Breast cancer patients are no strangers to needles, but several are finding that being pricked during acupuncture relieves pain caused by treatment rather than induces it.
Acupuncture is a traditional Chinese medicine that inserts thin needles into the skin, according to the National Center for Complementary and Alternative Medicine website nccam.nih.gov/.
Researchers at Penn Medicine led a controlled trial and found that a form of acupuncture called “electroacupunture” helped relieve the symptoms of breast cancer patients such as joint pain, fatigue and depression.
Electroacupuncture uses “small electric currents” as part of the needling process, said Dr. Jun Mao, the corresponding author of the study and an associate professor of Family Medicine and Community Health in Penn’s Perelman School of Medicine.
Mao said several breast cancer patients were expressing negative symptoms from the use of aromatase inhibitors, a drug used to treat cancer.
The hormonal drug therapy is “the most commonly prescribed medication to prevent disease recurrence among post-menopausal women with early-stage, hormone receptor positive breast cancer,” according to a press release about the study.
“It’s very effective for treating breast cancer … but it makes a lot of women feel very miserable,” Mao said.
He said after taking the drug, patients have complained of body aches, fatigue and feeling psychologically distressed. Mao said several women chose to stop the treatment prematurely because of these negative side effects.
“If you stop a factored drug, that could potentially effect survival,” Mao said.
He said studies have shown that up to a third of women decided to stop the hormonal drug because of its side effects and 50 percent of patients didn’t take the recommended amount. Mao said the situation wasn’t ideal so researchers wanted to provide a more natural method to relieve symptoms caused by aromatase inhibitors, which was the purpose of the study.
“We found that electroacupuncture was helpful not only for the joint pain but was also helpful for a variety of symptoms that’s common to breast cancer survivors,” Mao said.
In the study, about 60 women were assigned to electroacupuncture, sham acupuncture or usual care for treatment of symptoms. Before the treatment process of the study, patients measured their pain, fatigue, sleep, anxiety and depression symptoms so that they had something to compare at the end of the trial. Researchers followed the patients during treatment and did a follow-up four weeks after their last treatment.
“For the electroacupuncture group, the improvement in pain even continued beyond the last treatment,” Mao said.
He said the patients felt relief after using electroacupuncture but the amount of time it took varied by each individual.
“Some people felt a relief pretty quickly … while others really started noticing a change after about four or five treatments,” Mao said.
A press release about the study stated just how much improvement in symptoms patients felt after using electroacupuncture:
* Fatigue: “Compared with usual care, patients receiving electroacupuncture had a greater reduction in the fatigue score at week eight and the effect was maintained at week 12. On average, patients reported a 2.0 point reduction in fatigue on the Brief Fatigue Inventory, an instrument designed to assess fatigue severity on a numerical scale ranging from 0-10,”according to the press release.
* Anxiety: “By week 12, patients receiving electroacupuncture reported a significant improvement in their anxiety score, whereas patients receiving SA did not. On average, patients in the electroacupuncture group reported a 2.2 point reduction in anxiety on the Hospital Anxiety and Depression Scale (HADS) compared to the usual care group,” according to the press release.
* Depression: “Patients in both electroacupuncture and sham acupuncture groups reported a significant improvement in HADS-Depression scores (2.4 points and 2.0 points, respectively) compared with the usual care group by week eight. The effects of both electroacupuncture and sham acupuncture on depression were maintained at week 12,” according to the press release.
Mao said the electroacupuncture helped relieve physical pain which then helped relieve other symptoms felt by the patients such as anxiety and depression. He said usually when someone feels pain; they also feel tired from not getting enough sleep as well as anxious and depressed. Physical pain often leads to psychological distresses, Mao said.
Mao said the electric currents used in electroacupuncture have a positive effect on the endorphins being released in the brain. He said it helps modulate neurotransmitters such as serotonin and dopamine. Serotonin regulates mood, sleep cycle and pain control while dopamine helps with depression and focus, according to the website www.neurogistics.com.
“Those neurotransmitters are your chemicals in the brain. They are really important in pain processing and emotional regulation,” Mao said.
Mao is the Integrative Oncology Program director at the Abramson Cancer Center of Penn Medicine and he said electroacupuncture has been used by several of the center’s cancer patients. Mao said about 16 percent of the patients have used acupuncture treatment.
“It’s becoming more popular,” he said.
Women are using acupuncture services for several symptoms caused by cancer treatments such as chemotherapy, which often cause nausea and vomiting. Chemotherapy is a treatment where drugs travel through the body to reach cancer cells, according to the American Cancer Society website www.cancer.org.
Mao said several women have come to see him for acupuncture services because of chemotherapy related neuropathy since there are very few treatments that help this condition. Chemotherapy related neuropathy is a tingling sensation in the body that can include a “sharp, stabbing pain,” according to the American Cancer Society website. The website also stated that about 30 to 40 percent of cancer patients treated with chemotherapy have these symptoms.
Mao said another study found that acupuncture also helps with post mastectomy pain.
“I do think there are a number of pain and non-pain symptoms that acupuncture may help,” he said.
Acupuncture is one of many services offered through Penn’s Integrative Oncology Program. Services also include yoga, reiki therapies, massage therapies and mindfulness based meditation.
Mao said the Abramson Cancer Center is very interested in optimizing patient experience and patient outcomes.
“We are working hard to combine conventional programs such as nutrition and physical therapy with evidence-based alternative therapies such as yoga and meditation,” he said. “It’s to really enhance breast cancer patients’ experience during treatment and beyond treatment into survivorship.”
The integrative program at Penn started in 2007 with a small working group and has grown over the years, Mao said.
He said a qualitative study was done of breast cancer survivors. The study found that many survivors are interested in more natural treatments for their symptoms since they go through “very invasive and toxic treatments,” Mao said.
“They want to restore a sense of normalcy and wellness,” he said.
He said cancer affects patients physically, psychologically and spiritually. Patients going through cancer often feel a loss of control, Mao said.
“There’s a high degree of uncertainty about their future,” he said.
Mao said allowing women to try alternative therapies as part of their treatment based on preferences, gives them back a sense of control. He also said these natural methods of treatment have shown that they help patients. Trials and research found that yoga is beneficial for sleep and that meditation helps with distress and fatigue, Mao said. He said Penn Medicine is working very hard to develop research- based evidence for alternative therapies so they can meet patients’ needs.
Researchers found that about 60 percent of Penn Medicine cancer patients use the Integrative Oncology services which also included classes about nutrition and exercise.
Mao said the Abramson Cancer Center has experienced nutritionists that work with patients to discuss the optimal diet options during treatment and through survivorship. The nutritionists also talk with patients about the best supplement regimen to take. He said more and more data is finding that physical activity is vital for the health and well-being of cancer survivors. The Integrative Oncology Program includes exercise programs as well as physical therapy opportunities.
“As we provide care, we really need to put the patients in the center … as we research and develop different kinds of programs,” Mao said.
