Acupuncture supports cancer care

An increasing body of evidence supports the use of acupuncture for the control of cancer-related symptoms. Here we summarize the results of researched for the efficacy and safety of acupuncture for some of cancer symptoms and side effects of chemo- and radiotherapy.

Postchemotherapy chronic fatigue

An overwhelming majority of cancer patients experience fatigue. Fatigue is also common among cancer survivors. Currently administered pharmacologic agents include modafinil or corticosteroids. Patients also seek nonpharmacologic treatments such as acupuncture. A 2007 randomized trial demonstrated that true acupuncture showed substantial improvement (36%) in fatigue levels compared with sham acupuncture and acupressure [1]. A more recent randomized trial comparing acupuncture with sham acupuncture and with wait list controls also found a significant reduction in fatigue for patients receiving acupuncture versus controls after 2 weeks [2].

Xerostomia (Dry mouth)

Radiation-induced salivary gland damage produces xerostomia (dry mouth) due to impaired saliva production. Several clinical trials found that acupuncture alleviate radiation-induced xerostomia [3-5]. In a randomized, controlled, participant-blinded trial, 20 healthy volunteers received true versus sham acupuncture. Functional magnetic resonance imaging (fMRI) technology was used to evaluate the cortical regions activated or deactivated during treatment and saliva production was measured. Results showed that areas activated by true acupuncture at the acupoint LI-2 overlapped areas involved in gustation/salivation. Sham acupuncture was not associated with such neural activations. Moreover, true acupuncture induced significant saliva production compared with sham acupuncture [6]. These results corroborate past results and establish a foundation for further research into the mechanisms of acupuncture treatment for xerostomia.

Breast cancer related symptoms

Lymphedema
Lymphedema is the chronic swelling of a limb following lymph node removal. It is a frequent complication of breast cancer treatment. Patients must undergo regular intensive physical therapy to reduce lymphatic fluid volume in the affected arm. Treatment must be continuous in order to prevent fluid re-accumulation and patients are obligated to wear tight, uncomfortable elastic stockings to prevent increased swelling. Previous clinical trials indicated that acupuncture can decrease lymphedema symptoms as well as limb swelling in both upper and lower extremities [7,8]. In 2011, a pilot study was conducted at MSK to evaluate the safety and effectiveness of acupuncture in women with chronic lymphedema after breast cancer surgery. Nine patients received acupuncture twice a week for 4 weeks. Four patients showed at least a 30% reduction in the affected versus unaffected arm. It was concluded that acupuncture is safe and may be able to reduce lymphedema in breast cancer patients [9]. Another pilot study of breast cancer-related lymphedema (BCRL) was conducted in 2003. Eligible individuals had experienced lymphedema for 0.5-5 years and had an affected arm circumference of 2 cm or larger than the unaffected arm. Participants received acupuncture treatment twice weekly for 4 weeks prior to evaluation. Circumference differences between the affected and unaffected arm were assessed. Patients were followed monthly for 6 months after treatment to document complications and to obtain self-reported lymphedema status. Results showed that acupuncture significantly reduced the circumference in the affected arm. There were no reports of infections or other complications throughout treatment and follow-up [10]. These results corroborate past findings and suggest that acupuncture may be considered a potential treatment modality for BCRL patients.

Hot flashes
Acupuncture may be a potential treatment modality as current treatment options for hot flashes are limited, especially for breast cancer patients on hormonal therapy. Previous studies suggest that acupuncture may relieve hot flashes in breast cancer patients [11-15]. Two further studies demonstrated that true acupuncture can reduce hot flashes and related symptoms [16,17].

Postcolectomy ileus in colon cancer patients

Postoperative ileus (POI) commonly develops in patients after abdominal surgery and manifests in transient bowel dysfunction and reduced intestinal tract motility. POI is difficult to treat as interventions such as epidural local anesthetics are very costly. Acupuncture may be valuable as it is known to improve gastrointestinal motility in animal models. Two studies demonstrate that acupuncture is a potential candidate for mitigating postoperative ileus [18,19] as well as postoperative gastroparesis syndrome in abdominal surgical patients [20].

Pain, dysfunction, and xerostomia after neck dissection in head and neck cancer patients

Neck dissection is often required to prevent the spread of disease to the lymph nodes. The removal of the spinal accessory nerve in this procedure leads to neck or shoulder pain and dysfunction, which is common, occurring in 30-70% of patients after radial neck dissection. Patients relying on physical therapy exercises and anti-inflammatory drugs report low efficacy and incomplete symptom relief. Acupuncture may be a potential treatment modality as it is well tolerated and has analgesic effects. To assess whether acupuncture can reduce pain and dysfunction in cancer patients following neck dissection, 58 patients were randomly assigned to weekly acupuncture versus usual care (e.g., physical therapy and/or inflammatory drugs) for 4 weeks. Pain and function were assessed as well as xerostomia. Results indicated that acupuncture produced significant reductions in pain and dysfunction and in xerostomia, suggesting that acupuncture could be a valuable treatment to alleviate post-neck dissection pain and dysfunction, and to reduce xerostomia [21].

References

1. Molassiotis A, et al. The management of cancerrelated fatigue after chemotherapy with acupuncture and acupressure: a randomized controlled trial. Complementary Therapy in Medicine 2007;15:228-237.
2. Smith C, et al. The effect of acupuncture on postcancer fatigue and well-being for women recovering from breast cancer: a pilot randomized controlled trial. Acupuncture in Medicine 2013;31:9-15.
3. Jensen SB, et al. Xerostomia and hypofunction of the salivary glands in cancer therapy. Support Care Cancer 2003;11:207-225.
4. Cho JH, et al. Manual acupuncture improved quality of life in cancer patients with radiation-induced xerostomia. Journal of Alternative and Complementary Medicine 2008;14:523-526.
5. Simcock R, et al. ARIX: a randomized trial of acupuncture v oral care sessions in patients with chronic xerostomia following treatment of head and neck cancer. Annals of Oncology 2013;24:776-783.
6. Deng G, et al. Functional magnetic resonance imaging (fMRI) changes and saliva production associated with acupuncture at LI-2 acupuncture point: a randomized controlled study. BMC Complementary and Alternative Medicine 2008;8:37.
7. Kanakura Y, et al. Effectiveness of acupuncture and moxibustion treatment for lymphedema following intrapelvic lymph node dissection: a preliminary report. American Journal of Chinese Medicine 2002;30:37-43.
8. Alem M, Gurgel MS. Acupuncture in the rehabilitation of women after breast cancer surgeryea case series. Acupuncture in Medicine 2008;26:87-93.
9. Cassileth BR, et al. A safety and efficacy pilot study of acupuncture for the treatment of chronic lymphoedema. Acupuncture in Medicine 2011;29:170-172.
10. Cassileth BR, et al. Acupuncture in the treatment of upper-limb lymphedema: results of a pilot study. Cancer 2013;119: 2455-2461.
11. Nedstrand E, et al. Vasomotor symptoms decrease in women with breast cancer randomized to treatment with applied relaxation or electroacupuncture: a preliminary study. Climacteric 2005;8:243-250.
12. Cohen SM, et al. Can acupuncture ease the symptoms of menopause? Holistic Nursing Practice 2003;17:295-299.
13. Porzio G, et al. Acupuncture in the treatment of menopauserelated symptoms in women taking tamoxifen. Tumori 2002;88:128-130.
14. Nir Y, et al. Acupuncture for postmenopausal hot flashes. Maturitas 2007;56:383-395.
15. Frisk J, et al. Long-term follow-up of acupuncture and hormone therapy on hot flushes in women with breast cancer: a prospective, randomized, controlled multicenter trial. Climacteric 2008;11:166-174.
16. Kim KH, et al. Effects of acupuncture on hot flashes in perimenopausal and postmenopausal women – a multicenter randomized clinical trial. Menopause 2010;17:269-280.
17. Hervik J, Mja˚land O. Acupuncture for the treatment of hot flashes in breast cancer patients, a randomized, controlled trial. Breast Cancer Research and Treatment 2009;116:311-316.
18. Meng ZQ, et al. Electro-acupuncture to prevent prolonged postoperative ileus: a randomized clinical trial. World Journal of Gastroenterology 2010;16:104-111.
19. Ng SS, et al. Electro- acupuncture for ileus after laparoscopic colorectal surgery: a randomized sham-controlled study. Hong Kong Medical Journal 2013;19(Suppl. 9):33-35.
20. Sun BM, et al. Acupuncture versus 
metoclopramide in treatment of postoperative gastroparesis syndrome in abdominal surgical patients: a randomized controlled trial. Journal of Chinese Integrative Medicine 2010;8:641-644.
21. Pfister DG, et al. Acupuncture for pain and dysfunction after neck dissection: results of a randomized controlled trial. Journal of Clinical Oncology 2010;28:2565-2570.