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Ask an expert - body - cancer

7 questions

Q:] I have peripherial neuropathy in hands and feet for almost a year caused by chemotherapy for breast cancer. I also have lymphodema in my arm. How many acupuncture treatments before I should notice benefit or when should I consider stopping. Is  it safe to have acupuncture in lymphodema arm?

A:  The first question is difficult to answer, and is usually described as a 'how long is a piece of string' question. Our usual recommendation to patients in giving answers here is to review progress every four or five sessions, and to try to establish clear and measurable outcomes so that there is some objective evidence of whether the treatment is taking effect. We are really concerned that our colleagues avoid situations developing where a treatment 'habit' can run to fifteen or twenty sessions without discernible change - it's just very easy to book week after week with no sense of time passing. This tends to lead to discontent and occasionally complaints.
 
In this expert's view, there has to be some evidence of progress, however limited, after the first five sessions to have a good sense that it's worth continuing. This need not necessarily be in the main symptom; in Chinese medicine we treat the person, not the condition, and there can sometimes be good evidence from other systems of beneficial change which means the main problem will also be likely to move. This does not always mean drawing a line, but it does mean that if someone does decide to carry on it is with clear understanding of what is happening.
 
As far as needling a lymphoedematous arm is concerned, our current recommendation to members is that this is not to be done. Although there is little or no evidence to support the almost universal prohibition of acupuncture by consultants, we have to acknowledge that there is an increased risk of cellulitis and other infection from needling a limb below where lymph nodes have been removed. However, there are many ways of using the interconnections within the system as a whole to treat successfully at a distance within the body, and a qualified practitioner will have many ways at their disposal to effect change and improvement.
 
Indeed, one of our members, Beverley de Valois, has published several landmark papers in this area
 
http://www.researchgate.net/profile/Beverley_De_Valois/publications
 
and has shown that treating constitutionally without needling an affected limb can be very beneficial. 
 

Q:  My husband has had chemo and radiotherapy to treat throat cancer. Treatment finished 12 weeks ago and he is suffering with severe pain in his throat following the radiotherapy. Can acupuncture help?

A:  This is a very difficult question to answer. While acupuncture has always been used for pain relief, as our factsheet shows
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html
 
there is a considerable difference between a chronic back pain or chronic headache and the sorts of tissue damage which radiotherapy can create. We do have a factsheet on postoperative pain,
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/post-operative-pain.html
 
but this does not have anything specific to say about radiotherapy.
 
As far as other research is concerned, there is a systematic review
 
http://www.ncbi.nlm.nih.gov/pubmed/23341529
 
which summarises the results from all studies in this area, and seems to show a number of potential positive outcomes. These reviews will always conclude, however, that 'more work needs to be done' because the sample sizes are usually too small to generalise from - acupuncture research is not high on the agenda of mainstream medicine. There are a number of encouraging studies for the treatment of xerostomoa (dry mouth) resulting from radiotherapy in throat cancer, and insofar as these point to a return to normal function, there may be some hope that acupuncture might work with servere pain in the same area.
 
Each case is individual, however, and we would recommend that your husband would be best advised to visit a BAcC member local to you (you can find one by using the search function on our home page) and see if they will offer a face to face assessment of what may be possible. Most practitioners, if they took on a patient with a problem such as yours, would set some fairly tight review periods to make sure that treatment did not continue if there were no tangible benefit; it is very easy for the patient to want to keep going when there has been no discernible improvement.
 
We hope that your husband does find a way to reduce the pain. We know from our own experience of treating similar cases just how debilitating it can be.  
 

Q:  Can acupuncture help pain caused by scar adhesions resulting from raditation treatment for cancer? Is there any suggestion that after the lymp nodes have been removed that acupuncture treatment should not be done?

A:  Acupuncture has a considerable history of use for pain relief, as our factsheet shows
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html
 
The treatment of pain, and trying to understand the relationship between eastern treatment and western recognised effects in terms of endorphins and enkephalins, was one of the most commonly researched areas of acupuncture treatment, especially because the measurement of chemicals gives nice crisp data. 
 
However, as with any pain relief, the question is never as simple as 'does it work?' but is usually 'how much does it work and for how long?' In the case of scarring and adhesions inside the body we have no evidence to which we can point. Scarring on the surface of the body can occasionally block or prevent the free flow of energy in the channels, and there is some anecdotal evidence that treating local blockages caused by scarring can have considerable impact. However, although the same must apply to a degree internally, we have no anecdotal accounts to draw on. Indeed, it is fair to say that physical damage and irreversible change are just as much an impediment to health in eastern as in western medicine.
 
One could argue that the essential premise of Chinese medicine, that in restoring the balance of the whole system recovery of all kinds becomes improved, may have some impact, and there are certaonly styles of acupuncture premised entirely on restoring balance, treating the patient and not the condition, which can have profound results. We think that in this case this would be a very long shot. Most of the best results we have heard of involve a variety of physical therapies aimed at stretching out or releasing the adhesions and freeing up the internal tissues the movement of which they restrict.
 
The treatment of someone whose lymph nodes have been removed has been the subject of great discussion in the profession for years. Although acupuncture is routinely used in China for the accumulation of fluids, called lymphoedema, which can happen after lymph nodes have been removed, in this country the position is that people are told not to have acupuncture treatment in the affected limb because of the increased risk of infection, especially cellulitis. The advice we give to members is to take care not to needle the affected area, and to use alternative point combinations to achieve the desired aims. However, if treatment of the affected limb is avoided, acupuncture treatment performed according to the proper guidelines is perfectly safe.
 

Q:  I completed a course of daily radiology on April 5th 2013 this was successful as on 17th May my PSA was down to 0.38.  I have three monthly hormone injections which keep the prostate cancer under control, the side effects of these is of course hot flushes, my oncologist and the senior oncology nurse feel that acupuncture would help with this problem, please advise.

A:  From an evidence based perspective this is a difficult question to answer. There are very few studies to look at the incidence of hot flushes in post-radiotherapy men, although a considerable number looking at hot flushes in the menopausal woman. There are a number of systematic reviews of acupuncture used  post-radiotherapy over a wider range of conditions, such as
 
http://www.ncbi.nlm.nih.gov/pubmed/23341529
 
but the results tend to be assessed as inconclusive, mainly because the trial designs are regarded as inadequate rather than there being no changes.
 
There are also a number of small studies into the effects of the use of acupuncture to reduce the side-effects of hormone therapy, and the one reported here
 
http://www.sciencedaily.com/releases/2011/04/110421122406.htm
 
can be found at:
 
http://www.redjournal.org/article/S0360-3016(10)00124-0/abstract
 
There are a number of encouraging trial results for using acupuncture for xerostomia, a dry mouth brought on by the treatment, and this is interesting because it is a manifestation in Chinese medicine terms of excess heat in the system causing the loss of body fluids. From this perspective radiotherapy generates a great deal of heat within the body. Stephen Gascoigne, a medical doctor and acupuncturist whose textbooks are used in training institutions, has just written an article for our Newsletter which describes the effects of of cancer treatments in Chinese terms, and talks about the use of radiotherapy as something which 'burns and dries yin and blood'. This would create in the patient the sort of energetic balance which is naturally experienced by a woman entering the menopause, where the yin and blood are beginning to diminish with exactly the same sort of consequence of hot flushes as you are experiencing. When followed up with a course of three monthly hormone treatments, the problem is further compounded. The medications are likely to add to the underlying problem caused by the radiotherapy as understood from a Chinese medicine perspective. 
 
From this perspective, therefore, it should be possible to do something which helps to address the problem you have. The practitioner will, of course, not simply be looking at this symptom but at the whole way in which your system functions. Clearly, however, the oncologist has had good reports and feedback about acupuncture treatment for alleviating the side effects of the hormone treatment, and we are very encouraged by their recommendation.
 
The advice, as always, is to contact a BAcC member local to you and ask for a face to face assessment. Someone who can actually see what is happening in your system will be able to give you a far better idea of what can be done than we can at a distance.     
 
 

Q:  My Dad suffers from severe dry mouth after mouth cancer operations and radiation. Is there an acupuncturist who specialises in this?

A: As this extract from our factsheet on palliative care shows

 

Dry mouth (xerostomia)

A systematic review found possible benefits with acupuncture for radiotherapy-induced xerostomia (O’Sullivan 2010). Not all the inter-group differences were significant but this is typical in trials comparing acupuncture with sham acupuncture, for the latter is commonly viewed as being an active treatment itself, not a placebo, and hence may underestimate the effects of the therapy (Lundeberg 2011; Sherman 2009; Paterson 2005).The RCTs to date are few in number and small in size. Although they have produced encouraging results, and are supported by observational studies (for example, Meidell 2009), larger trials are required to achieve more robust evidence. Acupuncture may also help with xerostomia dysphagia (swallowing difficulty) in late-stage palliative care (Filshie 2003).

 there is some evidence for the value of acupuncture treatment for dry mouth after radiotherapy, and the two studies below certainly seem very positive.
 
Please click here
 
Please click here
 
Clearly there is a considerable difference between the kinds of functional disturbances caused by disruption of the balance of the body's energies through normal wear and tear and the kinds of damaged brought on by injury or accident. This does mean that it is more difficult to predict whether acupuncture treatment might be of benefit. Treatment of the kind used in the studies tends to be localised or precisely targeted, and this can mean that it does not really conform to the patterns of treatment which a Chinese medicine practitioner would employ. In broad terms, however, acupuncture treatment is aimed at putting the whole system back in balance with the underlying belief that a body in balance tends to deal with symptoms itsef, and on this basis it may well be worth talking to a BAcC member local to your father to see if a combination of systemic and local treatment may, in their view, be of benefit. Most BAcC members are more than happy to give up a little time without charge to give a face to face assessment of whether treatment would help.
 
We do not have any members of whom we are aware who specialise in this field of treatment. From our perspective all of our members are sufficiently skilled to be able to handle the vasy majority of conditions with which they are confronted, and know when to refer on if they feel it is beyond their limits of competence. In cases such as your father's, which are relativey infrequent in day to day practice, most members would as a matter of course undertake their own research to be au fait with the most recent research findings if presented with an unusual condition.
 
 
 
 

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