Acupuncture and Self Acupuncture for Long Term Treatment of Vasomotor Symptoms in Cancer Patients - Audit and Treatment Algorithm

Abstract

Introduction Since hormone replacement therapy given for long periods is now recognised to produce serious side effects, patients with troublesome vasomotor symptoms are increasingly using non-hormonal treatment including acupuncture. Several randomised controlled trials have shown that acupuncture reduces menopausal symptoms in patients experiencing the normal climacteric. It may have this effect by raising serotonin levels which alter the temperature set point in the hypothalamus. Va somotor symptoms can be extreme in breast cancer patients and patients with prostate cancer who are undergoing anticancer therapy. The safety of some herbal medicines and phytoestrogens has been questioned, as they could potentially interfere adversely with the bioavailability of tumouricidal drugs. Aprevious study reports short term benefit from acupuncture, and the aim of this report is to describe our approach to long term treatment. Acupuncture approach After piloting several approaches, six weekly treatments were given initially at LI4, TE5, LR3 and SP6 and two upper sternal points, but avoiding any limb with existing lymphoedema or prone to developing it. If there were no contraindications, patients were given clear instructions on how to perform self acupuncture using either semi-permanent needles or conventional needling at SP6, weekly for up to six years, for long term maintenance. Audit methods and results Aretrospective audit of electronic records was carried out by a doctor not involved in treatment. Atotal of 194 patients were treated, predominantly with breast and prostate cancer. One hundred and eighty two patients were female. The number of pre-treatment hot flushes per day was estimated by the patient: in the 159 cases providing adequate records, the mean was 16 flushes per day. Following treatment, 114 (79%) gained a 50% or greater reduction in hot flushes and 30 (21%) a less than 50% reduction. Treatment was abandoned in those who responded poorly or not at all. The duration of treatment varied from one month to over six years with a mean duration of nine months. Seventeen patients (9%) experienced minor side effects over the six year period, mostly minor rashes; one patient described leg swelling but this was likely to be due to a concurrent fracture. Conclusion Acupuncture including self acupuncture is associated with long term relief of vasomotor symptoms in cancer patients. Treatment is safe and costs appear to be low. An algorithm is presented to guide clinical use. We recommend the use of self acupuncture with needles at SP6 in preference to semipermanent needles in the first instance, but poor responders use indwelling studs if they fail to respond adequately to self acupuncture with regular needles. Point location may be of less importance than the overall 'dose', and an appropriate minimum dose may be required to initiate the effect.

Guidelines for Providing Acupuncture Treatment for Cancer Patients – a Peer-Reviewed Sample Policy Document

“…There is increasing evidence for its effect on vasomotor symptoms in non-cancer patients, [47][48][49] and cancer patients. [50][51][52][53][54][55][56] It is effective for patients troubled by xerostomia, [57][58][59] including those who have had radiotherapy and whose symptoms are not improved by pilocarpine.…”

Home Electroacupuncture for Persistent Postsurgical Pain: A Patient's Report

“…Filshie and Hester 10 mention self-acupuncture in their policy document relating to acupuncture in cancer patients but do not comment on patient experience. Filshie et al 7 had previously looked at self-acupuncture in the context of a treatment for hot flushes in cancer patients. Their results focused on safety and efficacy only.…”

“…2 Since then, self-acupuncture has been written about but never defined in the context of a therapy in the healthcare setting. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] In the absence of a standard definition for SHA, we define it as follows: 'Self-acupuncture or home acupuncture is acupuncture performed by a patient or patient's acupuncture partner following assessment and appropriate training by their attending regulated healthcare professional'.…”

Chinese Medicine and Biomodulation in Cancer Patients—Part Two

“…All demonstrated a reduction in vasomotor symptoms [309][310][311] . Prolonged stimulation using semi-permanent studs or needles, especially at SP6 appears to be associated with more long-term relief of symptoms 270 .…”

“…Acupuncture, along with other interventions, has been shown to be effective in managing pain and other symptoms in cancer patients 267 . In a retrospective study from the Royal Marsden Hospital in London, England, 183 cancer patients with malignant pain, iatrogenic pain, and radiation-induced chronic ulcers were treated with acupuncture [268][269][270] . An improvement was seen in 82% of the patients, but effectiveness lasted for more than 3 days in only half of the patients.…”