The role of acupuncture in integrative oncology

By Bill Reddy, LAc, DiplAc

Roughly twenty years ago, I met one of my first cancer patients.  He was a 34-year-old information technology professional who was diagnosed with squamous cell carcinoma in his left tonsil.  It was a stage 2, affecting one lymph node, no metastasis, with P16 expression that may suggest human papillomavirus.

This patient underwent a combination of radiation and chemotherapy and, as a result, suffered from xerostomia. Eating anything other than soup was an incredible challenge. His saliva production was reduced by close to 80 percent. He had significant trismus and was desperate for results.  Visual inspection of his tongue showed a dry, red surface with tiny cracks, and pulse palpation revealed a string-taut Liver pulse and a hollow Kidney pulse.

In Traditional Chinese Medicine, saliva and other fluids fall under the category of “yin” and lack of fluid indicates a yin deficiency.  Radiation therapy is viewed as an exogenous pathogenic factor of fire/heat that damages yin and depletes qi. The treatment plan was to tonify or strengthen yin and promote qi flow in the stomach channel using local acupuncture pointsST-5, ST-6, ST-7, SJ-17, and REN-24, and distal points LI-2, LU-7, SP-6, ST-36, LI-4, and P-6. 

Within six treatments, his ability to swallow improved along with being able to eat foods with low moisture content such as bread or crackers.  After 10 treatments, he had minor symptoms, normal jaw range of motion, and chose to discontinue treatment.  

Studies indicate that acupuncture increases blood flow, stimulates tissue regeneration of the parotid gland, and improves saliva flow rate in more than 60 percent of the patients treated. Acupuncture is used to support the cancer patient through their treatment plan, reducing pain, fatigue, hot flashes, prolonged postoperative ileus, anxiety, depression, nausea, loss of appetite, leukopenia, peripheral neuropathy, xerostomia, acid reflux, constipation, diarrhea, and insomnia or sleep disturbances.  A few hospitals offer inpatient acupuncture services, but the majority offer outpatient treatment where the procedure may or may not be covered by insurance. 

Some of the challenges to incorporating acupuncture in cancer treatment are finding space and administrative support.  Acupuncture ties up a treatment room for about an hour per session, requiring multiple treatment rooms for greater flow volume.  Furthermore, to initiate an acupuncturist’s involvement in an oncology center, there must be a physician champion working with the hospital administration to assist in moving the program forward.  There is also an educational component to demonstrate to both oncologists and oncology nurses and staff that acupuncture is both safe and applies evidence-based protocols. 

Another important concept to address is dosage.  For acute pain, scheduling treatments twice a week for two to three weeks may be appropriate.  For chronic pain, twice a week for four weeks would not be uncommon, then tapering down to once per week, but may require varied treatment plans modified upon patient response and overall constitution. This approach transfers to other acute and chronic conditions as well.

Acupuncture has grown in popularity in the oncology world based on its safety profile. There are less than 0.55 serious adverse events per 10,000 patients and can help patients achieve a greater sense of wellbeing and improved sleep quality. The following are a few specific conditions that acupuncture is effective at treating in an oncology setting.

Hormonal therapies designed to reduce estrogen in women following chemotherapy, such as aromatase inhibitors, trigger hot flashes and can be lessened through acupuncture treatment. Roughly 70 percent of breast cancer patients suffer from hot flashes. The approach is similar to treating hot flashes in menopausal women, although men can get hot flashes from prostate cancer treatment. Common differential diagnoses include Kidney yin deficiency and accumulation of dampness. Appropriate acupuncture point combinations are based on patterns of symptoms beyond the hot flashes and include sleep patterns, emotional status, and tongue and pulse information. Research has shown that it takes an average of six treatments for marked improvement. Common acupoints include LV-3, GB-20, LU-7, KD-3, SP-6, REN-4, and LV-8.

Acupuncture’s effectiveness at treating chemotherapy induced nausea and vomiting has been well studied in academic centers and doesn’t require many needles to obtain a positive therapeutic effect. Pericardium 6 (P6) acupoint located on the inner wrist between the tendons flexor carpi radialis and palmaris longus is commonly used.  It has the added benefit of treating anxiety, insomnia, angina, heart palpitations, chest pain, and post-operative opioid nausea. The common sea bands used for motion sickness apply pressure to this acupuncture point.  Adjunctive points include SJ-6 and ST-36.  Fresh ginger tea can alleviate nausea if the patient prefers not to take antiemetic medications.

Fatigue and insomnia are also common symptoms improved with acupuncture therapy. Usually two days after chemotherapy, a patient will “bottom out” and be couch-bound. Acupuncture is known for its autonomic nervous system regulation and endocrine balancing properties. It can upregulate the release of melatonin and serotonin in those suffering from insomnia as well as anxiety and depression.  Patients report improvements in both physical and mental aspects of fatigue, report high quality of sleep and improved libido and sense of wellbeing. Example diagnoses for fatigue are qi and blood deficiency, and accumulation of phlegm amp and for insomnia include yin deficiency and Heart Blood deficiency. Common acupoints include HT-7, SP-6, Yintang, DU-20, REN-17, and auricular shenmen.

Acupuncture is well-received by the majority of cancer patients, and its effect is independent of age, sex, type of cancer, stage, concurrent cancer treatment, or use of opioid medications.  Its pain relieving effect can, however, be blocked by opioid antagonists such as naloxone.  Acupuncture is gaining traction in oncology centers and hospitals nationwide and will continue to serve as an adjunctive therapy to cancer treatment, recovery, and palliative care.

References

Armstrong, K., Lanni, T., and Anderson, M. (2018) Integrative medicine and the oncology patient: options and benefits. Support Care Cancer. Retrieved from:26: 2267.

Blom, M., Dawidson I., and Angmar-Mansson B. The effect of acupuncture on salivary flow rates in patients with xerostomia. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology. Retrieved from: 1992;73:293-298.

Blom, M., Dawidson, I., Fernberg, J., Johnson, G., and Angmar-Mansson, B. Acupuncture treatment of patients with radiation-induced xerostomia. European Journal of Cancer. Retrieved from: 1996;32B:182-190.

Carpenter, J., Andrykowski, M., Cordova, M., Cunningham, L., Studts, J., and McGrath, P. Hot flashes in postmenopausal women treated for breast carcinoma: Prevalence, severity, correlates, management, and relation to quality of life. Cancer. Retrieved from:1998;82:1682‑91.

Hyeongjun, Y., Lingyun, S., Jun, J., (2017) Growth of Integrative Medicine at Leading Cancer Centers Between 2009 and 2016: A Systematic Analysis of NCI-Designated Comprehensive Cancer Center Websites. JNCI Monographs.

Towler P., Molassiotis A., and Brearley S.. What is the evidence for the use of acupuncture as an intervention for symptom management in cancer supportive and palliative care: an integrative overview of reviews. Support Care Cancer. Retrieved from: 2013;21:2913–2923.

White, A. (2004) A cumulative review of the range and incidence of significant adverse events associated with acupuncture.  Acupuncture Medicine Retrieved from: 22(3), 122-133.