Who would have thought needles could bring relief?! Acupuncture is a modality that has limited side effects, no interactions with medications, and has promise for improving lives of those undergoing active breast cancer treatment and post-treatment side-effect management. In this blog post, I will go through evidenced-informed practices of how acupuncture can help during breast cancer treatment
Cancer-related fatigue (CRF)
Cancer-related fatigue (CRF) can be debilitating emotionally, physically, and cognitively, resulting in a significant decline in quality of life. It is difficult to manage because currently, availability of medications that can effectively address this symptom is lacking. The use of acupuncture is slowly becoming more popular to address CRF as research builds on this topic. In a meta-analysis that pooled the results of over 1300 individuals, acupuncture has been shown to improve cancer-related fatigue from a variety of cancer types1 including: lung, liver, ovarian, cervical, breast, and pancreatic and in palliative cancer care cases2 compared to those doing conventional treatment alone. This is so incredibly powerful because it shows that acupuncture consistently improves CRF and ultimately, quality of life.
Menopausal symptoms
Any sort of hormone therapy (yup, the ER/PR+ or the triple positive tumors) will likely induce some sort of menopausal symptoms, and these symptoms can be distressing and quality-of-life-reducing. Fortunately (and unfortunately), these side effects really demonstrate the power of aromatase inhibitors or SERMs (i.e. Tamoxifen). Studies have found that acupuncture significantly reduces the frequencies of hot flashes and the severity of menopause-related symptoms of those taking aromatase inhibitors or tamoxifen3(p). Another study looked at comparing the efficacy of acupuncture for sleep disturbances due to hot flashes and medication (gabapentin). The results of that study showed that there was no difference between the two groups4 – so wait, isn’t this a bad thing? No! It’s not! This means that acupuncture is comparable to gabapentin for the relief of hot flashes!
Chemotherapy-induced peripheral neuropathy & nausea/vomiting
Peripheral neuropathy refers to a range of symptoms that include tingling, numbness and/or pain at fingers and toes. This is especially common in those who are receiving taxane chemotherapy (i.e. Paclitaxel or Docetaxel). There is currently a lack of adequate management for this symptom and is often the dose-limiting factor – meaning if the peripheral neuropathy gets bad enough, there is no other way to reduce it other than reducing the dose of chemotherapy, which is not ideal in terms of efficacy. Luckily, acupuncture is becoming a more accepted therapy to address these concerns. Two of the biggest benefits of using acupuncture in this setting are that there are no interactions with the chemotherapy and that it works. Studies have shown that acupuncture reduces the incidence of high grade neuropathy5, pain6, and improved sensory function6 for those on taxane chemotherapy. Interestingly, acupressure and auricular (ear) acupuncture has been shown to decrease frequency and intensity of nausea and vomiting episodes7,8. Since nausea and vomiting are usually well-managed with medication, the application for acupuncture and acupressure should be limited to those who are not adequately managed with medication alone.
Anxiety & depression
This isn’t necessarily a specific side effect of cancer treatment but these are concerns that are just as important to manage for individuals undergoing cancer treatment and also during survivorship. Emotional and mental health are often under-discussed within the talks of cancer-defeating/ controlling treatments. From a holistic perspective, it is important to address concerns of anxiety and depression throughout the cancer journey. Acupuncture has shown to help reduce general anxiety and mitigate depressive symptoms when performed on a regular basis9
…but is it SAFE?
In general, acupuncture has few side effects aside from the obvious inserting-a-needle-into-skin aspect of the treatment. Even though there is minimal pain associated with this treatment (because the needles are so thin), some individuals can still be sensitive to the insertion of the needles and cause discomfort and anxiety, especially if there is a fear of needles to begin with. No one likes getting poked. That is simply a fact of life. Since there are still needles that get inserted into the skin, an obvious side effect is bleeding/ bruising at the insertion site. This poses a caution for anyone who uses anticoagulants (such as warfarin) or anyone with bleeding/ clotting disorders. Always talk to your healthcare provider prior to getting treatment.
It is important emphasize that complementary therapies are meant to be used concomitantly with conventional medication, where available. Acupuncture is a powerful tool and should be utilized to minimize side effects from treatment or cancer itself.
References
1. Zhang Y, Lin L, Li H, Hu Y, Tian L. Effects of acupuncture on cancer-related fatigue: a meta-analysis. Support Care Cancer. 2018;26(2):415-425. doi:10.1007/s00520-017-3955-6
2. Lau CHY, Wu X, Chung VCH, et al. Acupuncture and Related Therapies for Symptom Management in Palliative Cancer Care: Systematic Review and Meta-Analysis. Medicine (Baltimore). 2016;95(9):e2901. doi:10.1097/MD.0000000000002901
3. Chiu H-Y, Shyu Y-K, Chang P-C, Tsai P-S. Effects of Acupuncture on Menopause-Related Symptoms in Breast Cancer Survivors: A Meta-analysis of Randomized Controlled Trials. Cancer Nurs. 2016;39(3):228-237. doi:10.1097/NCC.0000000000000278
4. Garland SN, Xie SX, Li Q, Seluzicki C, Basal C, Mao JJ. Comparative effectiveness of electro-acupuncture versus gabapentin for sleep disturbances in breast cancer survivors with hot flashes: a randomized trial. Menopause. 2017;24(5):517-523. doi:10.1097/GME.0000000000000779
5. Bao T, Seidman AD, Piulson L, et al. A phase IIA trial of acupuncture to reduce chemotherapy-induced peripheral neuropathy severity during neoadjuvant or adjuvant weekly paclitaxel chemotherapy in breast cancer patients. Eur J Cancer. 2018;101:12-19. doi:10.1016/j.ejca.2018.06.008
6. Li K, Giustini D, Seely D. A systematic review of acupuncture for chemotherapy-induced peripheral neuropathy. Curr Oncol. 2019;26(2). doi:10.3747/co.26.4261
7. Eghbali M, Yekaninejad MS, varaei S, Jalalinia SF, Samimi MA, Sa’atchi K. The effect of auricular acupressure on nausea and vomiting caused by chemotherapy among breast cancer patients. Complement Ther Clin Pract. 2016;24:189-194. doi:10.1016/j.ctcp.2016.06.006
8. Genç F, Tan M. The effect of acupressure application on chemotherapy-induced nausea, vomiting, and anxiety in patients with breast cancer. Palliat Support Care. 2015;13(2):275-284. doi:10.1017/S1478951514000248
9. Amorim D, Amado J, Brito I, et al. Acupuncture and electroacupuncture for anxiety disorders: A systematic review of the clinical research. Complement Ther Clin Pract. 2018;31:31-37. doi:10.1016/j.ctcp.2018.01.008
