Relief from Cancer Treatment

For many of the more than 100,000 individuals diagnosed with head and neck cancer each year in the United States, the cancer spreads from its primary location to lymph nodes in the neck. When this occurs, nerves known as spinal accessory nerves must also be removed along with the affected lymph node, which can lead to shoulder function problems.

A recent study [PubMed Abstract] conducted by Memorial Sloan-Kettering investigators and published in the April 2010 issue of the Journal of Clinical Oncology sought to determine if acupuncture could reduce pain and dysfunction in individuals with cancer of the head or neck who had received a surgical dissection of lymph nodes in their neck. The study evaluated 58 patients who were suffering from chronic pain or dysfunction as a result of neck dissection. For four weeks, study participants were randomly assigned into one of two groups: those receiving weekly acupuncture sessions and those receiving standard care, which included physical therapy, as well as pain and anti-inflammatory medication.

The study found that individuals in the group receiving acupuncture experienced significant reductions in pain and dysfunction when compared with individuals receiving standard care. Individuals in the acupuncture group also reported significant improvement in xerostomia, a condition in which patients receiving adjuvant radiation therapy experience extreme dry mouth. ⁽¹⁾

Many people with leukemia try additional treatments outside their standard care, hoping to manage symptoms and, in some cases, to improve their treatment outcome. In a commentary [PubMed Abstract] on the subject in the September 2009 issue of Expert Reviews Anticancer Therapies, Memorial Sloan-Kettering investigators examined the results from available studies testing the effectiveness of such approaches. They report that among the complementary therapies used to decrease symptoms and side effects, acupuncture is very beneficial for symptom management.

For some leukemia patients, cancer chemotherapy drugs can damage the peripheral nervous system (a condition known as peripheral neuropathy), causing pain, numbness, tingling, swelling, and muscle weakness in various parts of the body, especially in the hands and feet. In some cases, doctors must reduce the chemotherapy dose in order to prevent the neuropathy from progressing further. Acupuncture has been found to decrease these difficult neuropathy symptoms, allowing the maximum amount of chemotherapy to be used, thereby increasing the patient’s chance for a successful outcome.

Acupuncture is also known to reduce the effects of nausea caused by a variety of chemotherapy agents used to treat leukemia. Research has shown that timing the acupuncture sessions one to two days before chemotherapy infusion and continued weekly throughout the chemotherapy regimen produces the best results. In addition, the authors note that acupuncture has been proven safe for patients receiving the anticoagulation drugs Coumadin® or heparin during their leukemia treatment. ⁽¹⁾

A significant number of breast cancers have receptors for the hormone estrogen. These receptor-positive breast tumors are more likely to respond to therapy with anti-estrogen medications, which take advantage of the cancer cells’ dependence on hormones for growth. Women with these tumors are often given treatment that blocks the production of estrogen, which is meant to slow the growth of the tumor. These treatments can induce early menopause, leading to symptoms such as hot flashes, fatigue, and excessive sweating. Because these women cannot receive hormone replacement therapy, which is usually used to treat such symptoms, doctors typically prescribe antidepressants such as the drug venlafaxine (Effexor).

A recent study examined whether acupuncture reduces some of these common side effects and produces fewer adverse effects than antidepressants. In the study [PubMed Abstract], published in the February 2010 issue of the Journal of Clinical Oncology, 50 women with hormone-receptor positive breast cancer were assigned into one of two groups. The first group received 12 weeks of acupuncture, and the second group received treatment with venlafaxine.

Both groups experienced significant decreases in hot flashes, depressive symptoms, and other quality-of-life symptoms. However, women in the group taking venlafaxine began to re-experience their symptoms about two weeks after stopping drug therapy. In comparison, it took 15 weeks for the symptoms to return for women in the group receiving acupuncture. In addition, women in the acupuncture group reported no significant side effects during treatment, while the group taking venlafaxine experienced 18 incidences of adverse effects, including nausea, dry mouth, dizziness, and anxiety. ⁽¹⁾

Acupuncture given simultaneously with radiotherapy to the head and neck reduces the development and severity of xerostomia (dry mouth) and improves quality of life, according to results of a randomized controlled study published online November 9 in Cancer.

The majority of patients undergoing radiotherapy for head and neck cancer will develop xerostomia, which often severely impairs quality of life and leads to a host of other problems, say researchers from The University of Texas MD Anderson Cancer Center in Houston and Fudan University Shanghai Cancer Center in China.

The use of intensity modulated radiation therapy (IMRT) has reduced the incidence somewhat, but it still remains a significant problem in 60% to 80% of patients. Symptoms of radiation-induced xerostomia rarely improve spontaneously and treatment is largely palliative.

“Several approaches including saliva substitutes, chewing gum, sialogogue lozenges, pilocarpine, and amifostine have been attempted with limited benefit,” senior author Dr. Lorenzo Cohen said in an email to Reuters Health. “There are also unwanted side effects with many of these treatments.”

Dr. Cohen directs the Integrative Medicine Program at MD Anderson Cancer Center.

“Although the definitive, phase III, placebo-controlled trial is ongoing, clinicians should consider acupuncture during and subsequent to radiotherapy to help reduce and treatment xerostomia,” he advised.

The current study joins several previous studies that have shown positive results with acupuncture for relieving radiation-induced xerostomia, including one 2009 study performed by some of the same researchers at MD Anderson. (See Reuters Health report May 5, 2009.)

The new study, however, differs from previous ones in that it explored whether acupuncture can prevent xerostomia when delivered concurrently with radiotherapy; 86 patients with nasopharyngeal carcinoma were enrolled and treated at Fudan University Shanghai Cancer Center.

Forty were randomly assigned to acupuncture given three times a week on the same days as radiotherapy and 46 to a control group. Acupuncture was performed by an experienced acupuncturist and points were selected based on previously published reports and followed traditional Chinese medicine theory.

There were no between-group differences in patient age, sex, or tumor stage, or mean tumor radiation dose (70.8 and 70.9 Gy, respectively). The patients were followed for up to six months after the end of radiotherapy. Subjective measures included the Xerostomia Questionnaire and MD Anderson Symptom Inventory-Head and Neck (MDASI-HN). Objective measures were unstimulated and stimulated whole salivary flow rates.

For self-report measures and sialometry, group differences favoring acupuncture were evident as early as the third week and remained significant at one and six months after the end of radiotherapy, “even without additional acupuncture,” the investigators report.

Less than one third of patients in the acupuncture group reported clinically significant symptoms at six months, versus more than two thirds in the control group.

The researchers say it’s “noteworthy” that objective results supported subjective results and that significant differences in saliva flow between the two groups emerged as early as week three into treatment and remained six months later.

“Although this first study incorporating acupuncture during radiotherapy did not have a placebo control group, improvement in both subjective and objective measures suggests this treatment in more than just a placebo response,” Dr. Cohen told Reuters Health.

“The study also found an overall improvement in quality of life for patients who underwent acupuncture,” he noted.

At present, the putative biological mechanisms underlying the benefits of acupuncture on radiation-induced xerostomia are “not well understood” and need to be flushed out in further studies, the researchers say.

Regardless of the mechanism of action, however, they note that acupuncture is cost-effective, minimally invasive, and has a very low incidence of adverse effects. No adverse effects were seen in the current study, aside from mild discomfort from needle insertion in some patients. ⁽²⁾