ATYPICAL RESPONDERS LANDSCAPE REVIEW ∙ OCTOBER, 2017 23 improvement that lasted 12 months. This patient may be considered an exceptional survivor because malignant ascites accumulation is associated with a mean survival of about 5 months [61]. However, whether this patient’s prolonged survival was due to Iscador® , reduction in ascites accumulation, and/or some other factor(s) is undetermined. In another CIM study, the effectiveness of mindfulness-based stress reduction (MBSR) for cancer- related fatigue and related symptoms was evaluated in 35 cancer patients. The MBSR group underwent training in mindfulness meditation, yoga, and self-regulatory responses to stress. Compared to the control group, the MBSR group experienced significant improvements in fatigue, energy, depression, and sleep disturbance. Results were maintained or strengthened at the 1-month follow-up, and were also maintained 6 months after completing the training [62]. Other studies are ongoing. For example, researchers at the Osher Center for Integrative Medicine at the University of California at San Francisco are determining the optimal yoga intervention for supportive care for fatigue and other side effects from chemotherapy in patients with breast and other cancers in both the adjuvant and metastatic setting (read more). Not only are various CIM interventions associated with QOL outcomes, but these therapies may also play a role in enhanced survival and favorable biological outcomes as described below. •  A randomized clinical trial of 227 women revealed that interventions to reduce psychological stress in patients with breast cancer resulted in a reduced risk of cancer recurrence and death [63]. • Conversely, a meta-analysis found that stress-related psychosocial factors were associated with worse survival in patients with cancer [64]. • A meta-analysis concluded that newly diagnosed breast cancer patients with the highest quintile of serum Vitamin D levels had approximately half the death rate of those in the lowest Vitamin D quintile [54]. • A retrospective case series of 239 Stage IV lung cancer patients who utilized Pan-Asian medicine and vitamins showed that long-term use of this regimen beyond completion of conventional cancer care decreased deaths by 69% compared to conventional cancer care alone [65]. •  A study of MBC patients receiving highly customized CIM regimens showed survival times that were double those of patients receiving only standard medical care [66]. Although the specific biological reasons underlying these remarkable results are not fully understood, physiological evidence has been obtained that may offer at least a partial explanation. A randomized