Lung Cancer / Mesothelioma
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Loading ...I reviewed a few general principles of acupuncture in my last post on its use for pain control. In addition, acupuncture has also been studied as a potential treatment modality for other nausea/vomiting, with some evidence to support its use in addition to anti-nausea (also called antiemetic) medications. Current ACCP guidelines (abstract here, again) strongly recommended acupuncture as a treatment for nausea and vomiting associated with chemo if these symptoms are not well controlled or when side effects from other treatments are problematic. The data aren’t overwhelming, but the recommendation is largely based on acupuncture having very minimal potential adverse effects, so even modest/inconsistent benefits would be felt to outweigh the very slight risk.
A study in the setting of breast cancer (abstract here) randomized patients to receive electroacupuncture to a couple of relevant points, minimal needling at non-acupuncture sites (”sham” acupuncture, a form of placebo control), or anti-nausea medications with no attempted acupuncture, real or otherwise. Electroacupuncture reduced total vomiting episodes from 15 to 5 (median), compared to medications alone, while minimal needling produced results between the full treatment and medications alone (median 10 vomiting episodes).
Studies combining acupuncture with newer generation anti-nausea medications like serotonin receptor blockers (current staples like zofran, kytril, and anzamet, all very similar to each other) have been inconclusive. In a study of patients without cancer but with a form of rheumatic disease that required the chemo medication methotrexate), the combination of acupuncture at the PC6 acupuncture point above the wrist and zofran worked better than zofran alone (full text here). On the other hand, another study that compared zofran and acupuncture at the PC6 point to zofran with sham acupuncture (without penetrating skin) showed no real contribution from acupuncture (abstract here). Other studies demonstrate that acupuncture can reduce nausea/vomiting associated with recent surgery (abstract here) motion sickness (abstract here), and pregnancy (abstract here).
There was a recent meta-analysis of over 1200 patients from 11 trials of various modalities that included acupuncture, acupressure, electroacupuncture, and non-invasive electrostimulation of overlying skin (abstract here). Although not especially dramatic, all of these modalities except non-invasive electrostimulation was associated with some improvement in acute, but not delayed, vomiting.
Overall, the benefits of acupuncture have been rather subtle, but it appears to be an approach that may provide some modest added benefit over medications alone. One interpretation of the negative results in the setting of a bone marrow transplant is that acupuncture may be helpful for more moderate nausea/vomiting challenges, but it may not be effective enough in the setting of very severe anticipated nausea/vomiting. Regardless, these results were enough to have the ACCP say that acupuncture merits consideration as a treatment strategy for nausea/vomiting.
Posted in: General, Miscellaneous Other Problems from Lung Cancer, Supportive care
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I’m a believer and a practical example of what I consider great success with acupuncture. First started in Dec 2003 with the initial dx of stage IV nsclc to lung, spine, lymph and bone. The practitioner, (an MD in China, phd in molecular bio in US) explained the importance of doing chemo and that his job would be to minimize side effects (including nausea and aches and pains) AND be sure that newly generating immune system cells would be healthy ones. It sure seemed to have worked as I navigated carbo/taxol without too much fuss and recently gemzar/taxotere.
I’ve been a steady visitor for 4 years now and found acupuncture to be physicaly, spiritually and psychologically very beneficail.
It doesn’t hurt and actually brings on the best of naps!
tjc
My wife has also become a believer on the subtle benefits of acupuncture. She started acupuncture during her radiation treatment. We were concerned that her stamina will be very low at a time when she was also working full time. We feel that acupuncture helped her complete that part of the treatment without excessive fatigue.
Also, despite having had radiation over her entire thorax for 5 weeks, she had no esophagitis. This may have been independent from the acupuncture, but the radiation oncologist seeing her was so impressed that he asked for the acupuncturist’s name and address.
My wife has also been struggling with chronic pain from the scar of her lobotomy. Since she was not interested in getting medication for that, we turned again to the acupuncturist for help. Although her pain has not disappeared completely (it returns at night and when she is tired) she is now pain free during the day.
A final added benefit is that, as Tic says, during acupuncture she gets wonderful naps too.
Carlos
carlos
Carlos,
The benefits may well be on the subtle side, but I think it’s very unlikely it could be harmful, so I think it makes good sense for anyone who’s inclined to try it. I’m glad it seems to help in both of your cases.
-Dr. West
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