Ask an expert - body - cancer

18 questions

Q: A year ago I had a breast lumpectomy with all lymph nodes removed under left arm (lumpectomy left breast). I am suffering from pain in both areas - I cannot have any treatment on my left arm, but my holistic therapist has suggested accupunture on right side. I am anxious about this, I am needle phobic and was wondering where the needles would be placed and how many? If I do not feel comfortable, can I ask her to stop? She has told me I will be fine, but my anxiety is taking over.

A: The first and most important thing to say is that no-one can do anything in a treatment room without your consent. It is also not ethical to assume consent, so any healthcare professional who is about to do something which they could reasonably foresee you might object to, has to get explicit consent. If you say 'stop' and the person doesn't, it technically constitutes a criminal offence! If you want to immerse yourself in the legalities, the place to look is here:

https://www.gov.uk/government/publications/reference-guide-to-consent-for-examination-or-treatment-second-edition

Of course, what tends to happen in the treatment room is that patients often fall into a role of trust and deference which means they let things get far beyond where they would like without stopping the process, and we take great care to ensure that our members check every stage of treatment with patients rather than just carry blithely on. It might be best if you explain your anxiety to the practitioner first and agree before you start some form of words which means 'stop the music.'

As far as treatment itself is concerned, the restriction on treating the affected side is mainly to do with the risk of cellulitis or other infection. There are no case reports in the UK for this ever happening so it remains largely a theoretical risk, but as they say in research circles, absence of evidence is not the same as evidence of absence - there may have been cases but no-one made the connection. Interestingly, though, in China it is not at all unusual to treat lymphoedema on the affected side, and we did find a research trial involving western medics which used points on the affected side, so things may be changing.

No matter! One of our colleagues, Beverley de Valois, has researched and worked extensively in this area, and her listing on a teaching institution website shows the many papers she has written about effective treatment of problems when the arms cannot be needled after mastectomy with lymph node removal. In Chinese medicine there are all sorts of internal connections both side to side and above and below which means that there are always options to treat problems at a distance. Indeed, in many first aid protocols, treatment as far from the affected site as possible is used to get the greatest 'leverage.' A skilled practitioner is no more put off by this than by treating someone in a full leg plaster cast. How many needles and where placed we cannot say. There are many styles of acupuncture, and some use more needles than others. What we can say, though, is that the number of needles is completely under the control of the practitioner, and if asked to use less, we can. We can also reduce the depth of insertion and the amount of manipulation of the needle to address the problem of patients who are very sensitive and react strongly. Needle phobia is slightly different, but the average needle is a tenth of a millimetre across, inserted with a guide tube which dulls the sensation, and is barely perceptible. Many people are actually unaware that a needle has been inserted. A slightly dull ache or a tingling sensation are usually the most that people feel.

As above, though, you are in charge in the treatment room, and you can ask the therapist to work at a pace you feel comfortable with. If they won't, find someone else who will!

We hope that this has quelled some of your anxiety.

Q:  I work with cancer patients and am trying to establish how many sessions of acupuncture each person should have according to your protocol

A: We're not quite sure what you had in mind for a 'protocol for treating cancer.' Traditional acupuncture is primarily a generalist practice which treats people rather than conditions, and we suppose the answer that we would normally give would be along the lines of 'treatment specific to the unique problems of the individual for as long as it takes for the person to achieve the optimum result from treatment.' Clearly with treating many cancer patients this is not a matter of reversing their problems, but more often a matter of addressing some of the worse side-effects of their treatment and of trying to help their inner state as the disease progresses. As long as someone still feels that they derive benefit from treatment we would continue to treat.

 The question of numbers of treatments only usually arises where resources are scarce and someone sets a limit, often quite arbitrary, to the number of sessions that someone can have. In some cases, like the NICE recommendation for the treatment of low back pain, the number of sessions (ten) is not far away from what we might consider sufficient to have an impact. In other conditions, though, a fixed number makes little or no sense. Some migraine sufferers respond quickly, others take a long time because their problems are multifactorial. To say 'six sessions and done' would make no sense.


You may find, or already have found, that some NHS facilities do treatment which is a little more protocol based, but there are very few protocols in our work which both define a named condition and a set number of sessions to address it. That does not mean that we expect to be given a blank cheque to work as long as we like. Sometimes treatment works well, and sometimes it doesn't. It is absolutely vital to try to establish measurable outcomes and to review progress on a regular basis to ensure that there is some value in carrying on. With degenerative problems this can sometimes be a quite odd determination, like 'getting worse slower', but the question always has to be posed.

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A:  We are often asked about specialists in treating certain kinds of problem, and the answer is always the same - from a traditional Chinese medicine perspective we are all generalists because we treat the person, not the condition. Indeed, in ancient times the specialist was looked down on as a rather unworthy being because they only treated a small range of problems! In reality, there are a number of areas like paediatrics, obstetrics and mental health where we are investigating how to accredit expert practice because we do recognise that in each area there is supplementary knowledge and experience which is not a part on undergraduate training, but this does not mean that only these people can treat these groups. The difference is between good and better.

The nature of Chinese medicine is that the symptom or presenting condition has to be seen in the context of the person's overall health or balance. This explains why twenty people with the same named condition might be treated in twenty different ways. In reality, though, there is quite great deal of research using slightly more formulaic points which can help the problem of chemo-induced neuropathy. Western research tends to eliminate variables, so treatment protocols tend to be repetitive, unlike most practice which is evolutionary and developmental.

There is a systematic review found here

 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741953/

which looks at all of the studies which have been conducted, and tends to be a little bit negative, although conceding that there are studies which look promising. Part of the reason lies in the fact that many Chinese studies, of which there are thousands, tend to be more concerned with what works better than with whether acupuncture works, and these tend to be dismissed as methodologically weak, hence the almost universal request for 'more robust' studies. The reality is that the gold standard of research in conventional medicine, the randomised double blind control trial, is not best suited to testing a therapy with many variables, so results are always going to be strange. The more the treatment fits the conventional structure of testing, the less it looks like what we do.

Anyway, enough carping about research! Most of us have had successes quelling the worst aspects of neuropathy, but we have also had our failures. It is very important to review treatment to avoid a subtle accumulation of many treatments, and equally important to try to find measurable outcomes to test whether there really has been progress. On this basis a course of acupuncture treatment will certainly not do any harm, and will probably do some good. The question is really how much good and how sustainable.

To find a practitioner geographically closest the best thing to do is to use the postcode search facility on the BAcC home page. We have just  tried it and generated thirteen hits on SO22 and SO23, so we are sure that you will find a suitable practitioner close to where you live. Most of our colleagues are happy to invite people in for a chat before committing to treatment, and this is often the best way to establish whether someone is the practitioner for you.

Q: My wife has been suffering. from a  brain tumour for the past six years. She has had two surgeries and two radio therapies having been operated ten days ago. Doctors say tumours may recur in future. Can it be prevented by acupuncture treatment is it safe and can it be treated along with allopathic medicine?

A:  We are sorry to hear of your wife's predicament.

We have to be honest and say that there is no evidence that we have, either formal through studies or informal through anecdotal accounts, that acupuncture treatment could prevent the recurrence of brain tumours. We would not even be able to say how this could be measured; sometimes tumours simply do no recur and it would be impossible to determined whether something like acupuncture had been central to this happening.

The best that we can say is that acupuncture treating done according to traditional principles is aimed at balancing up the whole system to optimise its functions in the simple belief that a system in balance is  better equipped to deal with symptoms as they arise. This may have the impact of improving someone's ability to deal with quite aggressive conventional treatment, and may even have the effect of slowing down the progress of a chronic degenerative condition. More than this, though, we could not say.

Each person is different, however, and the only real way to get a sense of what may be possible for 'non-standard' conditions like this is to visit a practitioner and have a face to face chat so that they can see what is going on with the whole system. Most BAcC members are more than happy to sit down with a prospective patient for a short chat without charge to assess the potential benefits of treatment, and we hope that your wife is well enough to make such a visit.

As far as safety is concerned, acupuncture remains one of the safest forms of treatment around, with some of the lowest incidences of adverse events. It can also be used successfully alongside conventional treatments, and all acupuncturists are trained to ensure that they take conventional treatment into account when formulating treatment plans, especially when this treatment can render a patient immuno-compromised and not quite so well defended as they would normally be. You can read about acupuncture safety as www.acupuncturesafety.org.uk

 

Q: Please can you advise me if there are any contraindications to using acupuncture during conventional treatment of breast cancer in a woman aged 25?
For example, could it cause any conflicts during chemo or radiotherapy therapy treatment? I have researched the positive effects and do not find much in the way of acupuncture opposing treatment in anyway. 

A:  There is, as you say, quite a bit of evidence gathering for the use of acupuncture to treat the side-effects of chemotherapy, as you can see in the relevant sections of our factsheet on nausea

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/nausea-and-vomiting.html

There is also a growing body of evidence for the treatment of chemo-induced neuropathy, although not quite robust enough for us to make claims of efficacy.

In general, the use of acupuncture to help with the side effects of chemotherapy and radiotherapy is becoming well established within cancer treatment centres. The only contra-indications we have ever encountered are to do with the treatment of the limb beneath where lymph nodes have been stripped. In mastectomies and even some lumpectomies the lymph nodes under the armpit are stripped as well, and the received wisdom is that treatment of the affected arm creates an enhanced risk of infection, especially if the person has lymphoedema as a consequence of the removal of the glands. 

There has been a considerable amount of argument inside the profession about this, because in China doctors happily treat the affected limbs with acupuncture, and we can find no evidence of any 'smoking gun', a case where infection has been attributed to acupuncture treatment. We strongly suspect that this arose from the view of a small number of consultants and in the absence of evidence either way everyone has played safe. This is not an impediment to treatment, however. One of our colleagues, Beverley de Valois, has published several very authoritative studies showing that treatment according to traditional principles using substitute points elsewhere on the body has been just as effective as local treatment. A full list of her publications is to be found here:

https://www.researchgate.net/profile/Beverley_De_Valois/publications

The main factor which we have to bear in mind is that someone being bombarded with chemicals and radiation is immuno-suppressed and may not have as much resistance as the average patient. As a result we take special care with such patients, and may, for example, routinely swab all points before needling where normally we rely on professional judgement. Our health and safety consultant was always emphatic, though, that following our Codes of Safe Practice to the letter was a guarantee of safety from cross infection.

There is no evidence, either, of conflicts with any other forms of conventional treatment, as in trying to restore cells which the conventional treatment is trying to destroy. Because we are working from a different paradigm the treatments are aimed at different levels of function within the body, and do not cancel each other out.

If you do decide to have some acupuncture treatment, and we believe it will probably offer some real benefits, you can discuss this in depth with your practitioner. Our members are well informed on areas like this, and have had to address similar concerns on many occasions.

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