Acupuncture For Cancer Summery

Acupunctur
e in cancer
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist
Acupuncture is defined as the application of stimulation

such as needling, moxibustion, cupping, and acupressure
on specific sites of the body known as acupuncture points

& acupuncturist
In China, acupuncture is part of a TCM system of

traditional
medical knowledge and is practiced along with other
treatment modalities such as :
Herbal medicine
Tui na (massage and acupressure)
Mind/body exercise (e.g.,qigong and tai chi)
Dietary therapy
& acupuncturist
Acupuncture has been practiced in

China and other Asian countries for
more than 4,000 years

& acupuncturist
The relatively brief history of acupuncture in the United

States
can be traced back about 200 years, when Dr. Franklin
Bache
published a report in the North American Medical and
Surgical
Journal on his use of acupuncture to treat lower back pain

& acupuncturist
The U.S. Food and Drug Administration approved

the acupuncture needle as a medical device in 1996

& acupuncturist
The human body must be perceived and treated as a

whole and
as part of nature; health is the result of harmony among
bodily functions and between the body and nature, and
disease occurs
when this harmony is disrupted

& acupuncturist
Acupuncture is closely associated with Chinese meridian

theory
According to this theory, there are 12 primary meridians,
or
channels, and 8 additional meridians, each following a
particular directional course along the body

& acupuncturist

& acupuncturist
A vital energy known as qi flows through these meridians

and participates in the homeostatic regulation of various
bodily
functions.
Along the meridians are approximately 360 points that
serve
as both pathognomonic signs of disorder and as loci for
acupuncture treatments

& acupuncturist

& acupuncturist
When the normal flow of energy over a meridian is

obstructed
(e.g., as a result of tissue injury or a tumor), pain or other
symptoms result
The purpose of acupuncture therapy is to normalize
energy flow, thereby relieving the symptoms by
stimulating specific sites (acupuncture points) on the
meridians
& acupuncturist

& acupuncturist
Acupuncture
Mechanisms

& acupuncturist
Acupuncture Mechanisms
Activate the hypothalamus and the pituitary gland
Balance the sympathetic and parasympathetic systems
Anti-inflammatory effects
Endogenous opioid system
Boost animal immune function by enhancing NK cell
and lymphocyte activity

& acupuncturist
Laboratory and animal studies to explore the

mechanisms of acupuncture for cancer treatment have
focused mainly on the
role of acupuncture in the activation of immune
functions, such
as increasing blood cell count and enhancing lymphocyte
and
natural killer cell activity

& acupuncturist
Acupuncture indications in cancer

Manage cancer-related symptoms
Treat side effects induced by chemotherapy or radiation
therapy
Boost blood cell count
Enhance lymphocyte and natural killer (NK) cell activity
& acupuncturist
Primary use is symptom

management
Cancer pain
Chemotherapy-induced nausea and vomiting

& acupuncturist
The positive results of the studies on chemotherapyinduced N/V, which benefit from scientifically sound
research designs, are the most convincing

& acupuncturist
Other indications
Weight loss
Anxiety
Depression
Insomnia
Poor appetite
Xerostomia
Hot flashes
Peripheral neuropathy
Gastrointestinal symptoms (constipation and diarrhea)
& acupuncturist

& acupuncturist
Laboratory &
Animal
Preclinical Studies
& acupuncturist
At least seven animal studies

investigating the effects of acupuncture
in cancer or cancer-related conditions
have been reported in the scientific
literature

& acupuncturist
Four ex vivo studies suggested that

acupuncture is useful in anticancer therapy
either by actively stimulating immune
activity or by preventing chemotherapy
suppression of immune activity

& acupuncturist
In a study involving normal rats, electroacupuncture

applied at the point Tsu-Sanli (St36) for 2 hours daily on 3
consecutive days enhanced the cytotoxicity of splenic
natural killer (NK) cells compared with a stimulation of a
non acupuncture control point in the
abdominal muscle
Sato T, Yu Y, Guo SY, et al.: Acupuncture stimulation enhances splenic natural killer cell cytotoxicity
in rats. Jpn J Physiol 46 (2): 131-6, 1996

& acupuncturist
Another study found that NK cell activity and Tlymphocyte transformation rate were increased in a
mouse model of transplanted mammary cancer
compared with a control after eight sessions of
acupuncture and moxibustion
Liu LJ, Guo CJ, Jiao XM: [Effect of acupuncture on immunologic function and histopathology of
transplanted mammary cancer in mice] Zhongguo Zhong Xi Yi Jie He Za Zhi 15 (10): 615-7, 1995.

& acupuncturist
A study using moxibustion to warm the acupuncture

point Guanyuan (CV4) once a day for 10 days found
significantly increased production of erythrocytes,
compared with a nontreatment control
Wu P, Cao Y, Wu J: Effects of moxa-cone moxibustion at Guanyuan on erythrocytic immunity and its

regulative function in tumor-bearing mice. J Tradit Chin Med 21 (1): 68-71, 2001

& acupuncturist
Repeated EA treatments (12 treatments administered

over 30 days) in
PCO rats significantly lowered the concentrations of NGF
in the ovaries, compared with untreated PCO rats
Stener-Victorin E, Lundeberg T, Waldenstrm U, et al.: Effects of electro-acupuncture on nerve growth
factor and ovarian morphology in rats with experimentally induced polycystic ovaries. Biol Reprod 63 (5): 1497503, 2000

& acupuncturist
A study of cyclophosphamide -induced emesis in a ferret

behavioral model used acupuncture as an adjunct
therapy in treating the emetic side effects of
chemotherapy significantly reduced the total number of
emetic episodes by % 36-73
Lao L, Zhang G, Wong RH, et al.: The effect of electroacupuncture as an adjunct on

cyclophosphamide induced emesis in ferrets. Pharmacol Biochem Behav 74 (3): 691-9, 2003

& acupuncturist
The findings of these studies suggest that

acupuncture may be effective in treating
cancer-related symptoms and cancer
treatmentrelated disorders and that
acupuncture may be able to activate
immune functions and regulate the
autonomic nervous system
& acupuncturist
Only one study reported a decrease in tumor volume in

animals treated with acupuncture compared with control
animals (Limited scientific value)
Liu LJ, Guo CJ, Jiao XM: [Effect of acupuncture on immunologic function and
histopathology of transplanted mammary cancer in mice] Zhongguo Zhong Xi Yi Jie He Za
Zhi 15 (10): 615-7, 1995

& acupuncturist

& acupuncturist
Human/Clinical
Studies

& acupuncturist
Effect of Acupuncture on
Immune Function

& acupuncturist
At least seven human studies have evaluated the effect

of acupuncture on immune system function in patients
(all in china)
Acupuncture
Four randomized controlled trials enhanced or
regulated
One nonrandomized clinical study
immune
Two case series
function

& acupuncturist
The first randomized controlled trial

immune
Acupuncture treatment enhanced platelet

count and prevented leukocyte decrease
after radiation therapy or chemotherapy
Xia YQ, Zhang D, Yang CX, et al.: An approach to the effect on
tumors of acupuncture in combination with radiotherapy or
chemotherapy. J Tradit Chin Med 6 (1): 23-6, 1986

& acupuncturist
Second study
immune
Leukocyte phagocytosis was enhanced in the

treated group, compared with the baseline measurement
(P < .01)
Zhou RX, Huang FL, Jiang SR, et al.: The effect of acupuncture on the phagocytic
activity of human leukocytes. J Tradit Chin Med 8 (2): 83-4, 1988.

& acupuncturist
Third study
immune
The data showed that IL-2 level and NK cell activity were
significantly increased in the acupuncture group,
compared with the control group (P < .01)
Wu B, Zhou RX, Zhou MS: [Effect of acupuncture on interleukin-2 level and NK cell immunoactivity
of peripheral blood of malignant tumor patients] Zhongguo Zhong Xi Yi Jie He Za Zhi 14 (9): 537-9,
1994

& acupuncturist
Fourth study
immune
The data showed that acupuncture treatment increased the

proportion of the CD3+ and CD4+ T-lymphocyte subsets,
the CD4+/CD8+ ratio (P < .01), and the level of beta-EP
The investigators suggested that the anticancer effect of
acupuncture may be mediated via the mechanism of
immunomodulation
Wu B, Zhou RX, Zhou MS: [Effect of acupuncture on immunomodulation in patients with

malignant tumors] Zhongguo Zhong Xi Yi Jie He Za Zhi 16 (3): 139-41, 1996

& acupuncturist
Fifth study
immune
Electroacupuncture in patients undergoing chemotherapy

experienced no declines in T cells (CD3+, CD4+, CD8+)
or in NK cell activity, both of which are usually
suppressed by chemotherapy
Ye F, Chen S, Liu W: Effects of electro-acupuncture on immune function after chemotherapy in 28

cases.
J Tradit Chin Med 22 (1): 21-3, 2002

& acupuncturist
Sixth study
immune
48 patients with leukopenia including two cancer

patientswho were treated with manual acupuncture
experienced improvements in leukocyte count, and
immunoglobulin (IgG, IgA, and IgM) levels after 14 daily
acupuncture treatments, compared with their
pretreatment levels
Wei Z: Clinical observation on therapeutic effect of acupuncture at zusanli for

leukopenia.
J Tradit Chin Med 18 (2): 94-5, 1998
& acupuncturist

& acupuncturist
Effect of Acupuncture
on Cancer Pain

& acupuncturist
First study
pain
Randomized trial compared two type acupuncture and

conventional analgesic treatment in patients with gastric
cancer pain
There was equivalent analgesic effect among the three
groups observed after 2 months of treatment; however,
the conventionally treated group experienced significantly
superior analgesia in first 10 days of treatment
Dang W, Yang J: Clinical study on acupuncture treatment of stomach carcinoma pain. J Tradit Chin
Med 18 (1): 31-8, 1998

& acupuncturist
Second study
pain
In study evaluated the effect of auricular acupuncture in

20 cancer patients who were still experiencing pain after
treatment with analgesics While patients continued their
analgesic medication, auricular acupuncture needles
were embedded in ear acupuncture points.
pain intensity decreased or remained stable after
auricular acupuncture in all patients, with a significant
average pain intensity decrease of 33 mm (P < .001)
Alimi D, Rubino C, Leandri EP, et al.: Analgesic effects of auricular acupuncture for cancer pain. J Pain Symptom
Manage 19 (2): 81-2, 2000
& acupuncturist
Third study
Pain
In a case series involving 183 cancer patients who were

treated with acupuncture for cancer-related pain, 52%
were significantly helped (P value not stated
Filshie J, Redman D: Acupuncture and malignant pain problems. Eur J Surg Oncol 11 (4): 389-94,
1985
& acupuncturist
Forth study
pain
case series, 29 patients with malignant tumors who

developed pain received EA treatment . All experienced
various degrees of pain relief, and 25 out of 29 were able
to either reduce or eliminate their
analgesic requirements following multiple EA treatments
Wen HL: Cancer pain treated with acupuncture and electrical stimulation. Mod Med Asia 13 (2): 126, 1977
& acupuncturist
Most of these studies were positive but the findings have

limited significance because of methodologic weaknesses
such as :
Small sample sizes
An absence of patient blinding to treatment in most
cases
Varying acupuncture treatment regimens
A lack of standard outcome measurements
Absence of adequate randomization

& acupuncturist

& acupuncturist
Effect of Acupuncture on
Cancer Treatmentrelated
Side Effects

& acupuncturist
Pain due to cancer treatment -1

A RCT evaluated the effect of various combinations of
auricular acupuncture, Chinese herbs, and epidural morphine
to relieve
postoperative pain in 16 patients with liver cancer
All of the combination treatment groups experienced better
analgesia than did the placebo -treated control group
Li QS, Cao SH, Xie GM, et al.: Combined traditional Chinese medicine and Western medicine. Relieving effects of Chinese
herbs, ear-acupuncture and epidural morphine on postoperative pain in liver cancer Chin Med J (Engl) 107 (4): 289-94,
1994
& acupuncturist

The effect of acupuncture in postoperative pain
management and arm movement in breast cancer patients
after surgical excision of the cancer and axillary lymph node:
The acupuncture group had significant pain relief during arm
movement on the fifth and seventh days following surgery
and at the time of discharge. The range of arm motion also
increased significantly in the treatment group, (P < .001)
He JP, Friedrich M, Ertan AK, et al.: Pain-relief and movement improvement by acupuncture after ablation and axillary
lymphadenectomy in patients with mammary cancer. Clin Exp Obstet Gynecol 26 (2): 81-4, 1999

& acupuncturist

A small retrospective case review of acupuncture for
chemotherapy-induced peripheral neuropathy in 18
patients showed benefit with reduced symptoms in 82%
Donald GK, Tobin I, Stringer J: Evaluation of acupuncture in the management of chemotherapyinduced peripheral
neuropathy. Acupunct Med 29 (3): 230-3, 2011

& acupuncturist
Arthralgias and myalgias from

aromatase inhibitors
True acupuncture was significantly more effective than
sham acupuncture, as measured by Brief Pain InventoryShort Form scores in relieving joint symptoms
Crew KD, Capodice JL, Greenlee H, et al.: Randomized, blinded, sham-controlled trial of acupuncture for the
management of aromatase inhibitor-associated joint symptoms in women with early-stage breast cancer. J Clin Oncol 28
(7): 1154-60, 2010.
& acupuncturist
Chemotherapy-induced nausea and

vomiting
The positive effect of acupuncture on chemotherapyinduced nausea and vomiting (N/V) is the most
convincing, as demonstrated by the consistency of the
results of a variety of clinical study types

& acupuncturist
Chemotherapy-induced nausea and

vomiting
A systematic review of the effect of acupuncture on N/V
describes five clinical trials of chemotherapy-induced N/V,
conducted by different investigators on different groups of
patients and using different forms of acupuncture point
stimulation
All five trials yielded positive results
Vickers AJ: Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis
trials. J R Soc Med 89 (6): 303-11, 1996.
& acupuncturist
Radiation-induced nausea and

vomiting
In one randomized study, patients who were randomly
assigned to acupuncture experienced fewer episodes of
nausea and vomiting than did those who received
standard care
Enblom A, Lekander M, Hammar M, et al.: Getting the grip on nonspecific treatment effects: emesis
in patients randomized to acupuncture or sham compared to patients receiving standard care. PLoS
One 6 (3): e14766, 2011.

& acupuncturist
Vasomotor symptoms
Some studies have reported that acupuncture may be
effective in reducing vasomotor symptoms among
postmenopausal women with breast cancer and prostate
cancer patients on androgen-deprivation therapy

& acupuncturist
Vasomotor symptoms -1
In women with hormone receptorpositive breast cancer.
Acupuncture was just as effective as venlafaxine and
caused fewer adverse effects
Walker EM, Rodriguez AI, Kohn B, et al.: Acupuncture versus venlafaxine for the management of
vasomotor symptoms in patients with hormone receptor-positive breast cancer: a randomized
controlled trial. J Clin Oncol 28 (4): 634-40, 2010.

& acupuncturist
An uncontrolled prospective case series of 50 women on
tamoxifen for early breast cancer evaluated women After
acupuncture vasomotor symptoms dropped by 49.8% (P
< .0001)
de Valois BA, Young TE, Robinson N, et al.: Using traditional acupuncture for breast cancer-related
hot flashes and night sweats. J Altern Complement Med 16 (10): 1047-57, 2010.

& acupuncturist
In retrospective evaluation of 194 patients with
predominantly breast or prostate cancer found long-term
relief of vasomotor symptoms associated with acupuncture.
Filshie J, Bolton T, Browne D, et al.: Acupuncture and self acupuncture for long-term treatment of
vasomotor symptoms
in cancer patients--audit and treatment algorithm. Acupunct Med 23 (4): 171-80, 2005.

& acupuncturist
Fatigue
In a RCT, 47 cancer patients with moderate to severe
fatigue were randomly assigned to one of three groups.
The study concluded that acupuncture was a more
effective method than acupressure or sham acupressure
Molassiotis A, Sylt P, Diggins H: The management of cancer-related fatigue after chemotherapy with
acupuncture and acupressure: a randomised controlled trial. Complement Ther Med 15 (4): 22837,2007.

& acupuncturist
In next study, 302 breast cancer patients were randomly

assigned to a 6-week course of either daily Acupuncture
significantly reduced fatigue and improved quality of life
over that of the "enhanced usual care" group
Molassiotis A, Bardy J, Finnegan-John J, et al.: Acupuncture for cancer-related fatigue in patients with
breast cancer: a pragmatic randomized controlled trial. J Clin Oncol 30 (36): 4470-6, 2012.

& acupuncturist
Xerostomia
Acupuncture was associated with a decrease in the onset
of symptoms and an increased saliva flow in two
randomized studies that compared acupuncture with
standard care for preventing xerostomia in patients
undergoing radiation therapy
Braga FP, Lemos Junior CA, Alves FA, et al.: Acupuncture for the prevention of radiation-induced
xerostomia in patients with head and neck cancer. Braz Oral Res 25 (2): 180-5, 2011 Mar-Apr.
Meng Z, Garcia MK, Hu C, et al.: Randomized controlled trial of acupuncture for prevention of
radiation-induced xerostomia among patients with nasopharyngeal carcinoma. Cancer 118 (13):
3337-44, 2012.
& acupuncturist
Xerostomia
Compared with standard care, acupuncture significantly
improved xerostomia symptoms in patients who
experienced the condition following radiation therapy
Simcock R, Fallowfield L, Monson K, et al.: ARIX: a randomised trial of acupuncture v oral care
sessions in patients with chronic xerostomia following treatment of head and neck cancer. Ann Oncol
24 (3): 776-83, 2013
Pfister DG, Cassileth BR, Deng GE, et al.: Acupuncture for pain and dysfunction after neck dissection:
results of a
randomized controlled trial. J Clin Oncol 28 (15): 2565-70, 2010.
& acupuncturist

& acupuncturist
Other Treatment-related
Side Effects

& acupuncturist
In a RCT 76 patients with various types of cancer,

including esophageal cancer,gastric cancer, lung cancer
The acupuncture group in combination with radiation
therapy or chemotherapy, had the below benefits :
significantly more body weight (P < .001)
Greater improvements in the symptoms of cough,
thoracodynia, hemoptysis, and fever for patients with
lung cancer and the symptoms of chest pain, mucus
vomiting, and difficulty in swallowing for patients with
esophageal suffered
Xia YQ, Zhang D, Yang CX, et al.: An approach to the effect on tumors of acupuncture in combination
with radiotherapy or chemotherapy. J Tradit Chin Med 6 (1): 23-6, 1986.

& acupuncturist
An RCT of 138 patients treated with acupuncture plus

massage versus usual care showed decreased pain (P = .
05) and a decrease in
depressive mood (P = .003) in postoperative cancer
patients
Mehling WE, Jacobs B, Acree M, et al.: Symptom management with massage and
acupuncture in postoperative cancer patients: a randomized controlled trial. J Pain
Symptom Manage 33 (3): 258-66, 2007.
& acupuncturist
A retrospective survey study :

acupuncture clinics for :
Pain (53%),
Xerostomia (32%)
Hot flashes (6%)
Nausea/loss of appetite (6%)
Patients were referred to

Sixty percent of the
patients showed at
least 30% improvement in
their symptoms, and about
one-third had no change in
the severity of symptoms
Johnstone PA, Polston GR, Niemtzow RC, et al.: Integration of acupuncture into the
oncology clinic. Palliat Med 16 (3): 235-9, 2002.

& acupuncturist

& acupuncturist

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Acupunctur

Acupuncture is defined as the application of stimulation

Dr Mehran Rezvani pain fellowship anesthesiologist

In China, acupuncture is part of a TCM system of

Acupuncture has been practiced in

Dr Mehran Rezvani pain fellowship anesthesiologist

The relatively brief history of acupuncture in the United

Dr Mehran Rezvani pain fellowship anesthesiologist

The U.S. Food and Drug Administration approved

Dr Mehran Rezvani pain fellowship anesthesiologist

The human body must be perceived and treated as a

Dr Mehran Rezvani pain fellowship anesthesiologist

Acupuncture is closely associated with Chinese meridian

Dr Mehran Rezvani pain fellowship anesthesiologist

Dr Mehran Rezvani pain fellowship anesthesiologist

A vital energy known as qi flows through these meridians

Dr Mehran Rezvani pain fellowship anesthesiologist

Dr Mehran Rezvani pain fellowship anesthesiologist

When the normal flow of energy over a meridian is

Dr Mehran Rezvani pain fellowship anesthesiologist

Dr Mehran Rezvani pain fellowship anesthesiologist

Dr Mehran Rezvani pain fellowship anesthesiologist

Laboratory and animal studies to explore the

Dr Mehran Rezvani pain fellowship anesthesiologist

Acupuncture indications in cancer

Primary use is symptom

Dr Mehran Rezvani pain fellowship anesthesiologist

Dr Mehran Rezvani pain fellowship anesthesiologist

Dr Mehran Rezvani pain fellowship anesthesiologist

At least seven animal studies

Dr Mehran Rezvani pain fellowship anesthesiologist

Four ex vivo studies suggested that

Dr Mehran Rezvani pain fellowship anesthesiologist

In a study involving normal rats, electroacupuncture

Dr Mehran Rezvani pain fellowship anesthesiologist

Dr Mehran Rezvani pain fellowship anesthesiologist

A study using moxibustion to warm the acupuncture

Wu P, Cao Y, Wu J: Effects of moxa-cone moxibustion at Guanyuan on erythrocytic immunity and its

Dr Mehran Rezvani pain fellowship anesthesiologist

Repeated EA treatments (12 treatments administered

Dr Mehran Rezvani pain fellowship anesthesiologist

A study of cyclophosphamide -induced emesis in a ferret

Lao L, Zhang G, Wong RH, et al.: The effect of electroacupuncture as an adjunct on

Dr Mehran Rezvani pain fellowship anesthesiologist

The findings of these studies suggest that

Only one study reported a decrease in tumor volume in

Dr Mehran Rezvani pain fellowship anesthesiologist

Dr Mehran Rezvani pain fellowship anesthesiologist

Dr Mehran Rezvani pain fellowship anesthesiologist

Dr Mehran Rezvani pain fellowship anesthesiologist

At least seven human studies have evaluated the effect

Dr Mehran Rezvani pain fellowship anesthesiologist

The first randomized controlled trial

Acupuncture treatment enhanced platelet

Dr Mehran Rezvani pain fellowship anesthesiologist

Leukocyte phagocytosis was enhanced in the

Dr Mehran Rezvani pain fellowship anesthesiologist

Dr Mehran Rezvani pain fellowship anesthesiologist

The data showed that acupuncture treatment increased the

Wu B, Zhou RX, Zhou MS: [Effect of acupuncture on immunomodulation in patients with

Dr Mehran Rezvani pain fellowship anesthesiologist

Electroacupuncture in patients undergoing chemotherapy