CANCER RESEARCH © JCM Ltd

ACUPUNCTURE FOR BREAST CANCER DRUG PAIN
A preliminary trial by an American team has found acupuncture to be a promising way of treating arthralgia in women receiving aromatase inhibitors (AIs) for breast cancer. Twelve patients were provided with electro-acupuncture (EA) twice a week for two weeks, followed by six weekly treatments. Acupuncture was based on the TCM diagnosis of bi syndrome, with electrostimulation of needles around the painful joints. From baseline to the end of intervention patients reported reductions in pain severity (from 5.3 to 1.9), stiffness (from 6.9 to 2.4), and joint symptom interference (from 4.7 to 0.8). They considered joint symptoms ‘very much better’ and also reported a significant decrease in fatigue (from 4.4 to 1.9) and anxiety (from 7.1 to 4.8). No infection or development/worsening of lymphoedema was observed. (Feasibility trial of electroacupuncture for aromatase inhibitor-related arthralgia in breast cancer survivors. Integr Cancer Ther. 2009 Jun;8(2):123-9).

ACUPUNCTURE IMPROVES CANCER FATIGUE
A small American trial appears to show that acupuncture can benefit cancer-related fatigue. Twenty-three patients completed this double-blind, randomised, placebo-controlled trial. Both true and sham acupuncture groups showed improvements in fatigue, fatigue distress, quality of life and depression from baseline to ten weeks, but the differences between the groups were not statistically significant (true acupuncture 5.5 points versus sham acupuncture 3.73 points on a fatigue symptom scale). The authors note that although their study was underpowered it appears that subjects receiving true acupuncture may benefit more than subjects receiving sham acupuncture. (Pilot, randomized, modified, double-blind, placebo-controlled trial of acupuncture for cancer-related fatigue. J Soc Integr Oncol. 2009 Winter;7(1):4-11).

ACUPUNCTURE PROTECTS WHITE BLOOD CELLS DURING CHEMOTHERAPY
An American pilot study suggests that acupuncture may have a protective effect on white blood cell (WBC) populations in women undergoing chemotherapy for gynaecological malignancies. Twenty-one ovarian cancer patients received either active or sham acupuncture while undergoing myelosuppressive chemotherapy. A standardised acupuncture protocol involving manual and electrical stimulation was applied two to three times per week for a total of 10 sessions, starting one week before the second cycle of chemotherapy. The median leukocyte value in the acupuncture group was significantly higher on the first day of the third cycle of chemotherapy than in the control (8600 cell/µL versus 4400 cell/µL), and the incidence of grade two to four leukopenia was less in the acupuncture group than in the sham group (30% versus 90%). The authors conclude that acupuncture treatment resulted in clinically relevant trends of higher WBC values during chemotherapy, which suggests a potential myeloprotective effect of acupuncture. (Acupuncture for chemotherapy-induced neutropenia in patients with gynecologic malignancies: a pilot randomized, sham-controlled clinical trial. J Altern Complement Med. 2009 Jul;15(7):745-53).

ACUPUNCTURE REDUCES BREAST CANCER HOT FLUSHES
A Norwegian study has investigated the efficacy of acupuncture in women with breast cancer suffering from hot flushes as a result of anti-oestrogen medication (Tamoxifen). In a prospective, controlled trial, 59 wo freecyclebrighton@yahoogroups.commen were randomised to either 10 weeks of traditional Chinese acupuncture or sham acupuncture (SA). During the treatment period, verum (true) acupuncture significantly reduced the mean number of hot flushes from baseline, by 50% during the day and by almost 60% at night. Flushes were further reduced by 30% during both day and night over the next 12 weeks. In the sham acupuncture group a significant reduction of 25% in hot flushes during the day was seen during treatment, but this was reversed over the following 12 weeks. No reduction was seen in hot flushes at night. Kupperman index (a score of menopausal symptoms) was reduced by 44% from baseline to the end of the treatment period in the acupuncture group, and largely maintained 12 weeks after treatment ended. No corresponding changes were seen in the sham acupuncture group. (Acupuncture for the treatment of hot flashes in breast cancer patients, a randomized, controlled trial. Breast Cancer Res Treat. 2008 Oct 7. [Epub ahead of print]).

ACUPUNCTURE FOR CHEMO INDUCED NAUSEA AND VOMITING IN CHILDREN
Researchers have investigated whether acupuncture can reduce the need for antiemetic medication during chemotherapy in paediatric oncology. A multicentre crossover study carried out at five hospitals in Germany enrolled 23 children, mean age 13.6 years, who were receiving highly emetogenic chemotherapy for the treatment of solid malignant tumours. Patients were randomly allocated to receive acupuncture treatment during either the second or third identical chemotherapy course together with standard antiemetic medication. Forty-six chemotherapy courses with or without acupuncture were compared. The need for rescue antiemetic medication was found to be significantly lower in acupuncture courses compared to control courses. Episodes of vomiting per course were also significantly lower with acupuncture. (Acupuncture to alleviate chemotherapy-induced nausea and vomiting in pediatric oncology - a randomized multicenter crossover pilot trial. Klin Padiatr. 2008 Nov-Dec;220(6):365-70. Epub 2008 Oct 23).

AURICULAR ACUPUNCTURE FOR VASOMOTOR SYMPTOMS IN PROSTATE CANCER
The role of auricular acupuncture (AA) in men receiving luteinising-hormone releasing hormone (LHRH) analogues for cancer of the prostate has been investigated by a research group in the UK. Vasomotor symptoms similar to those observed in postmenopausal women can affect the quality of life in such men. Sixty patients (median age 74 years) received weekly AA for 10 weeks. Ninety-five percent of patients reported a decrease in the severity of symptoms, from a mean symptom score of 5.0 to 2.1. The authors concluded that the symptomatic improvement observed with AA was comparable with that achieved with pharmacotherapy and that, based on cost analysis, AA represented a viable alternative. (Auricular acupuncture: a novel treatment for vasomotor symptoms associated with luteinizing-hormone releasing hormone agonist treatment for prostate cancer. BJU Int. 2008 Aug 14).

ACUPUNCTURE FOR PROSTATE CANCER HOT FLUSHES
Both electroacupuncture (EA) and traditional acupuncture (TA) can reduce the impact of hot flushes on men who have had castrational treatment for prostate cancer. Swedish researchers randomised 31 men with hot flushes due to prostate cancer treatment to EA (12 points, with four electro-stimulated) or TA (12 points) weekly for 12 weeks. Hot flushes per 24 hours decreased significantly, from a median of 7.6 at baseline in the EA group to 4.1 after 12 weeks, and from 5.7 in the TA group to 3.4. Distress caused by flushes decreased from 8.2 in the EA group to 3.3, and from 7.6 to 3.4 in the TA group after 12 weeks. The overall ‘hot flush score’ decreased in the two groups by 78% and 73%, respectively, in line with or better than medical regimens for these symptoms. The effect lasted up to nine months after treatment ended. (Two Modes of Acupuncture as a Treatment for Hot Flushes in Men with Prostate Cancer-A Prospective Multicenter Study with Long-Term Follow-Up. Eur Urol. 2008 Feb 14. [Epub ahead of print]).

ELECTROACUPUNCTURE REDUCES BREAST CANCER HOT FLUSHES
Swedish researchers have compared the effects of electro-acupuncture (EA) and hormone therapy (HT) on vasomotor symptoms in women with a history of breast cancer. Forty-five women were randomised to EA for 12 weeks or HT for 24 months. The frequency of, and distress caused by, hot flushes were recorded daily before, during and up to 24 months after the start of treatment. In the EA group, the median number of hot flushes per 24 hours decreased significantly from 9.6 at baseline to 4.3 at 12 weeks of treatment. 12 months after start of treatment, 14 women who had received EA had a median number of flushes/24 hours of 4.9, and at 24 months, seven women treated by EA had 2.1 flushes/24 hours. The HT group had a baseline median number of flushes/24 hours of 6.6 and 0.0 at 12 weeks. (Long-term follow-up of acupuncture and hormone therapy on hot flushes in women with breast cancer: a prospective, randomized, controlled multicenter trial. Climacteric. 2008 Apr;11(2):166-74.)

ACUPUNCTURE AFTER BREAST CANCER SURGERY
A Brazilian case series suggests that acupuncture can help in the rehabilitation of women following breast cancer surgery. Twenty-nine women who had lymphoedema and/or a decrease in range of arm movement following surgery were studied. The patients underwent 24 weekly acupuncture sessions. Significant improvements were observed in range of shoulder flexion and abduction, degree of lymphoedema and sense of heaviness and tightening in the affected limb after six months of therapy. (Acupuncture in the rehabilitation of women after breast cancer surgery--a case series. Acupunct Med. 2008 Jun;26(2):87-93).

ACUPUNCTURE HELPS WITH DRY MOUTH
A small study carried out in South Korea has investigated the effects of acupuncture on objective and subjective assessment of symptom changes in patients with head and neck cancer who have with radiation-induced xerostomia (dry mouth due to lack of saliva). Twelve patients with radiation-induced xerostomia were randomised into real or sham acupuncture groups. Acupuncture was conducted twice weekly for six weeks in a single-blind setting. The effect was evaluated by measuring salivary flow rates (stimulated and unstimulated) and questionnaire-based assessment of subjective symptoms pre- and at three and six weeks post-treatment. Both groups showed a slight increase in salivary flow rates, with no significant difference between them. However, real acupuncture markedly increased unstimulated salivary flow rates, and improved the score for dry mouth according to a xerostomia questionnaire, by 2.33 points versus 0.33 in controls. The authors conclude that the results show a significantly meaningful amelioration of the subjective sensation of xerostomia and an associated increase in quality of life. (Manual acupuncture improved quality of life in cancer patients with radiation-induced xerostomia. J Altern Complement Med. 2008 Jun;14(5):523-6.)

ACUPUNCTURE FOR CANCER-RELATED FATIGUE
A randomised controlled pilot study has assessed the effects of acupuncture and acupressure in managing cancer-related fatigue. Forty-seven patients with cancer who experienced moderate to severe fatigue were randomised either to an acupuncture group, an acupressure group, or a sham acupressure group. The acupuncture group received six 20 minute sessions over two weeks, while the patients in the two acupressure groups were taught to press the points themselves and did so daily thereafter for two weeks. At the end of the intervention, there was a 36% improvement in fatigue levels in the acupuncture group, while the acupressure group improved by 19% and the sham acupressure by 0.6%. (The management of cancer-related fatigue after chemotherapy with acupuncture and acupressure: a randomised controlled trial. Complement Ther Med. 2007 Dec;15(4):228-37).

ACUPRESSURE FOR CHEMOTHERAPY SICKNESS
Self-applied acupressure for chemotherapy-induced nausea and vomiting has been found to compare favourably with placebo. A multicentre, longitudinal, randomised clinical trial enrolled 160 women undergoing chemotherapy for breast cancer. Subjects were randomised to one of three groups: acupressure at Neiguan P-6 point (active), acupressure to Houxi SI-3 point (placebo), or usual care only. Subjects completed a daily log for 21 days containing measures of nausea and vomiting and recording methods (including antiemetics and acupressure) used to control these symptoms. For delayed nausea and vomiting (occurring more than 24 hours following chemotherapy treatment), the acupressure group had a statistically significant reduction in the amount of vomiting and the intensity of nausea over time, compared with the placebo and usual-care groups. (Acupressure for chemotherapy-induced nausea and vomiting: a randomized clinical trial. Oncol Nurs Forum. 2007 Jul;34(4):813-20).

AURICULAR ACUPUNCTURE FOR CHEMO HOT FLUSHES
A small qualitative study carried out in the UK has found that a standardised auricular acupuncture protocol delivered in small group clinics is beneficial for women suffering from hot flushes caused by hormone treatment for breast cancer. The 16 women interviewed found the acupuncture to be helpful and relaxing. Many reported reductions in hot flush frequency, as well as improvements in overall emotional and physical wellbeing. The group treatment setting was regarded as supportive and encouraging. (Ear acupuncture for hot flushes - The perceptions of women with breast cancer. Complement Ther Clin Pract. 2007 Nov;13(4):250-7). 

GINSENG RELIEVES CANCER FATIGUE
A pilot study suggests that ginseng can relieve fatigue and boost energy levels in people with cancer. The US based trial tested three doses (750 mg, 1000 mg and 2000 mg) of American ginseng (Panax quinquefolius) against placebo in 282 patients suffering from a variety of types of cancer, about half of whom were receiving chemotherapy. After eight weeks, 25% of patients taking 1000 mg of ginseng and 27% of patients taking 2000 mg reported feeling "moderately better" or "much better," compared with only 10% of patients in both the placebo and the lowest dose ginseng groups. (American Society of Clinical Oncology 43rd Annual Meeting: Abstract 9001).

ACUPUNCTURE & MASSAGE AFTER CANCER SURGERY
Providing massage and acupuncture in addition to usual care results in decreased pain and depressive mood among postoperative cancer patients. One hundred and thirty eight cancer patients undergoing surgery were randomly assigned to receive either massage and acupuncture on postoperative days 1 and 2 in addition to usual care, or a control of usual care alone, and were followed over three days. Patients' pain, nausea, vomiting and mood were assessed at four time points. Participants in the intervention group experienced a decrease of 1.4 points on a 0-10 pain scale, compared to 0.6 in the control group, and a decrease in depressive mood of 0.4 (on a scale of 1-5) compared to no change in the control group. (Symptom management with massage and acupuncture in postoperative cancer patients: a randomized controlled trial. J Pain Symptom Manage. 2007 Mar;33(3):258-66).

CHINESE HERBS FOR CHEMOTHERAPY TOXICITY
Traditional Chinese herbal medicine (TCHM) does not reduce the toxic effects of chemotherapy on patients’ blood cell populations, however it does have a significant impact on control of nausea. One hundred and twenty patients with early-stage breast or colon cancer who required postoperative chemotherapy were enrolled. Participants were randomly assigned to receive either individualised TCHM prescriptions of herbal extract granules or placebo packages containing non-therapeutic herbs that smelled and tasted like a typical herbal tea. TCHM did not reduce chemotherapy toxicity as measured by any haematological parameters. Incidence of nausea was the only non-haematologic toxicity that was significantly reduced in the TCHM group (14.6% versus 35.7%). (A double-blind placebo-controlled randomized study of Chinese herbal medicine as complementary therapy for reduction of chemotherapy-induced toxicity. Ann Oncol. 2007 Apr;18(4):768-74).

GINSENG & CANCER
A study of nearly 1,500 breast cancer patients in Shanghai found that having taken ginseng regularly before their diagnosis resulted in a significantly reduced chance of dying from the cancer or other causes, and that taking it before and after diagnosis was associated with improved quality of life. The researchers
conclude that regular use of ginseng at 1.3 grams per day may bring significant benefits for cancer patients. (Association of Ginseng Use with Survival and Quality of Life among Breast Cancer Patients. The American Journal of Epidemiology, Vol. 163, April 1, 2006, pp. 645-53).

ACUPUNCTURE/ACUPRESSURE FOR CHEMOTHERAPY VOMITING
A systematic review published by the Cochrane Collaboration, an international organisation that evaluates medical research, pooled results from nine studies into the use of acupuncture for post-chemotherapy vomiting. Overall, 22% of patients who received acupuncture suffered vomiting the first day after chemotherapy, compared to 33% of those who did not receive acupuncture. When acupressure studies were evaluated, it was found that it was able to relieve nausea the day after chemotherapy (which acupuncture did not do) although it had no effect on vomiting. (Ezzo JM et al. Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. The Cochrane Database of Systematic Reviews 2006, Issue 2).

CHINESE HERBS FOR CANCER
Hosni Mubarak ordered a global search for effective lung cancer treatments after his favourite actor died of the disease. This has led to the announcement of a phase-111 trial of a traditional Chinese herbal medicine formula at Cairo University Hospital. The formula (Sanyang Kangtai, also known as Jiangjie Buxue Heji) has already been trialled at Beijing City Tumour Hospital and seven other Chinese hospitals. Results from those trials showed that 77% of 62 patients with middle and advanced stage lung cancer, who were also receiving chemotherapy, experienced complete or partial recovery compared to a control group receiving chemotherapy plus granulocyte colony-stimulating factor. (The Journal of Complementary Medicine (2006) 5; 1).

ACUPUNCTURE AIDS XEROSTOMIA
Xerostomia(dry mouth) is a common sequela of radiation for head and neck cancer as well as a consequence of medications such as antihistamines, decongestants, antidepressants and diuretics. A small study which treated seven patients suffering from xerostomia after radiation for head and neck cancer has confirmed previous studies which have shown the effectiveness of acupuncture for this condition. Eight months after treatment (once a week for 405 weeks then 2 or 3 biweekly treatments) all seven reported a reduction in dry mouth symptoms, increased saliva flow and improvements in eating, speaking and sleeping. (Academy of General Dentistry).

ACUPUNCTURE & CANCER PAIN
90 patients with cancer pain that was unrelieved by medication were randomly assigned to receive a. two courses of auricular acupuncture at points detected using a point detector, b. auricular acupuncture at points where there was no signal from the detector (placebo points), or c. auricular press seeds at placebo points. At two months after the start of the study, the patients in group a. showed a 36% reduction in pain scores, with only 2% change shown in the placebo groups. (J Clin Oncol. Nov 15 2003: 4120-4126).

ACUPUNCTURE FOR TAMOXIFEN SIDE EFFECTS
A study carried out at at Mount Vernon Hospital in Middlesex, England, has found that traditional acupuncture is able to relieve the hot flushes that many women experience when taking tamoxifen to prevent breast cancer. Of 54 women on tamoxifen suffering from side effects of flushes or sweats before the treatment, 36% reported that their symptoms had decreased by 50% or more, while 89% reported some improvement. These positive results were maintained after treatment had ended. Personal accounts also showed that the women felt their energy levels had increased, that they could do more, and that their overall quality of life had improved after acupuncture. (UK Complementary Health Care Conference, 5th December 2002).

ACUPUNCTURE & XEROSTOMIA (DRY MOUTH)
Another study has confirmed the benefit of acupuncture in the treatment of painful xerostomia (dry mouth) following radiotherapy for head or neck cancer. The trial involved 50 patients who received 3 needles in each ear plus bilateral Hegu L.I.-4.  70% of the patients in the trial experienced pain relief. Although some patients experienced continued pain relief without maintenance therapy, the researchers recommend a programme of three to four weekly treatments followed by monthly sessions. (Cancer 2002;94(4):1151-6).

ACUPUNCTURE FOR DRY MOUTH
Radiation therapy for cancer can induce secondary xerostomia (dryness of the mouth) which may be resistant to conventional pilocarpine therapy. In a study to assess the value of acupuncture in helping salivary production, twelve patients with xerostomia secondary to radiation therapy for head and neck cancer received treatment at points including Erjian L.I.-2, Hegu L.I.-4 and ear points zero, shenmen and salivary gland. Results showed that an increased degree of salivation was subjectively present in all patients after acupuncture and follow-up evaluations up to 1 month found that the oral buccal mucosa was moist, saliva was present and all patients were capable of expectoration (Medical Acupuncture, 2000, Volume 12/Number 1). In a separate Swedish study, researchers studied the effect of acupuncture on a range of patients with dry mouth, including those suffering from radiotherapy, Sjögren’s syndrome, menopause and depression. Patients received acupuncture twice weekly over four months at points including Juliao ST-3, Daying ST-5, Jiache ST-6, Tianrong SI-17, Futu L.I.-18, Yifeng SJ-17, Baihui DU 20, Shenmen HE-7, Neiguan P-6, Sanjian L.I.-3, Hegu L.I.-4, Quchi L.I.-11, Waiguan SJ-5, Zusanli ST 36, Sanyinjiao SP-6, Zulinqi GB-41, Taichong LIV 3, Taixi KID-3 and Shuiquan KID-5. All patients had significantly higher salivary flow rates after treatment, with the best results seen in the irradiated cancer patients. Benefits were still observed six months after treatment, which was maintained for several years among those who elected to have periodic additional treatment (Oral Diseases 2000; 6(1):15-24).

ACUPUNCTURE & VASOMOTOR SYMPTOMS
A Swedish study has shown acupuncture to be effective in reducing vasomotor symptoms (hot flushes) in men following castration therapy for prostatic carcinoma. Patients received twice weekly acupuncture for 2 weeks, and weekly for 10 weeks. Flushes were reduced by 70% after 10 weeks and was 50% lower 3 months after the last treatment (Journal of Urology 1999; 161(3); 853-856).

ACUPUNCTURE AND XEROSTOMIA
Xerostomia, a condition of dryness of the mouth due to salivary dysfunction, is a common and usually irreversible side effect in patients receiving radiotherapy for head and neck cancer. A study has now shown that acupuncture can have a considerable effect in promoting salivary flow, benefiting 68% of a group of patients who received classical acupuncture. It seemed to make no difference how long ago the radiotherapy had been received, and it was noted that among those patients who showed improvement after twelve acupuncture sessions, the improvement was likely to be maintained for at least one year of follow-up observation. Interestingly, the control group in this study who received superficial acupuncture as a placebo also showed significant improvement (50%) and the authors suggest that superficial acupuncture should therefore preferably not be used as a placebo (European Journal of Cancer 1996;32B(3): 182-190).

TCM AND RADIOTHERAPY
The Chinese medicine Si Jun Zi Tang (Four Gentlemen Decoction) was found to reduce the decrease of leukocytes, erythrocytes, thrombocytes and hematocrit in irradiated mice. Its protection was more effective in leukocytes and thrombocytes than other hematocytes. It also exerted a beneficial effect on clinical syndromes such as anemia. From the results in this study, the authors concluded that the most effective concentration with least toxicity was about 20 mg/20 g body weight (J Ethnopharmacol 1996 Nov;54(2-3):69-75).

ASTRAGALUS COMBINES WELL WITH CHEMOTHERAPY
The combination of Huang Qi (Astragali Radix)-based Chinese herbal medicine and platinum-based chemotherapy is more effective in the treatment of non-small cell lung cancer than the chemotherapy alone. An analysis of data from 34 published clinical trials suggests that at 12 months the mortality rate was reduced by 33% among those treated with the dual therapy. The Astragalus may work by stimulating macrophage and natural killer cell activity. (McCulloch M et al. Astragalus-Based Chinese Herbs and Platinum-Based Chemotherapy for Advanced Non–Small-Cell Lung Cancer: Meta-Analysis of Randomized Trials. J Clin Oncol. Jan 20 2006: 419-430).