Patient profile: Female, 48 years old.

Presentation: The patient had Stage II hormone-receptor positive invasive ductal carcinoma following lumpectomy. She was due to start adjuvant chemotherapy and endocrine therapy. She reported significant fatigue, poor sleep, anxiety about chemotherapy, a 5 kg weight gain over 6 months, and concerns about immunity and recurrence risk.

Assessment: A full oncology review was completed, including pathology and receptor status. Baseline tests included CBC, CMP, fasting glucose, HbA1c, lipids, thyroid function, 25-OH vitamin D, ferritin, CRP, albumin and, where needed, immune markers. Sleep, psychosocial stress, physical activity and diet were also assessed.

Clinical picture: The patient had treatment-related fatigue and insomnia, recent weight gain, vitamin D insufficiency, mild iron deficiency and raised inflammation. There were no identified contraindications to an integrative support plan.

Support plan: The plan was coordinated with the oncology team to make sure supplements and supportive strategies were timed safely around chemotherapy. Nutritional support focused on a Mediterranean-style anti-inflammatory diet with cruciferous vegetables, fibre at 25 to 30 g per day, lean protein and omega-3-rich foods, while reducing refined carbohydrates and processed meats. The target was steady weight loss of around 0.5 kg per week. Supplement support included vitamin D3 at 2,000 to 4,000 IU daily, omega-3 EPA/DHA at 2 to 3 g daily, methylated B-complex where appropriate, and zinc or selenium only if deficiency was confirmed. Adaptogenic support such as Ashwagandha at 300 to 600 mg daily was considered only after oncology clearance. Sleep support included sleep hygiene measures, cognitive behavioural strategies and short-term melatonin at 1 to 3 mg only with oncologist approval. Exercise support included supervised resistance training twice weekly and 150 minutes of moderate aerobic activity per week. Weekly CBT-based support and mindfulness-based stress reduction were also included to help anxiety and sleep.

Outcome at 6 months: The patient completed chemotherapy without unexpected adverse interactions. Fatigue improved by 40% on a validated fatigue scale. Sleep quality improved, with PSQI reducing by 6 points. Vitamin D increased from 18 ng/mL to 45 ng/mL. hs-CRP reduced from 4.2 mg/L to 1.8 mg/L. Weight reduced by 4 kg, while lean mass was preserved. She also reported reduced anxiety and a greater sense of control over her health.

Key point: This case shows that well-coordinated integrative support can sit safely alongside conventional oncology treatment and improve quality of life.