The use of complementary medicine for the treatment of cancer and its side effects has skyrocketed in recent years. Complementary therapies refer to ones that are nonpharmaceutical in nature, and that have the potential to not only enhance quality of life, but also to reduce side effects of conventional therapy. Such therapies include massage, yoga, meditation, acupuncture, nutritional supplementation, and intravenous therapies.
People living with cancer often have many sources of side effects. First, they may have pain associated with the cancer itself, or intense emotional turmoil, such as anxiety and depression, which often cause sleep disruption. Second, they can have side effects directly related to surgery, chemotherapy, radiation, or hormone therapy, such as nausea and vomiting, chronic surgical pain, fatigue, mouth sores, or hot flashes. Third, they can have side effects from prescription medications commonly given to treat those side effects. Minimizing and preventing side effects is unfortunately a poorly handled area of medicine, and finding and utilizing therapies that are effective, safe, and have low side-effect profiles is of utmost importance. Acupuncture has long been used in traditional Chinese medicine and is becoming more commonly used in Western countries. It involves the insertion of very thin needles into the skin at points on the body that have been shown to have increased conductive capacity. Studies continuously report the safety of acupuncture treatments in cancer patients, with very low rates of adverse effects. The most common adverse effects are bruising or pain at the site of the needle, and one review stated that the risk of an adverse effect was 0.05 per 10,000 treatments. The potential for acupuncture to improve quality of life in the cancer-patient population is huge. A review of the medical research is quite impressive. A recent review concluded that the majority of studies support the benefit of acupuncture for cancer-related pain, cancer-related fatigue, nausea and vomiting, hot flashes, and quality of life. This begs the question as to why this therapy is not considered as a part of standard of care.
IMMUNE FUNCTION The immune system is a key player in fighting cancer and in preventing metastatic spread. It is often weakened during conventional treatments, which can lead to treatment interruption and increased risk of infection. Treatments that can prevent the drop in our immune cells are vitally important. Many studies have shown that acupuncture treatments can increase macrophages, neutrophils, natural killer cells, lymphocytes, and immunoglobulin production. One recent study, although very small in nature, randomized 18 participants with either stage‑2 or ‑3 colorectal cancer to receive weekly acupuncture sessions alongside chemotherapy, or chemotherapy alone. The acupuncture group showed increased white blood cells, natural killer cells, and neutrophils compared to the chemotherapy-alone group.
PERIPHERAL NEUROPATHY Peripheral neuropathy is characterized by tingling and pain in the fingers and toes, and patients can also be exquisitely sensitive to hot, cold, and pressure. It greatly interferes with quality of life, can persist for many months or even years, and is inadequately treated with prescription medications. A recent review summarized the research findings with respect to the effect of acupuncture on peripheral neuropathy. In one small study of five patients suffering from peripheral neuropathy, once weekly acupuncture for two six-week sessions (separated by four weeks) showed a significant improvement in pain scores, and benefits persisted for six months in four out of five patients. A recent pilot study of 25 patients who had grade‑2 or greater peripheral neuropathy for an average time of 19 months postchemotherapy received once-weekly treatments for ten weeks. At the end of ten weeks, pain scores decreased from 20.1 to 13.2, 56% of people reported improved daily function (walking, doing up buttons), and 40% of patients reported more than a 50% decrease in symptoms. Results persisted at four-week follow-up.
NAUSEA AND VOMITING
Nausea and vomiting is a common experience in postoperative settings, as well as postchemotherapy. A Cochrane review looked at the results from 26 studies with more than 3000 patients who had received acupuncture for nausea and vomiting, and found that stimulation of one single point was extremely effective. Further, data indicated that acupuncture was superior to antiemetic medications.
FATIGUE Cancer-related fatigue is not the sort of fatigue that is alleviated simply by rest and sleep; it is often debilitating and can persist chronically posttreatment. Patients often seek out complementary care for this symptom. One study of stage‑1 to ‑3 breast cancer patients randomized 75 patients to usual care (no acupuncture) and 227 to receive once-weekly treatments for six weeks. Fatigue scores were measured before and after treatment, and after the six weeks of treatment, there were significant improvements in fatigue in the acupuncture group compared to the control group.
HOT FLASHES Hot flashes are a very common side effect of hormone therapies given to women with breast cancer and men with prostate cancer. Both men and women can experience severe hot flashes many times per day. Standard treatment for hot flashes are SSRIs or gabapentin, but often patients do not experience complete relief. One small study looked at seven men with prostate cancer who had been prescribed androgen deprivation therapy and who were experiencing hot flashes. Each man had twice weekly acupuncture sessions for six weeks, and at the end of treatment the severity of hot flashes had decreased, and all men reported at least a 50% reduction in the frequency of hot flashes. Another larger clinical trial involved 120 breast-cancer survivors who were experiencing at least twice-daily hot flashes. They were randomized to receive either weekly acupuncture sessions for eight weeks, or daily gabapentin. The hot flashes improved the greatest in the acupuncture group, with fewer side effects.
PAIN Cancer pain can be a result of surgery, side effects of radiation or chemotherapy, and from the tumour itself causing pressure and inflammation. It is commonly managed with strong prescription pain medications, such as opiates, that all can have unpleasant side effects. Complementary treatments for pain management are very important. One study of 183 patients who were either in remission or actively receiving treatment treated them with acupuncture for the chief complaint of pain. Results showed that mean symptom severity scores for chronic pain decreased from 7.04 to 2.56. Joint pain is also a common complaint in women taking aromatase inhibitors for breast cancer. One study randomized 67 women to receive ten sessions of electroacupuncture or a wait list control, which showed that pain scores as measured by the Brief Pain Inventory were significant lower in the acupuncture group, and the benefits persisted at 12-week follow-up.
XEROSTOMIA Xerostomia, or dry mouth, is common in head- and neck-cancer patients who have received radiation. The salivary glands can become impaired, which decreases production of saliva. There is significant positive research for the benefits of acupuncture for the treatment of this chronic condition. One study randomized 145 head- and neckcancer patients suffering from dry mouth to eight sessions of acupuncture or usual oral care. Compared with usual care, acupuncture produced significantly greater reductions in patients reports of severe dry mouth, sticky saliva, needing to sip fluids constantly, and waking in the night to drink.
OTHERS Many other studies have been conducted aiming to assess acupuncture for general quality-of-life parameters in cancer patients, which tend to show benefit. One study of breast cancer patients randomized 40 women to receive ten weekly acupuncture sessions or placebo. The researchers were looking at whether acupuncture could improve fatigue, sleep, and psychological distress. Results showed a statistically significant improvement in fatigue and a decrease in anxiety, as well as a slight improvement in sleep. Another study treated 33 lung-cancer patients once or twice weekly for 7–13 sessions. There were significant improvements in scores related to pain, nausea, appetite, and overall wellbeing.
CONCLUSION Acupuncture is a highly researched and well-supported treatment for the side effects of conventional cancer treatments, and can significantly improve quality of life.
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