Acupuncture Reverses Chemotherapy Side Effects

Acupuncture Reverses Chemotherapy Side Effects

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In the United States, acupuncture is used to treat a variety of symptoms and conditions associated with cancer and the side effects of cancer treatments. A number of cancer centers in the U.S., including Dana-Farber Cancer Institute (DFCI) in Boston, Memorial Sloan-Kettering Cancer Center in New York, and M.D. Anderson Cancer Center in Houston are integrating acupuncture into cancer care. Despite interest by conventional care providers and the public in the integration of acupuncture into cancer care, the full extent to which acupuncture can be applied to oncology care is limited by research evidence regarding its efficacy and safety in treating and preventing cancer-related symptoms.

There are a few conditions for which sound research has demonstrated acupuncture to be an effective and safe adjunct therapy for cancer care. Randomized clinical trials (RCT) have demonstrated that acupuncture is effective for chemotherapy-induced nausea and vomiting. Research studies also suggest acupuncture may be helpful in managing cancer-related pain, chemotherapy-related neutropenia, cancer fatigue, and radiation-induced xerostomia.

What is acupuncture?

The National Institutes of Health (NIH) has defined acupuncture as “a family of procedures involving stimulation of anatomical locations on the skin by a variety of techniques. The most studied mechanism of stimulation of acupuncture points uses penetration of the skin by thin, solid, metallic needles, which are manipulated manually or by electrical stimulation

Mechanism of Action

The mechanism of action of acupuncture has been of great interest to many researchers. Numerous mechanistic studies of acupuncture in animal models and humans suggest that the effect of acupuncture is primarily based on stimulation to and the responses of the neuroendocrine system involving the central and peripheral nervous systems.

Data from animal research suggests that therapeutic acupuncture is partially mediated through opioidergic and/or monoaminergic neurotransmission involving the brainstem, thalamus, hypothalamic as well as pituitary function. Human neuroimaging data from functional magnetic resonance imaging (fMRI), positron emission tomography (PET), and electroencephalography (EEG) have demonstrated that acupuncture stimulation moderates a wide network of brain regions, including the primary somatosensory, secondary somatosensory, and anterior cingulated, prefrontal, and insular cortices, amygdale, hippocampus, hypothalamus, and other areas.

In several animal models, acupuncture and other stimulation methods of acupuncture points, such as thread implantation and point injection, suggest that acupuncture could down regulate the expression of Transforming Growth Factor (TGF). Particularly, two independent studies on rat models of liver fibrosis and chronic renal failure found an inhibition of TGF-β1 expression in the tissues after acupuncture points were stimulated by either a thread implantation or injection with Chinese herbs.

Chemotherapy-induced nausea and vomiting

After the NIH Consensus Conference in 1997, several well-designed clinical trials generated promising results. A randomized controlled trial further confirmed acupuncture’s antiemetic effect on patients receiving chemotherapy, with a significant reduction of mean emesis episodes (5 vs. 15; P<0.001) compared with pharmacotherapy alone.

In addition to chemotherapy-induced nausea and vomiting, acupuncture has been shown to be effective in the prevention of post operative nausea and vomiting.

A systematic review in 2017 looked at acupuncture in people with breast cancer. It showed that doctors could use acupuncture with other anti-sickness medication. And that it could have a real benefit in helping with nausea and vomiting.

Cancer pain

Pain is a long-standing and unresolved clinical issue among cancer patients. Even after over 20 years since the World Health Organization (WHO) published its recommendation of an analgesic ladder for pain control,45 fifty-five percent of cancer patients still suffer from various forms of pain that significantly impacts their quality of life (QOL).

Several systematic reviews support the use of acupuncture for a wide range of non-cancer-specific pain conditions in clinical practice. These pain conditions include osteoarthritis, chronic knee pain, shoulder pain, neck pain and acute dental pain. Although the numbers of acupuncture clinical trials for cancer-specific pain are still small, results of these non-cancer related clinical trials may support benefit for patients with cancer. cancer pain may be brought on by a combination of biological, psychological and social components. Acupuncture-induced analgesic effects can strongly influence the psychological aspect of pain.

Several small studies showed that acupuncture can help with joint pain and stiffness. Joint pain is a common side effect of aromatase inhibitors. These are a type of hormone treatment for breast cancer.

A systematic review in 2017 looked at acupuncture in people with breast cancer. It showed that doctors could use acupuncture with other anti-sickness medication. And that it could have a real benefit in helping with nausea and vomiting.

Depression and anxiety

A recently published RCT reports that massage combined with acupuncture in post-operative cancer patients can improve the depressive mood of these patients when used in conjunction with usual care (p=0.003).

A review study in 2017 found that acupuncture could have a small benefit in helping with anxiety.

Hot flashes

Hot flushes and sweats are a common side effect of treatment. This is in people having treatment for breast, prostate or womb cancers.

Several studies have had varying results on the use of acupuncture for hot flushes.

A 2013 review of acupuncture trials with 281 people found that there is not enough evidence to say that it can help with hot flushes. It concluded that we need more research.

The AcCliMaT study in 2016 was with people with breast cancer. They had hot flushes. It found that people who had acupuncture, had fewer symptoms.

A review study in 2017 said that acupuncture had a small effect on improving hot flushes. This study was also in people with breast cancer.

Leukopenia

Although there is an absence of medical literature in the English language on the use acupuncture for leukopenia, several RCTs conducted in China have suggested that acupuncture could be effective in reducing marrow suppression related leukopenia in patients undergoing chemotherapy. An exploratory meta-analysis of clinical trials conducted in China suggests that acupuncture use is associated with an increase in leukocytes in patients during chemotherapy or chemo-radiotherapy, with a weighted mean difference of 1,221 WBC/µL on average (95% confidence interval 636–1,807; p < .0001)

Fatigue

Tiredness (fatigue) after chemotherapy is hard to manage and can have a big effect on your life. It sometimes lasts for years.

Several prospective pilot trials have shown acupuncture may benefit patients with chemotherapy related fatigue. In patients with persistent fatigue who had previously completed cytotoxic therapy and were not anemic, acupuncture resulted in a 31.3% improvement in the baseline fatigue score.

The ACU.FATIGUE trial in 2012 was a study of 302 people. It looked at acupuncture for tiredness after chemotherapy treatment for breast cancer.The results showed that it helped to reduce fatigue and improved the women’s quality of life.

Neuropathy

Chemotherapy-induced neuropathy, e.g., from platinum and taxol related compounds, is a common problem. A small pilot study of 5 patients suggested a partial response to acupuncture that could not be explained by any other known neurophysiologic mechanism81. A positive impact from acupuncture on neuropathy in DFCI clinic patients also has been observed

Insomnia

Insomnia is one of the most significant symptoms of cancer patients, along with anxiety. Acupuncture has been researched among patients with insomnia with mixed results. A small, non-cancer study found acupuncture may significantly reduce insomnia and anxiety, with clear objective improvements in nocturnal melatonin secretion and in polysomnographic measures. A meta-analysis showed that the improvement rate of insomnia produced by ear acupuncture was significantly higher than those from diazepam (p < 0.05).

A review of studies in 2017 found that at the moment there is not enough evidence. It suggested that we need more research.

Radiation-induced xerostomia

Xerostomia, or dry mouth, is considered a significant factor underlying dysphagia. Several pilot clinical studies suggest that acupuncture may improve xerostomia caused by radiation therapy in patients with head and neck cancers.

Studies using fMRI found a relationship between stimulating acupuncture point, LI-2, located at the base of index finger, and the activation of the brain function area responsible for salivary production.

A systematic review study in 2018 looked at how well acupuncture worked for a dry mouth caused by different conditions. It included a dry mouth caused by radiotherapy treatment for cancer. The researchers found that there is not enough evidence to say that acupuncture is a treatment for a dry mouth backed up by research.

Summary

Clinical research on acupuncture in cancer care is a new and challenging field in oncology. The results of clinical research will continue to provide us with clinically relevant answers for patients and oncologists. The evidence currently available has suggested that acupuncture is a safe and effective therapy to manage cancer and treatment related

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