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Mind-Body Practices in Cancer Care

  • Integrative Care (C Lammersfeld, Section Editor)
  • Published:
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Abstract

Being diagnosed with a life-threatening disease such as cancer and undergoing treatment can cause unwanted distress and interferes with quality of life. Uncontrolled stress can have a negative effect on a number of biological systems and processes leading to negative health outcomes. While some distress is normal, it is not benign and must be addressed, as failure to do so may compromise health and QOL outcomes. We present the evidence for the role of stress in cancer biology and mechanisms demonstrating how distress is associated with worse clinical outcomes. The National Comprehensive Cancer Network states that all patients be screened with the single-item distress thermometer and to also indicate the source of distress and to get appropriate referral. In addition to the many conventional approaches for managing distress from the fields of psychology and psychiatry, many patients are seeking strategies to manage their distress that are outside conventional medicine such as mind-body techniques. Mind-body techniques such as meditation, yoga, tai chi, and qigong have been found to lower distress and lead to improvements in different aspects of quality of life. It is essential that the standard of care in oncology include distress screening and the delivery of different techniques to help patients manage the psychosocial challenges of diagnosis and treatment of cancer.

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References

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  1. Satin JR, Linden W, Phillips MJ. Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis. Cancer. 2009;115(22):5349–61.

    Article  PubMed  Google Scholar 

  2. Metcalfe C, Davey Smith G, Macleod J, Hart C. The role of self-reported stress in the development of breast cancer and prostate cancer: a prospective cohort study of employed males and females with 30 years of follow-up. Eur J Cancer. 2007;43(6):1060–5.

    Article  PubMed  Google Scholar 

  3. Chrousos GP, Gold PW. The concepts of stress and stress system disorders. Overview of physical and behavioral homeostasis. JAMA. 1992;267(9):1244–52.

    Article  CAS  PubMed  Google Scholar 

  4. Epel ES, Blackburn EH, Lin J, Dhabhar FS, Adler NE, Morrow JD, et al. Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci U S A. 2004;101(49):17312–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Torpy JM, Lynm C, Glass RM. JAMA patient page. Chronic stress and the heart. JAMA. 2007;298(14):1722.

    Article  CAS  PubMed  Google Scholar 

  6. Cohen S, Janicki-Deverts D, Miller GE. Psychological stress and disease. JAMA. 2007;298(14):1685–7.

    Article  CAS  PubMed  Google Scholar 

  7. Chang L. The role of stress on physiologic responses and clinical symptoms in irritable bowel syndrome. Gastroenterology. 2011;140(3):761–5.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Hammen C. Stress and depression. Annu Rev Clin Psychol. 2005;1:293–319.

    Article  PubMed  Google Scholar 

  9. Lutgendorf SK, Sood AK, Antoni MH. Host factors and cancer progression: biobehavioral signaling pathways and interventions. J Clin Oncol. 2010;28(26):4094–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Sloan EK, Priceman SJ, Cox BF, Yu S, Pimentel MA, Tangkanangnukul V, et al. The sympathetic nervous system induces a metastatic switch in primary breast cancer. Cancer Res. 2010;70(18):7042–52.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Lutgendorf SK, Sood AK, Anderson B, McGinn S, Maiseri H, Dao M, et al. Social support, psychological distress, and natural killer cell activity in ovarian cancer. J Clin Oncol. 2005;23(28):7105–13.

    Article  PubMed  Google Scholar 

  12. Antoni MH, Lutgendorf SK, Cole SW, Dhabhar FS, Sephton SE, McDonald PG, et al. The influence of bio-behavioural factors on tumour biology: pathways and mechanisms. Nat Rev Cancer. 2006;6(3):240–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Lutgendorf SK, Sood AK. Biobehavioral factors and cancer progression: physiological pathways and mechanisms. Psychosom Med. 2011;73(9):724–30.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Lutgendorf SK, DeGeest K, Dahmoush L, Farley D, Penedo F, Bender D, et al. Social isolation is associated with elevated tumor norepinephrine in ovarian carcinoma patients. Brain Behav Immun. 2011;25(2):250–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Thaker PH, Han LY, Kamat AA, Arevalo JM, Takahashi R, Lu C, et al. Chronic stress promotes tumor growth and angiogenesis in a mouse model of ovarian carcinoma. Nat Med. 2006;12(8):939–44.

    Article  CAS  PubMed  Google Scholar 

  16. Armaiz-Pena GN, Cole SW, Lutgendorf SK, Sood AK. Neuroendocrine influences on cancer progression. Brain Behav Immun. 2013;30:S19–25. This manuscript outlines the biological mechanisms whereby chronic stress responding can lead to procession of disease and make the tumor microenvironment more hospital to tumor growth.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Sood AK, Armaiz-Pena GN, Haider J, Nick AM, Stone RL, Hu W, et al. Adrenergic modulation of focal adhesion kinase protects human ovarian cancer cells from anoikis. J Clin Investig. 2010;120(5):1515–23.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Armaiz-Pena GN, Allen JK, Cruz A, Stone RL, Nick AM, Lin YG, et al. Src activation by beta-adrenoreceptors is a key switch for tumour metastasis. Nat Commun. 2013;4:1403.

    Article  PubMed Central  PubMed  Google Scholar 

  19. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology TM distress management V.1.2010. 2010. www.nccn.org. Accessed 15 Mar 2010.

  20. Sharpe M, Walker J, Hansen CH, Martin P, Symeonides S, Gourley C, et al. Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial. Lancet. 2014;384(9948): 1099-108. doi:10.1016/S0140-6736(14)61231-9.

  21. Walker J, Hansen CH, Martin P, Symeonides S, Gourley C, Wall L, et al. Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT Oncology-3): a multicentre randomised controlled trial in patients with lung cancer. Lancet Oncol. 2014;15(10):1168–76.

    Article  PubMed  Google Scholar 

  22. Chen Z, Meng ZQ, Milbury K, Bei W, Zhang Y, Thornton B, et al. Qigong improves quality of life in women undergoing radiotherapy for breast cancer: results of a randomized controlled trial. Cancer. 2013;119(9):1690–8.

    Article  PubMed  Google Scholar 

  23. Dusek JA, Otu HH, Wohlhueter AL, Bhasin M, Zerbini LF, Joseph MG, et al. Genomic counter-stress changes induced by the relaxation response. PLoS ONE [Electronic Resource]. 2008;3(7):e2576.

    Article  PubMed Central  Google Scholar 

  24. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer. J Clin Oncol. 2013;31(25):3119–26. A modified MBSR program for breast cancer survivors experiencing distress found the intervention resulted in lower symptoms of stress compared to a supportive expressive therapy program and a brief education control group, and improved QOL compared to the control group. Contrary to their hypothesis, the mindfulness intervention also resulted in higher levels of social support compared to supportive expressive therapy. In addition, both interventions resulted in more normative diurnal cortisol profiles than the control group.

    Article  PubMed  Google Scholar 

  25. Mustian KM, Sprod LK, Janelsins M, Peppone LJ, Palesh OG, Chandwani K, et al. Multicenter, randomized controlled trial of yoga for sleep quality among cancer survivors. J Clin Oncol. 2013;31(26):3233–41. Largest RCT to date examining the benefits of yoga in cancer survivors. Patients experiencing clinically significant sleep disturbances were randomized to a yoga group or usual care. Yoga participants reported improved subjective and objective sleep outcomes.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Chandwani KD, Thornton B, Perkins GH, Arun B, Raghuram NV, Nagendra HR, et al. Yoga improves quality of life and benefit finding in women undergoing radiotherapy for breast cancer. J Soc Integr Oncol. 2010;8(2):43–55.

    PubMed  Google Scholar 

  27. Chandwani KD, Perkins G, Nagendra HR, Raghuram NV, Spelman A, Nagarathna R, et al. Randomized, controlled trial of yoga in women with breast cancer undergoing radiotherapy. J Clin Oncol. 2014;32(10):1058-65. doi:10.1200/JCO.2012.48.2752. First RCT in an oncology population to show that the benefits of yoga go beyond the benefits of simple stretching exercises and usual care leading to reduction of fatigue, increase physical functioning, better general health reports, and better cortisol regulation for women with breast cancer undergoing radiotherapy.

  28. Milbury K, Chaoul A, Biegler K, Wangyal T, Spelman A, Meyers CA, et al. Tibetan sound meditation for cognitive dysfunction: results of a randomized controlled pilot trial. Psychooncology. 2013.

  29. Wells RE, Yeh GY, Kerr CE, Wolkin J, Davis RB, Tan Y, et al. Meditation’s impact on default mode network and hippocampus in mild cognitive impairment: a pilot study. Neurosci Lett. 2013;556:15–9. doi:10.1016/j.neulet.2013.10.001.

    Article  CAS  PubMed  Google Scholar 

  30. Holzel BK, Carmody J, Vangel M, Congleton C, Yerramsetti SM, Gard T, et al. Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Res. 2011;191(1):36–43.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Jindal V, Gupta S, Das R. Molecular mechanisms of meditation. Mol Neurobiol. 2013;48(3):808–11.

    Article  CAS  PubMed  Google Scholar 

  32. Buffart LM, van Uffelen JG, Riphagen II, Brug J, van Mechelen W, Brown WJ, et al. Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials. BMC Cancer. 2012;12:559.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Lepore SJ, Coyne JC. Psychological interventions for distress in cancer patients: a review of reviews. Ann Behav Med. 2006;32(2):85–92.

    Article  PubMed  Google Scholar 

  34. Archie P, Bruera E, Cohen L. Music-based interventions in palliative cancer care: a review of quantitative studies and neurobiological literature. Support Care Cancer. 2013;21(9):2609–24.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Svensk AC, Oster I, Thyme KE, Magnusson E, Sjodin M, Eisemann M, et al. Art therapy improves experienced quality of life among women undergoing treatment for breast cancer: a randomized controlled study. Eur J Cancer Care (Engl). 2009;18(1):69–77.

    Article  Google Scholar 

  36. Milbury K, Spelman A, Wood C, Matin SF, Tannir N, Jonasch E, et al. Randomized controlled trial of expressive writing for patients with renal cell carcinoma. J Clin Oncol. 2014;32(7):663–70.

    Article  PubMed  Google Scholar 

  37. Wallace RK, Benson H, Wilson AF. A wakeful hypometabolic physiologic state. Am J Physiol. 1971;221(3):795–9.

    CAS  PubMed  Google Scholar 

  38. Wurtzen H, Dalton SO, Elsass P, Sumbundu AD, Steding-Jensen M, Karlsen RV, et al. Mindfulness significantly reduces self-reported levels of anxiety and depression: results of a randomised controlled trial among 336 Danish women treated for stage I-III breast cancer. Eur J Cancer. 2013;49(6):1365–73.

    Article  PubMed  Google Scholar 

  39. Hoffman CJ, Ersser SJ, Hopkinson JB, Nicholls PG, Harrington JE, Thomas PW. Effectiveness of mindfulness-based stress reduction in mood, breast- and endocrine-related quality of life, and well-being in stage 0 to III breast cancer: a randomized, controlled trial. J Clin Oncol. 2012;30(12):1335–42.

    Article  PubMed  Google Scholar 

  40. Garland SN, Tamagawa R, Todd SC, Speca M, Carlson LE. Increased mindfulness is related to improved stress and mood following participation in a mindfulness-based stress reduction program in individuals with cancer. Integr Cancer Ther. 2013;12(1):31–40.

    Article  PubMed  Google Scholar 

  41. Carlson LE, Ursuliak Z, Goodey E, Angen M, Speca M. The effects of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients: 6-month follow-up. Support Care Cancer. 2001;9(2):112–23.

    Article  CAS  PubMed  Google Scholar 

  42. Zernicke KA, Campbell TS, Speca M, McCabe-Ruff K, Flowers S, Carlson LE. A randomized wait-list controlled trial of feasibility and efficacy of an online mindfulness-based cancer recovery program: the eTherapy for cancer applying mindfulness trial. Psychosom Med. 2014;76(4):257–67.

    Article  PubMed  Google Scholar 

  43. Weitz MV, Fisher K, Lachman VD. The journey of women with breast cancer who engage in mindfulness-based stress reduction: a qualitative exploration. Holist Nurs Pract. 2012;26(1):22–9.

    Article  PubMed  Google Scholar 

  44. Leal I, Engebretson J, Cohen L, Rodriguez A, Wangyal T, Lopez G, et al. Experiences of paradox: a qualitative analysis of living with cancer using a framework approach. Psychooncology. 2014.

  45. Nagendra HR, Nagarathna R. Applications of integrated approach of yoga therapy—a review. A new life for asthmatics. Vivekananda Kendra; 1986.

  46. Telles S, Naveen KV. Yoga for rehabilitation: an overview. Indian J Med Sci. 1997;51(4):123–7.

    CAS  PubMed  Google Scholar 

  47. Lin KY, Hu YT, Chang KJ, Lin HF, Tsauo JY. Effects of yoga on psychological health, quality of life, and physical health of patients with cancer: a meta-analysis. Evid Based Complement Alternat Medi eCAM. 2011;2011:659876.

    Google Scholar 

  48. Cramer H, Lange S, Klose P, Paul A, Dobos G. Yoga for breast cancer patients and survivors: a systematic review and meta-analysis. BMC Cancer. 2012;12:412.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Harder H, Parlour L, Jenkins V. Randomised controlled trials of yoga interventions for women with breast cancer: a systematic literature review. Support Care Cancer. 2012;20(12):3055–64.

    Article  CAS  PubMed  Google Scholar 

  50. Bower JE, Garet D, Sternlieb B, Ganz PA, Irwin MR, Olmstead R, et al. Yoga for persistent fatigue in breast cancer survivors: a randomized controlled trial. Cancer. 2012;118(15):3766–75.

    Article  PubMed Central  PubMed  Google Scholar 

  51. Bower JE, Greendale G, Crosswell AD, Garet D, Sternlieb B, Ganz PA, et al. Yoga reduces inflammatory signaling in fatigued breast cancer survivors: a randomized controlled trial. Psychoneuroendocrinology. 2014;43:20–9.

    Article  CAS  PubMed  Google Scholar 

  52. Bower JE, Ganz PA, Irwin MR, Kwan L, Breen EC, Cole SW. Inflammation and behavioral symptoms after breast cancer treatment: do fatigue, depression, and sleep disturbance share a common underlying mechanism? J Clin Oncol. 2011;29(26):3517–22.

    Article  PubMed Central  PubMed  Google Scholar 

  53. Bower JE, Lamkin DM. Inflammation and cancer-related fatigue: mechanisms, contributing factors, and treatment implications. Brain Behav Immun. 2013;30(Suppl):S48–57.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  54. Kiecolt-Glaser JK, Bennett JM, Andridge R, Peng J, Shapiro CL, Malarkey WB, et al. Yoga’s impact on inflammation, mood, and fatigue in breast cancer survivors: a randomized controlled trial. J Clin Oncol. 2014;32(10):1040–9. Large RCT in beast cancer survivors showing the benefits of yoga at improving fatigue and vitality as well as reducing inflammatory cytokines. Moreover, there was evidence that the more the patients practiced yoga the better their outcomes.

  55. Kumar N, Bhatnagar S, Velpandian T, Patnaik S, Menon G, Mehta M, et al. Randomized controlled trial in advance stage breast cancer patients for the effectiveness on stress marker and pain through Sudarshan Kriya and Pranayam. Indian J Palliat Care. 2013;19(3):180–5.

    Article  PubMed Central  PubMed  Google Scholar 

  56. Fouladbakhsh JM, Davis JE, Yarandi HN. A pilot study of the feasibility and outcomes of yoga for lung cancer survivors. Oncol Nurs Forum. 2014;41(2):162–74.

    Article  PubMed  Google Scholar 

  57. Fouladbakhsh JM, Davis JE, Yarandi HN. Using a standardized Viniyoga protocol for lung cancer survivors: a pilot study examining effects on breathing ease. J Complement Integr Med. 2013;10.

  58. Martin AC, Keats MR. The impact of yoga on quality of life and psychological distress in caregivers for patients with cancer. Oncol Nurs Forum. 2014;41(3):257–64.

    Article  PubMed  Google Scholar 

  59. Milbury K, Chaoul A, Engle R, Liao Z, Yang C, Carmack C, et al. Couple-based Tibetan yoga program for lung cancer patients and their caregivers. Psychooncology. 2014.

  60. Oh B, Butow P, Mullan B, Hale A, Lee MS, Guo X, et al. A critical review of the effects of medical qigong on quality of life, immune function, and survival in cancer patients. Integr Cancer Ther. 2011.

  61. Oh B, Butow PN, Mullan BA, Clarke SJ, Beale PJ, Pavlakis N, et al. Effect of medical qigong on cognitive function, quality of life, and a biomarker of inflammation in cancer patients: a randomized controlled trial. Support Care Cancer. 2012;20(6):1235–42. doi:10.1007/s00520-011-1209-6.

    Article  PubMed  Google Scholar 

  62. Zeng Y, Luo T, Xie H, Huang M, Cheng AS. Health benefits of qigong or tai chi for cancer patients: a systematic review and meta-analyses. Complement Ther Med. 2014;22(1):173–86.

    Article  PubMed  Google Scholar 

  63. Fong SS, Ng SS, Luk WS, Chung LM, Wong JY, Chung JW. Effects of qigong training on health-related quality of life, functioning, and cancer-related symptoms in survivors of nasopharyngeal cancer: a pilot study. Evid Based Complement Alternat Med eCAM. 2014;2014:495274.

    Google Scholar 

  64. Wang R, Liu J, Chen P, Yu D. Regular tai chi exercise decreases the percentage of type 2 cytokine-producing cells in postsurgical non-small cell lung cancer survivors. Cancer Nurs. 2013;36(4):E27–34.

    Article  PubMed  Google Scholar 

  65. Mustian KM, Katula JA, Gill DL, Roscoe JA, Lang D, Murphy K. Tai Chi Chuan, health-related quality of life and self-esteem: a randomized trial with breast cancer survivors. Support Care Cancer. 2004;12(12):871–6.

    Article  PubMed  Google Scholar 

  66. Mustian KM, Katula JA, Zhao H. A pilot study to assess the influence of tai chi chuan on functional capacity among breast cancer survivors. J Support Oncol. 2006;4(3):139–45.

    PubMed  Google Scholar 

  67. Fong SS, Ng SS, Luk WS, Chung JW, Chung LM, Tsang WW, et al. Shoulder mobility, muscular strength, and quality of life in breast cancer survivors with and without Tai Chi qigong training. Evidence Based Complement Alternat Med eCAM. 2013;2013:787169.

    Google Scholar 

  68. Fong SS, Ng SS, Luk WS, Chung JW, Ho JS, Ying M, et al. Effects of qigong exercise on upper limb lymphedema and blood flow in survivors of breast cancer: a pilot study. Integr Cancer Ther. 2014;13(1):54–61.

    Article  PubMed  Google Scholar 

  69. Cohen KS. The way of qigong: the art and science of Chinese energy healing. 1st ed. New York: Ballentine Books; 1997.

    Google Scholar 

  70. Wang C, Schmid CH, Rones R, Kalish R, Yinh J, Goldenberg DL, et al. A randomized trial of tai chi for fibromyalgia. N Engl J Med. 2010;363(8):743–54.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  71. Yan JH, Pan L, Zhang XM, Sun CX, Cui GH. Lack of efficacy of Tai Chi in improving quality of life in breast cancer survivors: a systematic review and meta-analysis. Asian Pac J Cancer Prev APJCP. 2014;15(8):3715–20.

    Article  Google Scholar 

  72. Campo RA, Agarwal N, LaStayo PC, O’Connor K, Pappas L, Boucher KM, et al. Levels of fatigue and distress in senior prostate cancer survivors enrolled in a 12-week randomized controlled trial of qigong. J Cancer Surviv. 2014;8(1):60–9.

    Article  PubMed  Google Scholar 

  73. Fong SS, Ng SS, Luk WS, Chung JW, Leung JC, Masters RS. Effects of a 6-month Tai Chi qigong program on arterial hemodynamics and functional aerobic capacity in survivors of nasopharyngeal cancer. J Cancer Surviv. 2014.

  74. Holzel BK, Hoge EA, Greve DN, Gard T, Creswell JD, Brown KW, et al. Neural mechanisms of symptom improvements in generalized anxiety disorder following mindfulness training. NeuroImage Clin. 2013;2:448–58. doi:10.1016/j.nicl.2013.03.011.

    Article  PubMed Central  PubMed  Google Scholar 

  75. Villemure C, Ceko M, Cotton VA, Bushnell MC. Insular cortex mediates increased pain tolerance in yoga practitioners. Cereb Cortex. 2014;24(10):2732–40.

    Article  PubMed  Google Scholar 

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Conflict of Interest

Alejandro Chaoul, Kathrin Milbury, Anil K. Sood, Sarah Prinsloo, and Lorenzo Cohen declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of General Oncology, Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Alejandro Chaoul, Kathrin Milbury, Sarah Prinsloo & Lorenzo Cohen

  2. Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Anil K. Sood

  3. Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Lorenzo Cohen

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  1. Alejandro Chaoul
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  2. Kathrin Milbury
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  3. Anil K. Sood
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  4. Sarah Prinsloo
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  5. Lorenzo Cohen
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Correspondence to Lorenzo Cohen.

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This article is part of the Topical Collection on Integrative Care

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Chaoul, A., Milbury, K., Sood, A.K. et al. Mind-Body Practices in Cancer Care. Curr Oncol Rep 16, 417 (2014). https://doi.org/10.1007/s11912-014-0417-x

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