| Acupoints No.1 Review of Acupuncture in Cancer Care Kevin Mutschler, MA, RPP, L.Ac., Dipl.Ac. Acupuncture and complementary medicine. Acupuncture is a complementary medicine modality with a deep and rich history of clinical effectiveness for a wide variety of complaints. It is based in a tradition that has made a science of restoring balance to promote health. Acupuncture stands in a distinct complementary relationship to conventional cancer care. The focus of conventional cancer treatment is curative. The focus of acupuncture care is restorative. This, together with the fact that acupuncture achieves results without chemical intervention makes it an ideal complement to conventional treatments for cancer. Acupuncture and palliative cancer care. Acupuncture is increasingly being used to palliate cancer pain and discomfort, and to help reduce some of the common side-effects of conventional cancer treatments. Acupuncture care now commonly includes treatment for pain associated with surgery or tumor growth, and for nausea and vomiting associated with cytotoxic chemotherapies. It also includes treatment to mitigate the burning and drying effects associated with radiation therapies. Cancer patients coming into our clinic for acupuncture also report finding relief from the anxiety and depression often associated with their experience of cancer and its treatment. Despite the benefits reported by thousands of cancer patients receiving acupuncture care, there has until recently, been a relative dearth of scientific studies of acupuncture efficacy in cancer care. This is now beginning to change. In 1997, the National Center for Complementary and Alternative Medicine at NIH issued a consensus statement on acupuncture which reported, "Studies of both acupuncture and electroacupuncture show that the techniques can be effective for the treatment of chemotherapy-induced acute nausea and produce few or no side effects." (1) In the years since this statement was issued, research on acupuncture use and its efficacy for cancer care has begun to pick up momentum both here in the U.S. and around the world. Acupuncture and cancer care studies worldwide. In China and Japan, there is already a substantial body of literature documenting the use of acupuncture to promote a wide variety of benefits for cancer patients. These include studies confirming the efficacy of acupuncture for pain relief and anti-emesis, both of which are now fairly widely recognized in the West. They also include studies suggesting broader, immune-enhancing and other post-surgical benefits as well. For example, a 2002 study at Qihu Hospital at Shandong University found that electro-acupuncture treatments helped restore immune function in post-chemotherapy patients. (2) And, another 2002 study, at Fujita Health University in Japan, found that acupuncture and moxibustion helped relieve lymphedema following lymph node surgery. (3) In Europe, countries such as Germany, Sweden, Norway, Great Britain, Ireland and Italy, are contributing to a rapidly growing body of literature regarding both patient use patterns for acupuncture and complementary medicine, as well as documenting the clinical efficacy of some of these treatments in cancer care. Complementary medicine in the U.S. Research in the United States published in the New England Journal of Medicine (4) and in the Journal of the American Medical Association (5) reveals a steady increase in the numbers of Americans seeking support from complementary and alternative medicine (CAM) for many health conditions, including cancer. According to a study conducted by the National Center for Complementary and Alternative Medicine at NIH, based upon data gathered in the CDC's 2002 National Health Interview Survey, CAM use has reached some 36% among all Americans for all health conditions. (6) Among cancer patients, the number of people making use of CAM is even higher, approaching 70-80% according to studies in some American cities, including Boston and Seattle. (7) CAM use has also grown among specific populations of cancer patients. For example, an article published in the journal, Gynecological Oncology, discusses increasing CAM use among women with gynecological cancers. (8) Clinical studies of acupuncture efficacy conducted in the United States and elsewhere, are also multiplying, especially in recent months and years. Moreover, these studies, which had been appearing in general medical journals, such as JAMA, CAM journals and nursing care journals, are increasingly appearing in journals of clinical specialties, such as clinical oncology and urology. Acupuncture and cancer care: anti-emesis. In a 1990 study, clinicians at Belvoir Park Hospital, in Belfast, Ireland reported in the Journal of the Royal Society of Medicine, that acupuncture treatment was an effective anti-emetic prior to chemotherapy infusions and that patient-stimulation of appropriate acupoints can prolong the anti-emetic effectiveness. (9) In the same year, Italian researchers at the Ospedale Policlinico, in Perugia, found that women given routine anti-emetic medications for nausea associated with cisplatin treatments saw increased and prolonged anti-emetic effectiveness with lower intensity of nausea when their treatments were augmented with acupuncture. (10) Ten years later, in 2000, JAMA published a landmark, three arm, parallel-group, randomized controlled trial examining the anti-emesis efficacy of acupuncture for treating breast cancer patients receiving high-dose chemotherapy. The study compared anti-emesis treatment with routine pharmacological agents alone and in conjunction with either low-voltage electroacupuncture, or sham minimal-needling acupuncture. Results showed that the use of genuine acupuncture produced the greatest reduction in emesis. Although, even adjunctive minimal needling improved the effectiveness of treatment over pharmacotherapy alone. (11) In another 2000 anti-emesis study for women with breast cancer, this one at the Institute for Health and Aging at the University of California, San Francisco, researchers found that patients who were taught how to stimulate specific acupressure points reported less intensity and lower frequency of nausea. (12) Anxiety, depression and vasomotor symptoms. A 2002 pilot study at the Medical Oncology Unit, University of L'Aquila, in Italy suggests that menopausal symptoms induced in women treated with tamoxifen can be effectively treated with acupuncture. The researchers noted reductions in anxiety, depression, somatic and vasomotor symptoms among the treated women. (13) A Swedish study, conducted at the University of Linkoping, and published in the Journal of Urology in 1999, also points to the benefits of acupuncture in treating vasomotor symptoms in men with prostate cancer. (14) Pain and mobility. In a 1999 study of the use of acupuncture with lymphadenectomy, researchers in the Department of Obstetrics and Gynecology at the University of Saarland in Homborg, Germany, found that acupuncture treatment helped to both reduce pain and increase mobility in women with breast cancer. (15) Radiation burn effects. A 1996 study in Sweden documented the benefits of acupuncture for treating radiation-induced xerostomia in patients being treated for cancers of the neck and head. (16) Another Swedish study, in 1999, found acupuncture effective, as well, for patients in late-stage palliative care suffering from dry mouth and xerostomia-induced dysphagia. (17) Clinicians in the Radiation Oncology Division of the Naval Medical Center, San Diego, examined the use of acupuncture for radiation therapy-induced xerostomia. They concluded, in a 2001 report, that acupuncture reduces xerostomia in some patients who are refractory to best current symptom management practices. (18) Fatigue and distress. Researchers in the United Kingdom reported in 1996, in the journal, Palliative Medicine, that acupuncture has been helpful in the palliative management of cancer-related breathlessness, noting that 70% of treated patients experienced improvement in ease of breathing. (19) More recently, the Journal of Clinical Oncology, May, 2004, reports on a phase II clinical study designed to evaluate the efficacy of acupuncture for treating post-chemotherapy fatigue, conducted at Memorial Sloan-Kettering Cancer Center in New York. The study focused on patients who had finished chemotherapy, but who experienced persisting fatigue lasting, on average, over two years. Researchers found that patients treated with acupuncture experienced a mean improvement in their conditions of over 31% and recommended that acupuncture treatment for persistent fatigue receive further study. (20) Current programs and studies. Today, there is a growing number of research initiatives examining more ways in which acupuncture may be helpful in cancer care. For example, the National Cancer Institute is sponsoring clinical trials on the application of acupuncture to augment anti-emesis for pediatric sarcomas, and on the effectiveness of wrist-band acupoint stimulation for relief of chemotherapy-induced nausea. The NCI is also sponsoring establishment of The International Center for Traditional Chinese Medicine, a joint venture involving the M.D. Anderson Cancer Center at the University of Texas, and the Cancer Hospital at Fudan University in Shanghai, China. The Center will be examining the efficacy of acupuncture in cancer care, as well as the role of herbal therapies and Tai Chi / Qigong exercise. Clinicians and researchers continue to explore other ways in which acupuncture can contribute to enhanced cancer care. For instance, a recent report published in the Journal of Traditional Chinese Medicine suggests that acupuncture may be effective in treating secondary amenorrhea, a side effect of chemotherapy for breast cancer, which can be very troubling for some women of reproductive age. (21) Clinical observations. At Acumedicine Associates, P.C., we take care of patients in all stages of treatment and remission, as well as those who come to us for palliative care. Our clinical experience confirms the research findings outlined above. In addition, we see cancer patients benefiting from regular acupuncture care in a number of other significant ways. Our patients frequently report better than average blood counts throughout their anti-cancer treatment regimes. While there must certainly be other contributing factors besides regular acupuncture, we mention this observation because our patients so often bring in their lab results showing their blood counts tending to stay up. Patients receiving regular acupuncture care in our clinic also report less gastro-intestinal disruption with their chemotherapy treatments than would normally be expected. We cannot say that acupuncture is entirely responsible for this, although patient reports of dramatic relief from distress often do seem to follow their acupuncture treatments. We also find that cancer patients in our care appreciate the safe and supportive atmosphere that we provide. With the complementary medicine care they receive here, patients report feeling better able to process the experience of their illness and of their often very challenging treatment regimes. It is not uncommon after their first or second visit to our clinic, for us to hear a patient say of their cancer and its treatment, "I think I can face this now." References: 1. NIH Consensus Statement 1997 Nov 3-5; 15(5):1-34. "Acupuncture" 2. J Tradit Chin Med. 2002 Mar;22(1):21-3. "Effects of electro-acupuncture on immune function after chemotherapy in 28 cases." Ye F, Chen S, Liu W. Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China. 3. Am J Chin Med. 2002;30(1):37-43. "Effectiveness of acupuncture and moxibustion treatment for lymphedema following intrapelvic lymph node dissection: a preliminary report." Kanakura Y, Niwa K, Kometani K, Nakazawa K, Yamaguchi Y, Ishikawa H, Watanabe A, Tokunaga Y. Department of Gynecology and Obstetrics, Second Teaching School of Medicine, Fujita Health University, Nagoya, Aichi, Japan. 4. NEJM. 1993: 328:246-252. "Unconventional Medicine in the United States: prevalence, costs, and patterns of use." Eisenberg DM, et al. 5. JAMA. 1998; 279:1548-1553. "Why Patients Use Alternative Medicine: Results of a National Study." Astin JA. 6. CDC Advance Data Report #343. May 27, 2004. "Complementary and Alternative Medicine Use Among Adults: United States, 2002." Barnes P, Powell-Griner E, McFann K, Nahin R. 7. The Journal of Alternative and Complementary Medicine: Paradigm, Practice and Policy, Vol. 8, No. 4, 2002, pp. 477-485 "Types of Alternative Medicine Used by Breast, Colon, Prostate Cancer Patients: Predictors, Motives and Costs" Patterson, et al.. 8. Gynecol Oncol. 2002 Mar;84(3):363-7. Comment in: Gynecol Oncol. 2002 Mar;84(3):360-2. "Use of complementary and alternative medicine among women with gynecologic cancers." Swisher EM, Cohn DE, Goff BA, Parham J, Herzog TJ, Rader JS, Mutch DG. Department of Obstetrics and Gynecology, Washington University 9. J R Soc Med. 1990 Jun;83(6):360-2. "Prolongation of the antiemetic action of P6 acupuncture by acupressure inpatients having cancer chemotherapy." Dundee JW, Yang J. Northern Ireland Radiotherapy Centre, Belvoir Park Hospital, Belfast. 10. Cancer Chemother Pharmacol. 1990;26(3):239-40. "A pilot study of metoclopramide, dexamethasone, diphenhydramine and acupuncture in women treated with cisplatin." Aglietti L, Roila F, Tonato M, Basurto C, Bracarda S, Picciafuoco M, Ballatori E, Del Favero A. Medical Oncology Division, Ospedale Policlinico, Perugia, Italy. 11. JAMA. 2000 Dec 6;284(21):2755-61. Comments in: JAMA. 2001 Feb 28;285(8):1015-6; author reply 1016. JAMA. 2001 Feb 28;285(8):1016. "Electroacupuncture for control of myeloablative chemotherapy-induced emesis: a randomized controlled trial." Shen J, Wenger N, Glaspy J, Hays RD, Albert PS, Choi C, Shekelle PG. National Institutes of Health, Laboratory of Clinical Studies/NIAAA 12. Oncol Nurs Forum. 2000 Jan-Feb;27(1):41-7. "Acupressure for nausea: results of a pilot study." Dibble SL, Chapman J, Mack KA, Shih AS. Institute for Health and Aging, University of California, San Francisco. 13. Tumori. 2002 Mar-Apr;88(2):128-30. "Acupuncture in the treatment of menopause-related symptoms in women taking tamoxifen." Porzio G, Trapasso T, Martelli S, Sallusti E, Piccone C, Mattei A, Di Stanislao C, Ficorella C, Marchetti P. Medical Oncology Unit, University of L'Aquila, Italy. 14. J Urol. 1999 Mar;161(3):853-6. "Acupuncture treatment of vasomotor symptoms in men with prostatic carcinoma: a pilot study." Hammar M, Frisk J, Grimas O, Hook M, Spetz A, Wyon Y Department of Health and Environment, Faculty of Health Sciences, University of Linkoping, Sweden. 15. Clin Exp Obstet Gynecol. 1999;26(2):81-4. "Pain-relief and movement improvement by acupuncture after ablation and axillary lymphadenectomy in patients with mammary cancer." He JP, Friedrich M, Ertan AK, Muller K, Schmidt W. Department of Obstetrics and Gynecology, University of the Saarland, Homburg, Germany. 16. Eur J Cancer B Oral Oncol. 1996 May;32B(3):182-90. Oral Oncol. 1997 Mar;33(2):146-7. "Acupuncture treatment of patients with radiation-induced xerostomia." Blom M, Dawidson I, Fernberg JO, Johnson G, Angmar-Mansson B. Department of Cariology, Karolinska Institutet, Huddinge, Sweden. 17. J Palliat Care. 1999 Winter;15(4):20-3. "Acupuncture for patients in hospital-based home care suffering from xerostomia." Rydholm M, Strang P. Hospital-Based Home Care Unit, Motala Hospital, Sweden. 18. Int J Radiat Oncol Biol Phys. 2001 Jun 1;50(2):353-7. "Acupuncture for pilocarpine-resistant xerostomia following radiotherapy for head and neck malignancies." Johnstone PA, Peng YP, May BC, Inouye WS, Niemtzow RC. Radiation Oncology Division, Naval Medical Center, San Diego. 19. Palliat Med. 1996 Apr;10(2):145-50. "Acupuncture for the relief of cancer-related breathlessness." Filshie J, Penn K, Ashley S, Davis CL. Royal Marsden Hospital, Sutton, Surrey, UK. 20. J Clin Oncol. 2004 May 1;22(9):1731-5. "Acupuncture for postchemotherapy fatigue: a phase II study." Vickers AJ, Straus DJ, Fearon B, Cassileth BR. Intergrative Medicine Service, and Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York. 21. J Tradit Chin Med. 2004 Mar:24(1):42-43 "Treatment of secondary amenorrhea with abdomen acupuncture." Yan H. |
