Acupuncture for Post Cancer

Acupuncture is used in integrative oncology programs (in combination with conventional treatment) around the world including USA, Israel and Australia to improve quality of life for patients undergoing cancer treatment and for cancer survivors. Research has confirmed that Acupuncture is effective in the management of chemotherapy induced nausea and vomiting in combination with anti-emetic medications, but research into other symptoms such as cancer related fatigue, cancer related insomnia, cancer pain and neuropathy is still ongoing. 

Post cancer related symptoms or cancer adverse effects may be present from chemotherapy, radiotherapy, surgery, bone marrow transplants, biological therapies or hormone therapies all of which may contribute to the following side effects (1, 2):

• Fatigue.
• Pain.
• Nausea and vomiting.
• Xerostomia (dry mouth).
• Peripheral neuropathy.
• Hot flushes.
• Cancer-related insomnia.
• Cancer-related psychological disorders.

We understand that one or more of the above symptoms can place a burden on you, or a loved one’s quality of life in relation to physical function, ability to perform daily activities or psychological distress. We also understand the financial pressure that may be involved or the inability to work, and the distress that this or the impact of symptoms may have on you, your family or friends. We want to be able to provide you and your family with as much support as possible.

In saying this, we take into consideration your body as a whole and treat according to the presenting symptoms, your lifestyle and dietary habits and also make note of any environmental or emotional distress that may be present. By understanding this allows us to design a treatment plan specific to your needs in hope that we can help successfully enhance your quality of life in combination with any current or usual care that you already receive.

Chemotherapy induced nausea and vomiting is an unwanted side effect of cancer treatment and is often not fully controlled even with state-of-the-art antiemetics. Acupuncture can assist in improving quality of life for these cancer patients and is accepted as an appropriate referral option (7, 8). Acupuncture is also recognised as having a potential positive effect on cancer pain (7).

Cancer-related fatigue is difficult to understand unless you have truly experienced it. It is unlike any other fatigue you may have experienced. It is commonly defined as a subjective feeling of physical, emotional or cognitive tiredness or exhaustion that is not proportional to the recently performed activity (3). Acupuncture for post cancer related fatigue is still inconclusive but research is ongoing. Acupuncture may be effective in particular fatigue contexts that favourably affect symptoms that amplify fatigue such as:

• Pain.
• Sleep disturbances.
• Stress or psychological distress.

Research

 Chemotherapy-induced nausea and vomiting (CINV)

• For chemotherapy – induced nausea and vomiting acupuncture was rated as ‘effective’ in the Australian DVA review (2010) and was not reviewed separately to ‘cancer adverse effects’ in the USVA Evidence map of acupuncture (2014) (6, 7).
• In 2013, a systematic review of seven acupuncture and six acupressure RCTs found that acupuncture reduced the frequency of acute vomiting and the dose of rescue medication but did not reduce acute nausea severity or frequency compared to control. Acupressure showed a decrease in frequency of nausea but not acute vomiting or delayed symptoms. All studies used state-of-the-art combination anti-emetics in addition acupuncture/acupressure. The reviewers rated the quality of evidence in the acupuncture studies as low to moderate while the acupressure studies were moderate to high quality. There was insufficient evidence to draw firm conclusions due to underpowered studies - The Acupuncture Evidence Project © AACMA 9 (9).
• An updated systematic review by Garcia et al in 2014 (using 18 new RCTs) found that acupuncture is an appropriate referral option for chemotherapy-induced nausea and vomiting (10). On this basis, acupuncture for CINV has been rated as positive potential effect.
• Acupuncture may reduce fatigue after cancer treatment; low quality evidence (Finnegan-John 2013 - SR of CAM 20 studies; 3 acupuncture/acupressure RCTs), Acupuncture plus education superior to usual care; low qualoty evidence (Zeng 2014 (SR of 7 RCTs) (11)  

 References:

1. Cancer Council Victoria, 2016 ‘Information, treatment, and side effects’, viewed on 11 June 2017.
2. Weis, J 2011, ‘Cancer-related fatigue: prevalence, assessment and treatment strategies’. Expert review of pharmacoeconomics & outcomes research, vol. 11, no. 4, pp. 441 – 6.
3. Campos MP, Hassan BJ, Riechelmann R, Giglo D, 2011, ‘A Cancer-related fatigue: a practical review’, Annals of Oncology, vol.22, is. 2, pp.1273 – 1279.
4. Zick S, 2011, ‘research Article: Relaxation Acupressure Reduces Persistent Cancer-Related Fatigue’, Evidence Based Complementary and Alternative Medicine, Hindawi Publishing Corporation, vol. 2011, Article ID 142913, pp.1 – 10.
5. McDonald J, Janz S, 2017, ‘The Acupuncture Evidence Project: A Comparative Literature Review (Revised edition). Brisbance: Australian Acupuncture and Chinese Medicine Association Ltd; 2017. http://www.acupunctrue.org.au
6. McKeon C, Smith C.A, Hardy J & Chang E, 2013, Acupuncture and acupressure for chemo-therapy induced nausea and vomiting: a systematic review. Australian Journal of Acupuncture and Chinese Medicine. 8 (1) pp. 2.
7. Biotext. Alternative therapies and Department of Veterans' Affairs Gold and White Card arrangements. In: Australian Government Department of Veterans' Affairs, editor: Australian Government Department of Veterans' Affairs; 2010.

8. Hempel S, Taylor SL, Solloway MR, Miake-Lye IM, Beroes JM, Shanman R, et al. VA Evidence-based Synthesis

9. McKeon C, Smith, C.A., Hardy, J. & Chang, E. Acupunctrue and acupressure for chemotherapy-induced nausea and vomiting : a systematic review. Australian Journal of Acupuncture and Chinese Medicine. 2013;8(1):2-17.

10. Garcia MK, McQuade J, Lee R, Haddad R, Spano M, Cohen L. Acupuncture for symptom management in cancer care: an update. Curr Oncol Rep. 2014 Dec;16(12):418.

11.  Zeng Y, Luo T, Finnegan-John J, Cheng AS. Meta-Analysis of Randomized Controlled Trials of Acupuncture for Cancer-Related Fatigue. Integr Cancer Ther. 2014 May;13(3):193-200.