Supportive Care in Cancer

, Volume 26, Issue 12, pp 4039–4048 | Cite as

Inverse relationship between reduced fatigue and severity of anemia in oncology patients treated with integrative medicine: understanding the paradox

  • Eran Ben-Arye
  • Ofer Dahan
  • Ilanit Shalom-Sharabi
  • Noah Samuels
Original Article



To assess the impact of integrative medicine (IM) on cancer-related fatigue in patients undergoing chemotherapy for early and advanced breast and gynecological (ovarian, endometrial, and cervical) cancer.


Patients reporting significant levels of fatigue (on the Edmonton Symptom Assessment Scale (ESAS), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), or Measure Yourself Concerns and Wellbeing questionnaire (MYCAW)) were offered complementary and integrative medicine (CIM) treatments in addition to standard supportive care. Patients who did not undergo IM treatments were designated as controls. Attending at least five CIM treatments less than 30 days between each session was considered as high adherence to integrative care (AIC).


Of 258 eligible patients reporting significant fatigue, follow-up assessment at 6 and 12 weeks was considered optimal for 120 patients in the intervention group and for 64 controls; 88 of treated patients found to be adherent to the IM intervention. At 12 weeks, ESAS (P < 0.001) and EORTC (p = 0.001) scores for fatigue improved more significantly in treated patients, with a higher percent with optimal relative dose intensity in the AIC subgroup, both at 6 weeks (P = 0.002) and at 12 weeks (P < 0.001). IM treatment was paradoxically associated with a greater decrease in hemoglobin levels at 12 weeks (P = 0.016), more so in the AIC subgroup (P = 0.024).


Integrative medicine program may alleviate cancer-related fatigue in patients with breast and gynecological cancer undergoing chemotherapy.


Cancer-related fatigue Integrative medicine Complementary medicine Relative dose intensity Quality of life Anemia 


Contributions of authors

EBA, OD, and NS initiated the trial, collected the data, and analyzed this study. EBA, ISS, OD, and NS planned the study and wrote the manuscript draft. All authors participated in the revision of the manuscript.

Compliance with ethical standards

Conflict of interests

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Integrative Oncology ProgramLin and Carmel Medical Centers, Clalit Health ServicesHaifaIsrael
  2. 2.Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  3. 3.Tal Center for Integrative Oncology, Institute of OncologySheba Medical Center, Tel HashomerRamat GanIsrael

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