Acupuncture for the prevention of radiation-induced xerostomia in patients with head and neck cancer.

Abstract

The aim of this study was to evaluate the effectiveness of acupuncture in minimizing the severity of radiation-induced xerostomia in patients with head and neck cancer. A total of 24 consecutive patients receiving > 5000 cGy radiotherapy (RT) involving the major salivary glands bilaterally were assigned to either the preventive acupuncture group (PA, n = 12), treated with acupuncture before and during RT, or the control group (CT, n = 12), treated with RT and not receiving acupuncture. After RT completion, clinical response was assessed in all patients by syalometry, measuring the resting (RSFR) and stimulated (SSFR) salivary flow rates, and by the visual analogue scale (VAS) regarding dry mouth-related symptoms. Statistical analyses were performed with repeated-measures using a mixed-effect modeling procedure and analysis of variance. An alpha level of 0.05 was accepted for statistical significance. Although all patients exhibited some degree of impairment in salivary gland functioning after RT, significant differences were found between the groups. Patients in the PA group showed improved salivary flow rates (RSFR, SSFR; p < 0.001) and decreased xerostomia-related symptoms (VAS, p < 0.05) compared with patients in the CT group. Although PA treatment did not prevent the oral sequelae of RT completely, it significantly minimized the severity of radiation-induced xerostomia. The results suggest that acupuncture focused in a preventive approach can be a useful therapy in the management of patients with head and neck cancer undergoing RT.

Braz Oral Res. 2011 Apr;25(2):180-5.

Braga Fdo P, Lemos Junior CA, Alves FA, Migliari DA.

Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil.

Acupuncture improves health-related quality-of-life (HRQoL) and sleep in women with breast cancer and hot flushes.

Abstract

PURPOSE: Evaluate effects of electro-acupuncture (EA) and hormone therapy (HT) on health-related quality-of-life (HRQoL) and sleep in breast cancer survivors with vasomotor symptoms.

METHODS: Forty-five women, randomized to EA (n = 27) for 12 weeks or HT (n = 18) for 24 months, were followed for up to 2 years. Distress caused by, and numbers of, hot flushes, hours slept and times woken up/night, Psychological and General Well-being Index (PGWB) and Women's Health Questionnaire (WHQ) were registered before and during treatment and at 6, 9, 12, 18 and 24 months after start of treatment.

RESULTS: After 12 weeks of EA (n = 19), WHQ improved from 0.32 (IQR 0.23-0.53) at baseline to 0.24 (IQR 0.12-0.39; p < 0.001) and PGWB from 78 (IQR 53-89) to 79 (IQR 68-93; p = 0.002). All sleep parameters improved and Hot Flush Score (HFS) decreased by 80%. At 12 months, WHQ, PGWB and all sleep parameters remained significantly improved (n = 14) and HFS decreased by 65%. After 12 weeks of HT (n = 18), WHQ improved from 0.29 (IQR 0.15-0.44) at baseline to 0.15 (IQR 0.05-0.22; p = 0.001), PGWB from 75 (IQR 59-88) to 90 (62-97; p = 0.102) and three of five sleep parameters improved.

CONCLUSION: Both EA and HT increased HRQoL and sleep, probably through decreasing numbers of and distress by hot flushes. Although flushes decreased less in the EA group than in the HT group, HRQoL improved at least to the same extent maybe due to other effects of EA, not induced by HT, e.g. on anxiety, vitality and sleep, supported by subscale analyses. EA should be further evaluated as treatment for women with breast cancer and climacteric complaints, since HT no longer can be recommended for these women.

Support Care Cancer. 2011 Apr 6. [Epub ahead of print]

Frisk J, Källström AC, Wall N, Fredrikson M, Hammar M.

Obstetrics and Gynaecology, Faculty of Health Sciences, Linköping University, University Hospital, 581 85, Linköping, Sweden, Jessica.frisk@liu.se.

Getting the grip on nonspecific treatment effects: emesis in patients randomized to acupuncture or sham compared to patients receiving standard care.

Abstract

BACKGROUND: It is not known whether or not delivering acupuncture triggers mechanisms cited as placebo and if acupuncture or sham reduces radiotherapy-induced emesis more than standard care.

METHODOLOGY/PRINCIPAL FINDINGS: Cancer patients receiving radiotherapy over abdominal/pelvic regions were randomized to verum (penetrating) acupuncture (n = 109; 99 provided data) in the alleged antiemetic acupuncture point PC6 or sham acupuncture (n = 106; 101 provided data) performed with a telescopic non-penetrating needle at a sham point 2-3 times/week during the whole radiotherapy period. The acupuncture cohort was compared to a reference cohort receiving standard care (n = 62; 62 provided data). The occurrence of emesis in each group was compared after a mean dose of 27 Gray. Nausea and vomiting were experienced during the preceding week by 37 and 8% in the verum acupuncture group, 38 and 7% in the sham acupuncture group and 63 and 15% in the standard care group, respectively. The lower occurrence of nausea in the acupuncture cohort (verum and sham) compared to patients receiving standard care (37% versus 63%, relative risk (RR) 0.6, 95 % confidence interval (CI) 0.5-0.8) was also true after adjustment for potential confounding factors for nausea (RR 0.8, CI 0.6 to 0.9). Nausea intensity was lower in the acupuncture cohort (78% no nausea, 13% a little, 8% moderate, 1% much) compared to the standard care cohort (52% no nausea, 32% a little, 15% moderate, 2% much) (p = 0.002). The acupuncture cohort expected antiemetic effects from their treatment (95%). Patients who expected nausea had increased risk for nausea compared to patients who expected low risk for nausea (RR 1.6; Cl 1.2-2.4).

CONCLUSIONS/SIGNIFICANCE: Patients treated with verum or sham acupuncture experienced less nausea and vomiting compared to patients receiving standard care, possibly through a general care effect or due to the high level of patient expectancy.

PLoS One. 2011 Mar 23;6(3):e14766.

Enblom A, Lekander M, Hammar M, Johnsson A, Onelöv E, Ingvar M, Steineck G, Börjeson S.

SourceDivision of Nursing Science, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.

The Analgesic Effect of Magnetic Acupressure in Cancer Patients Undergoing Bone Marrow Aspiration and Biopsy: A Randomized, Blinded, Controlled Trial.

Abstract

CONTEXT: Bone marrow aspiration and biopsy (BMAB) is a frequently performed and painful procedure.

OBJECTIVE: To evaluate the efficacy of magnetic acupressure in reducing pain in cancer patients undergoing BMAB.

METHODS: Cancer patients without previous acupuncture or acupressure were stratified by the number of prior BMAB and randomized to having magnetic acupressure delivered to either the large intestine 4 (LI4) acupoint or a sham site. The primary study endpoint was the patient's pain intensity rating during the procedure using a visual analog scale (VAS).

RESULTS: Seventy-seven eligible patients received magnetic acupressure: 37 were randomized to treatment at the LI4 site arm and 40 at the designated sham site arm. There was no significant difference between the median pain scores of patients treated at the LI4 site and the sham site (P=0.87). However, severe pain (VAS≥7) was reported in only one patient (2.7%) treated at the LI4 site compared with eight patients (20%) at the sham site (P=0.03). No patients experienced significant magnetic acupressure-related toxicities.

CONCLUSIONS: Magnetic acupressure at the LI4 acupoint requires minimal training and expense and is well tolerated. Although its use did not significantly reduce median pain scores in patients undergoing BMAB, it does appear to reduce the proportion of patients with severe pain associated with this invasive procedure.

J Pain Symptom Manage. 2011 Feb 8.

Bao T, Ye X, Skinner J, Cao B, Fisher J, Nesbit S, Grossman SA.

The University of Maryland Marlene and Stewart Greenebaum Cancer Center and the Center for Integrative Medicine (T.B.), University of Maryland School of Medicine, Maryland; and The Sidney Kimmel Comprehensive Cancer Center (X.Y., J.S., B.C., J.F., S.N., S.A.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Reducing vasomotor symptoms with acupuncture in breast cancer patients treated with adjuvant tamoxifen: a randomized controlled trial.

Abstract

To evaluate true acupuncture to control acupuncture (CTRL) (non-insertive stimulation at non-acupuncture points) in breast cancer patients treated with adjuvant tamoxifen suffering from hot flushes and sweatings. Eighty-four patients were randomized to receive either true acupuncture or CTRL twice a week for 5 weeks. Seventy-four patients were treated according to the protocol. In the true acupuncture group 42% (16/38) reported improvements in hot flushes after 6 weeks compared to 47% (17/36) in the CTRL group (95% CI, -28 to 18%). Both groups reported improvement regarding severity and frequencies in hot flushes and sweatings but no statistical difference was found between the groups. In a subanalysis regarding the severity of sweatings at night a statistically significant difference P = 0.03 was found in the true acupuncture group. Former experience of true acupuncture did not influence the perception of true acupuncture or CTRL. No significant differences in hormonal levels were found before and after treatment. In conclusion, convincing data that true acupuncture is more effective than CTRL in reducing vasomotor symptoms is still lacking. Our study shows that both true and CTRL reduce vasomotor symptoms in breast cancer patients treated with adjuvant tamoxifen.

Breast Cancer Res Treat. 2010 Dec 14. [Epub ahead of print]

Liljegren A, Gunnarsson P, Landgren BM, Robéus N, Johansson H, Rotstein S.

SourceDepartment of Oncology, Radiumhemmet, Karolinska University Hospital and Karolinska Institutet, 171 76, Stockholm, Sweden, annelie.liljegren@karolinska.se.

Clinical effectiveness and safety of acupuncture in the treatment of irradiation-induced xerostomia in patients with head and neck cancer: a systematic review.

Abstract

BACKGROUND: Irradiation-induced xerostomia seriously reduces quality of life for patients with head and neck cancer (HNC). Anecdotal evidence suggests that acupuncture may be beneficial.

OBJECTIVE: To systematically review evidence on clinical effectiveness and safety of acupuncture in irradiation-induced xerostomia in patients with HNC.

METHODS: A detailed search was performed to identify randomised controlled trials (RCTs) and systematic reviews of RCTs on acupuncture in irradiation-induced xerostomia, using AMED, BNIA, CINAHL, Cochrane, Embase, HPSI, PsycInfo and Medline. Grey literature was explored and 11 journals hand searched. Search terms included: acupuncture, xerostomia, salivary hypofunction, hyposalivation, dry mouth, radiotherapy, irradiation, brachytherapy, external beam. Two authors independently extracted data for analysis using predefined selection criteria and quality indicators.

RESULTS: 43 of the 61 articles identified were excluded on title/abstract. 18 articles underwent full-text review; three were deemed eligible for inclusion. Two trials had moderate risk of bias; one had high risk. Two trials compared acupuncture with sham acupuncture; one control arm received 'usual care'. Outcome measurements included salivary flow rates (SFRs) in two trials and subjective questionnaires in three. All three trials reported significant reduction in xerostomia versus baseline SFR (p<0.05); one reported greater effect in the intervention group for stimulated SFR (p<0.01). Subjective assessment reported significant differences between real acupuncture and control in two trials (p<0.02-0.05). Insufficient evidence was presented to undertake risk/benefit assessment.

CONCLUSIONS: Limited evidence suggests that acupuncture is beneficial for irradiation-induced xerostomia. Although current evidence is insufficient to recommend this intervention, it is sufficient to justify further studies. Highlighted methodological limitations must be dealt with.

Acupunct Med. 2010 Dec;28(4):191-9. Epub 2010 Nov 9.

O'Sullivan EM, Higginson IJ.

SourceOral and Maxillofacial Surgery Department, Cork University Dental School and Hospital, UCC, Wilton, Cork 9999, Ireland. eleanor.osullivan@ucc.ie