ATYPICAL RESPONDERS LANDSCAPE REVIEW ∙ OCTOBER, 2017 22 • Alternative Medicine: If a non-mainstream practice and/ or product is used in place of conventional medicine, it is considered alternative. Examples of CIM include consumption of natural products, dietary supplements, and substances that are not FDA approved, as well as mind-body holistic practices such as yoga, massage, meditation, acupuncture, and music therapy. Complementary and integrative health practices are widely used by breast cancer patients to manage symptoms, mitigate side effects, and improve QOL, and several studies have concluded that these interventions play a role in enhanced well-being. Given that the majority of North American women with breast cancer report utilizing some form of integrative medicine [55], specific studies are warranted to determine which complementary and integrative therapies are best suited for specific patient populations. For example, a randomized study analyzed the role of acupuncture in reducing pain and dysfunction in individuals with cancer of the head or neck who had undergone surgical dissection of the lymph nodes in their neck [56]. The study found that individuals in the group receiving acupuncture experienced significant reduction in pain and dysfunction compared with individuals receiving standard care. Interestingly, the mistletoe extract Iscador® is widely used in the CIM setting among cancer patients, especially in Germany and elsewhere in Europe. Iscador formulations are labeled based on the tree from which the mistletoe was harvested (M for Malus (apple); P for Pinus (pine); Q for Quercus (oak); and U for Ulmus (elm)), with different therapeutic effects attributed to each. A study in patients with advanced pancreatic cancer reported both survival and symptom improvements [57]. Other studies with cancer patients suggest that chemotherapy regimens may be better tolerated with fewer negative effects when adding a prescribed mistletoe regimen, and that mistletoe can improve symptoms, QOL [58], and survival [59], although such studies may be hampered by publication bias and low internal quality. A Phase II study examined 23 extremely ill cancer patients who had short life expectancies due to peritoneal ascites accumulation that required repeated peritoneal punctures for drainage. Following drainage of fluid, Iscador M® 10 mg was injected intraperitoneally, and the interval until the next drainage was measured in comparison with a baseline time interval recorded in the absence of administration of Iscador M® . After the first administration of Iscador M® , the median time interval between drainage events increased from 7 days (baseline) to 12 days. No toxicity was observed [60]. A proposed reason for the positive effects of Iscador® in cancer patients includes beneficial effects on the immune system, and further study is warranted (read more). Interestingly, one of the 23 patients with ascites showed a clinically objective Complementary and integrative health practices are widely used by breast cancer patients to manage symptoms, mitigate side effects, and improve quality of life.