About cancer care
Cancer and the treatments for cancer are associated with various symptoms. Fatigue is the most common symptom reported by survivors of cancer (Johnston 2007). Forty percent of people with early or intermediate stage cancer, and 90% with advanced cancer, have moderate to severe pain; up to 70% of those with cancer pain do not receive adequate pain relief (Paley 2011). Hot flushes are common in women with a history of breast cancer but, while hormonal therapies are known to reduce these symptoms, they are not recommended for these women due to their potential unwanted effects (Rada 2010).
More than 70% of seriously ill patients with cancer suffer from xerostomia and the associated problems of swallowing, chewing and speaking (Meidell 2009). Leukopenia and neutropenia are common side effects during cancer treatment (Lu 2007). Many patients undergoing chemotherapy experience nausea and vomiting (Gralla 1999; Hesketh 1998). The symptoms can be severe, impairing a patient's quality of life (Osoba 1997), causing emotional distress (Love 1989), and aggravating cancer-related symptoms such as cachexia, lethargy and weakness (Griffin 1996; Roscoe 2000).
Gralla R et al. Recommendations for the use of antiemetics: Evidence-based, clinical practice guidelines. Journal of Clinical Oncology 1999; 17: 2971-94.
Griffin A et al. On the receiving end: V Patient perceptions of the side effects of chemotherapy in 1993. Annals of Oncology 1996; 7: 189-95.
Hesketh P et al. Methodology of antiemetic trials: response assessment, evaluation of new agents and definition of chemotherapy emotogenecity. Supportive Care Cancer 1998; 6: 221-7.J
Johnston MF et al. Acupuncture and fatigue: current basis for shared communication between breast cancer survivors and providers. J Cancer Surviv 2007 Dec;1(4):306-12.
Lu W et al. Acupuncture for chemotherapy-induced leukopenia: exploratory meta-analysis of randomized controlled trials. Journal Of The Society For Integrative Oncology 2007; 5: 1-10
Love R et al. Side effects and emotional distress during cancer chemotherapy. Cancer 1989; 63: 604-12.
Meidell L, Holritz Rasmussen B. Acupuncture as an optional treatment for hospice patients with xerostomia: an intervention study. Int J Palliat Nurs 2009; 15: 12-20.
Osoba D et al. Effect of postchemotherapy nausea and vomiting on health-related quality of life. The Quality of Life and Symptom Control Committees of the National Cancer Institute of Canada Clinical Trials Group. Supportive Care Cancer 1997; 5: 307-13
Paley CA et al. Acupuncture for cancer pain in adults. Cochrane Database Syst Rev. 2011 Jan 19;(1):CD007753.
Rada G et al. Non-hormonal interventions for hot flushes in women with a history of breast cancer. Cochrane Database Syst Rev. 2010 Sep 8;(9):CD004923.
Roscoe J et al. Nausea and vomiting remain a significant clinical problem: trends over time in controlling chemotherapy-induced nausea and vomiting in 1413 patients treated in community clinical practices. Journal of Pain and Symptom Management 2000; 20: 113-21.
How acupuncture can help
Pain. One systematic review provided limited evidence that acupuncture may provide long-term pain relief in patients with cancer (Paley 2011). The review found there was a shortage of good quality trials, though more recent examples have strengthened the evidence. For example, one found it more effective than usual care for pain and dysfunction after neck dissection (Pfister 2010); in another it was more effective than cobamamide for peripheral neuropathy due to chemotherapy (Xu 2010); and a third found it to be better than sham acupuncture for joint symptoms caused by aromatase inhibitors (Crew 2010).
Fatigue. Two small randomised controlled trials showed that acupuncture may be more effective than sham acupuncture (Balk 2010; Molassiotis 2007), but further data is needed to make a convincing case.
Xerostomia (radiotherapy-induced). A systematic review found possible benefits with acupuncture (O’Sullivan 2010), though not all the inter-group differences were significant.
Leukopaenia. A systematic review concluded acupuncture may possibly be effective for chemotherapy-induced leukopaenia (Lu 2007), though the studies were of poor quality. More recent randomised controlled trials found it to increase granulocyte colony-stimulating factor and improve leukopaenia (Han 2010), and to increase white blood cell values (Lu 2009).
Vasomotor symptoms. One systematic review of three trials in women with breast cancer (Lee 2009a), plus a further four more recent trials (Frisk 2011; Liljegren 2010; Walker 2010; Hervik 2009), provide mixed results from which it is hard to draw definite conclusions. Acupuncture has been found superior to sham in two out of three; better than venlafaxine in one out of two; similar to relaxation; and less effective than hormone therapy (but without the serious side effects). There is also a systematic review in respect of men with prostate cancer: the results were promising but very much preliminary (Lee 2009b).
Nausea and vomiting. Three systematic reviews found that moxibustion or acupuncture can help relieve nausea and vomiting (Lee 2010; Chao 2009; Ezzo 2006), especially in acute situations. There is more about the effects of acupuncture on these symptoms in the Nausea and Vomiting factsheet. In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.
Research has shown that acupuncture treatment may specifically benefit symptoms associated with cancer and its treatment by:
- Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);
- Regulating neurotransmitters (or their modulators) and hormones such as serotonin, noradrenaline, dopamine, GABA, neuropeptide Y and ACTH; hence altering the brains’s mood chemistry to help to combat negative affective states (Lee 2009; Cheng 2009; Zhou 2008);
- Increasing the release of adenosine, which has antinociceptive properties (Goldman 2010);
- Improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling;
- Stimulating production of endogenous opioids that affect the autonomic nervous system (Arranz 2007). Stress activates the sympathetic nervous system, while acupuncture can activate the opposing parasympathetic nervous system, which initiates the relaxation response;
- Reversing pathological changes in levels of inflammatory cytokines (Arranz 2007);
- Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003);
- • Reversing stress-induced changes in behaviour and biochemistry (Kim 2009);
- Increasing levels of T lymphocyte subsets such as CD(3) , CD(4), and CD(8) , as well as Natural Killer cells (Zhao 2010);
- Relieving nausea and vomiting by regulating gastric myo-electrical activity (Streitberger 2006) , modulating the actions of the vagal nerve and autonomic nervous system (Huang 2005), and regulating vestibular activities in the cerebellum (Streitberger 2006);
- Reducing vasopressin-induced nausea and vomiting and suppressing retrograde peristaltic contractions (Tatewaki 2005).
N.B. Acupuncture may be used for some of the symptoms of cancer, and the sideeffects of conventional cancer treatments, but it is not used to address the cancer itself.
About the British Acupuncture Council
With over 3000 members, the British Acupuncture Council (BAcC) is the UK’s largest professional body for traditional acupuncturists. Membership of the BAcC guarantees excellence in training, safe practice and professional conduct. To find a qualified traditional acupuncturist, contact the BAcC on 020 8735 0400 or visit www.acupuncture.org.uk