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Cancer patients turn to acupuncture to cope with symptoms, side effects

Acupuncture, the traditional Chinese medicine that uses needles for treatment, is increasingly being used with cancer patients. Dr. Ting Bao, an assistant professor at the University of Maryland School of Medicine and faculty at Maryland's Marlene and Stewart Greenebaum Cancer Center and Center for Integrative Medicine, regularly used acupuncture to alleviate pain and treat side effects.

Question: How common is it for cancer patients to seek relief using acupuncture?

Answer: It is difficult for me to come up with a percentage because there have not been many studies performed to answer this question yet. What I can say is that based on my experience at the University of Maryland Greenebaum Cancer Center, more and more cancer patients are interested in integrating acupuncture into their cancer treatment. I started an acupuncture clinic two years ago at UMGCC and at that time, most of my patients were surprisingly not cancer patients but were there getting help for pain, anxiety, constipation or weight loss. Now, most of my patients are cancer patients seeking help to treat or prevent their cancer symptoms or the side effects of their cancer treatments.

Q: What is acupuncture and how does it work?

A: Acupuncture is a traditional Chinese medicine technique that involves inserting and manipulating filiform needles in predefined points on the skin to achieve therapeutic effect. Acupuncture has been widely used in China to treat a range of medical conditions such as pain, nausea, vomiting, infertility and seasonal allergies. Acupuncture was introduced in the United States in 1971 after New York Times reporter James Reston reported that acupuncture relieved his postoperative pain after an emergency appendectomy while he was in Beijing. While the specific mechanism of acupuncture is not fully understood, it has been proposed that acupuncture works through its effect on neurotransmitters and neurohormones. Animal research suggests that acupuncture accomplishes its effect by stimulating nerves in the muscle, which then relay a signal to the spinal cord, midbrain, and hypothalamus and pituitary system, which then leads to the release of neurotransmitters and hormones such as endorphins and enkephalins. Other mechanisms such as activation of descending pain inhibiting pathways, deactivation of the limbic system, cortical cerebral vasodilation resulting in neuropeptide release and inhibition of the release of inflammatory factors have also been suggested to explain the analgesic effects of acupuncture. A recent article in Nature suggests that acupuncture works through adenosine, a neuromodulator with pain-relieving properties.

Q: What are the side effects of acupuncture?

A: Acupuncture has been demonstrated to be a safe procedure, especially when used by competent practitioners. Some common adverse reactions are temporary and minor. These include local pain and bruising, minor bleeding, and lightheadedness. Serious side effects are rare. A cumulative review of eight systemic literature reviews between 1966 and 2001 reported 715 severe adverse events worldwide, including trauma such as pneumothorax, infection and miscellaneous events such as seizure and drowsiness. Adverse reactions such as these have significantly declined since 1988, when using disposable and sterilized needles was required by law and when more rigorous requirements for acupuncture training were mandated.

Q: Are there studies on effectiveness of treating breast cancer patients with acupuncture or any in the works? What symptoms of breast cancer and treatment could it help alleviate?

A: Yes, there have been several studies on the effect of acupuncture in helping breast cancer patients. The conditions that acupuncture was shown to help are chemotherapy-induced nausea, vomiting, tamoxifen-induced hot flashes, and aromatase inhibitor-induced joint pain and stiffness. A number of clinical trials have shown that acupuncture helped reduce chemotherapy-induced nausea and vomiting. So far, there have been three randomized, controlled clinical trials showing that acupuncture significantly alleviates tamoxifen-induced hot flashes in breast cancer patients with minimal side effects. We recently finished a multi-center randomized, controlled trial assessing the effect of acupuncture in reducing aromatase inhibitor induced musculoskeletal symptoms. We are analyzing the data and will present the results soon.

Q: Are some cancer patients better suited for acupuncture or those who should avoid it?

A: We do not have a good answer yet. We are conducting clinical trials to try to answer this question. Based on my experience, the majority of cancer patients I have treated did show some improvement after acupuncture treatment, although not everyone responded to it. Because acupuncture is a relatively safe and non-invasive procedure, very few absolute arguments are used against it. We do know that we need to be extra careful when we perform acupuncture on patients with a low white cell count or a low platelet count to reduce the risk of infection and bleeding.

Q: When should a patient expect relief and how long should it last?

A: It depends on the condition the patient is being treated for and the patient's state of health and stage of disease. Some conditions, such as chemotherapy-induced nausea and vomiting may only require one or two treatments, whereas chronic conditions such as chemotherapy-induced peripheral neuropathy (nerve pain) may take 4-8 treatments to see relief. Again, the duration of the treatment response, which may last from hours to weeks, depends on the condition being treated and on the patients themselves. In my acupuncture clinic, depending on the condition being treated, I usually start with once- or twice-weekly acupuncture treatments and then gradually adjust the frequency.

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