Ovarian Cancer
Integrative
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Guidelines
Examples
Integrative
Therapies
Treatment
Terrain
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Information
Quick Reference GuideOpen a 2-page quick reference summary of the therapies best supported by evidence for use with ovarian cancer:
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Our goal is to help you live as well as you can for as long as you can using an optimal integrative combination of conventional and complementary therapies and approaches.
Key Points
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Many women with ovarian cancer are interested in going beyond conventional cancer therapies—that is, having an integrative approach to care that blends the best of conventional and complementary therapies. Your reading this indicates that you are likely one of these women.
Perhaps you have just been diagnosed with ovarian cancer or with a recurrence of your cancer. Now you may be embarking on surgery, chemotherapy, radiation therapy or some combination of these—maybe even all three. You are curious to see if complementary therapies or healing practices could help your treatment be more effective or bolster your resilience or prevent or manage treatment side effects.
Or maybe you’ve completed your treatments and you want to know what else you can do to keep the cancer from coming back or keep it at bay. Perhaps living with ovarian cancer has brought on difficult emotions, or made it hard to sleep well or challenged your relationships. Is there help for that?
Or perhaps you’re dealing with advanced cancer and your conventional treatment options are slim—you ask "Are there any complementary therapies that would help me?” Or perhaps you feel you have limited time to live, and you want to bring the best quality to your life, however long that is.
So, what can I start with now? Any of the 7 Healing Practices are a good beginning in creating a body that cancer doesn’t like. These practices support you through and possibly enhance your treatment. Ultimately, let your intuition guide you in choosing where to start with these healing practices. The 7 Healing Practices lead off the Integrative Therapies section of this handbook.
We have scoured the research literature to find what natural products (such as curcumin) and off-label drugs (such as metformin) might be beneficial or harmful in dealing with ovarian cancer. We have also found novel approaches such as chronomodulated treatment—scheduling your chemotherapy to coincide with your body’s optimum circadian rhythms for killing cancer cells and protecting normal cells.
Optimally and safely using natural products, off-label drugs and unique administration methods happens best under the care of licensed healthcare providers who are knowledgeable and skilled in integrative cancer care. We help you explore these therapies in depth, as well as find help in putting together the options best for you.
Laura Pole
Integrative Care in Ovarian Cancer
Authors
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Nancy Hepp, MS, BCCT Project ManagerNo matter where you are in your experience with ovarian cancer, there’s good reason to seek integrative care: Women with ovarian cancer who followed a weekly individualized integrative medicine program during chemotherapy or palliative care had improved quality of life. They saw improvements in appetite, general well-being and ability to complete their conventional treatments. They also noted better control of symptoms such as fatigue, pain, anxiety, sleep disruption, nausea and cognitive impairment (see at right).1
Our goal is to help you live as well as you can for as long as you can using an optimal integrative combination of conventional and complementary therapies and approaches. Before investigating integrative care in ovarian cancer, we recommend reviewing integrative cancer care in general. For cancer care to be considered truly integrative, patients and their cancer treatment teams work together to find the best blend of conventional and complementary therapies that have been shown to be effective and safe.
We also recommend that you learn about your body terrain, which is your internal environment that is influenced by external factors such as the foods you eat, the chemicals around you, and the light and radiation you’re exposed to. It’s also influenced by internal factors such as stress hormones, sex hormones, your fitness level, your feelings of being loved, and your sense of purpose. This body terrain can influence the tumor microenvironment—the biochemical and physical interaction of cancer cancers and normal cells—in which the cancer exists, making it either more or less likely to spread. You can sometimes improve your body terrain with integrative practices. See Body Terrain and the Tumor Microenvironment.
Symptoms of Ovarian Cancer
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Clinical Practice Guidelines
- National Comprehensive Cancer Network:
- Professional Guidelines (Login required)
- Guidelines for Patients: Ovarian Cancer
- American Society of Clinical Oncology: Gynecologic Cancer
Examples: Treatment Approaches from Noted Specialists and Researchers
Bastyr Integrative Oncology Care—A Naturopathic Oncology Approach
Naturopathic oncology care is complementary rather than alternative to conventional care—complementary therapies are used in conjunction with conventional treatments. Naturopathic oncologists are oriented to deliver integrative oncology care in tandem with their conventional oncology colleagues. For more information, see our discussion of naturopathic medicine and oncology at Integrative Medical Systems in Practice in the US and Canada.
BCCT advisor Leanna Standish, ND, is a fellow of the American Board of Naturopathic Oncology (FABNO) and works within the research institute of Bastyr University. Dr. Standish has been leading research studies investigating integrative therapies provided by naturopathic oncologists, as well as the costs and outcomes of that care.
A 2013 news article2 described preliminary results from the Bastyr University Integrative Oncology Research Center (BIORC) in treating 12 patients with stage 4 ovarian cancer. In looking at preventing recurrence, the researchers found that with their protocols, 83 percent of patients were still alive at three years. This is substantially higher than the 49 percent survival reported in the Surveillance, Epidemiology, and End Results Program (SEER) national data for those receiving conventional standard care (for all stages). Bear in mind, however, 12 patients is a small number—too small to conclude that these results are significant in comparison with the large SEER database.3
BIORC includes intravenous (IV) therapies. Of 46 patients, 18 received IV therapy, including IV artemisinin. At three years, a treatment effect was becoming apparent.
Bastyr University is also involved in the Canadian/US Integrative Oncology Study (CUSIOS): Advanced Integrative Oncology Treatment for Patients with Advanced Stage Cancer: A Prospective Outcomes Study, which is recruiting patients until January 2021.
Natural Products Used in the BIORC Stage 4 Ovarian Cancer Protocol
According to Neil McKinney’s Integrative Naturopathic Oncology4
- Intravenous (IV) ascorbic acid
- Turkey tail mushroom (Trametes versicolor)
- Curcumin
- Bromelain
- Quercetin
- ECGC
- Helixor M mistletoe (made from apple tree mistletoe)
Integrative Oncology Program, The Oncology Service, Lin and Carmel Medical Centers, Clalit Health Services Israel
Patient Expectations in Using Complementary ApproachesOne study found that patients using complementary medicine expected their gynecologic oncologist to be actively involved in the process of integration within supportive care and that complementary medicine consultations would focus on improving well-being.5 |
Lin and Carmel Medical Centers Haifa and Western Galilee District of Israel has an integrative oncology program. One of their leading services is integrative gynecologic oncology, based on a very close collaboration with their gynecologic oncologists. The integrative gynecologic oncology program is co-directed by Professors Eran Ben-Arye and Ofer Lavie.
According to Dr. Eran Ben-Arye, patients are referred by their gynecologic oncologists to the Integrative Oncology Program, where they begin by consulting with an integrative physician who develops a patient-specific complementary integrative medicine plan. The referring gynecologic oncologist is expected to contribute to the plan and support the patient in following it. Typical complementary therapy services:6
- Guidance on using herbs and dietary supplements
- Acupuncture and other manual-movement and body-based methods, such as acupressure, reflexology, qigong, the Paula and Feldenkrais methods
- Mind-body-spirit therapies, such as guided imagery, music therapy and spiritual care
- Anthroposophic medicine
The Integrative Oncology Program conducts research to explore the effectiveness of the patient-centered integrative model as a whole rather than a specific modality or intervention. Their studies focus on improvement in quality of life as well as improved adherence to chemotherapy protocols, mostly carboplatin and taxol.
Main findings:
- Greater chemotherapy completion: Participating in and adhering to a patient-oriented complementary integrative medicine treatment program may be linked to completion of the planned chemotherapy regimen, as shown by a higher relative dose intensity (RDI), especially with carboplatin and paclitaxel.7
- Reduced drug use: The intervention may lower the need for drugs for managing symptoms, especially non-opioid pain relievers and anti-anxiety drugs.8
- Reduced fatigue: The intervention was associated with reduced cancer-related fatigue and improved other outcomes related to quality of life, especially among those who adhered to the regimen by having four or more treatments within 30 days of each session.9
- Reduced gastrointestinal symptoms: Breast and gynecological cancer patients experienced improved appetite, nausea/vomiting, mouth sores and/or pain, heartburn, abdominal flatulence and/or pain, and diarrhea or constipation. Greater benefit was seen in patients attending at least four treatment sessions.10 A separate study found reduced gastrointestinaI concerns, with fewer chemotherapy-related hospitalizations. Including consultation with a registered dietician during complementary integrative medicine treatments led to greater reduction in nausea.11
- Improved quality of life: Improvements were seen in fatigue, physical function, role functioning, pain, drowsiness, anxiety, sleep disruption and other outcomes related to quality of life. Greater benefit was seen in patients attending at least four treatment sessions.12
- Altered patient perspective: Patients’ experiencing empathy, emotional support, togetherness, and being treated as an individual seemed to generate internal processes and helped patients feel they weren’t alone in their struggle. Patients felt a sense of agency, actively participating in the healing process.13
In sum, this program finds that patient-tailored complementary integrative medicine interventions may improve quality of life and well-being of patients undergoing chemotherapy and palliative care. These benefits come through both specific and non-specific mechanisms.14
Integrative Programs, Protocols and Medical Systems
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For more information about protocols and programs, see our Integrative Protocols and Programs page. |
- Plans, protocols, and programs
- Alschuler & Gazella complementary approaches15
- Bastyr University Integrative Oncology Research Center (BIORC) protocol
- Block program16
- McKinney protocols17
- Traditional systems
- Ayurveda
- Traditional Chinese medicine18
- Traditional Korean medicine19
Integrative Therapies in Ovarian Cancer
The Ultimate Guide to Cancer: DIY Research
This guide from Ralph Moss, PhD, BCCT advisor and leading chronicler of integrative cancer treatments, shows you how to use four of the main tools that doctors use to decide on the best cancer treatments. It will help you learn why some cancer treatments that look good in clinical trials may not work for “real world” patients. It will help you answer two questions that the doctor may be hesitant to answer in the detail you need to decide about treatment:
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7 Healing Practices: The Foundation
Let your intuition guide you in choosing where to start with these healing practices.
Any of the 7 Healing Practices are a good beginning. Eating well and moving more pack a powerful one-two punch in potentially improving treatment outcomes, enhancing quality of life and/or reducing risk of recurrence in ovarian cancer. Moreover, evidence shows that managing stress, sleeping well, creating a healing environment, sharing love and support and exploring what matters now can help women with ovarian cancer. Ultimately, let your intuition guide you in choosing where to start with these healing practices.
Eating Well
We at BCCT believe that eating well is one of the therapies that may help enhance your cancer treatments as well as restore your health, improve your quality of life and reduce your risk of recurrence. However, we emphasize that eating well alone will not likely prevent, cure or control cancer. Like every other therapy or approach included on this website, eating well is one component of an individualized integrative plan rather than a stand-alone therapy.
Treating the Cancer
The impact of diet on ovarian cancer survival:20
| Higher Survival | Lower Survival |
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The researchers also found no association between total vitamin C, vitamin E, beta-carotene and retinol from diet plus supplements and ovarian cancer survival.21
Medline Plus recommends changes such as these to improve your poly- to monounsaturated fat ratio:22
- Snack on nuts instead of crackers or cookies
- Choose fish over red meat
- Add freshly ground flaxseed to foods
- Replace butter or margarine with healthier oils such as olive oil
Reducing Risk
Food choices are associated with ovarian cancer risk, although sometimes studies find conflicting results:23
| Lower Risk | Higher Risk |
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- No reduced risk of recurrence was found from double-brewed green tea as a maintenance intervention in women with advanced stage ovarian cancer after standard treatment.24
- Some studies have reported an increased risk with a pro-inflammatory diet (high levels of saturated fatty acids, trans fatty acids and cholesterol),25 but two large, prospective cohort studies did not find an association.26
No significant associations are reported for red meat, eggs, fruit, vitamin D, vitamin C, coffee or four major carotenoids (alpha-carotene, beta-cryptoxanthin, lycopene and lutein). Lycopene (sources include tomatoes and other red vegetables and fruits) shows inconsistent results, but with more advantage among premenopausal women.27 See a recommendation for eating eggs in the Commentary section below.
Reduced risk was found for “an Asian diet”, but details of the diet were not reported.28
Optimizing Your Terrain
Foods can impact terrain factors to either promote or deter cancer growth and spread:
- Foods with a high glycemic index quickly raise blood sugar and may lead to chronic hyperinsulinaemia (abnormally high levels of insulin in blood), which is a potential risk factor for cancer.29
- High levels of triglyceride and low levels of HDL (high density lipoprotein, a type of cholesterol) correlate with a high severity (stage 3 or 4) of epithelial ovarian cancer.30
Moving More
Our Moving More summary has ideas on weaving this healing practice into your integrative cancer care plan.
Treating the Cancer
- Low muscle density at diagnosis and loss of muscle mass during treatment may be associated with worse survival outcomes.31
- Vigorous physical activity may benefit survival32
Managing Side Effects and Promoting Wellness
Benefits:
- Higher physical well-being for ovarian cancer patients engaging in increased moderate to strenuous physical activity during chemotherapy33
- Decreases in behavioral fatigue, cognitive fatigue and symptoms of depression, and improvements in sleep duration, sleep problems and daytime dysfunction for women who recently had surgery and completed their first cycle of adjuvant chemotherapy34
- Posttraumatic growth (positive psychological change experienced as a result of adversity and other challenges) in gynecological cancer survivors35
- Quality of life improvements in ovarian cancer survivors in a 2015 review of non-randomized studies;36 however, no effect on overall quality of life or specific aspects of quality of life (physical, emotional, social well-being and fatigue) in gynecologic cancer survivors in a 2018 review and meta-analysis37
Reducing Risk
- Risk reduction among the most active women in case–control studies but inconsistent results in cohort studies38
Managing Stress
Living with ovarian cancer can be stressful, and unmanaged stress can be harmful. Managing your responses to stressful situations and stimuli is possible and can benefit your health in many ways. Several complementary approaches promote healthy responses to stress: natural products, mind-body approaches, eating well, sleeping well and sharing love and support. See Managing Stress to explore taming stress and aiming it in a helpful direction.
Managing Side Effects and Promoting Wellness
- Improvements in quality of life and psychological flexibility as well as reduced distress, emotional disturbances, physical pain, and traumatic responses in patients receiving Acceptance and Commitment Therapy (ACT)39
Reducing Risk
- A large longitudinal study found that women with high posttraumatic stress disorder (PTSD) symptoms had a two-fold greater risk of ovarian cancer compared to women with no trauma exposure.40
Optimizing Your Terrain
- Chronic behavioral stress results in higher levels of stress hormones in tissues, greater tumor burden, and a more invasive pattern of ovarian cancer growth in mice. Tumors in stressed animals have increased formation of blood vessels (angiogenesis) and other markers of disease progression.41
Sleeping Well
Sleeping well can have profound ripple effects: reducing risk for ovarian cancer, managing stress, improving mood and energy, and modulating your immune system, to name a few.
Some lifestyle behaviors can promote quality sleep. For example, going to bed before midnight is associated with longer sleep in ovarian cancer survivors in the first six months following treatment.42 Explore this vital healing practice in BCCT’s Sleeping Well summary.
Reducing Risk
- Compared to average sleepers (7-9 hours per night), long sleepers (10 or more hours per night) had an increased risk of estrogen-mediated cancers, including ovarian cancer.43
Creating a Healing Environment
If you are trying to reduce your risk of cancer recurrence, or if you are at risk for ovarian cancer, creating a healing environment may be an important part of your wellness plan. Ideas for reducing harmful exposures linked to ovarian cancer and increasing your exposure to clean air and water, nature and beneficial light are reviewed in Creating a Healing Environment.
Reducing Risk
Many environmental exposures are associated with increased risk of ovarian cancer. Reducing or eliminating these exposures in your life can reduce your risk:
- Talcum powder used in the genital area, with varying risk according to cancer subtype44
- Endocrine-disrupting chemicals (EDCs) can cause cell growth in estrogen-responsive ovarian cancer cells.45 Hundreds or even thousands of EDCs are used in consumer products, including foods and food packaging. Those with known or suspected impacts on ovarian cancer cells include these:
- Bisphenol A (BPA)
- Hormone residues in meat, poultry and dairy products
- Some pesticides, such as organophosphates
- Asbestos46
- Ionizing radiation, such as x-rays47
Sharing Love and Support
The experience of being surrounded by love, family and friends who care about you, and the kindness of strangers—including doctors and other healers who care for you—is for many a powerful experience. Sharing Love and Support guides you in this practice to light the path to your healing.
Managing Side Effects and Promoting Wellness
- Social support predicted lower psychological distress and higher psychological well-being among women with ovarian cancer.48
- Social support was associated with improved mental state and various aspects of quality of life in women with ovarian cancer undergoing chemotherapy.49
- Compared to those who felt alone, helpless and emotionally distraught, women with ovarian cancer who felt loved and supported and who kept up their morale had more combative natural killer (NK) cells—lymphocytes identified for their ability to kill tumor cells.50
Reducing Risk
- A Swedish study found a decreased risk of serous ovarian cancer in women with fewer people available for informal socializing.51 This is opposite to findings (above) that greater social support is associated with better disease outcomes after diagnosis. The authors speculate that perhaps informal socializing in a large social network may “imply stressful expectations to support others to a higher degree.” Because this is the only study we could find with this result, we await further research to confirm and explain these results.
Exploring What Matters Now
Whether you approach meaning from a spiritual or religious perspective or from a practical perspective, paying attention to what matters to you now is perhaps one of the best places to start in making decisions about your care. This exploration may also improve your response to treatment, lower your distress and improve the quality of your life. Look inside BCCT’s Exploring What Matters Now summary.
Treating the Cancer
Greater decline in levels of CA-125 (a biomarker of ovarian cancer) during treatment were associated with higher levels of optimism at the start of chemotherapy.52
Managing Side Effects and Promoting Wellness
Lower levels of distress and a positive association with health-related quality of life in epithelial ovarian cancer patients undergoing chemotherapy were seen with higher levels of optimism.53
Chemosensitivity TestingIn many ways, each case of cancer is unique. Your personal body terrain and tumor microenvironment, which is a combination of genes, nutritional status, stress response, circadian rhythms, fitness, microbiome, history of infectious disease, hormone levels and much more, is as unique to you as your fingerprints are. Your body and tumor may not respond exactly like others to any given treatment. If feasible, your healthcare team can collect a live sample of tumor tissue and send it for chemosensitivity testing to identify your cancer’s responses to both standard and complementary therapies. Test results can identify which chemotherapies and natural products are likely to be either most effective or ineffective or in treating the tumor. Medical advocate and BCCT advisor Gwen Stritter, MD, writes, “Ovarian cancer is one of the few cancers I know of where oncologists will do chemosensitivity testing right after initial diagnosis.” Indeed, the National Comprehensive Cancer Network (NCCN) guideline for ovarian cancer says that a number of their member institutions use chemotherapy/resistance and other biomarker tests to help select chemotherapy when multiple chemotherapy options are available. However, the National Comprehensive Cancer Network (NCCN) states that the current level of evidence of using this testing is not strong, and they do not recommend such testing. The American Society of Clinical Oncology (ASCO) advises that this testing not be used in ovarian cancer except in the clinical trial setting.54 If your doctor is following the NCCN or ASCO guidelines closely, he or she is not likely to bring up this testing with you. If you’d like to consider chemosensitivity testing, you may need to take the initiative. First, you will need to preplan. Live cells need to be prepared and shipped overnight to a special lab, and so you must discuss this with your doctor before your tumor tissue is removed. For information about this see Standard and Non-Standard Diagnostic Approaches. Knowing how your cancer behaves may influence the type of testing and treatment used, prepare you for possible treatment side effects and guide you in steps to prevent or minimize these effects. It will help you understand and choose the complementary therapies and lifestyle approaches that may enhance your conventional treatment, manage side effects and improve your quality of your life. BCCT advisor Dr. Keith Block relates a case of a patient with recurrent ovarian cancer with chemo-resistance and a high CA-125 level. Block’s team arranged for a tumor biopsy which was assessed by the Nagourney Cancer Institute. Test results showed the tumor was sensitive to a combination of two chemotherapy drugs—even though her tumor had shown resistance to both drugs when used individually. Within two months of starting the drug combination, her CA-125 level dropped significantly and her disease stabilized. Block states he would never have come up with this combination if not for the testing.55 |
Beyond the 7 Healing Practices: Further Integrative Therapies
Complementary Approaches in Ovarian Cancer: Involving Conventional Healthcare ProvidersA 2018 review of complementary treatments for gynecologic cancer found these rates of use and communication between patients and healthcare providers:56
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Conventional treatments are readily available and are discussed below. Complementary therapies can be useful to enhance conventional treatment effects, improve quality of life and possibly even extend life for those with ovarian cancer. Many complementary therapies―when chosen thoughtfully, reviewed with your oncology treatment team and used alongside conventional therapies—can become part of your integrative cancer care approach.
Therapies are grouped according to their effects:
- Treating the cancer
- Managing side effects and promoting wellness
- Reducing risk
- Optimizing your terrain
We present natural products in six groups:
- Good clinical evidence of efficacy & safety, easy access
- Good clinical evidence of efficacy & safety, limited access
- Limited clinical evidence of efficacy but good safety, used in leading integrative programs
- Limited clinical evidence of efficacy, or significant cautions, but potential significant benefit
- Especially promising preclinical or emerging clinical evidence of efficacy and safety
- Evidence of no efficacy or may be dangerous
Off-label, overlooked and novel cancer approaches (ONCAs) are grouped separately:
- Group A: Good clinical evidence of efficacy
- Group B: Limited clinical evidence of efficacy
- Group C: Promising preclinical evidence only
- Group D: Evidence of no efficacy or may be dangerous
Other integrative therapies and approaches are described but not categorized. See the full summaries as linked for more information on each of these therapies.
Treating the Cancer
Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action
Conventional Treatments
Integrative Approaches and SurgerySurgery may be part of the recommended treatment for this cancer type. We provide helpful information about how integrative approaches can coordinate with surgery on our Integrative Approaches and Surgery page. |
In general, the earlier the stage of the cancer, the better the response to treatment. Unfortunately, ovarian cancer is typically diagnosed in more advanced stages, which is why treatments are less effective.
The most common primary conventional treatments for ovarian cancer are surgery, chemotherapy and targeted therapy. Radiation therapy is not typically used as a first-line treatment but may be used for small localized recurrent tumors. Hormone therapy may be prescribed for relapsed low-grade tumors.
Some newer therapies and their outcomes:
- Pressurised intraperitoneal aerosol chemotherapy (PIPAC) is a relatively new treatment for patients with peritoneal metastases. A 2019 review found that an objective clinical response of 62–88 percent was reported for patients with ovarian cancer (median survival of 11–14 months) with PIPAC. Repeated PIPAC did not have a negative effect on quality of life.57
- Pulsed low-dose rate radiation therapy (PLDR-RT) delivers conventional radiation doses in pulses of small doses with intermittent pauses. A small study involved PLDR-RT for patients with gynecologic and other cancers of the pelvis. Patients had undergone radiation therapy to the pelvis previously. Twenty-three patients were treated with a curative intent and 15 were treated palliatively. At one-year, 59 percent of patients treated for curative intent had a clinical, biochemical or radiographic response, and six of the 23 patients had no evidence of disease at their last follow-up. Among the patients treated palliatively, 61 percent had a clinical or radiographic response.58
- Percutaneous thermal ablation (TA) uses either heat, cold or a chemical to destroy cancerous tissue in a target organ. A special type of needle is advanced directly into a tumor within the target organ, guided by ultrasound, computerized tomography (CT) scan and/or X-ray.59 A single session was safe and highly effective in controlling local tumors in metastatic ovarian cancer.60
Sometimes adjustments in how conventional treatments are applied can impact outcomes. A 2011 retrospective analysis suggested that epidural anesthesia and analgesia for ovarian serous adenocarcinoma surgery may reduce mortality during the initial years of follow-up compared to general anesthesia (GA) and intravenous opioid analgesia.61
We recommend these resources to introduce the science and conventional therapies:
Natural Products
Traditional Medicine TherapiesThroughout this summary, you will find examples of therapies used by and in many cases created by traditional medical systems. Foods and herbs such as medicinal mushrooms, soy and curcumin are part of traditional systems. Evidence shows that herbs used in traditional Chinese medicine (TCM) may help in maintaining immune function in women with ovarian cancer. Mind-body practices such as mindfulness meditation and yoga also have roots in these systems. Acupuncture, another approach that is part of the Chinese and Korean medicine traditions, has helped those with ovarian cancer manage symptoms such as nausea. |
“While many herbals have been shown to have anticancer properties, the research to date has been largely preclinical (in vitro), without clinical evidence of their effectiveness.”62 Here we make clear the level of evidence behind natural products.
Group 1: Good clinical evidence of efficacy & safety, easy access
| Therapy | Notes |
|---|---|
| Combination therapy of Indole 3-carbinol (I3C) (About Herbs) and EGCG | Improved survival, progression-free survival, performance scores and quality of life when used prior to and during combined treatment, including neoadjuvant (prior to surgery) platinum-taxane chemotherapy, surgery, and adjuvant (supplemental) platinum-taxane chemotherapy63 |
Group 3: Limited clinical evidence of efficacy but good safety, used in leading integrative programs
| Therapy | Notes |
|---|---|
| Melatonin |
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| Mistletoe (Viscum album) |
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Group 4: Potential significant benefit, but either limited clinical evidence of efficacy or significant cautions
May be used in leading integrative oncology programs. Therapies in this group may need more medical oversight and surveillance.
| Therapy | Notes |
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| Combinations of therapies |
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| Glutathione |
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| Intravenous vitamin C |
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Other therapies with preclinical evidence only for treating the cancer
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Group 5: Especially promising preclinical or emerging clinical evidence of efficacy and safety
| Therapy | Notes |
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| Agaricus blazei Murill mushroom | |
| Ashwagandha (Withaferin A) |
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| Combinations of therapies |
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| Flaxseed |
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| Lycopene supplements |
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| Milk thistle components |
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| Nicotinamide (About Herbs) (a form of vitamin B3, also known as niacinamide) | |
| Quercetin | |
| Selenium |
Group 6: Evidence of no efficacy or may be dangerous
| Therapy | Notes |
|---|---|
| Ginseng (About Herbs) |
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| Vitamin D supplements |
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Off-label, Overlooked or Novel Cancer Approaches (ONCAs)
These therapies have exciting potential and/or proven benefits. However, some carry higher risks of side effects, interactions with other treatments and other adverse medical events than other therapies we review. Cautions are noted with each therapy, and we strongly encourage you to consult your doctor before using these therapies—even over-the-counter drugs—for cancer treatment. We also note whether a prescription is needed or if a therapy is not widely available.
Group A: Good clinical evidence of efficacy
May be used in integrative protocols and programs
| Therapy | Notes |
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| Beta blockers |
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| Chronomodulated treatment |
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| Metformin |
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Group B: Limited clinical evidence of efficacy
May be used in integrative protocols and programs
| Therapy | Notes |
|---|---|
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Copper chelation using tetrathiomolybdate or other chelators |
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Non-steroidal anti-inflammatory drugs (NSAIDs) including aspirin and COXII inhibitors |
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Group C: Promising preclinical evidence only
| Therapy | Notes |
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Therapies using heat, sound or light
Hyperthermia
- Hyperthermic intraperitoneal chemotherapy (HIPEC)
- Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is recommended by the Peritoneal Surface Oncology Group International for ovarian cancer.133
- Improved overall survival rates for both primary and recurrent epithelial ovarian cancer (EOC) in several reviews134
- Other reviews concluded that evidence to date is insufficient to support a general recommendation for use in ovarian cancer.135
- Whole-body hyperthermia
- Small clinical trials have found isolated cases of complete remission, extended survival and other benefits for ovarian cancer patients.136
See Hyperthermia.
Managing Side Effects and Promoting Wellness
Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being
Sexual Activity, Depression and Ovarian CancerA number of sexual difficulties can arise if ovarian cancer treatment causes hormonal changes:
Focus on survival can lead to a lack of interest in sex. Symptoms, including depression, anxiety and fatigue can also lead to sexual difficulties. Your oncology care team should ask about changes in sexual function since your diagnosis, but if you haven't been asked about or prepared for managing potential sexual difficulties, ask your doctor about this. For providers uncomfortable with management, a number of programs in sexuality after cancer are available at tertiary care centers.137 A study of sexual activity and functioning of epithelial ovarian cancer survivors (EOCSs) found patterns regarding sexual activity, sexual pleasure and sexual discomfort:138
Because sexual activity and pleasure contribute to survivors’ quality of life, the researchers suggest that healthcare professionals be mindful of sexual health and function, informing and treating patients as indicated. See Sexual Difficulties. |
Conventional Treatments
A study of sexual activity and functioning of epithelial ovarian cancer survivors found that “low estrogen levels were significantly associated with sexual discomfort.”139 Vaginal moisturizers and vaginal rings supplying low-dose estrogen are used to address sexual discomfort and difficulties. Although these are conventional therapies, they may not be included in many conventional treatment programs unless or until a patient expresses a need.
Hormone replacement therapy (HRT) is used for hot flashes and sexual discomfort that arise with ovarian cancer and treatments.
A combination regimen of megestrol acetate (MA) plus L-carnitine, celecoxib (a non-steroidal anti-inflammatory drug) and antioxidants has shown these effects:140
- Improved metabolism and inflammation as well as lean body mass, resting energy expenditure, fatigue and overall quality of life compared to MA alone
- Improved appetite and performance status (a measure of physical function) compared to MA alone
Pulsed low-dose rate radiation therapy (PLDR-RT) delivers conventional radiation doses in pulses of small doses with intermittent pauses. A small study involved PLDR-RT for ovarian and other cancers of the pelvis. Of the 50 percent of patients who reported pain at the local site before treatment, 68 percent reported an improvement in pain after PLDT-RT.141
Natural Products
Group 1: Good clinical evidence of efficacy & safety, easy access
These therapies may be widely used in integrative cancer protocols and traditional medical systems.
| Therapy | Notes |
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Panax ginseng (About Herbs) |
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| Reduced peripheral neuropathy in several small clinical studies, one of which used alpha-tocopherol (a form of vitamin E)150 |
Group 2: Good clinical evidence of efficacy & safety, limited access
Some may require a prescription, for example.
| Therapy | Notes |
|---|---|
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Group 3: Limited clinical evidence of efficacy but good safety, used in leading integrative programs
| Therapy | Notes |
|---|---|
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Individualized homeopathy |
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Mistletoe (Viscum album) |
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Group 4: Potential significant benefit, but either limited clinical evidence of efficacy or significant cautions
May be used in leading integrative oncology programs. Therapies in this group may need more medical oversight and surveillance.
| Therapy | Notes |
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Combinations of therapies |
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Ginkgo biloba (About Herbs) |
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Glutathione (About Herbs) |
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Intravenous vitamin C |
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Red ginseng (About Herbs) |
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| Selenium |
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Group 5: Especially promising preclinical or emerging clinical evidence of efficacy and safety
| Therapy | Notes |
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Off-label, Overlooked or Novel Cancer Approaches (ONCAs)
These therapies have exciting potential and/or proven benefits. However, some carry higher risks of side effects, interactions with other treatments and other adverse medical events than other therapies we review. Cautions are noted with each therapy, and we strongly urge you consult your doctor before using these therapies—even over-the-counter drugs—for cancer treatment. We also note whether a prescription is needed or if a therapy is not widely available.
Group C: Promising preclinical evidence only
| Therapy | Notes |
|---|---|
|
|
|
Energy Therapies
Healing Touch
- No evidence of improvements in quality of life with hypnosis, therapeutic massage and healing touch with each cycle of chemotherapy181
Mind-Body, Spiritual and Consciousness-changing Approaches
Training, Relaxation and/or Behavioral therapy
- Improved overall sexual functioning and psychological distress that was maintained at a six-month follow-up182
- Improved symptoms of anxiety and personality development, but not major depression183
- Reduced anxiety, with psycho-oncology therapy slightly more effective than a single relaxation intervention in preventing depression184
Hypnosis
- Reduced pain185
- No evidence of improvements in quality of life with each cycle of chemotherapy when combined with therapeutic massage and healing touch186
Yoga
- Improved depression, negative affect (emotional state), state anxiety (anxiety in response to a specific situation), mental health and overall quality of life, with decreases in fatigue187
See Mind-Body Approaches and Yoga.
Manipulative and Body-Based Methods
Acupuncture
- Improved social function, but not symptoms of pain or insomnia (preliminary evidence)188
- Prevented immediate-onset vomiting following carboplatin-paclitaxel chemotherapy; as effective as the anti-nausea drug ondansetron for immediate-onset vomiting and superior to ondansetron in preventing delayed vomiting at days four and five. The acupuncture-treated group also reported less insomnia and constipation and better general quality-of-life scores.189
- Lower frequency of nausea and incidence of constipation in patients treated by chemotherapy when combined with ginger moxibustion, plus fewer side effects, lower cost, and less risk than the control therapy of intravenous tropisetron hydrochloride and dexamethasone190
See Acupuncture.
Massage Therapy
- Clinical practice guidelines:
- The 2016 American Society of Clinical Oncology clinical practice guideline for managing chronic pain in survivors of adult cancers makes a weak recommendation for using massage.191
- The patient-education resource from the American Society for Clinical Oncology (ASCO) advises an integrative approach including massage to manage peripheral neuropathy.192
- Reduced feelings of hopelessness in ovarian cancer patients undergoing treatment193
- Reduced severity of subjective physical complaints and reduced urinary epinephrine, a marker of stress following Anma therapy (Japanese massage) in gynecologic cancer survivors194
- No evidence of improvements in quality of life with hypnosis, therapeutic massage and healing touch with each cycle of chemotherapy195
- The National Cancer Institute urges massage therapists to take precautions with all cancer patients and avoid massaging specific vulnerable areas of the body. In addition, certain patients with multiple bone metastases may be at risk for fracture during deep massage.196
See Massage Therapy.
Diets and Metabolic Therapies
Fasting
- Fasting from 36 hours before to 24 hours after chemotherapy (60-hour fast) improved quality of life and fatigue during chemotherapy.197
- Preliminary evidence (not yet peer-reviewed) found that a 48-hour, water-only fast at the time of each chemotherapy cycle was well tolerated without increasing weight loss, hospital admissions or chemotherapy dose reduction or delays. Patients did not see an improvement in quality of life, but the fasting patients needed only half as many treatment modifications as the nonfasting group.198
- Fasting reduced chemotherapy side effects of neutropenia (low count of white blood cells called neutrophils) and thrombocytopenia (low count of platelets) in a patient with ovarian cancer.199
- See a recommendation from Dr. Lise Alschuler in Commentary below.
Reducing Risk
Reducing the risk of developing cancer or the risk of recurrence
Managing ThrombosisOvarian cancer brings a high risk of formation of blood clots (thrombosis).200 For prevention, BCCT advisor Dr. Keith Block provides information on modifying the terrain factor he calls hypercoagulation.201 He discusses testing, lifestyle approaches and supplements to reduce risks. For more information see chapter 17, “Blood Circulation and Cancer: The Thick and the Thin.” |
Risk Factors
Risk factors for ovarian cancer that are generally not under a woman’s control:202
- Family history of ovarian cancer or BRCA1 and BRCA2 mutation (these mutations are responsible for most family history incidence)
- Age and menopause status
- Greater genetically predicted adult height
- Greater number of menstrual cycles, influenced by early menarche, late menopause, fewer pregnancies or periods of lactation or contraceptive use
- Infertility
- Personal history of breast cancer
Lifestyle Associations
Increased Risk
Risk factors that may be influenced by a woman’s lifestyle choices and behaviors:203
- Smoking tobacco with (borderline) mucinous cancers
- Use of hormone replacement therapy (estrogen plus progesterone) for serous and endometrioid ovarian cancers
- Breastfeeding is modestly associated with a decreased risk of premenopausal ovarian cancer for the mother, likely related to fewer menstrual cycles.
- Lack of physical activity (limited evidence)
- Being overweight or obese (inconsistent evidence)
An extensive meta-analysis did not find an overall association between ever-exposure to night-shift work and the risk of ovarian cancer.204 However, other evidence shows that rotating between night shifts and day or evening shifts, especially for many years, is linked to higher risk of ovarian cancer, and especially fatal cancer.205
Some initial evidence shows that the microbiome in the cervix and vagina may relate to or indicate ovarian cancer risk. Lower levels of the protective bacteria Lactobacillus in the microbiota in the cervix was associated with higher incidence of ovarian cancer or BRCA1 mutation status, especially in younger women. The research is too preliminary to draw a causal relationship, and no evidence yet shows that restoring the Lactobacillus microbiota in the cervix/vagina might lower the risk.206
Decreased Risk
Oral contraceptive use has shown a protective effect against ovarian cancer and may last several decades after use is discontinued. Use was also associated with a slightly increased risk of breast cancer, but this increase disappeared a few years after use was discontinued.207
Natural Products
Group 1: Good clinical evidence of efficacy & safety, easy access
These therapies may be widely used in integrative cancer protocols and traditional medical systems.
| Therapy | Notes |
|---|---|
|
Isoflavones, including genistein from soy Benefits of soy foods are discussed above in Eating Well |
|
|
Group 3: Limited clinical evidence of efficacy but good safety, used in leading integrative programs
| Therapy | Notes |
|---|---|
|
Combined therapies |
|
|
Intravenous, high-dose vitamin C |
|
Group 4: Potential significant benefit, but either limited clinical evidence of efficacy or significant cautions
May be used in leading integrative oncology programs. Therapies in this group may need more medical oversight and surveillance.
| Therapy | Notes |
|---|---|
|
Ginkgo biloba (About Herbs) |
|
Group 5: Especially promising preclinical or emerging clinical evidence of efficacy and safety
Other therapies with preclinical evidence only for reducing risk
|
| Therapy | Notes |
|---|---|
|
|
|
Lycopene supplements |
|
Group 6: Evidence of no efficacy or may be dangerous
| Therapy | Notes |
|---|---|
|
|
|
Oral vitamin C |
|
|
Vitamin D supplements |
|
Off-label, Overlooked or Novel Cancer Approaches (ONCAs)
These therapies have exciting potential and/or proven benefits. However, some carry higher risks of side effects, interactions with other treatments and other adverse medical events than other therapies we review. Cautions are noted with each therapy, and we strongly urge you consult your doctor before using these therapies—even over-the-counter drugs—for cancer treatment. We also note whether a prescription is needed or if a therapy is not widely available.
Group B: Limited clinical evidence of efficacy
| Therapy | Notes |
|---|---|
|
Non-steroidal anti-inflammatory drugs (NSAIDs) including aspirin and COXII inhibitors |
|
|
Optimizing Your Terrain
Creating an environment within your body that does not support cancer development, growth or spread
Natural Products
Group 1: Good clinical evidence of efficacy & safety, easy access
| Therapy | Notes |
|---|---|
|
|
|
Group 3: Limited clinical evidence of efficacy but good safety, used in leading integrative programs
| Therapy | Notes |
|---|---|
| Bromelain (About Herbs) |
|
| Isoflavones, including genistein from soy |
|
Group 4: Potential significant benefit, but either limited clinical evidence of efficacy or significant cautions
May be used in leading integrative oncology programs. Therapies in this group may need more medical oversight and surveillance.
| Therapy | Notes |
|---|---|
| Agaricus blazei Murill mushroom |
|
Group 5: Especially promising preclinical or emerging clinical evidence of efficacy and safety
| Therapy | Notes |
|---|---|
|
Turkey tail mushroom polysaccarides (PSK ) |
|
Energy Therapies
Healing Touch
- Trends of higher levels of immune modulators (CD4, CD8 and natural killer (NK) cells) with healing touch in combination with therapeutic massage and hypnosis with each cycle of chemotherapy243
See Healing Touch.
Manipulative and Body-Based Methods
Acupuncture
- Higher white blood cell counts during one cycle of chemotherapy (modest evidence)244
Massage
- Trends of higher levels of immune modulators (CD4, CD8 and natural killer (NK) cells) with therapeutic massage in combination with hypnosis and healing touch with each cycle of chemotherapy245
Mind-Body, Spiritual and Consciousness-changing Approaches
Hypnosis
- Trends of higher levels of immune modulators (CD4, CD8 and natural killer (NK) cells) with hypnosis in combination with therapeutic massage and healing touch with each cycle of chemotherapy246
See Mind-Body Approaches.
Commentary
Fasting
For people having significant side effects, especially gastrointestinal, from chemo, naturopathic oncologist and BCCT advisor Lise Alschuler recommends fasting for 48 hours—from after dinner on the day before chemo, through the day of chemo and the day following chemotherapy. The chemo fast can be a water fast (which includes coconut water and vegetable broths), or you can eat up to 600 calories per day of vegetable soup and/or low-carb vegetables. She stresses the importance of your being motivated to fast, and also that fasting during chemotherapy should be cleared with your treating oncologist. You should modify or stop the fast if you become dizzy or weak (try adding boiled eggs or nuts), or if you feel worse than if you had eaten.
Eggs
Dr. Alschuler and her colleague Karolyn Gazella advise people with risk for ovarian to consider limiting egg intake to fewer than five eggs a week, while choosing eggs from free-roaming, organically fed chickens. They also advise boiling or poaching eggs, as these methods do not oxidize the yolk fat.247
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General Information on Ovarian Cancer Treatments
- National Cancer Institute: Contact Us for Help
Information specialists at the NCI Contact Center are available to help answer your cancer-related questions in English and Spanish whether you are a patient, family member or friend, health care provider, or researcher. We also respond to questions and requests for information about NCI and its programs and provide support in quitting smoking. - American Cancer Society:
- Continuous Update Project. Ovarian cancer: How diet, nutrition and physical activity affect ovarian cancer risk. Diet and Cancer Report. World Cancer Research Fund International.
- Beavis AL, Smith AJ, Fader AN. Lifestyle changes and the risk of developing endometrial and ovarian cancers: opportunities for prevention and management. International Journal of Women’s Health. 2016 May 23;8:151-67.
- McKee D. Off Label Pharmaceutical ‘Cocktails’ For Cancer Treatment (excerpts relevant to ovarian cancer). A4M Integrative Cancer Therapies Module 6. June 6-8, 2013.
- Sweet ES, Standish LJ, Goff BA, Andersen MR. Adverse events associated with complementary and alternative medicine use in ovarian cancer patients. Integrative Cancer Therapies. 2013 Nov;12(6):508-16.
- Kobayashi Y, Banno K, Kunitomi H, Tominaga E, Aoki D. Current state and outlook for drug repositioning anticipated in the field of ovarian cancer. Journal of Gynecologic Oncology. 2019 Jan;30(1):e10.
- Cortez AJ, Tudrej P, Kujawa KA, Lisowska KM. Advances in ovarian cancer therapy. Cancer Chemotherapy and Pharmacology. 2018 Jan;81(1):17-38.
- Halkia E, Spiliotis J. The role of cytoreductive surgery and HIPEC in epithelial ovarian cancer. Journal of BUON. 2015 May;20 Suppl 1:S12-28.
- Moss Report Podcast: Dr. Nasha: Perseverance and Progress
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- National Comprehensive Cancer Network: Advocacy and Support Groups; select your topic or cancer of interest from the dropdown menu.
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