acupuncture for cancer summery.ppt

Acupuncture in cancerDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist

Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist

Acupuncture is defined as the application of stimulation such as needling, moxibustion, cupping, and acupressure on specific sites of the body known as acupuncture pointsDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


In China, acupuncture is part of a TCM system of traditional medical knowledge and is practiced along with other treatment modalities such as :Herbal medicineTui na (massage and acupressure)Mind/body exercise (e.g.,qigong and tai chi)Dietary therapyDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Acupuncture has been practiced in China and other Asian countries for more than 4,000 years



The relatively brief history of acupuncture in the United States can be traced back about 200 years, when Dr. Franklin Bache published a report in the North American Medical and Surgical Journal on his use of acupuncture to treat lower back painDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


The U.S. Food and Drug Administration approved the acupuncture needle as a medical device in 1996Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


The human body must be perceived and treated as a whole and as part of nature; health is the result of harmony among bodily functions and between the body and nature, and disease occurs when this harmony is disruptedDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Acupuncture is closely associated with Chinese meridian theory

According to this theory, there are 12 primary meridians, or channels, and 8 additional meridians, each following a particular directional course along the bodyDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


A vital energy known as qi flows through these meridians and participates in the homeostatic regulation of various bodily functions. Along the meridians are approximately 360 points that serve as both pathognomonic signs of disorder and as loci for acupuncture treatmentsDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


When the normal flow of energy over a meridian is obstructed (e.g., as a result of tissue injury or a tumor), pain or other symptoms result

The purpose of acupuncture therapy is to normalize energy flow, thereby relieving the symptoms by stimulating specific sites (acupuncture points) on the meridiansDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Acupuncture MechanismsDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Acupuncture MechanismsActivate the hypothalamus and the pituitary glandBalance the sympathetic and parasympathetic systemsAnti-inflammatory effectsEndogenous opioid systemBoost animal immune function by enhancing NK cell and lymphocyte activity



Laboratory and animal studies to explore the mechanisms of acupuncture for cancer treatment have focused mainly on the role of acupuncture in the activation of immune functions, such as increasing blood cell count and enhancing lymphocyte and natural killer cell activityDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Acupuncture indications in cancer

Manage cancer-related symptoms

Treat side effects induced by chemotherapy or radiation therapy

Boost blood cell count

Enhance lymphocyte and natural killer (NK) cell activity



Primary use is symptom managementCancer pain

Chemotherapy-induced nausea and vomiting



The positive results of the studies on chemotherapy-induced N/V, which benefit from scientifically sound research designs, are the most convincingDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Other indicationsWeight lossAnxietyDepressionInsomniaPoor appetiteXerostomiaHot flashesPeripheral neuropathyGastrointestinal symptoms (constipation and diarrhea)Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Laboratory & AnimalPreclinical StudiesDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


At least seven animal studies investigating the effects of acupuncture in cancer or cancer-related conditions have been reported in the scientific literatureDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Four ex vivo studies suggested that acupuncture is useful in anticancer therapy either by actively stimulating immune activity or by preventing chemotherapy suppression of immune activityDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


In a study involving normal rats, electroacupuncture applied at the point Tsu-Sanli (St36) for 2 hours daily on 3 consecutive days enhanced the cytotoxicity of splenic natural killer (NK) cells compared with a stimulation of a non acupuncture control point in theabdominal muscle

Sato T, Yu Y, Guo SY, et al.: Acupuncture stimulation enhances splenic natural killer cell cytotoxicity in rats. Jpn J Physiol 46 (2): 131-6, 1996Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Another study found that NK cell activity and T-lymphocyte transformation rate were increased in a mouse model of transplanted mammary cancer compared with a control after eight sessions of acupuncture and moxibustion

Liu LJ, Guo CJ, Jiao XM: [Effect of acupuncture on immunologic function and histopathology of transplanted mammary cancer in mice] Zhongguo Zhong Xi Yi Jie He Za Zhi 15 (10): 615-7, 1995.Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


A study using moxibustion to warm the acupuncture point Guanyuan (CV4) once a day for 10 days found significantly increased production of erythrocytes, compared with a nontreatment control

Wu P, Cao Y, Wu J: Effects of moxa-cone moxibustion at Guanyuan on erythrocytic immunity and its regulative function in tumor-bearing mice. J Tradit Chin Med 21 (1): 68-71, 2001Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Repeated EA treatments (12 treatments administered over 30 days) inPCO rats significantly lowered the concentrations of NGF in the ovaries, compared with untreated PCO rats

Stener-Victorin E, Lundeberg T, Waldenstrm U, et al.: Effects of electro-acupuncture on nerve growthfactor and ovarian morphology in rats with experimentally induced polycystic ovaries. Biol Reprod 63 (5): 1497-503, 2000Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


A study of cyclophosphamide -induced emesis in a ferret behavioral model used acupuncture as an adjunct therapy in treating the emetic side effects of chemotherapy significantly reduced the total number of emetic episodes by % 36-73

Lao L, Zhang G, Wong RH, et al.: The effect of electroacupuncture as an adjunct on cyclophosphamide induced emesis in ferrets. Pharmacol Biochem Behav 74 (3): 691-9, 2003



The findings of these studies suggest that acupuncture may be effective in treating cancer-related symptoms and cancer treatmentrelated disorders and that acupuncture may be able to activate immune functions and regulate the autonomic nervous systemDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Only one study reported a decrease in tumor volume in animals treated with acupuncture compared with control animals (Limited scientific value)

Liu LJ, Guo CJ, Jiao XM: [Effect of acupuncture on immunologic function and histopathology of transplanted mammary cancer in mice] Zhongguo Zhong Xi Yi Jie He Za Zhi 15 (10): 615-7, 1995Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Human/Clinical StudiesDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Effect of Acupuncture on Immune FunctionDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


At least seven human studies have evaluated the effect of acupuncture on immune system function in patients (all in china)

Four randomized controlled trials One nonrandomized clinical studyTwo case series Acupuncture enhanced or regulated immune functionDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


The first randomized controlled trial immuneAcupuncture treatment enhanced platelet count and prevented leukocyte decrease after radiation therapy or chemotherapy

Xia YQ, Zhang D, Yang CX, et al.: An approach to the effect on tumors of acupuncture in combination with radiotherapy or chemotherapy. J Tradit Chin Med 6 (1): 23-6, 1986Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Second studyimmuneLeukocyte phagocytosis was enhanced in thetreated group, compared with the baseline measurement (P < .01)

Zhou RX, Huang FL, Jiang SR, et al.: The effect of acupuncture on the phagocytic activity of human leukocytes. J Tradit Chin Med 8 (2): 83-4, 1988.Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Third studyimmuneThe data showed that IL-2 level and NK cell activity were significantly increased in the acupuncture group, compared with the control group (P < .01)

Wu B, Zhou RX, Zhou MS: [Effect of acupuncture on interleukin-2 level and NK cell immunoactivity of peripheral blood of malignant tumor patients] Zhongguo Zhong Xi Yi Jie He Za Zhi 14 (9): 537-9, 1994Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Fourth studyimmuneThe data showed that acupuncture treatment increased the proportion of the CD3+ and CD4+ T-lymphocyte subsets, the CD4+/CD8+ ratio (P < .01), and the level of beta-EP The investigators suggested that the anticancer effect of acupuncture may be mediated via the mechanism of immunomodulation

Wu B, Zhou RX, Zhou MS: [Effect of acupuncture on immunomodulation in patients with malignant tumors] Zhongguo Zhong Xi Yi Jie He Za Zhi 16 (3): 139-41, 1996Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Fifth studyimmuneElectroacupuncture in patients undergoing chemotherapy experienced no declines in T cells (CD3+, CD4+, CD8+) or in NK cell activity, both of which are usually suppressed by chemotherapy

Ye F, Chen S, Liu W: Effects of electro-acupuncture on immune function after chemotherapy in 28 cases. J Tradit Chin Med 22 (1): 21-3, 2002Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Sixth studyimmune48 patients with leukopenia including two cancer patientswho were treated with manual acupuncture experienced improvements in leukocyte count, and immunoglobulin (IgG, IgA, and IgM) levels after 14 daily acupuncture treatments, compared with their pretreatment levels

Wei Z: Clinical observation on therapeutic effect of acupuncture at zusanli for leukopenia. J Tradit Chin Med 18 (2): 94-5, 1998



Effect of Acupuncture on Cancer PainDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


First studypainRandomized trial compared two type acupuncture and conventional analgesic treatment in patients with gastric cancer painThere was equivalent analgesic effect among the three groups observed after 2 months of treatment; however, the conventionally treated group experienced significantly superior analgesia in first 10 days of treatment

Dang W, Yang J: Clinical study on acupuncture treatment of stomach carcinoma pain. J Tradit ChinMed 18 (1): 31-8, 1998Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Second studypain In study evaluated the effect of auricular acupuncture in 20 cancer patients who were still experiencing pain after treatment with analgesics While patients continued their analgesic medication, auricular acupuncture needles were embedded in ear acupuncture points.pain intensity decreased or remained stable after auricular acupuncture in all patients, with a significant average pain intensity decrease of 33 mm (P < .001)

Alimi D, Rubino C, Leandri EP, et al.: Analgesic effects of auricular acupuncture for cancer pain. J Pain Symptom Manage 19 (2): 81-2, 2000



Third studyPainIn a case series involving 183 cancer patients who were treated with acupuncture for cancer-related pain, 52% were significantly helped (P value not stated

Filshie J, Redman D: Acupuncture and malignant pain problems. Eur J Surg Oncol 11 (4): 389-94, 1985Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Forth studypaincase series, 29 patients with malignant tumors who developed pain received EA treatment . All experienced various degrees of pain relief, and 25 out of 29 were able to either reduce or eliminate theiranalgesic requirements following multiple EA treatments

Wen HL: Cancer pain treated with acupuncture and electrical stimulation. Mod Med Asia 13 (2): 12-6, 1977Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Most of these studies were positive but the findings have limited significance because of methodologic weaknesses such as :

Small sample sizesAn absence of patient blinding to treatment in most casesVarying acupuncture treatment regimensA lack of standard outcome measurements Absence of adequate randomizationDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Effect of Acupuncture on Cancer Treatmentrelated Side EffectsDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Pain due to cancer treatment -1A RCT evaluated the effect of various combinations of auricular acupuncture, Chinese herbs, and epidural morphine to relievepostoperative pain in 16 patients with liver cancerAll of the combination treatment groups experienced better analgesia than did the placebo -treated control group

Li QS, Cao SH, Xie GM, et al.: Combined traditional Chinese medicine and Western medicine. Relieving effects of Chinese herbs, ear-acupuncture and epidural morphine on postoperative pain in liver cancer Chin Med J (Engl) 107 (4): 289-94, 1994Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Pain due to cancer treatment -2The effect of acupuncture in postoperative pain management and arm movement in breast cancer patients after surgical excision of the cancer and axillary lymph node:The acupuncture group had significant pain relief during arm movement on the fifth and seventh days following surgery and at the time of discharge. The range of arm motion also increased significantly in the treatment group, (P < .001)

He JP, Friedrich M, Ertan AK, et al.: Pain-relief and movement improvement by acupuncture after ablation and axillary lymphadenectomy in patients with mammary cancer. Clin Exp Obstet Gynecol 26 (2): 81-4, 1999



Pain due to cancer treatment -3A small retrospective case review of acupuncture for chemotherapy-induced peripheral neuropathy in 18 patients showed benefit with reduced symptoms in 82%

Donald GK, Tobin I, Stringer J: Evaluation of acupuncture in the management of chemotherapyinduced peripheral neuropathy. Acupunct Med 29 (3): 230-3, 2011Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Arthralgias and myalgias from aromatase inhibitorsTrue acupuncture was significantly more effective than sham acupuncture, as measured by Brief Pain Inventory-Short Form scores in relieving joint symptoms

Crew KD, Capodice JL, Greenlee H, et al.: Randomized, blinded, sham-controlled trial of acupuncture for the management of aromatase inhibitor-associated joint symptoms in women with early-stage breast cancer. J Clin Oncol 28 (7): 1154-60, 2010.Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Chemotherapy-induced nausea and vomitingThe positive effect of acupuncture on chemotherapy-induced nausea and vomiting (N/V) is the most convincing, as demonstrated by the consistency of the results of a variety of clinical study typesDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Chemotherapy-induced nausea and vomitingA systematic review of the effect of acupuncture on N/V describes five clinical trials of chemotherapy-induced N/V, conducted by different investigators on different groups of patients and using different forms of acupuncture point stimulationAll five trials yielded positive results

Vickers AJ: Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials. J R Soc Med 89 (6): 303-11, 1996.Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Radiation-induced nausea and vomitingIn one randomized study, patients who were randomly assigned to acupuncture experienced fewer episodes of nausea and vomiting than did those who received standard care

Enblom A, Lekander M, Hammar M, et al.: Getting the grip on nonspecific treatment effects: emesis in patients randomized to acupuncture or sham compared to patients receiving standard care. PLoS One 6 (3): e14766, 2011.Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Vasomotor symptomsSome studies have reported that acupuncture may be effective in reducing vasomotor symptoms among postmenopausal women with breast cancer and prostate cancer patients on androgen-deprivation therapy



Vasomotor symptoms -1In women with hormone receptorpositive breast cancer. Acupuncture was just as effective as venlafaxine and caused fewer adverse effects

Walker EM, Rodriguez AI, Kohn B, et al.: Acupuncture versus venlafaxine for the management of vasomotor symptoms in patients with hormone receptor-positive breast cancer: a randomized controlled trial. J Clin Oncol 28 (4): 634-40, 2010.Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


Vasomotor symptoms -2An uncontrolled prospective case series of 50 women on tamoxifen for early breast cancer evaluated women After acupuncture vasomotor symptoms dropped by 49.8% (P < .0001)

de Valois BA, Young TE, Robinson N, et al.: Using traditional acupuncture for breast cancer-related hot flashes and night sweats. J Altern Complement Med 16 (10): 1047-57, 2010.



Vasomotor symptoms -3In retrospective evaluation of 194 patients with predominantly breast or prostate cancer found long-term relief of vasomotor symptoms associated with acupuncture.

Filshie J, Bolton T, Browne D, et al.: Acupuncture and self acupuncture for long-term treatment of vasomotor symptoms in cancer patients--audit and treatment algorithm. Acupunct Med 23 (4): 171-80, 2005.Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


FatigueIn a RCT, 47 cancer patients with moderate to severe fatigue were randomly assigned to one of three groups. The study concluded that acupuncture was a more effective method than acupressure or sham acupressure

Molassiotis A, Sylt P, Diggins H: The management of cancer-related fatigue after chemotherapy with acupuncture and acupressure: a randomised controlled trial. Complement Ther Med 15 (4): 228-37,2007.



In next study, 302 breast cancer patients were randomly assigned to a 6-week course of either daily Acupuncture significantly reduced fatigue and improved quality of life over that of the "enhanced usual care" group

Molassiotis A, Bardy J, Finnegan-John J, et al.: Acupuncture for cancer-related fatigue in patients with breast cancer: a pragmatic randomized controlled trial. J Clin Oncol 30 (36): 4470-6, 2012.Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


XerostomiaAcupuncture was associated with a decrease in the onset of symptoms and an increased saliva flow in two randomized studies that compared acupuncture with standard care for preventing xerostomia in patientsundergoing radiation therapy

Braga FP, Lemos Junior CA, Alves FA, et al.: Acupuncture for the prevention of radiation-induced xerostomia in patients with head and neck cancer. Braz Oral Res 25 (2): 180-5, 2011 Mar-Apr.

Meng Z, Garcia MK, Hu C, et al.: Randomized controlled trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma. Cancer 118 (13): 3337-44, 2012.



XerostomiaCompared with standard care, acupuncture significantly improved xerostomia symptoms in patients who experienced the condition following radiation therapy

Simcock R, Fallowfield L, Monson K, et al.: ARIX: a randomised trial of acupuncture v oral care sessions in patients with chronic xerostomia following treatment of head and neck cancer. Ann Oncol 24 (3): 776-83, 2013.

Pfister DG, Cassileth BR, Deng GE, et al.: Acupuncture for pain and dysfunction after neck dissection: results of a randomized controlled trial. J Clin Oncol 28 (15): 2565-70, 2010.



Other Treatment-related Side EffectsDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


In a RCT 76 patients with various types of cancer, including esophageal cancer,gastric cancer, lung cancerThe acupuncture group in combination with radiation therapy or chemotherapy, had the below benefits :significantly more body weight (P < .001)Greater improvements in the symptoms of cough, thoracodynia, hemoptysis, and fever for patients with lung cancer and the symptoms of chest pain, mucus vomiting, and difficulty in swallowing for patients with esophageal suffered

Xia YQ, Zhang D, Yang CX, et al.: An approach to the effect on tumors of acupuncture in combination with radiotherapy or chemotherapy. J Tradit Chin Med 6 (1): 23-6, 1986.Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


An RCT of 138 patients treated with acupuncture plus massage versus usual care showed decreased pain (P = .05) and a decrease indepressive mood (P = .003) in postoperative cancer patients

Mehling WE, Jacobs B, Acree M, et al.: Symptom management with massage and acupuncture in postoperative cancer patients: a randomized controlled trial. J Pain Symptom Manage 33 (3): 258-66, 2007.Dr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist


A retrospective survey study : Patients were referred to acupuncture clinics for :Pain (53%),Xerostomia (32%)Hot flashes (6%)Nausea/loss of appetite (6%)

Johnstone PA, Polston GR, Niemtzow RC, et al.: Integration of acupuncture into the oncology clinic. Palliat Med 16 (3): 235-9, 2002.Sixty percent of the patients showed atleast 30% improvement in their symptoms, and about one-third had no change in the severity of symptomsDr Mehran Rezvani pain fellowship anesthesiologist & acupuncturist




*Dry Mouth (Xerostomia)Dry mouth, also called xerostomia (ZEER-oh-STOH-mee-ah), is the condition of not having enough saliva, or spit, to keep the mouth wet. Dry mouth can happen to anyone occasionallyfor example, when nervous or stressed. However, when dry mouth persists, it can make chewing, eating, swallowing and even talking difficult

Hot flashes, a common symptom of menopause and perimenopause, are typically experienced as a feeling of intense heat with sweating and rapid heartbeat, and may typically last from two to thirty minutes for each occurrence. The sensation of heat usually begins in the face or chest, although it may appear elsewhere such as the back of the neck, and it can spread throughout the whole body. Some women feel as if they are going to faint. In addition to being an internal sensation, the surface of the skin, especially on the face, becomes hot to the touch*Four of the studies were ex vivo laboratory investigations using blood samples or tissues;[1-3,5] the remaining study was an animal behavioral study testing the effect of acupuncture on chemotherapy-induced nausea and vomiting*(EA) (1 Hz, 520 V, 1-millisecond pulse width, 2 hours)

*A study involving tumor -bearing mice (sarcoma S180) using moxibustion to warm the acupuncture pointGuanyuan (CV4) once a day for 10 days found significantly increased production of erythrocytes, comparedwith a nontreatment control.[*fourth ex vivo study used a rat model to investigate the effect of EA on nerve growth factor (NGF), whichis associated with polycystic ovary syndrome (PCOS). Women with PCOS have an increased risk ofendometrial cancer and other diseases. Repeated EA treatments (12 treatments administered over 30 days) inPCO rats significantly lowered the concentrations of NGF in the ovaries, compared with untreated PCO rats*A study of cyclophosphamide -induced emesis in a ferret behavioral model used acupuncture as an adjuncttherapy in treating the emetic side effects of chemotherapy. EA at 100 Hz, 1.5 V, for 10 minutes in combinationwith subeffective doses of antiemetics such as ondansetron (0.04 mg/kg), droperidol (0.25 mg/kg), andmetoclopramide (2.24 mg/kg) significantly reduced the total number of emetic episodes by 52%, 36%, and73%, respectively (P < .01), in this ferret model.[*Only one study reported a decrease in tumor volume inanimals treated with acupuncture compared with control animals; however, the scientific value of this report islimited because of insufficient information about the research methodology.[*A second study involved a group of 40 postoperative cancer patients, 20 of whom received daily acupuncturetreatment and 20 of whom served as a control group. After 3 days, leukocyte phagocytosis was enhanced in thetreated group, compared with the baseline measurement (P < .01); no such enhancement was observed in thecontrol group.[*A third study observed the effect of acupuncture on interleukin-2 (IL-2) and natural killer (NK) cell activity inthe peripheral blood of patients with malignant tumors. The patients were divided into an acupuncturetreatment group (n = 25), which received 30 minutes of acupuncture daily for 10 days, and a nonacupuncturecontrol group (n = 20). The data showed that IL-2 level and NK cell activity were significantly increased in theacupuncture group, compared with the control group (P < .01).[*A fourth study observed the effect of acupuncture on T-lymphocyte subsets (CD3+, CD4+, and CD8+), solubleIL-2 receptor (SIL-2R), and beta-endorphin (beta-EP) in the peripheral blood of patients with malignanttumors. The data showed that acupuncture treatment increased the proportion of the CD3+ and CD4+T-lymphocyte subsets, the CD4+/CD8+ ratio (P < .01), and the level of beta-EP. It decreased the level ofSIL-2R (P < .01). The investigators suggested that the anticancer effect of acupuncture may be mediated viathe mechanism of immunomodulation.*In a clinical case series, 28 cancer patients who were treated with electroacupuncture (EA) while undergoingchemotherapy experienced no declines in T cells (CD3+, CD4+, CD8+) or in NK cell activity, both of which areusually suppressed by chemotherapy*In another clinical case series, 48 patients with leukopenia including two cancer patientswho were treatedwith manual acupuncture experienced improvements in leukocyte count, intracutaneous phytohemagglutinin(PHA), and immunoglobulin (IgG, IgA, and IgM) levels after 14 daily acupuncture treatments, compared withtheir pretreatment levels*HOLY BASIL ARNICA BOSWELLIA SEAWEED

*Seven clinical studies of acupuncture as a treatment for cancer-related pain have been reported in the EnglishLanguageThree studies were randomized controlled clinicaltrials, with two studies conducted in China and one in France.[10,14,15] Four studies were case series, with oneeach from England, France, Hong Kong, and the United States*One randomized trial compared classical Chinese acupuncture, acupuncture point injection with freeze-driedhuman transfer factor, and conventional analgesic treatment in patients with gastric cancer pain.[10] Theinvestigators reported an equivalent analgesic effect among the three groups observed after 2 months oftreatment; however, the conventionally treated group experienced significantly superior analgesia comparedwith both acupuncture treatment groups during the first 10 days of treatment. The researchers reported thatthe patients in both acupuncture treatment groups also experienced improved quality of life and a decrease inthe side effects of chemotherapy, in addition to analgesia.*A nonrandomized, single-arm, observational clinical study evaluated the effect of auricular acupuncture in 20cancer patients who were still experiencing pain after treatment with analgesics.[11] While patients continuedtheir analgesic medication, auricular acupuncture needles were embedded in ear acupuncture points, chosenaccording to clinical symptoms and electrodermal response, and were left in place until they fell out. In somecases, the needles remained in place for 35 days, while in others they fell out after 5 days. Pain intensity wasmeasured by a nurse on the Visual Analog Scale (VAS) on day 0 and day 60, and the data were analyzed usinga t test. The results showed that pain intensity decreased or remained stable after auricular acupuncture in allpatients, with a significant average pain intensity decrease of 33 mm (P < .001).*In a case series involving 183 cancer patients who were treated with acupuncture for cancer-related pain, 52%were significantly helped (P value not stated).[12] Multiple treatments at intervals of 1 to 4 weeks were nearlyalways necessary for significant and long-term pain control.*In another case series, 29 patients with malignant tumors who developed pain received EA treatment.[13]. Allexperienced various degrees of pain relief, and 25 out of 29 were able to either reduce or eliminate theiranalgesic requirements following multiple EA treatments.*Five studies published in English have addressed the use of acupuncture for pain related to cancer treatment,mostly postsurgical pain*A randomized clinical trial evaluated theeffect of various combinations of auricular acupuncture, Chinese herbs, and epidural morphine to relievepostoperative pain in 16 patients with liver cancer.[16] The study design was complicated and had a very smallsample size (n = 2 per group). On the basis of the VAS (0100 mm), all of the combination treatment groupsexperienced better analgesia than did the placebo -treated control group*A nonrandomized study investigated the effect of acupuncture in postoperative pain management and armmovement in breast cancer patients after surgical excision of the cancer and axillary lymph nodedissection.[17] Forty-eight patients were treated with acupuncture on the third, fifth, and seventh days aftersurgery and on the day of patient discharge. Compared with a control group of 32 patients who had the samesurgery but did not receive acupuncture treatment, the acupuncture group had significant pain relief duringarm movement on the fifth and seventh days following surgery and at the time of discharge. The range of armmotion also increased significantly in the treatment group, compared with the control group, during thepostoperative period (P < .001). The authors concluded that acupuncture point selection based on the state ofthe patient and obtaining a needling "de qi" sensation were important in achieving an effective acupuncturetreatment. *Aromatase converts androstenedione to estrone

Aromatase inhibitors (AIs) are a class of drugs used in the treatment of breast cancer and ovarian cancer in postmenopausal women. AIs may also be used off-label to treat or prevent gynaecomastia in men.

Aromatase is the enzyme that synthesizes estrogen. As breast and ovarian cancers require estrogen to grow, AIs are taken to either block the production of estrogen or block the action of estrogen on receptors.

Available aromatase inhibitors (AIs) include:Non-selectiveAminoglutethimideTestolactone (Teslac)SelectiveAnastrozole (Arimidex)Letrozole (Femara)Exemestane (Aromasin)Vorozole (Rivizor)Formestane (Lentaron)Fadrozole (Afema)Other4-Hydroxyandrostenedione [3]1,4,6-Androstatrien-3,17-dione (ATD)4-Androstene-3,6,17-trione ("6-OXO")NaturalResveratrol[4]Nicotine[5]Myosmine[6]Zinc[7]Catechin[8][9]Chalcones[10]Apigenin[11]Eriodictyol[11]Isoliquiritigenin[11]Mangostin[11]

Brief Pain Inventory-Short Form scores The BPI is a brief, simple, and easy to use tool for the assessment of pain in both clinical and research settings. The BPI uses simple numeric rating scales from 0 to10 that are easy to understand and easy to translate into other languages. On the BPI, mild pain is defined as a worst pain score of 1 - 4, moderate pain is defined as a worst pain score of 5 - 6, and severe pain is defined as a worst pain score of 7 - 10.The BPI has been used extensively around the world to measure the severity and interference of pain in patients with cancer. It has also been used effectively in patients with pain from other causes, such as AIDS-related pain and pain due to sickle cell disease.

*IN PREVENTION OF N/V SOME STUDIES WAS POSITIVE AND SOME SUDIES WAS NEGATIVE RESPONSES*Acupuncture has also been used to relieve radiation-induced nausea and vomiting. In one randomized study,patients who were randomly assigned to receive either verum or sham acupuncture experienced fewerepisodes of nausea and vomiting than did those who received standard care*hot flashes/night sweats commonly begin in perimenopause; stem from hormone fluctuations which impact centers in the brain that regulate capillary dilation and perspiration

Hot flashes or night sweats that result from sudden opening of the blood vessels close to the skin, usually due to hormonal fluctuations in menopause and perimenopause

Androgen deprivation therapy (ADT), also called androgen suppression therapy, is a treatment based on the reduction of androgen hormones, which stimulate prostate cancer cells to grow*One study randomly assigned 55 patients to acupuncture versus venlafaxine for management ofvasomotor symptoms in women with hormone receptorpositive breast cancer. Acupuncture was just aseffective as venlafaxine and caused fewer adverse effects*An uncontrolled prospective case series of 50 women on tamoxifen for early breast cancer evaluated womenreceiving eight treatments of traditional acupuncture weekly. Mean frequency of vasomotor symptomsdropped by 49.8% (P < .0001) at the end of treatment. Seven domains of the Women's Health Questionnaireshowed statistically significant improvement.[*A retrospective evaluation of 194 patients with predominantly breast or prostate cancer and experiencingvasomotor symptoms found long-term relief of vasomotor symptoms associated with acupuncture andself-acupuncture. The authors suggested that overall treatment dose may be more important than pointlocation, but favored SP6.[*In a randomized controlled trial, 47 cancer patients with moderate to severe fatigue were randomly assigned toone of three groups. One group received six 20-minute sessions of acupuncture (n = 15); one group wasinstructed to use acupressure (n = 16); and the third group, the sham acupressure group (n = 16), was taughtto apply pressure in three points unrelated to true acupressure. All three groups continued with the sametechniques for 2 weeks. The study concluded that acupuncture was a more effective method than acupressureor sham acupressure*In a randomized clinical trial,[1] 76 patients with various types of cancer, including 38 with esophageal cancer,24 with gastric cancer, and 14 with lung cancer, were randomly assigned to two groups (n = 38 per group). Thetreatment group received acupuncture in combination with radiation therapy or chemotherapy, and thecontrol group was treated with radiation therapy or chemotherapy alone. The data showed that the patients inthe acupuncture group gained significantly more body weight than patients in the control group (P < .001).The acupuncture group also showed greater improvement than the controls in the symptoms of cough,thoracodynia, hemoptysis, and fever for patients with lung cancer and the symptoms of chest pain, mucusvomiting, and difficulty in swallowing for patients with esophageal cancer. In addition, the acupuncture groupsuffered fewer side effects (poor appetite, N/V, dizziness, or fatigue) from radiation therapy or chemotherapythan the control group. However, no statistical analysis was performed on these data.*An RCT of 138 patientstreated with acupuncture plus massage versus usual care showed decreased pain (P = .05) and a decrease indepressive mood (P = .003) in postoperative cancer patients.[20]*A retrospective survey study involved patients of an oncology clinic who were offered acupuncture treatmentfor potential palliation of symptoms.[72] Among 89 patients treated with acupuncture, 79 responded to atelephone questionnaire survey. The data indicated that the major reasons for referral included pain (53%),xerostomia (32%), hot flashes (6%), and nausea/loss of appetite (6%). Sixty percent of the patients showed atleast 30% improvement in their symptoms, and about one-third had no change in the severity of symptoms.Patients were not questioned regarding acupuncture treatment expectations*

acupuncture for cancer summery.ppt

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