if there is suspicion of a deep vein thrombosis in the leg.

Reiki

Reiki  is a system of healing. Reiki is a spiritual healing discipline with its roots in ancient eastern teachings, and is a Japanese word meaning Universal Life (Rei) Energy (Ki). Reiki is thus the vital life energy which flows through all living things and which can be activated for the purpose of healing. The Reiki therapist channels the Ki through his or her hands to the recipient, activating the body’s natural ability to heal itself.

When a person’s Ki is strong and flowing freely, the body and mind are in a positive state of health. However, the vital energy may become weak or blocked, and this may lead to symptoms on a physical or emotional level. The Therapist’s hands are placed lightly on the body in a series of positions. It can alleviate pain (18), anxiety and low mood and help generate relaxation and a feeling of well-being.

Nutrition

Nutrition  plays a vital part in our health, and some people may suffer from allergic reactions or food intolerance, or may simply need a more balanced diet. A Nutritionist examines dietary intake and lifestyle in order to discover and remedy any imbalances. Dietary changes may be suggested and nutritional supplements or tests recommended if the person is interested. Dietary changes, particularly increasing the amount of fruit, quantity and variety of vegetables, drinking enough water, and reducing the amount of saturated fat, sugar, denatured and processed foods we consume can help in staying healthy.

(Ed: As regulars will know, we have extensive information on this web site on this whole area, including the benefits of supplements, vitamins and minerals, an appropriate diet for chemotherapy, the issues of insulin or obesity and cancer. Readers might like to know about recent research from North Carolina which showed that a woman with breast cancer had a lowered risk of recovery the greater her weight above ’ideal’)

Shiatsu

Shiatsu literally translated means ’finger pressure’ and is based on the same principles as acupuncture but uses touch of varying pressures and gentle stretches to help release and balance the energy system of the body, which encourages self-healing to occur. Coming originally from the traditional Chinese medical system, shiatsu is a deeply relaxing and also energising treatment and can be used to help with fatigue, stress, anxiety, worry, muscular tension, insomnia, hot flushes and the side effects of drugs e.g. indigestion and constipation. Shiatsu is given with the person clothed, often on a mat on the floor, although other positions can be used for those unable to lie down. It is little known treatment, but used in a number of complementary cancer treatment centres.

Groups and Classes

Many of the groups and classes offered at Breast Cancer Haven not only provide support but also enable people to develop self-help skills

Alexander Technique

The Alexander Technique is a gentle and non-manipulative method for changing the way people ’use’ their bodies and themselves. Common examples of people ’using’ their bodies poorly include having a slumping posture and holding the breath, which in turn leads to stiff and restricted movement. This restriction and tension can be exacerbated by pain and complex emotions. The Alexander Teacher gently works with the tension and movement patterns of the person, helping them to become aware of and correct them. This can help also help bring awareness and relief to some emotional patterns and emotional states held in the body (19).

Art Therapy

Art Therapy is the spontaneous use of paint, pastels, clay or other art materials to help people communicate and overcome emotional and psychological difficulties. It is now considered a valuable therapeutic aid for people coping with illnesses and provides a means of communicating feelings and experiences, which may sometimes be difficult to put into words. It can be a form of relaxation and a way to explore quality of life issues and can help people come to terms with diagnosis and treatment for cancer. Used in many cancer treatment centres, it is recognised for its value in this setting. It is worth noting that participants do not need to be artistic or have any experience of using art materials to benefit from this therapy.

Auricular (ear) Acupuncture

Auricular (ear) acupuncture is used for the side effects that may occur during and after breast cancer treatment. In this group each person has five small, fine acupuncture needles inserted into points on the outer ear and left there for about 40 minutes during which time people sit quietly. The group has proved very successful in helping to reduce hot flushes, relieve nausea, anxiety, headaches, fatigue and insomnia. Auricular Acupuncture helps the body to detoxify itself, increases energy levels and gives an enhanced sense of well-being.

Hair and makeup workshops

Hair and makeup workshops are available to give advice and support with appearance and hair. Tips will be given to overcome the problems created by cancer treatments such as loss of eyebrows and lashes from chemotherapy. In addition to this, advice and help with wigs will be given. These workshops are fun and can enhance self-confidence during or after treatments.

Meditation

Meditation is about paying attention. It is about being present and fully aware in our lives and the self-healing that this brings. To start meditation, concentration is enhanced using the focus of awareness on the breath, a sound, an image or sensations in the body to help keep the ever wandering mind present. With practice, meditation practised mindfully can bring deeper levels of peace, aid well-being, reduce anxiety, pain and stress and improving mood state and energy levels (20,21). This can also help dealing with the numerous stressful situations in everyday life.

(Ed: We have covered US Clinical Trials in icon on meditation - for example, meditation prior to surgery has been proven to reduce bleeding )

Emotional Freedom Technique (EFT)

Emotional Freedom Technique is a powerful technology for quickly resolving emotional distress. It is even capable of relieving physical complaints such as pain, allergic symptoms, and much more. When effective, not only does it do this quickly, but it works without forcing the recipient to repeatedly re-experience the negative emotional state. This treatment is generally lasting, relatively easy to apply and is free of negative side effects.

When a person remembers a painful or traumatic incident it causes their energy system to disrupt. As the body recalls the memory, it also re-produces the original emotional state associated with that time. EFT works directly to re-balance the energy field; as a result, negative emotions are cleared and harmony is restored. The feelings connected to even the most intense memories or limitations are then dispelled.(Ed: we have a more complete artcle by David Broom on the subject )

NES Energetic Analysis

NES Energetic Analysis is an energy field scanner that quickly and accurately analyses the location and causes of ill health. Developed over 25 years by an Australian team of scientists, the Nutri-Energetics System (NES) machine effectively maps the human body-field, establishing which organs are lacking in energy, where blockages have been triggered by environmental chemicals, heavy metals, bacteria and viruses, nutritional imbalances, allergies or muscular-skeletal trauma and correcting any damage caused.

The device then recommends specific energetically based remedies that correct these disruptions at a molecular and cellular level, enabling the body’s energy fields to re-align themselves and re-activate their innate self-healing abilities. A course of sessions with the NES runs over a period of 4 months with two weekly scans, each involving the recommendation of up to three homeopathic-like remedies to help rebalance the body’s energy. These remedies do not interact with cancer treatments therefore are safe to use during treatment.

Support Groups

Support Groups  offer people an opportunity to come together to share and discuss any issues that have arisen in their lives as a result of having breast cancer and its treatments. The issues may relate to coping with the shock and trauma of diagnosis and treatment, relationship issues, body image or matters of intimacy. Support groups are led by a counsellor experienced with groups and are open to anyone affected by breast cancer. Havens have a support group specifically designed to meet the needs of younger women with breast cancer as there are fewer younger women diagnosed with the illness, they can feel quite isolated and may have different issues to contend with. There has been much research published regarding the role of psychological and emotional support for people with cancer (22).

Stretch and Relaxation

Stretch and Relaxation is a combination of strengthening and stretching exercises. It uses the fundamental principles and practices of Yoga and Pilates to create a holistic workout with a relaxation and visualisation technique at the end of the class that brings the body and mind into a state of balance and harmony. These exercises bring flexibility and strength, relieve stress and bring emotional calm.

Yoga

Yoga  is an ancient Indian philosophy and practice. The word ’Yoga’ means ’union’ or ’ integration’ and yoga uses stretching, postures and breathing to help harmonise the body, mind and spirit. These classes consist of specifically and appropriately chosen exercises to help promote movement and lymphatic drainage following breast cancer treatment. Yoga relaxes and energises whilst bringing flexibility, strength, concentration, self-confidence and peacefulness. It has been shown to reduce sleep disturbance and increase emotional well-being and spiritual integration (23, 24, 25).

(Ed: There are a number of studies on Yoga from the USA - notably one from Seattle where, even in beginners classes, there was a 50 per cent reduction in cortisol (the stress hormone linked to cancer) levels after one week, compared to just a 5 per cent reduction if the patient went home to rest and calm down! On Meditation prior to surgery there are even clinical trials showing blood loss is reduced by 40 per cent - New York Presbyterian Hospital)

Lymphoedema Awareness Classes

Lymphoedema  Awareness Classes are aimed at teaching people affected by breast cancer what they can do to help prevent the development of lymphoedema. This includes the giving of information and advice about daily activities as well as the opportunity to learn specific exercises, known as The Lebed Method, which focuses on healing through movement and dance. It is a therapeutic exercise program for women who have had any kind of breast surgery, node dissection, radiation, chemotherapy, lymphoedema, or who suffer with chronic fatigue.

Two doctors and a dance movement specialist created this programme to help women and men. It aims to regain range of motion, increase flexibility in frozen shoulder, work with balance issues both physically and emotionally, help reduce swelling from lymphoedema, may help reduce the risk of lymphoedema decrease depression, add to sexuality, increases femininity, promotion of positive self image and joy, weight stabilization. No special physical abilities required.

The classes are complemented by a DVD made in collaboration with St George’s Hospital NHS Trust entitled ’Lymphoedema Awareness: reducing your risk’ and is available from Breast Cancer Haven. Anita Wallace, Chair of the Lymphoedema Support Network described the film as ’an excellent resource for at risk patients.’

Support for those not near a Haven

We are also working to extend our support to those who are not able to directly access a Haven. As well as our literature, DVD’s and website, which offer extensive information, we offer telephone consultations to individuals and welcome people along to our Haven Support Workshop wherever they are based. The workshop offers information, practical tips and an introduction to the complementary therapies on offer.

References

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2. Alimi D, Rubino C, Pichard-Léandri E, Fermand-Brulé S. et al. Analgesic effects of auricular acupuncture for cancer pain. Journal of Clinical Oncology, 2003; 21: 4120 -4126.


3. Ezzo JM, Richardson MA, Vickers A. et al. Acupuncture-point stimulation for chemotherapy- induced nausea or vomiting (Review). The Cochrane Database of Systematic Reviews, 2006, Issue 2. Art No.CD002285.pub2. DOI:10.1002/14651858.CD002285.pub2.


4. Robert A. Schnoll, Lisa L. Harlow, Leo L. Stolbach, Ursula Brandt. A structural model of the relationships among stage of disease, age, coping, and psychological adjustment in women with breast cancer. Psycho-Oncology 1997, Volume 7, Issue 2, Pages 69 - 77.


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10. Balzarini A, Felisi E, Martini A et al. Efficacy of homeopathic treatment of skin reactions during radiotherapy for breast cancer: a randomised double-blind clinical trial. British Homeopathic Journal 2000; 89: 8 - 12.


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15. Quattrin R, Zanini A, Buchini S. et al. The use of reflexology foot massage to reduce anxiety in hospitalised cancer patients chemotherapy treatment: methodology and outcomes. Journal of Nursing Management. 2006; 14: 96 - 105.


16. Stephenson NLN, Weinrich SP, Tavakoli A. The effects of foot reflexology on anxiety and pain in patients with breast and lung cancer. Oncology Nursing Forum, 2001; 27: 67-72.


17. Stephenson N, Dalton, JA, Carlson J. The effect of foot reflexology on pain in patients with metastatic cancer. Applied Nursing Research, 2003; 16: 284-286.


18. Olson K., Hanson, J. and Michaud, M. (2003) A phase II trial of reiki for the management of pain in advanced cancer. Journal of Pain and Symptom Management. Vol 26, Issue 5, November 2003. pp 990 -997.


19. Stallibrass, C. Randomized controlled trial of the Alexander Technique for idiopathic Parkinson’s disease. Clinical Rehabilitation, 2002; Vol. 16, No. 7, 695-708 (2002)


20. Richardson J., Smith J., Hoffman C. and Pilkington K. (2005) Meditation as a supportive therapy in cancer: A systematic review. Complementary and Alternative Medicine Evidence On Line (CAMEOL) (Online) (access August 2006,) Available from URL http://www.rccm.org.uk/cameol/Default.aspx


21. Smith JE, Richardson J, Hoffman C. et al. Mindfulness-Based Stress Reduction as supportive therapy in cancer care: systematic review. Journal of Advanced Nursing 2005; 52: 315 - 327.


22. Ross, L., Boesen, E., Dalton, S., Johansen, C. Mind and cancer: does psychosocial intervention improve survival and psychological well-being? European Journal of Cancer, 2002, 38 pp 1447 - 1457.


23. Richardson J, Smith J, Hoffman C, et al. Yoga as a supportive therapy in cancer: a systematic review. 2005. (Online) (access August 2006) Available from URL. Complementary and Alternative Medicine Evidence On Line (CAMEOL) Database. http://www.rccm.org.uk/cameol/Default.aspx


24. Cohen L, Warneke C, Fouladi RT et al. Psychological adjustment and sleep quality in a randomised trial of the effects of Tibetan yoga Intervention in patients with lymphoma. Cancer 2004; 100: 2253 - 2260.


25. Targ EF and Levine EG. The efficacy of a mind-body-spirit group for women with breast cancer: a randomised controlled trial. General Hospital Psychiatry 2002; 24: 238 - 248.


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