Coenzyme Q10

Efficacy
The evidence for the effects of Coq10 on cardiotoxicity is inconclusive. The results are based on one SR (n=5 CCTs). Three of the five included CCTs reported positive effects on surrogate parameters of cardiac function, however all studies were of high risk of bias.

Safety
Generally, well tolerated when taken as a dietary supplement. One observational study reported a non-significantly increased hazard of breast cancer recurrence.

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L-Carnitine

Efficacy
The evidence is contradictory on the effect L-Canitine on cardiotoxiticy. Two RCTs have evaluated the effect of L-Carnitine on cardiotoxicity. One RCT (n=40) found no evidence that L-Canitine protects against anthracycline-related cardiotoxicity while another RCT (n=30) found fewer cardiac complications when high-dose interleukin-2 was used among those treated with L-Carnitine.

Safety
Generally, well tolerated and has been safely used in clinical trials at doses from 250mg to 6g per day for up to six months.  Interactions with thyroid medications have been reported.

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Milk Thistle (Silybum marianum)

Efficacy
Few data are available of milk thistle for cardiotoxicity. One RCT among children (n=40) with ALL concluded that silymarin significantly decreased early doxorubicin-induced left ventricular systolic function disturbances. The second study (n=83) found that silymarin is a useful agent as it resulted in more beneficial effects on iron profile.

Safety
Although generally considered safe, there are precautions for some patient groups. There is insufficient information to assess safety in pregnancy and lactation.

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Acupuncture

Efficacy
The evidence for the effects of acupuncture on breathlessness is inconclusive. Two RCTs of acupuncture (n=47, n=173), a RCT of acupressure (n=60), and a small pilot RCT of acupressure (n=11) are available. One trial suggested possible beneficial effects of acupuncture in reducing morphine requirements and reducing anxiety related to breathlessness. The remaining trials showed unclear or non-significant effects. 

Safety
Generally safe when administered by a professional qualified practitioner. 
Mild adverse effects, such as pain or bleeding at the site of acupuncture, can be expected in about 10% of all cases. Serious complications seem to be very rare.

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Tai chi

Efficacy
Only few data are available. Tai chi enhances lung function and increases blood oxygen levels in lung cancer patients reported in one RCT (n=100). 

Safety
Generally considered safe when administered by a qualified practitioner. As it is a moderate form of aerobic exercise, it may be beneficial for people to check with their health practitioner if they have a known heart condition, severe osteoporosis, or musculoskeletal difficulties.

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Yoga

Efficacy
Few data are available. Among lung cancer patients, short-term beneficial effects have been reported on lung function. The results were obtained from a small RCT (n=32).

Safety
Generally considered safe when administered by a qualified practitioner. Few adverse events are reported in clinical trials and serious adverse effects appear to be rare. Overall injury rates are comparable to other exercise types.

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Qigong

Efficacy
Few data are available. A study suggests qigong to be effective in reducing upper limp circumference and increasing blood flow in breast cancer patients with lymphoedema. The results are derived from a small (n=23), non-randomized trial and is therefore limited. 

Safety
Generally considered safe when administered by a qualified practitioner. As it is a moderate form of aerobic exercise, it may be beneficial for people to check with their health practitioner if they have a known heart condition, severe osteoporosis, or musculoskeletal difficulties.

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Selenium

Efficacy
The evidence for the effects of selenium on lymphoedema is incoclusive. The data from the most relevant SR (3 RCTS) and trials are inconclusive because the studies have been assessed as low quality, or the quality of the studies was not assessed. or the clinical significance is unclear. A recent RCT (n=26) not included in the SR reported Selenium improving the lymphoedema diagnostic stage. The results of the RCT should be interpreted with caution as it was a small study, and the randomization and allocation procedures are unknown. 

Safety
Selenium is generally considered safe. However, the safety of the therapy has not been systematically assessed. It has been associated with risks related to over-supplementation. Chronic Selenium poisoning has been reported. Symptoms include hair loss, thickened nails, nausea, vomiting, fatigue, paraesthesia, and paralysis. Long-term supplementation may increase the risk of type 2 diabetes.  

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Aromatherapy

Efficacy
Few data are available. Aromatherapy has been reported to have a positive effect in preventing phlebitis among cancer patients receiving massage with sesame oil. These findings are based on one small RCT (n=60). 

Safety
Generally safe and only associated with minimal adverse effect when used in appropriate dilutions. Allergic reactions can occur with all oils. Should not be used undiluted.

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Qigong

Efficacy
The evidence suggests qigong not to be effective on the breathlessness-fatigue-anxiety cluster have been found in an RCT (n=156) in lung patients.

Safety
Generally considered safe when administered by a qualified practitioner. As it is a moderate form of aerobic exercise, it may be beneficial for people to check with their health practitioner if they have a known heart condition, severe osteoporosis or musculoskeletal difficulties.

Read the full version of the Qigong summary.