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Thursday, 24 November 2016

Acupuncture: could it become everyday practice in oncology?

. 2016; 20(2): 119–123.
Published online 2016 Jun 14. doi:  10.5114/wo.2016.60065
PMCID: PMC4925730


Aneta Kilian-Kita, Mirosława Puskulluoglu,corresponding author Kamil Konopka, and Krzysztof Krzemieniecki
Department of Clinical Oncology, University Hospital in Krakow, Krakow, Poland
corresponding authorCorresponding author.
Address for correspondence: Mirosława Puskulluoglu, Department of Clinical Oncology, University Hospital in Krakow, Śniadeckich 10, 31-501 Krakow, Poland. e-mail: lp.pw@llocrim

Abstract

Abstract

Acupuncture is a complementary and alternative medical treatment (CAM) which is increasingly used in the care of cancer patients. Traditionally derived from Chinese medicine, nowadays it is becoming a part of evidence-based oncology. The use of acupuncture in these patients has been recommended by the American Cancer Society (ACS) for the treatment of side effects associated with conventional cancer therapy and cancer-related ailments. A growing body of evidence supports the use of acupuncture in the treatment of cancer-induced pain and chemotherapy-related nausea and vomiting. Also other indications, such as xerostomia, fatigue, hot flashes, anxiety and peripheral neuropathy, are being constantly evaluated. This article summarizes the most important discoveries related to the possible usefulness of this method in contemporary oncology. Emphasis is placed on the results of randomized controlled trials with an adequate level of evidence. However, explanation of the mechanisms responsible for these effects requires confirmation in further studies with an adequate level of evidence. In future, acupuncture may become an interesting and valuable addition to conventional medicine.
Keywords: acupuncture, cancer, complementary and alternative treatment, side effects, supportive treatment

Introduction

Complementary and alternative medical treatment (CAM) has gained significant interest in recent years []. Although the list of CAM has changed over the years, the Office of Alternative Medicine (established at the National Institutes of Health [NIH] in the USA) nowadays recognizes five major categories []. Acupuncture, belonging to the Manipulative Therapies category, due to its low cost, safety (considering all possible contraindications) and the minimal number of side effects is gaining popularity among patients []. Acupuncture has repeatedly been reported to be useful in oncological practice in alleviating side effects of anti-tumor treatment. Numerous clinical trials of acupuncture indicate its potential role in fighting the following ailments: nausea and chemotherapy-induced vomiting, pain, xerostomia, vasomotor symptoms, neutropenia, fatigue, anxiety, insomnia, lymphoedema after mastectomy, and peripheral neuropathy [–]. A sudden increase in the number of studies on acupuncture in oncology was first noted in 1997, when at the NIH conference a consensus was reached on the use of acupuncture, which was then acknowledged as a useful medical procedure []. This article reviews the literature concerning the referred studies.

What is acupuncture?

Acupuncture is a method of treatment that has its origins in Traditional Chinese Medicine and is based on over 4,000 years of empirical evidence. The technique involves the insertion of thin needles into specific locations (energy points) on the patient's body along energy pathways or meridians. According to Chinese philosophy, the hypothetical substance Qi (vital energy) flows in the human body along the meridians, and blockage of Qi leads to a particular ailment []. There are 12 main and 8 extra meridians. All the main meridians consist of internal channels connected with the 12 body organs and the external channels spreading symmetrically on the skin surface. The literature describes around 360 energy points located on the external parts of the meridians. Acupuncture is considered to cure diseases by stimulating particular acupoints and removing blockage of Qi []. Figures 1–3 present acupuncture meridian pathways.
Fig. 1
The course of main meridians on the anterior surface of the body
Fig. 3
The course of main meridians on the lateral surface of the body
Fig. 2
The course of main meridians on the posterior surface of the body
Although acupuncture has been studied extensively in both animal and human models, little is known about its mechanisms that could explain acupuncture's therapeutic qualities. Table 1 shows suggested mechanisms of acupuncture. This treatment method has been the focus of increased interest, which has resulted in a growing number of studies.
Table 1
Possible mechanisms of action of acupuncture

Acupuncture as supportive treatment

Chemotherapy agents are considered to be medications with the most severe side effects, which in many cases may force the patient to abandon therapy. Because of that, proper alleviation of side effects is most crucial. Acupuncture should not be seen as a replacement for modern medicines, but rather an adjunct with a low level of procedure-related complications that may enhance efficacy and in some cases allow the dosage of other drugs to be reduced. Acupuncture as part of supportive treatment in oncology has been tested for numerous indications. The strongest evidence from a randomized controlled trial (RCT) with low risk of bias supports the use of acupuncture for control of nausea and vomiting related to chemotherapy []. This indication seems to be very important, as the high emetogenicity of many cytostatic agents is hard to control even with three-drug therapy []. Despite many RCTs on treatment of other chemotherapy-induced side effects, the level of evidence is not yet satisfactory, but considering its relative safety, acupuncture may be useful in everyday practice. Descriptions of these clinical trials on the effectiveness of acupuncture in minimizing cancer treatment-related side effects are summarized in Table 2.
Table 2
Possible mechanisms of action of acupuncture and its effectiveness in the treatment of various types of ailments related to cancer therapy

Level of evidence issue

A recently published systemic review stated that other indications, such as pain, xerostomia, vasomotor symptoms, fatigue, mood disorders, and insomnia, were not evaluated in RCTs with an appropriate level of evidence []. One of the major problems with the reviewed studies is their poor methodological quality, mostly difficulty with blinding and a low number of subjects. Also the optimal design of such studies (acupuncture vs placebo, acupuncture vs sham acupuncture) has not been established yet []. In spite of satisfactory results in most of these studies, further research on a larger group of patients is necessary.

Summary

In an oncological setting, acupuncture is still being constantly reviewed. Nevertheless, the present available evidence suggests that acupuncture may become a safe, low-cost and efficient form of complementary therapy in modern oncology. The potential role of acupuncture has been found in alleviation of various symptoms, but the data from the majority of clinical studies on acupuncture are heterogeneous. The incomplete description of procedural methodology and insufficient patient groups limit their value. Thus, further research on a larger scale on the potential use of acupuncture in contemporary oncology is required. It should be emphasized that alternative medicine may become the source of a number of interesting concepts worth examining and testing in research and clinical settings.

Acknowledgments

The authors would like to thank Ms Joanna Gołąb for editing the article.
The authors declare no conflict of interest.

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