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.
 
 
 
 

Q: My  husband has been diagnosed with primary liver cancer & it is at an advanced stage. We have both had acupuncture in the past & find it very effective. Could you advise me in what ways acupuncture may be useful with his type of cancer? Would we need to choose an acupuncturist who specifically  haD experience of cancer patients, or is cancer treatment within the expertise of most acupuncturists? thanks in advance for your help.

A:  We are always very cautious in responding to questions about cancer. Not only is it illegal to claim to be able to cure cancer, or even imply that a cancer is treatable. The best one can say of the use of acupuncture in the treatment of any terminal condition is that there is some possibility that it might be able to provide a modicum of pain relief and reduction in the severity of the symptoms which the person is experiencing. The theory of Chinese medicine, based as it is on theories of balance and harmony in the flow of energy and on the inseparable nature of body, mind and spirit, would also make the case that someone's inner state might be helped by a reduction in the anxieties and fears that people experience. Each person reacts differently, however, and some not at all.
 
There are a very small number of members who work in palliative care facilities, and if you are local to one of these (sadly we don't record this information) you might find that their experience is invaluable. many hospices have a range of complementary therapists on whom they occasionally call, and it might well be worthwhile calling ones local to you for a recommendation. Our experience of hospice staff has been very positive, and we are sure that they would guide you.
 
While the scope of practice of acupuncturists extends to nearly any condition, i.e. there are very few where treatment is not permitted, dealing with terminal illness is something many training institutions recommend that their new graduates stay away from until they have greater clinical experience or unless they have training in terminal care already. The majority of our members, however, would be more than happy to provide what help they can.
 

Acupuncture should not be used as the primary treatment for cancers of any kind. Our advice to members is that if they treat people with cancers the treatment cannot be described as helping to treat the cancer, nor should they create any expectations in the patient that cure or remission are possible. We would be extremely concerned if anyone did not avail themselves of all the possible support available from conventional medicine because they had been led to believe that acupuncture could replace the normal treatment.

It is true, however, that many people choose to use acupuncture alongside the conventional treatment as a part of their strategy for dealing with the disease, and there are some symptoms arising from the cancers for which there is evidence that acupuncture is beneficial. One of the leading American acupuncturists and authors, Bob Flaws, has published a number of articles such as

http://www.acupuncturetoday.com/mpacms/at/article.php?id=28009

which describe how a Chinese medicine practitioner may use herbal medicine alongside conventional treatment for lymphomas. He is something of a visionary and trailblazer, however, and the research which we quotes is as yet very limited. There is undoubted scientific interest in this kind of approach, with the Chinese in particular looking at the integrated use of traditional and conventional medicine.