Acupuncture in Cancer Care
Acupuncture in Cancer Care
Acupuncture is a therapeutic modality in Traditional Chinese Medicine (TCM), developed over the millennia. Treatment involves the placement of needles at selected points on the body, followed by manipulation with physical forces, heat, or, in modern times, electrical stimuli. According to TCM theory, vital energy ("Chi" or "Qi" in Chinese) flows throughout the body along channels called meridians (Figure 1). It was believed that the interruption or obstruction of the body's energy makes one vulnerable to illness. Insertion of needles at specific points along the meridian is thought to regulate the energy flow, which produces a therapeutic benefit.
The concepts of "Qi" and meridians are inconsistent with our current understanding of human anatomy and physiology. However, research supports the clinical effects of acupuncture. Recent neuroscience research suggests that it appears to work by modulating the nervous system. Therefore, "Qi" and meridians may be viewed as metaphors to explain the clinical responses observed by TCM practitioners during acupuncture.
During a treatment, the therapist first interviews the patient, then performs an examination according to TCM teachings, with special focus on the qualities of the pulse and appearance of the tongue, and arrives at a TCM diagnosis. The diagnosis typically is a description of a disease pattern rather than a pathological opinion. Based on the diagnosis, acupuncture points are selected.
These points on the body are located and the skin is cleaned. Then the needle, in its guide tube, is placed at each identified point. A gentle tap applied to the top of the needle helps it to penetrate the skin. The guide tube is subsequently removed, and the needle is advanced to the desired depth via a gentle twisting and pushing movement. The practitioner may decide to apply heat or electrical stimuli to the needle. Heat is traditionally provided by TCM practitioners through moxibustion, a burning mound of the chrysanthemum species Artemisia vulgaris, or in modern times, by a heat lamp. As of the latter part of the 20th century, some acupuncturists attach a small electric pulse-generating device to each needle to increase stimulation of the acupuncture points. Such practice is called "electroacupuncture." Acupuncture needles are regulated as a medical device in the United States. They are filiform, sterile, single-use, and thin (28 to 40 gauge), about the width of a human hair. The needles are usually made of stainless steel and are individually packaged in a guide tube (see Figure 2).
How Is It Currently Used?
Historically, acupuncture was used to prevent and treat many ailments. Its efficacy has been evaluated with rigorous scientific research methodology only in the last few decades, when acupuncture's physiologic effects, possible mechanisms of action, and clinical efficacy for specific indications have been documented. It has been shown to be efficacious in randomized controlled clinical trials for pain, nausea and vomiting, and other symptoms.[2–5] Acupuncture is perhaps the most accepted TCM modality in Western countries, due in large part to this growing body of research. Acupuncture can induce objective, measurable neurophysiologic changes in animals and humans.
During the last decade, acupuncture has become increasingly integrated into mainstream cancer care in the US. Most major comprehensive cancer centers and many community hospitals have an integrative medicine component that includes acupuncture treatment as a supportive care modality. Acupuncture is not used as a treatment for disease. Accredited acupuncturists who often are physicians provide acupuncture. Some patients seek care from acupuncture practitioners who are in the community and not affiliated with major medical institutions.
What Is the Evidence for Use of Acupuncture in Cancer Care?
There is no evidence that acupuncture has direct effects against cancer, and it should not be used in efforts to treat disease. However, clinical research shows that acupuncture can reduce many important physical and emotional symptoms commonly experienced by cancer patients, thereby improving patients' quality of life.
Pain is the most common and best-studied indication for acupuncture. Strong evidence in support of acupuncture as a supportive treatment comes from studies of headache, lower back pain, and arthritic pain.[4,6–8] Acupuncture appears to be effective against cancer-related pain, although the evidence is less strong.[9–11] A randomized placebo-controlled trial tested auricular (outer ear) acupuncture for patients experiencing pain despite stable medication. Small acupuncture needles were implanted at selected points on the ears for 1 month. Pain intensity decreased by 36% at 2 months from baseline in the treatment group, a statistically significant difference compared with two control groups in the study, for whom little pain reduction was seen. Skin penetration per se showed no significant analgesic effect. These results are interesting because most of the study patients had neuropathic pain, which rarely responds to conventional treatment.
Other painful conditions in cancer patients have been studied. For example, breast cancer patients taking aromatase inhibitors often experience joint pain. A randomized controlled trial evaluated auricular and full-body acupuncture treatment for aromatase-inhibitor-induced arthralgia in breast cancer patients. Fifty-one postmenopausal women were randomized to receive true or sham acupuncture twice weekly for 6 weeks. The worst pain scores, pain severity, and pain-related functional interference were significantly reduced by actual versus sham acupuncture treatment.