Introduction
Myeloproliferative neoplasms (MPN) represent a complex disorder of hematopoietic stem cells characterized by clonal expansion of mature myeloid cells [ 1 ]. The revised WHO and International consensus criteria recognize three main subgroups: Polycythemia Vera (PV), Essential Thrombocythemia (ET), and Primary Myelofibrosis (PMF) [ 2 , 3 ]. Despite their relatively low global annual incidence rates (PV at 0.84 cases, ET at 1.03, and PMF at 0.47/100,000), patients with MPNs face the chronic course of the disease, with survival measured in decades [ 4 ]. This chronicity brings forth a myriad of challenges, including increased risk of thrombosis-associated cardiovascular events, microvascular symptoms, splenomegaly, potential for leukemic transformation, and various constitutional symptoms [ 5 ]. Consequently, patients endure years of physical discomfort, cognitive impairment, diminished quality of life, and decreased work productivity [ 6 , 7 ].
Our understanding of the pathological mechanisms underlying MPNs continues to evolve. Common somatic diseases driver mutations, such as Janus Kinase2 (JAK2), Calreticulin (CALR), and mutations in the thrombopoietin receptor (MPL), drive signal transduction and transcription activation. This is often accompanied by inflammatory cascades involving interleukins IL-1, IL-4, IL-6, IL-8, and tumor necrosis factor (TNF) [ 8 , 9 ]. Extrinsic risk factors like older age, male sex, increased body mass index (BMI), smoking, gut microbiome dysbiogenesis, ionizing radiation, benzene exposure, and low socio-economic status are linked with disease onset and progression [ 10 ].
Standard therapies for MPN include phlebotomy, aspirin, cytoreduction, interferons, JAK-inhibition, allogeneic stem cell transplant (for MF), and many new therapeutics in the pipeline [ 11 ]. While treatment aims to reduce symptom burden and improve survival, there are unmet challenges with chronic use. These include residual MPN symptoms not ameliorated with pharmacological therapy or side effects from treatments themselves, such as fatigue with phlebotomy, bleeding tendencies with aspirin, increased inflammation with interferons, dose-dependent anemia, and thrombocytopenia with JAK inhibition, and risks of secondary cancers [ 12 – 15 ]. The second-line JAK inhibitors like fedratinib, pacritinib, and momelotinib show promise to cytopenic patients, yet are associated with other potential side effects [ 12 ]. Modulating MPN and associated symptoms is complex, with multiple inflammatory and non-inflammatory pathways playing a role [ 16 ]. Treatment response can vary significantly due to the heterogeneous clinical and phenotypical features of MPNs. Therefore, symptom management relies on comprehensive tools like the Myeloproliferative Neoplasm Symptom Assessment Form- Total Symptom Score (MPNSAF-TSS) to gauge treatment efficacy [ 17 ].
Despite therapeutic advancements, treatment-related side effects and inconsistent responses persist, prompting interest in an Integrative Oncology (IO) approach. IO is defined as a patient-centered, evidence informed filed of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. IO aims to optimize health, quality of life, and clinical outcomes across the cancer care continuum and to empower people to prevent cancer and become active participants before, during, and beyond cancer treatment. This encompasses a range of modalities, including exercise, mind–body therapies like yoga, meditation, tai-chi, and qigong, as well as dietary interventions and supplements [ 18 ••]. There is an increased utilization of these minimal-risk interventions among cancer patients. These interventions empower patients to actively manage their health, mitigate treatment-related complications, and potentially augment the effectiveness of cancer treatment [ 19 – 23 ]. This review will explore the available literature on the efficacy, feasibility, dosage-frequency recommendations, adverse effects or contraindications, and perceptions of IO in alleviating the symptom burden associated with MPN. (Table 1 ).
Table 1. Outcomes of IO in MPN
Table 1.
Outcomes of IO in MPN
Physical activity (PA)
Most research on targeted exercise interventions in hematological malignancies centers around leukemia, lymphoma, and multiple myeloma; however, emerging evidence suggests positive outcomes in MPNs [ 23 ]. Exercise yields significant improvement in cancer treatment-related adverse effects, quality of life, psychosocial distress, fatigue, cognitive function, and sexual health in cancer patients [ 24 ]. The physically active population is at a lower risk of some cancers, such as esophageal, liver, colorectal, lung, leukemia, and melanoma [ 25 ]. Exercise is further associated with low all-cause and cancer-specific mortality in breast and colorectal cancer [ 26 ]. One potential explanation of exercise benefit lies in the upregulation of immune pathways, as exercise-induced mobilization of natural killer (NK) cells and release of IL-6 reduced tumor size in murine models [ 27 – 29 ]. Exercise may also impact insulin-related growth-promoting biomarkers, as observed in breast cancer [ 30 ]. Additionally, enhanced physical tolerance to cancer treatment, resulting in increased completion rates, and observed favorable epigenetic modifications are among the mechanisms through which exercise confers benefit [ 31 , 32 ].
Specific to the MPN population, where the risk of vascular thrombosis is notably elevated, exercise can be instrumental in attaining cardiovascular fitness by boosting fibrinolytic activation [ 33 ]. MPN patients frequently report more significant fatigue and lower quality of life associated with a sedentary lifestyle [ 34 , 35 ]. One large multicenter international survey based analysis observed lower symptom burden (p = 0.01) and depression (p = 0.006) with aerobic exercise and strength training. Another small-scale preliminary study noted similar results with no significant improvement in fatigue and quality of life following a 12-week exercise program [ 37 ]. These discrepancies may be attributed to various factors, including differences in patient characteristics, adherence to exercise programs, and study methodologies [ 36 •, 37 ]. Nevertheless, evidence indicates improved upper and lower body strength (p = 0.01, p < 0.001) and increased maximal oxygen uptake (p = 0.01) with physical intervention in MPN patients, suggesting the feasibility of PA in this population [ 37 ].
Questions regarding the optimal frequency, intensity, and type of exercise in MPNs remain unanswered. Proposed recommendations are based on NCCN guidelines for physical activity in cancer survivors, advocating for at least 150 min per week of combined moderate-intensity aerobic and strength training exercises performed at least two or more times a week [ 38 ]. Patients with PV were observed to prefer individualized training regimes, mainly conducted outdoors, averaging 45–60 min per week, at least twice a week [ 39 ]. Patients with specific risks like splenomegaly, balance issues, bleeding tendencies, and skin symptoms could have modified training like avoiding contact or ball sports, low injury training, and Ultraviolet light protection while outdoors. Identified barriers to PA include anxiety, depression, and fear of injuries from maximal intensity exercise. Therefore, incorporating cognitive therapies and tailoring training programs to individual needs can complement the effects of PA and may help overcome these barriers [ 39 , 40 ].
Mind–body Therapies
Mind–body therapies (MBT) combine a delicate synergy of mental focus, physical postures, and breathing exercises that contribute to overall well-being [ 41 ]. They may include yoga, meditation/mindfulness, tai-chi, and qigong. MBT has demonstrated positive effects on various aspects of cancer-related distress, including anxiety, depression, sleep disturbances, and pain [ 42 •]. The underlying mechanisms of these benefits are intricate, likely involving a reduction in inflammation (observed via reduced inflammatory markers like C reactive protein (CRP) and IL-6) and alteration in leukocyte gene transcriptions such as downregulation in pro-inflammatory NF-kB genes and activation of glucocorticoid receptor gene [ 43 ]. Observed effects may also stem from the modulation of autonomic nervous and central nervous system pathways. Increased mindfulness, decreased rumination, and enhanced self-compassion mediate beneficial effects derived from mindfulness practices within MBT [ 44 ].
Studies have shown that yoga is associated with enhanced psychosocial outcomes in other cancer types, such as breast cancer and lymphoma patients [ 45 ]. Similarly, positive results, including improved sleep, symptom scores, pain, anxiety, and depression, have been observed in MPN patients who engaged in 60 min of online yoga weekly for 12 weeks [ 46 ]. MPN patients linked yoga with improved circulation, eating habits, breathing, and an increased sense of enjoyment [ 46 , 47 ]. The feasibility of yoga in MPN is supported by high adherence to the regime, satisfaction with outcomes, and follow-up rates exceeding 70% in yoga studies [ 48 ].
Additionally, decreased plasma TNF level was seen with yoga in MPN, and no effect on IL-6 was seen [ 49 ]. Notably, the beneficial effect of yoga was more pronounced in overweight MPN patients [ 50 ]. Adverse events such as spleen irritation have been reported but can be mitigated with pose modifications [ 46 , 49 ]. Similar to PA, barriers to engaging in yoga therapies for cancer patients can include fatigue, pain, and transportation issues. These obstacles can be lessened by opting for remote participation and starting with minimal therapy doses [ 51 ]. The studies did not provide specific recommendations regarding type, dose, and frequency of yoga. Mild to moderate intensity Hatha and Vinyasa style yoga was included, and interestingly, yoga exceeding 60 min a week did not confer additional benefits. Therefore, large randomized control trials (RCT) are needed to explore this aspect [ 46 , 49 ].
Mindfulness, the deliberate practice of focusing on the present moment without judgment, offers a pathway to cultivating control and wisdom in one’s life [ 52 ]. In the realm of MPNs, digital mindfulness applications like Calm and My Wellness Coach (MWC) have garnered attention for their feasibility and efficacy. Users reported satisfaction with these apps, often recommending them to fellow patients [ 53 , 54 ]. There is evidence that these apps alleviate anxiety and depression, pervasive issues within the MPN community, particularly benefitting those grappling with existing mental health challenges [ 55 ]. MWC, with its emphasis on goal setting and behavior modification, demonstrated positive impacts on various symptoms, including impaired concentration, dizziness, night sweats, bone pain, sexual health and sedentary behavior [ 54 ]. Patients noted a profound sense of calmness and improved well-being while engaging in these platforms [ 56 ]. However, the anticipated improvement in sleep disturbances was not as pronounced, possibly due to relatively short trial durations (4–8 weeks in Calm and 12 weeks in MWC). While the accessibility of these apps via online platforms was appreciated, challenges such as internet connectivity issues, intrusive reminders, and technology barriers among older individuals were noted [ 54 , 56 ]. Further investigation is warranted to determine the optimal dosage and type; a study found no discernible variance in mental wellness scores between individuals practicing 10 versus 30 min of mindfulness [ 57 ].
Nutrition
The World Cancer Research Fund (WCRF) and its affiliates, such as the American Institute for Cancer Research (AICR), champion dietary regimens aimed at cancer prevention and supporting cancer survivorship [ 58 ••]. Within the spectrum of cancer care, d iet and weight management play an integral role, as underscored by the ABC D Es of cancer care according to NCCN guidelines [ 59 ]. Nutrition interventions have long been linked with better cancer outcomes and enhanced cardiovascular health through their anti-inflammatory and antioxidant properties [ 60 ]. Notably, individuals with MPN face a heightened risk of cardiovascular issues from increased inflammation, defective macrophage lipid efflux, release of reactive oxygen species, neutrophil extracellular trap formation, and altered platelet function and form [ 61 ]. Interestingly, clonal hematopoiesis of indeterminate potential (CHIP), often a precursor to MPN, also independently correlates with atherosclerosis, highlighting the importance of early dietary interventions [ 62 ]. While tailored dietary guidelines for MPNs continue to evolve, recommendations from the WCRF and AICR generally advocate for a daily intake of 30 g of fiber alongside a variety of whole grains, pulses, and five servings of non-starchy vegetables and fruits for cancer patients [ 58 ••].
The Mediterranean diet, particularly when supplemented with extra virgin olive oil (EVOO), has shown promise in reducing major cardiovascular events in high-risk populations due to its anti-inflammatory properties of phenolic compounds in EVOO and potential role in gut microbiome modulation, which is pivotal in innate immune system development and hematopoiesis regulation [ 63 – 65 ]. The Mediterranean diet was found to be safe and had a high Mediterranean Diet Adherence Score (MEDAS > 8) compared to the conventional U.S. Dietary Guidelines Americans (USDA) diet among MPN patients. The Mediterranean diet was also associated with low symptom burden in MPNs in a small study [ 66 ]. Additionally, a low level of low-density lipoprotein ( -13 g/dl) was observed with nine weeks of the Mediterranean diet, prompting a discussion on its potential role in mitigating cardiovascular morbidity in individuals with MPNs. However, sustained adherence and ongoing education are essential for maintaining these positive outcomes [ 66 ]. Conversely, no change in inflammatory markers, gut microbiome composition, and JAK allele burden was observed with the Mediterranean diet in MPNs. This can be attributed to shorter duration of intervention, differences in diet strength, and less diverse gut microbiome in industrialized countries [ 66 , 67 ].
Other dietary factors, such as coffee, should be considered. Interestingly, an inverse relationship between coffee consumption and PV risk was reported, possibly attributed to the anti-inflammatory and antitumor properties of bioactive compounds present in coffee [ 68 – 70 ].
MPNs consuming alcohol (p = 0.001), dairy products (p = 0.02), pasta (p = 0.02), and baked foods (p = 0.02) reported lower total symptom scores (MPNSAF-TSS). However, fast foods (p = 0.07), pre-made snacks (p = 0.03), soda (p < 0.0001), refined sugar (p = 0.01), and tacos (p = 0.03) observed worse MPNSAF-TSS [ 71 ]. Similar observations associated increased risk of PV with sugar consumption from fruits like citrus, melon, and berry [ 72 ]. While the associations between food intake and TSS are interesting, they are interpreted with caution given data was retrospective and patient-reported and thus, potentially biased and inaccurate. As such, more prospective and randomized studies are needed to explore this further. Barriers to implementing dietary changes include minimal data, food restrictions and intolerances due to disease, and logistical challenges like time and energy required for meal preparation [ 73 ].
Supplements
Individuals with MPNs often turn to supplements to bolster their overall health, address nutritional deficiencies, and alleviate disease symptoms [ 36 •, 71 ]. Research indicates that supplement usage is more prevalent among females, older, and physically active MPN patients [ 71 ]. Commonly consumed supplements among MPN patients include amino acid supplements, N acetyl Cysteine (NAC), bach flowers remedies, vitamin D, multivitamins, omega 3 fatty acids, calcium, turmeric, green tea, vitamin E, medical marijuana, and medicinal mushrooms [ 36 •, 71 ]. While omega 3 fatty acids (p = 0.03), amino acid (p = 0.02), and NAC (p = 0.02) have been linked to lower symptom burden, consumers of bach flower remedies reported high symptom burden [ 36 •, 71 ]. However, the remaining supplements showed no significant correlation with symptom burden, depression, fatigue, and quality of life in MPN patients [ 36 •].
Omega fatty acids are polyunsaturated acids known for their anticancer properties, primarily attributed to their affinity for the cyclooxygenase pathway, which hampers the proliferation of helper T cells associated with cancer susceptibility and their anti-inflammatory effects [ 74 ].
NAC, through its anti-oxidant properties, inhibited thrombosis in JAK2V617F murine models and prevented in vitro extracellular trap formation in neutrophils from human MPNs [ 75 ]. Given that neutrophil extracellular trap formation exacerbates thrombosis in MPNs [ 61 ] and MPN cells exhibit resistance to oxidative stress, NAC holds promise as a therapeutic agent.
Moreover, vitamin D appears to influence macrophage differentiation via the vitamin D-linked receptor pathway, potentially implicating its role in macrophage-mediated myelofibrosis in JAK2 transgenic mice [ 76 ]. While vitamin D deficiency is prevalent among MPNs, its therapeutic implications remain ambiguous [ 77 ]. However, treatment with vitamin D demonstrated a significant reduction in platelet counts in vitamin D-deficient patients, which theoretically could be beneficial in managing vitamin D-deficient ET by decreasing elevated platelet levels [ 78 ].
Curcumin, a natural compound, has been found to have anti-proliferative and pro-apoptotic effects on JAK2V617F mutated MPN cells by inhibiting JAK2/STAT and mTOR1 signaling pathways [ 79 ]. Additionally, curcumin also negatively regulates JAK-STAT signaling by activating suppressors of cytokine signaling (SOCS 2 and SOCS3) and inhibiting histone deacetylase (HDAC1 and HDAC8), indicating its potential as a therapeutic strategy for JAK-positive MPNs [ 80 ].
While the evidence regarding supplement mechanism and impacts on MPNs are growing, more data is needed to recommend any supplementation in MPN patients. Patients should be encouraged to disclose and discuss supplementation with health care teams to avoid potential harm and drug interactions.
Additional Integrative Oncology Therapies
Cancer patients often face significant challenges in receiving clear information about IO from their treating team, leading many to seek support from alternative healthcare providers, such as chiropractors, naturopathic doctors, and acupuncturists [ 81 ]. This trend has resulted in a rise in the utilization of modalities such as massage, homeopathy, and acupuncture within the cancer community. In the context of MPN, research indicates an increased prevalence of complementary therapies, with statistics revealing the use of massage (28.4%), acupuncture (19.3%), chiropractic (16.2%), aroma therapy (8.6%), homeopathy (6.3%), reiki (5.8%), Ayurveda (2.8%), and hypnosis (2%) among MPN patients [ 36 •].
Interestingly, MPN patients who incorporate massage into their care regimen report a higher quality of life (p = 0.04), albeit with heightened symptom burden and fatigue (p < 0.01); likely reflecting the differences in individual symptom profiles [ 36 •]. Furthermore, a case report showed that thirteen acupuncture sessions over six months improved fatigue, bone pain, headache, and itching in a PV patient [ 82 ]. Massage observed benefits can be from neurotransmitter modulation, like increased serotonin and dopamine and decreased cortisol and norepinephrine levels [ 83 ]. Similarly, acupuncture’s efficacy is due to its influence on neurotransmitters, gene alteration, and opioid upregulation [ 84 ].
Given the growing interest in these interventions, it is imperative that oncologists facilitate open communication with patients and guide them toward reputable integrative care resources. This proactive approach not only empowers patients to make informed decisions but also ensures their safety and well-being throughout their cancer journey. (Fig. 1 ). Fig. 1 IO mechanisms and MPN risk management
Conclusion
Individuals with MPN often protract a prolonged survival period. The armamentarium of pharmacological therapy continues to grow, offering promise in controlling the disease and ameliorating symptom burden, but patients continue to have unmet needs. Recent research indicates that IO can potentially enhance the physical, social, and psychological well-being of MPN patients, as well as potentially mitigate cardiovascular outcomes at minimal cost and low risk. Clinicians should integrate their clinical expertise in pharmacotherapy with evidence-based IO approaches to optimize patient care, considering patient’s preferences and realistic expectations. However, the current understanding of IO in MPN exhibits variability and represents a small sample size, preventing definite conclusions. Future studies should focus on larger, longer term studies with standardized interventions, control groups, and study methodologies limiting social desirability and recall bias. Additionally, investigations should also prioritize diverse participant cohorts while adjusting for modifiable risk factors, such as gender, BMI, and educational background, to establish more robust evidence in this domain.
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Author contributions
SS and SP wrote the manuscript. AL and KG reviewed the manuscript. SS and SP prepared figures and tables.
Data Availability
No datasets were generated or analysed during the current study.
Declarations
There are no conflicts of interest to disclose.
Competing interests
The authors declare no competing interests.
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
1. Tefferi A Pardanani A Myeloproliferative neoplasms: a contemporary review JAMA Oncol 2015 1 1 97 105 10.1001/jamaoncol.2015.89 26182311 Tefferi A, Pardanani A. Myeloproliferative neoplasms: a contemporary review. JAMA Oncol. 2015;1(1):97–105. 26182311 10.1001/jamaoncol.2015.89
2. Thiele J Kvasnicka HM Orazi A Gianelli U Gangat N Vannucchi AM Barbui T Arber DA Tefferi A The international consensus classification of myeloid neoplasms and acute leukemias: myeloproliferative neoplasms Am J Hematol 2023 98 1 166 179 10.1002/ajh.26751 36200127 Thiele J, Kvasnicka HM, Orazi A, Gianelli U, Gangat N, Vannucchi AM, Barbui T, Arber DA, Tefferi A. The international consensus classification of myeloid neoplasms and acute leukemias: myeloproliferative neoplasms. Am J Hematol. 2023;98(1):166–79. 36200127 10.1002/ajh.26751
3. Arber DA Orazi A Hasserjian R Thiele J Borowitz MJ Le Beau MM Bloomfield CD Cazzola M Vardiman JW The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia Blood J Am Soc Hematol 2016 127 20 2391 2405 10.1182/blood-2016-03-643544 27069254 Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, Bloomfield CD, Cazzola M, Vardiman JW. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood J Am Soc Hematol. 2016;127(20):2391–405. 10.1182/blood-2016-03-643544 27069254
4. Titmarsh GJ Duncombe AS McMullin MF O'Rorke M Mesa R De Vocht F Horan S Fritschi L Clarke M Anderson LA How common are myeloproliferative neoplasms? A systematic review and meta-analysis Am J Hematol 2014 89 6 581 587 10.1002/ajh.23690 24971434 Titmarsh GJ, Duncombe AS, McMullin MF, O’Rorke M, Mesa R, De Vocht F, Horan S, Fritschi L, Clarke M, Anderson LA. How common are myeloproliferative neoplasms? A systematic review and meta-analysis. Am J Hematol. 2014;89(6):581–7. 24971434 10.1002/ajh.23690
5. Barbui T Barosi G Birgegard G Cervantes F Finazzi G Griesshammer M Harrison C Hasselbalch HC Hehlmann R Hoffman R Kiladjian JJ Philadelphia-negative classical myeloproliferative neoplasms: critical concepts and management recommendations from European LeukemiaNet J Clin Oncol 2011 29 6 761 10.1200/JCO.2010.31.8436 21205761 PMC4979120 Barbui T, Barosi G, Birgegard G, Cervantes F, Finazzi G, Griesshammer M, Harrison C, Hasselbalch HC, Hehlmann R, Hoffman R, Kiladjian JJ. Philadelphia-negative classical myeloproliferative neoplasms: critical concepts and management recommendations from European LeukemiaNet. J Clin Oncol. 2011;29(6):761. 21205761 10.1200/JCO.2010.31.8436 PMC4979120
6. Harrison CN Koschmieder S Foltz L Guglielmelli P Flindt T Koehler M Mathias J Komatsu N Boothroyd RN Spierer A Perez RJ The impact of myeloproliferative neoplasms (MPNs) on patient quality of life and productivity: results from the international MPN Landmark survey Ann Hematol 2017 96 1653 1665 10.1007/s00277-017-3082-y 28780729 PMC5569657 Harrison CN, Koschmieder S, Foltz L, Guglielmelli P, Flindt T, Koehler M, Mathias J, Komatsu N, Boothroyd RN, Spierer A, Perez RJ. The impact of myeloproliferative neoplasms (MPNs) on patient quality of life and productivity: results from the international MPN Landmark survey. Ann Hematol. 2017;96:1653–65. 28780729 10.1007/s00277-017-3082-y PMC5569657
7. Yu J Parasuraman S Paranagama D Bai A Naim A Dubinski D Mesa R Impact of Myeloproliferative neoplasms on patients’ employment status and work productivity in the United States: results from the living with MPNs survey BMC Cancer 2018 18 1 9 10.1186/s12885-018-4322-9 29653557 PMC5899342 Yu J, Parasuraman S, Paranagama D, Bai A, Naim A, Dubinski D, Mesa R. Impact of Myeloproliferative neoplasms on patients’ employment status and work productivity in the United States: results from the living with MPNs survey. BMC Cancer. 2018;18:1–9. 29653557 10.1186/s12885-018-4322-9 PMC5899342
8. Luque Paz D Kralovics R Skoda RC Genetic basis and molecular profiling in myeloproliferative neoplasms Blood 2023 141 16 1909 1921 10.1182/blood.2022017578 36347013 PMC10646774 Luque Paz D, Kralovics R, Skoda RC. Genetic basis and molecular profiling in myeloproliferative neoplasms. Blood. 2023;141(16):1909–21. 36347013 10.1182/blood.2022017578 PMC10646774
9. Geyer HL Dueck AC Scherber RM Mesa RA Impact of inflammation on myeloproliferative neoplasm symptom development Mediators Inflamm 2015 11 2015 10.1155/2015/284706 PMC4619953 26538823 Geyer HL, Dueck AC, Scherber RM, Mesa RA. Impact of inflammation on myeloproliferative neoplasm symptom development. Mediators Inflamm. 2015;11:2015. 10.1155/2015/284706 PMC4619953 26538823
10. Ramanathan G Hoover BM Fleischman AG Impact of host, lifestyle and environmental factors in the pathogenesis of MPN Cancers 2020 12 8 2038 10.3390/cancers12082038 32722135 PMC7463688 Ramanathan G, Hoover BM, Fleischman AG. Impact of host, lifestyle and environmental factors in the pathogenesis of MPN. Cancers. 2020;12(8):2038. 32722135 10.3390/cancers12082038 PMC7463688
11. Geyer HL Mesa RA Therapy for myeloproliferative neoplasms: when, which agent, and how? Blood J Am Soc Hematol 2014 124 24 3529 3537 10.1182/blood-2014-05-577635 25472969 Geyer HL, Mesa RA. Therapy for myeloproliferative neoplasms: when, which agent, and how? Blood J Am Soc Hematol. 2014;124(24):3529–37. 10.1182/blood-2014-05-577635 25472969
12. Tremblay D Mesa R Addressing symptom burden in myeloproliferative neoplasms Best Pract Res Clin Haematol 2022 35 2 101372 10.1016/j.beha.2022.101372 36333066 Tremblay D, Mesa R. Addressing symptom burden in myeloproliferative neoplasms. Best Pract Res Clin Haematol. 2022;35(2):101372. 36333066 10.1016/j.beha.2022.101372
13. Mesa RA Scherber RM Geyer HL Reducing symptom burden in patients with myeloproliferative neoplasms in the era of Janus kinase inhibitors Leuk Lymphoma 2015 56 7 1989 1999 10.3109/10428194.2014.983098 25644746 Mesa RA, Scherber RM, Geyer HL. Reducing symptom burden in patients with myeloproliferative neoplasms in the era of Janus kinase inhibitors. Leuk Lymphoma. 2015;56(7):1989–99. 25644746 10.3109/10428194.2014.983098
14. Birgegård G Folkvaljon F Garmo H Holmberg L Besses C Griesshammer M Gugliotta L Wu J Achenbach H Kiladjian JJ Harrison CN Leukemic transformation and second cancers in 3649 patients with high-risk essential thrombocythemia in the EXELS study Leuk Res 2018 1 74 105 109 10.1016/j.leukres.2018.10.006 30368038 Birgegård G, Folkvaljon F, Garmo H, Holmberg L, Besses C, Griesshammer M, Gugliotta L, Wu J, Achenbach H, Kiladjian JJ, Harrison CN. Leukemic transformation and second cancers in 3649 patients with high-risk essential thrombocythemia in the EXELS study. Leuk Res. 2018;1(74):105–9. 10.1016/j.leukres.2018.10.006 30368038
15. Mazza GL Mead-Harvey C Mascarenhas J Yacoub A Kosiorek HE Hoffman R Dueck AC Mesa RA Symptom burden and quality of life in patients with high-risk essential thrombocythaemia and polycythaemia vera receiving hydroxyurea or pegylated interferon alfa-2a: a post-hoc analysis of the MPN-RC 111 and 112 trials Lancet Haematol 2022 9 1 e38 48 10.1016/S2352-3026(21)00343-4 34971581 PMC9098160 Mazza GL, Mead-Harvey C, Mascarenhas J, Yacoub A, Kosiorek HE, Hoffman R, Dueck AC, Mesa RA. Symptom burden and quality of life in patients with high-risk essential thrombocythaemia and polycythaemia vera receiving hydroxyurea or pegylated interferon alfa-2a: a post-hoc analysis of the MPN-RC 111 and 112 trials. Lancet Haematol. 2022;9(1):e38-48. 34971581 10.1016/S2352-3026(21)00343-4 PMC9098160
16. Fisher DA Miner CA Engle EK Hu H Collins TB Zhou A Allen MJ Malkova ON Oh ST Cytokine production in myelofibrosis exhibits differential responsiveness to JAK-STAT, MAP kinase, and NFκB signaling Leukemia 2019 33 8 1978 1995 10.1038/s41375-019-0379-y 30718771 PMC6813809 Fisher DA, Miner CA, Engle EK, Hu H, Collins TB, Zhou A, Allen MJ, Malkova ON, Oh ST. Cytokine production in myelofibrosis exhibits differential responsiveness to JAK-STAT, MAP kinase, and NFκB signaling. Leukemia. 2019;33(8):1978–95. 30718771 10.1038/s41375-019-0379-y PMC6813809
17. Emanuel RM Dueck AC Geyer HL Kiladjian JJ Slot S Zweegman S Te Boekhorst PA Commandeur S Schouten HC Sackmann F Kerguelen FA Myeloproliferative neoplasm (MPN) symptom assessment form total symptom score: prospective international assessment of an abbreviated symptom burden scoring system among patients with MPNs J Clin Oncol 2012 30 33 4098 4103 10.1200/JCO.2012.42.3863 23071245 PMC4872304 Emanuel RM, Dueck AC, Geyer HL, Kiladjian JJ, Slot S, Zweegman S, Te Boekhorst PA, Commandeur S, Schouten HC, Sackmann F, Kerguelen FA. Myeloproliferative neoplasm (MPN) symptom assessment form total symptom score: prospective international assessment of an abbreviated symptom burden scoring system among patients with MPNs. J Clin Oncol. 2012;30(33):4098–103. 23071245 10.1200/JCO.2012.42.3863 PMC4872304
18. •• Witt CM, Balneaves LG, Cardoso MJ, Cohen L, Greenlee H, Johnstone P, Kücük Ö, Mailman J, Mao JJ. 2017 A comprehensive definition for integrative oncology. J Natl Cancer Institute Monographs 2017(52) lgx012. The editorial presents a comprehensive definition and understanding of Integrative oncology in the context of cancer care, supplanting the outdated complementary and alternative medicine terminology. 10.1093/jncimonographs/lgx012 29140493
19. Cutshall SM Cha SS Ness SM Stan DL Christensen SA Bhagra A Price KA Thompson CA Hashmi SK Chon TY McCray TJ Symptom burden and integrative medicine in cancer survivorship Support Care Cancer 2015 23 2989 2994 10.1007/s00520-015-2666-0 25724408 PMC4552597 Cutshall SM, Cha SS, Ness SM, Stan DL, Christensen SA, Bhagra A, Price KA, Thompson CA, Hashmi SK, Chon TY, McCray TJ. Symptom burden and integrative medicine in cancer survivorship. Support Care Cancer. 2015;23:2989–94. 25724408 10.1007/s00520-015-2666-0 PMC4552597
20. Frenkel M Sierpina V Sapire K Effects of complementary and integrative medicine on cancer survivorship Curr Oncol Rep 2015 17 1 3 10.1007/s11912-015-0445-1 25749658 Frenkel M, Sierpina V, Sapire K. Effects of complementary and integrative medicine on cancer survivorship. Curr Oncol Rep. 2015;17:1–3. 25749658 10.1007/s11912-015-0445-1
21. Mao JJ Farrar JT Xie SX Bowman MA Armstrong K Use of complementary and alternative medicine and prayer among a national sample of cancer survivors compared to other populations without cancer Complement Ther Med 2007 15 1 21 29 10.1016/j.ctim.2006.07.006 17352968 Mao JJ, Farrar JT, Xie SX, Bowman MA, Armstrong K. Use of complementary and alternative medicine and prayer among a national sample of cancer survivors compared to other populations without cancer. Complement Ther Med. 2007;15(1):21–9. 17352968 10.1016/j.ctim.2006.07.006
22. Mao JJ Palmer SC Straton JB Cronholm PF Keddem S Knott K Bowman MA Barg FK Cancer survivors with unmet needs were more likely to use complementary and alternative medicine J Cancer Surviv 2008 2 116 124 10.1007/s11764-008-0052-3 18648980 Mao JJ, Palmer SC, Straton JB, Cronholm PF, Keddem S, Knott K, Bowman MA, Barg FK. Cancer survivors with unmet needs were more likely to use complementary and alternative medicine. J Cancer Surviv. 2008;2:116–24. 18648980 10.1007/s11764-008-0052-3
23. Eckert R Huberty J Gowin K Mesa R Marks L Physical activity as a nonpharmacological symptom management approach in myeloproliferative neoplasms: recommendations for future research Integr Cancer Ther 2017 16 4 439 450 10.1177/1534735416661417 27458250 PMC5739136 Eckert R, Huberty J, Gowin K, Mesa R, Marks L. Physical activity as a nonpharmacological symptom management approach in myeloproliferative neoplasms: recommendations for future research. Integr Cancer Ther. 2017;16(4):439–50. 27458250 10.1177/1534735416661417 PMC5739136
24. Cormie P Zopf EM Zhang X Schmitz KH The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects Epidemiol Rev 2017 39 1 71 92 10.1093/epirev/mxx007 28453622 Cormie P, Zopf EM, Zhang X, Schmitz KH. The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiol Rev. 2017;39(1):71–92. 28453622 10.1093/epirev/mxx007
25. Moore SC Lee IM Weiderpass E Campbell PT Sampson JN Kitahara CM Keadle SK Arem H De Gonzalez AB Hartge P Adami HO Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults JAMA Intern Med 2016 176 6 816 25 10.1001/jamainternmed.2016.1548 27183032 PMC5812009 Moore SC, Lee IM, Weiderpass E, Campbell PT, Sampson JN, Kitahara CM, Keadle SK, Arem H, De Gonzalez AB, Hartge P, Adami HO. Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Intern Med. 2016;176(6):816–25. 27183032 10.1001/jamainternmed.2016.1548 PMC5812009
26. Ballard-Barbash R Friedenreich CM Courneya KS Siddiqi SM McTiernan A Alfano CM Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review J Natl Cancer Inst 2012 104 11 815 840 10.1093/jnci/djs207 22570317 PMC3465697 Ballard-Barbash R, Friedenreich CM, Courneya KS, Siddiqi SM, McTiernan A, Alfano CM. Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. J Natl Cancer Inst. 2012;104(11):815–40. 22570317 10.1093/jnci/djs207 PMC3465697
27. Shephard RJ Shek PN Effects of exercise and training on natural killer cell counts and cytolytic activity: a meta-analysis Sports Med 1999 28 177 195 10.2165/00007256-199928030-00003 10541441 Shephard RJ, Shek PN. Effects of exercise and training on natural killer cell counts and cytolytic activity: a meta-analysis. Sports Med. 1999;28:177–95. 10541441 10.2165/00007256-199928030-00003
28 Idorn M, P, Thor Straten. Exercise and cancer: from “healthy” to “therapeutic”? Cancer Immunol Immunother. 2017;66:667–71. 10.1007/s00262-017-1985-z PMC5406418 28324125
29. Pedersen L Christensen JF Hojman P Effects of exercise on tumor physiology and metabolism Cancer J 2015 21 2 111 116 10.1097/PPO.0000000000000096 25815851 Pedersen L, Christensen JF, Hojman P. Effects of exercise on tumor physiology and metabolism. Cancer J. 2015;21(2):111–6. 25815851 10.1097/PPO.0000000000000096
30. Löf M Bergström K Weiderpass E Physical activity and biomarkers in breast cancer survivors: a systematic review Maturitas 2012 73 2 134 142 10.1016/j.maturitas.2012.07.002 22840658 Löf M, Bergström K, Weiderpass E. Physical activity and biomarkers in breast cancer survivors: a systematic review. Maturitas. 2012;73(2):134–42. 22840658 10.1016/j.maturitas.2012.07.002
31. Courneya KS Segal RJ Mackey JR Gelmon K Reid RD Friedenreich CM Ladha AB Proulx C Vallance JK Lane K Yasui Y Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial J Clin Oncol 2007 25 28 4396 4404 10.1200/JCO.2006.08.2024 17785708 Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD, Friedenreich CM, Ladha AB, Proulx C, Vallance JK, Lane K, Yasui Y. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. J Clin Oncol. 2007;25(28):4396–404. 17785708 10.1200/JCO.2006.08.2024
32. Denham J Marques FZ O’Brien BJ Charchar FJ Exercise: putting action into our epigenome Sports Med 2014 44 189 209 10.1007/s40279-013-0114-1 24163284 Denham J, Marques FZ, O’Brien BJ, Charchar FJ. Exercise: putting action into our epigenome. Sports Med. 2014;44:189–209. 24163284 10.1007/s40279-013-0114-1
33. Chen YW Apostolakis S Lip GY Exercise-induced changes in inflammatory processes: Implications for thrombogenesis in cardiovascular disease Ann Med 2014 46 7 439 455 10.3109/07853890.2014.927713 25012964 Chen YW, Apostolakis S, Lip GY. Exercise-induced changes in inflammatory processes: Implications for thrombogenesis in cardiovascular disease. Ann Med. 2014;46(7):439–55. 25012964 10.3109/07853890.2014.927713
34. Tolstrup Larsen R Tang LH Brochmann N MeulengrachtFlachs E Illemann Christensen A Hasselbalch HC Zwisler AD Associations between fatigue, physical activity, and QoL in patients with myeloproliferative neoplasms Eur J Haematol 2018 100 6 550 559 10.1111/ejh.13048 29464777 Tolstrup Larsen R, Tang LH, Brochmann N, MeulengrachtFlachs E, Illemann Christensen A, Hasselbalch HC, Zwisler AD. Associations between fatigue, physical activity, and QoL in patients with myeloproliferative neoplasms. Eur J Haematol. 2018;100(6):550–9. 29464777 10.1111/ejh.13048
35. Scherber RM Kosiorek HE Senyak Z Dueck AC Clark MM Boxer MA Geyer HL McCallister A Cotter M Van Husen B Harrison CN Comprehensively understanding fatigue in patients with myeloproliferative neoplasms Cancer 2016 122 3 477 485 10.1002/cncr.29753 26670597 Scherber RM, Kosiorek HE, Senyak Z, Dueck AC, Clark MM, Boxer MA, Geyer HL, McCallister A, Cotter M, Van Husen B, Harrison CN. Comprehensively understanding fatigue in patients with myeloproliferative neoplasms. Cancer. 2016;122(3):477–85. 26670597 10.1002/cncr.29753
36. Gowin KL Langlais BT Millstine D Kosiorek HE Huberty J Eckert R Mesa RA Survey of Integrative Medicine in Myeloproliferative Neoplasms (The SIMM Study-2) Blood 2018 29 132 3047 10.1182/blood-2018-99-119493 PMC7774715 33140580 • Gowin KL, Langlais BT, Millstine D, Kosiorek HE, Huberty J, Eckert R, Mesa RA. Survey of Integrative Medicine in Myeloproliferative Neoplasms (The SIMM Study-2). Blood. 2018;29(132):3047. This large-scale multicenter study explores all domains of integrative oncology (physical activity, mind-body therapy, nutrition, supplement, and other therapies) utilization, perception, and outcomes (physical, behavioral, and quality of life) among patients with MPN. This research can be a foundational blueprint for informing future study designs in this field.
37. Pedersen KM Zangger G Brochmann N Grønfeldt BM Zwisler AD Hasselbalch HC Tang LH The effectiveness of exercise-based rehabilitation to patients with myeloproliferative neoplasms—An explorative study Eur J Cancer Care 2018 27 5 e12865 10.1111/ecc.12865 29888803 Pedersen KM, Zangger G, Brochmann N, Grønfeldt BM, Zwisler AD, Hasselbalch HC, Tang LH. The effectiveness of exercise-based rehabilitation to patients with myeloproliferative neoplasms—An explorative study. Eur J Cancer Care. 2018;27(5):e12865. 10.1111/ecc.12865 29888803
38. Ligibel JA Denlinger CS New NCCN guidelines® for survivorship care J Natl Compr Canc Netw 2013 11 5S 640 644 10.6004/jnccn.2013.0191 23704233 Ligibel JA, Denlinger CS. New NCCN guidelines® for survivorship care. J Natl Compr Canc Netw. 2013;11(5S):640–4. 10.6004/jnccn.2013.0191 23704233
39. Felser S Rogahn J Hollenbach L Gruen J le Coutre P Al-Ali HK Schulze S Muegge LO Kraze-Kliebhahn V Junghanss C Physical exercise recommendations for patients with polycythemia vera based on preferences identified in a large international patient survey study of the East German Study Group for Hematology and Oncology (OSHO# 97) Cancer Med 2023 12 17 18235 18245 10.1002/cam4.6413 37559463 PMC10523957 Felser S, Rogahn J, Hollenbach L, Gruen J, le Coutre P, Al-Ali HK, Schulze S, Muegge LO, Kraze-Kliebhahn V, Junghanss C. Physical exercise recommendations for patients with polycythemia vera based on preferences identified in a large international patient survey study of the East German Study Group for Hematology and Oncology (OSHO# 97). Cancer Med. 2023;12(17):18235–45. 37559463 10.1002/cam4.6413 PMC10523957
40. Felser S Rogahn J le Coutre P Al-Ali HK Schulze S Muegge LO Gruen J Geissler J Kraze-Kliebhahn V Junghanss C Anxieties, age and motivation influence physical activity in patients with myeloproliferative neoplasms-a multicenter survey from the East German study group for hematology and oncology (OSHO# 97) Front Oncol 2023 4 12 1056786 10.3389/fonc.2022.1056786 PMC9846799 36686756 Felser S, Rogahn J, le Coutre P, Al-Ali HK, Schulze S, Muegge LO, Gruen J, Geissler J, Kraze-Kliebhahn V, Junghanss C. Anxieties, age and motivation influence physical activity in patients with myeloproliferative neoplasms-a multicenter survey from the East German study group for hematology and oncology (OSHO# 97). Front Oncol. 2023;4(12):1056786. 10.3389/fonc.2022.1056786 PMC9846799 36686756
41. Mind-body practice. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/mind-body-practice
42. Deleemans JM Mather H Spiropoulos A Toivonen K Baydoun M Carlson LE Recent progress in mind–body therapies in Cancer Care Curr Oncol Rep 2023 25 4 293 307 10.1007/s11912-023-01373-w 36753025 • Deleemans JM, Mather H, Spiropoulos A, Toivonen K, Baydoun M, Carlson LE. Recent progress in mind–body therapies in Cancer Care. Curr Oncol Rep. 2023;25(4):293–307. This review synthesizes definition, use, observed effects of mind body therapies among cancer patients in general. 36753025 10.1007/s11912-023-01373-w
43. Bower JE Irwin MR Mind–body therapies and control of inflammatory biology: A descriptive review Brain Behav Immun 2016 1 51 1 1 10.1016/j.bbi.2015.06.012 PMC4679419 26116436 Bower JE, Irwin MR. Mind–body therapies and control of inflammatory biology: A descriptive review. Brain Behav Immun. 2016;1(51):1–1. 10.1016/j.bbi.2015.06.012 PMC4679419 26116436
44. Carney LM, Park CL, Hingorany P. The mechanisms of mindfulness-based stress reduction and mindfulness-based cognitive therapy for cancer patients and survivors: A systematic review. Psychology of Consciousness: Theory, Research, and Practice. 2023 Jun 15. 10.1037/cns0000362 PMC12221244 40693695
45. Buffart LM van Uffelen JG Riphagen II Brug J van Mechelen W Brown WJ Chinapaw MJ 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 1 21 10.1186/1471-2407-12-559 23181734 PMC3571972 Buffart LM, van Uffelen JG, Riphagen II, Brug J, van Mechelen W, Brown WJ, Chinapaw MJ. Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials. BMC Cancer. 2012;12:1–21. 23181734 10.1186/1471-2407-12-559 PMC3571972
46. Huberty J Eckert R Dueck A Kosiorek H Larkey L Gowin K Mesa R Online yoga in myeloproliferative neoplasm patients: results of a randomized pilot trial to inform future research BMC Complement Altern Med 2019 19 1 2 10.1186/s12906-019-2530-8 31174535 PMC6556039 Huberty J, Eckert R, Dueck A, Kosiorek H, Larkey L, Gowin K, Mesa R. Online yoga in myeloproliferative neoplasm patients: results of a randomized pilot trial to inform future research. BMC Complement Altern Med. 2019;19:1–2. 31174535 10.1186/s12906-019-2530-8 PMC6556039
47. Huberty J Eckert R Larkey L Gowin K Mitchell J Mesa R Perceptions of myeloproliferative neoplasm patients participating in an online yoga intervention: a qualitative study Integr Cancer Ther 2018 17 4 1150 1162 10.1177/1534735418808595 30352518 PMC6247535 Huberty J, Eckert R, Larkey L, Gowin K, Mitchell J, Mesa R. Perceptions of myeloproliferative neoplasm patients participating in an online yoga intervention: a qualitative study. Integr Cancer Ther. 2018;17(4):1150–62. 30352518 10.1177/1534735418808595 PMC6247535
48. Huberty J Eckert R Gowin K Mitchell J Dueck AC Ginos BF Larkey L Mesa R Feasibility study of online yoga for symptom management in patients with myeloproliferative neoplasms Haematologica 2017 102 10 e384 10.3324/haematol.2017.168583 28596279 PMC5622867 Huberty J, Eckert R, Gowin K, Mitchell J, Dueck AC, Ginos BF, Larkey L, Mesa R. Feasibility study of online yoga for symptom management in patients with myeloproliferative neoplasms. Haematologica. 2017;102(10):e384. 28596279 10.3324/haematol.2017.168583 PMC5622867
49. Eckert R Huberty J Dueck A Kosiorek H Larkey L Mesa RA A pilot study of online yoga to improve fatigue and quality of life in myeloproliferative neoplasm patients Blood 2017 8 130 3443 Eckert R, Huberty J, Dueck A, Kosiorek H, Larkey L, Mesa RA. A pilot study of online yoga to improve fatigue and quality of life in myeloproliferative neoplasm patients. Blood. 2017;8(130):3443.
50. Eckert R Huberty J Gowin KL Ginos B Kosiorek HE Dueck AC Mesa RA Impact of weight on symptom burden outcomes in myeloproliferative neoplasm patients participating in an online yoga intervention Blood 2016 128 22 5481 10.1182/blood.V128.22.5481.5481 Eckert R, Huberty J, Gowin KL, Ginos B, Kosiorek HE, Dueck AC, Mesa RA. Impact of weight on symptom burden outcomes in myeloproliferative neoplasm patients participating in an online yoga intervention. Blood. 2016;128(22):5481.
51. van Waart H van Harten WH Buffart LM Sonke GS Stuiver MM Aaronson NK Why do patients choose (not) to participate in an exercise trial during adjuvant chemotherapy for breast cancer? Psychooncology 2016 25 8 964 970 10.1002/pon.3936 26282696 van Waart H, van Harten WH, Buffart LM, Sonke GS, Stuiver MM, Aaronson NK. Why do patients choose (not) to participate in an exercise trial during adjuvant chemotherapy for breast cancer? Psychooncology. 2016;25(8):964–70. 26282696 10.1002/pon.3936
52. Kabat-Zinn J, Living FC. Using the wisdom of your body and mind to face stress, pain, and illness. New York, NY: Bantam Doubleday Dell. 1990; 2383411.
53. Huberty J Eckert R Larkey L Kurka J De Jesús SA Yoo W Mesa R Smartphone-based meditation for myeloproliferative neoplasm patients: feasibility study to inform future trials JMIR Form Res 2019 3 2 e12662 10.2196/12662 31033443 PMC6658299 Huberty J, Eckert R, Larkey L, Kurka J, De Jesús SA, Yoo W, Mesa R. Smartphone-based meditation for myeloproliferative neoplasm patients: feasibility study to inform future trials. JMIR Form Res. 2019;3(2):e12662. 31033443 10.2196/12662 PMC6658299
54. Win H Russell S Wertheim BC Maizes V Crocker R Brooks AJ Mesa R Huberty J Geyer H Eckert R Larsen A Mobile app intervention on reducing the myeloproliferative neoplasm symptom burden: pilot feasibility and acceptability study JMIR Form Res 2022 6 3 e33581 10.2196/33581 35357315 PMC9015738 Win H, Russell S, Wertheim BC, Maizes V, Crocker R, Brooks AJ, Mesa R, Huberty J, Geyer H, Eckert R, Larsen A. Mobile app intervention on reducing the myeloproliferative neoplasm symptom burden: pilot feasibility and acceptability study. JMIR Form Res. 2022;6(3):e33581. 35357315 10.2196/33581 PMC9015738
55. Puzia ME Huberty J Eckert R Larkey L Mesa R Associations between global mental health and response to an app-based meditation intervention in myeloproliferative neoplasm patients Integr Cancer Ther 2020 19 1534735420927780 10.1177/1534735420927780 32564631 PMC7307391 Puzia ME, Huberty J, Eckert R, Larkey L, Mesa R. Associations between global mental health and response to an app-based meditation intervention in myeloproliferative neoplasm patients. Integr Cancer Ther. 2020;19:1534735420927780. 32564631 10.1177/1534735420927780 PMC7307391
56. Huberty J Eckert R Larkey L Joeman L Mesa R Experiences of using a consumer-based mobile meditation app to improve fatigue in myeloproliferative patients: qualitative study JMIR Cancer 2019 5 2 e14292 10.2196/14292 31333197 PMC6681641 Huberty J, Eckert R, Larkey L, Joeman L, Mesa R. Experiences of using a consumer-based mobile meditation app to improve fatigue in myeloproliferative patients: qualitative study. JMIR Cancer. 2019;5(2):e14292. 31333197 10.2196/14292 PMC6681641
57. Fincham GW Mavor K Dritschel B Effects of mindfulness meditation duration and type on well-being: an online dose-ranging randomized controlled trial Mindfulness 2023 14 5 1171 1182 10.1007/s12671-023-02119-2 37304656 PMC10090715 Fincham GW, Mavor K, Dritschel B. Effects of mindfulness meditation duration and type on well-being: an online dose-ranging randomized controlled trial. Mindfulness. 2023;14(5):1171–82. 37304656 10.1007/s12671-023-02119-2 PMC10090715
58. Clinton SK Giovannucci EL Hursting SD The world cancer research fund/American institute for cancer research third expert report on diet, nutrition, physical activity, and cancer: impact and future directions J Nutr 2020 150 4 663 71 10.1093/jn/nxz268 31758189 PMC7317613 •• Clinton SK, Giovannucci EL, Hursting SD. The world cancer research fund/American institute for cancer research third expert report on diet, nutrition, physical activity, and cancer: impact and future directions. J Nutr. 2020;150(4):663–71. The WCR/AICR expert report offers evidence-based recommendations on diet, nutrition, and physical activity for cancer survivors. It guides practitioners and policymakers toward better health outcomes among cancer survivors and can help explore lifestyle outcomes in MPN and other cancer types. 31758189 10.1093/jn/nxz268 PMC7317613
59. Denlinger CS Sanft T Moslehi JJ Overholser L Armenian S Baker KS Broderick G Demark-Wahnefried W Friedman DL Goldman M Henry NL NCCN guidelines insights: survivorship, version 22020: featured updates to the NCCN guidelines J Natl Compr Canc Netw 2020 18 8 1016 23 10.6004/jnccn.2020.0037 32755975 PMC7785060 Denlinger CS, Sanft T, Moslehi JJ, Overholser L, Armenian S, Baker KS, Broderick G, Demark-Wahnefried W, Friedman DL, Goldman M, Henry NL. NCCN guidelines insights: survivorship, version 22020: featured updates to the NCCN guidelines. J Natl Compr Canc Netw. 2020;18(8):1016–23. 32755975 10.6004/jnccn.2020.0037 PMC7785060
60. Sharman R Harris Z Ernst B Mussallem D Larsen A Gowin K Lifestyle Factors and Cancer: A Narrative Review Mayo Clin Proc Innov Qual Outcomes 2024 8 2 166 183 10.1016/j.mayocpiqo.2024.01.004 38468817 PMC10925935 Sharman R, Harris Z, Ernst B, Mussallem D, Larsen A, Gowin K. Lifestyle Factors and Cancer: A Narrative Review. Mayo Clin Proc Innov Qual Outcomes. 2024;8(2):166–83. 38468817 10.1016/j.mayocpiqo.2024.01.004 PMC10925935
61. Leiva O Hobbs G Ravid K Libby P Cardiovascular disease in myeloproliferative neoplasms: JACC: cardiooncology state-of-the-art review Cardio Oncology 2022 4 2 166 182 10.1016/j.jaccao.2022.04.002 PMC9270630 35818539 Leiva O, Hobbs G, Ravid K, Libby P. Cardiovascular disease in myeloproliferative neoplasms: JACC: cardiooncology state-of-the-art review. Cardio Oncology. 2022;4(2):166–82. 10.1016/j.jaccao.2022.04.002 PMC9270630 35818539
62. Gumuser ED Schuermans A Cho SM Sporn ZA Uddin MM Paruchuri K Nakao T Yu Z Haidermota S Hornsby W Weeks LD Clonal hematopoiesis of indeterminate potential predicts adverse outcomes in patients with atherosclerotic cardiovascular disease J Am Coll Cardiol 2023 81 20 1996 2009 10.1016/j.jacc.2023.03.401 37197843 PMC10249057 Gumuser ED, Schuermans A, Cho SM, Sporn ZA, Uddin MM, Paruchuri K, Nakao T, Yu Z, Haidermota S, Hornsby W, Weeks LD. Clonal hematopoiesis of indeterminate potential predicts adverse outcomes in patients with atherosclerotic cardiovascular disease. J Am Coll Cardiol. 2023;81(20):1996–2009. 37197843 10.1016/j.jacc.2023.03.401 PMC10249057
63. Estruch R Ros E Salas-Salvadó J Covas MI Corella D Arós F Gómez-Gracia E Ruiz-Gutiérrez V Fiol M Lapetra J Lamuela-Raventos RM Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts N Engl J Med 2018 378 25 e34 10.1056/NEJMoa1800389 29897866 Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med. 2018;378(25):e34. 29897866 10.1056/NEJMoa1800389
64. Estruch R Anti-inflammatory effects of the Mediterranean diet: the experience of the PREDIMED study Proc Nutr Soc 2010 69 3 333 340 10.1017/S0029665110001539 20515519 Estruch R. Anti-inflammatory effects of the Mediterranean diet: the experience of the PREDIMED study. Proc Nutr Soc. 2010;69(3):333–40. 20515519 10.1017/S0029665110001539
65. De Filippis F Pellegrini N Vannini L Jeffery IB La Storia A Laghi L Serrazanetti DI Di Cagno R Ferrocino I Lazzi C Turroni S High-level adherence to a Mediterranean diet beneficially impacts the gut microbiota and associated metabolome Gut 2016 65 11 1812 1821 10.1136/gutjnl-2015-309957 26416813 De Filippis F, Pellegrini N, Vannini L, Jeffery IB, La Storia A, Laghi L, Serrazanetti DI, Di Cagno R, Ferrocino I, Lazzi C, Turroni S. High-level adherence to a Mediterranean diet beneficially impacts the gut microbiota and associated metabolome. Gut. 2016;65(11):1812–21. 26416813 10.1136/gutjnl-2015-309957
66. Luque LF Avelar-Barragan J Nguyen H Nguyen J Soyfer EM Liu J Chen JH Mehrotra N Huang X Kosiorek HE Dueck A The NUTRIENT Trial (NUTRitional Intervention among myEloproliferative Neoplasms): Results from a Randomized Phase I Pilot Study for Feasibility and Adherence Cancer Res Commun 2024 4 3 660 10.1158/2767-9764.CRC-23-0380 38391189 PMC10913729 Luque LF, Avelar-Barragan J, Nguyen H, Nguyen J, Soyfer EM, Liu J, Chen JH, Mehrotra N, Huang X, Kosiorek HE, Dueck A. The NUTRIENT Trial (NUTRitional Intervention among myEloproliferative Neoplasms): Results from a Randomized Phase I Pilot Study for Feasibility and Adherence. Cancer Res Commun. 2024;4(3):660. 38391189 10.1158/2767-9764.CRC-23-0380 PMC10913729
67. Avelar-Barragan J Mendez Luque LF Nguyen J Nguyen H Odegaard AO Fleischman AG Whiteson KL Characterizing the microbiome of patients with myeloproliferative neoplasms during a Mediterranean diet intervention MBio 2023 14 6 e02308 e2323 10.1128/mbio.02308-23 37877698 PMC10746218 Avelar-Barragan J, Mendez Luque LF, Nguyen J, Nguyen H, Odegaard AO, Fleischman AG, Whiteson KL. Characterizing the microbiome of patients with myeloproliferative neoplasms during a Mediterranean diet intervention. MBio. 2023;14(6):e02308-e2323. 37877698 10.1128/mbio.02308-23 PMC10746218
68. Podoltsev NA Wang X Wang R Hofmann JN Liao LM Zeidan AM Mesa R Ma X Lifestyle factors and risk of myeloproliferative neoplasms in the NIH-AARP diet and health study Int J Cancer 2020 147 4 948 57 10.1002/ijc.32853 31904114 PMC8919268 Podoltsev NA, Wang X, Wang R, Hofmann JN, Liao LM, Zeidan AM, Mesa R, Ma X. Lifestyle factors and risk of myeloproliferative neoplasms in the NIH-AARP diet and health study. Int J Cancer. 2020;147(4):948–57. 31904114 10.1002/ijc.32853 PMC8919268
69. Tej GN Nayak PK Mechanistic considerations in chemotherapeutic activity of caffeine Biomed Pharmacother 2018 1 105 312 319 10.1016/j.biopha.2018.05.144 29864619 Tej GN, Nayak PK. Mechanistic considerations in chemotherapeutic activity of caffeine. Biomed Pharmacother. 2018;1(105):312–9. 10.1016/j.biopha.2018.05.144 29864619
70. Eini H Frishman V Yulzari R Kachko L Lewis EC Chaimovitz C Douvdevani A Caffeine promotes anti-tumor immune response during tumor initiation: Involvement of the adenosine A2A receptor Biochem Pharmacol 2015 98 1 110 118 10.1016/j.bcp.2015.08.092 26296573 Eini H, Frishman V, Yulzari R, Kachko L, Lewis EC, Chaimovitz C, Douvdevani A. Caffeine promotes anti-tumor immune response during tumor initiation: Involvement of the adenosine A2A receptor. Biochem Pharmacol. 2015;98(1):110–8. 26296573 10.1016/j.bcp.2015.08.092
71. Scherber RM Langlais BT Geyer H Dueck A Kosoriek H Johnston C Padrnos L Palmer J Fleischman AG Mesa RA Nutrition and supplement use characteristics in the myeloproliferative neoplasms: results from the Nutrient Survey Blood 2017 8 130 2193 Scherber RM, Langlais BT, Geyer H, Dueck A, Kosoriek H, Johnston C, Padrnos L, Palmer J, Fleischman AG, Mesa RA. Nutrition and supplement use characteristics in the myeloproliferative neoplasms: results from the Nutrient Survey. Blood. 2017;8(130):2193.
72. Podoltsev NA Wang X Wang R Hofmann JN Liao LM Zeidan AM Mesa RA Ma X Diet and risk of myeloproliferative neoplasms in older individuals from the NIH-AARP Cohort Cancer Epidemiol Biomark Prev 2020 29 11 2343 2350 10.1158/1055-9965.EPI-20-0592 PMC8895351 32868318 Podoltsev NA, Wang X, Wang R, Hofmann JN, Liao LM, Zeidan AM, Mesa RA, Ma X. Diet and risk of myeloproliferative neoplasms in older individuals from the NIH-AARP Cohort. Cancer Epidemiol Biomark Prev. 2020;29(11):2343–50. 10.1158/1055-9965.EPI-20-0592 PMC8895351 32868318
73. Scherber RM Morse S Leproux A Craver BM Lai HY Geyer H Dueck AC Palmer J Padrnos L Mesa RA Fleischman AG Needs and preferences regarding nutrition and supplement use among individuals with myeloproliferative neoplasms: a focus group study Blood 2017 8 130 5669 Scherber RM, Morse S, Leproux A, Craver BM, Lai HY, Geyer H, Dueck AC, Palmer J, Padrnos L, Mesa RA, Fleischman AG. Needs and preferences regarding nutrition and supplement use among individuals with myeloproliferative neoplasms: a focus group study. Blood. 2017;8(130):5669.
74. Giannattasio S Dri M Merra G Caparello G Rampello T Di Renzo L Effects of Fatty Acids on Hematological Neoplasms: A Mini Review Nutr Cancer 2022 74 5 1538 1548 10.1080/01635581.2021.1960389 34355630 Giannattasio S, Dri M, Merra G, Caparello G, Rampello T, Di Renzo L. Effects of Fatty Acids on Hematological Neoplasms: A Mini Review. Nutr Cancer. 2022;74(5):1538–48. 34355630 10.1080/01635581.2021.1960389
75. Craver BM Ramanathan G Hoang S Chang X Mendez Luque LF Brooks S Lai HY Fleischman AG N-acetylcysteine inhibits thrombosis in a murine model of myeloproliferative neoplasm Blood Adv 2020 4 2 312 321 10.1182/bloodadvances.2019000967 31978215 PMC6988398 Craver BM, Ramanathan G, Hoang S, Chang X, Mendez Luque LF, Brooks S, Lai HY, Fleischman AG. N-acetylcysteine inhibits thrombosis in a murine model of myeloproliferative neoplasm. Blood Adv. 2020;4(2):312–21. 31978215 10.1182/bloodadvances.2019000967 PMC6988398
76. Cortes M Chen MJ Stachura DL Liu SY Kwan W Wright F Vo LT Theodore LN Esain V Frost IM Developmental Vitamin D Availability Impacts Hematopoietic Stem Cell Production Cell Rep 2016 17 458 468 10.1016/j.celrep.2016.09.012 27705794 PMC5338633 Cortes M, Chen MJ, Stachura DL, Liu SY, Kwan W, Wright F, Vo LT, Theodore LN, Esain V, Frost IM, et al. Developmental Vitamin D Availability Impacts Hematopoietic Stem Cell Production. Cell Rep. 2016;17:458–68. 27705794 10.1016/j.celrep.2016.09.012 PMC5338633
77. Pardanani A Drake MT Finke C Lasho TL Rozell SA Jimma T Tefferi A Vitamin D insufficiency in myeloproliferative neoplasms and myelodysplastic syndromes: Clinical correlates and prognostic studies Am J Hematol 2011 86 1013 1016 10.1002/ajh.22181 22086864 Pardanani A, Drake MT, Finke C, Lasho TL, Rozell SA, Jimma T, Tefferi A. Vitamin D insufficiency in myeloproliferative neoplasms and myelodysplastic syndromes: Clinical correlates and prognostic studies. Am J Hematol. 2011;86:1013–6. 22086864 10.1002/ajh.22181
78. Küçükay MU, Alanlı RE. 2021 Vitamin D replacement effect on platelet counts. J Coll Physicians Surg Pak 31 (9). 10.29271/jcpsp.2021.09.1064 34500522
79. Petiti J Rosso V Lo Iacono M Panuzzo C Calabrese C Signorino E Pironi L Cartellà A Bracco E Pergolizzi B Beltramo T Curcumin induces apoptosis in JAK2-mutated cells by the inhibition of JAK2/STAT and mTORC1 pathways J Cell Mol Med 2019 23 6 4349 4357 10.1111/jcmm.14326 31033209 PMC6533565 Petiti J, Rosso V, Lo Iacono M, Panuzzo C, Calabrese C, Signorino E, Pironi L, Cartellà A, Bracco E, Pergolizzi B, Beltramo T. Curcumin induces apoptosis in JAK2-mutated cells by the inhibition of JAK2/STAT and mTORC1 pathways. J Cell Mol Med. 2019;23(6):4349–57. 31033209 10.1111/jcmm.14326 PMC6533565
80. Chen CQ Yu K Yan QX Xing CY Chen Y Yan Z Shi YF Zhao KW Gao SM Pure curcumin increases the expression of SOCS1 and SOCS3 in myeloproliferative neoplasms through suppressing class Ι histone deacetylases Carcinogenesis 2013 34 7 1442 1449 10.1093/carcin/bgt070 23430957 Chen CQ, Yu K, Yan QX, Xing CY, Chen Y, Yan Z, Shi YF, Zhao KW, Gao SM. Pure curcumin increases the expression of SOCS1 and SOCS3 in myeloproliferative neoplasms through suppressing class Ι histone deacetylases. Carcinogenesis. 2013;34(7):1442–9. 23430957 10.1093/carcin/bgt070
81. Cassileth BR Deng G Complementary and alternative therapies for cancer Oncologist 2004 9 1 80 89 10.1634/theoncologist.9-1-80 14755017 Cassileth BR, Deng G. Complementary and alternative therapies for cancer. Oncologist. 2004;9(1):80–9. 14755017 10.1634/theoncologist.9-1-80
82. 어진김, 소영허, 조현황, 은경장, 장훈이, 영철김. A Case Report on Symptom Improvement in a Polycythemia Vera Patient Treated with Acupuncture J Int Korean Med 2021 42 5 976 81 10.22246/jikm.2021.42.5.976 어진김, 소영허, 조현황, 은경장, 장훈이, 영철김. A Case Report on Symptom Improvement in a Polycythemia Vera Patient Treated with Acupuncture. J Int Korean Med. 2021;42(5):976–81.
83. Field T Diego M Hernandez-Reif M Massage therapy research Dev Rev 2007 27 1 75 89 10.1016/j.dr.2005.12.002 Field T, Diego M, Hernandez-Reif M. Massage therapy research. Dev Rev. 2007;27(1):75–89.
84. Guo HF Tian J Wang X Fang Y Hou Y Han J Brain substrates activated by electroacupuncture of different frequencies (I): comparative study on the expression of oncogene c-fos and genes coding for three opioid peptides Mol Brain Res 1996 43 1–2 157 166 10.1016/S0169-328X(96)00170-2 9037529 Guo HF, Tian J, Wang X, Fang Y, Hou Y, Han J. Brain substrates activated by electroacupuncture of different frequencies (I): comparative study on the expression of oncogene c-fos and genes coding for three opioid peptides. Mol Brain Res. 1996;43(1–2):157–66. 9037529 10.1016/s0169-328x(96)00170-2