We recently wrote a paper called: “The potential role for acupuncture for treating symptoms in patients with lung cancer: an observational longitudinal study” and discussed whether acupuncture is useful for symptom improvement in lung cancer patients.
Most lung cancer patients experience multiple symptoms related either to the cancer or treatment side effects, such as pain, fatigue, nausea and vomiting, distress, depression, anxiety [1-7]. Many patients often try complementary modalities such as mindful meditation, deep relaxation techniques, massage and acupuncture in conjunction with standard treatments [8-11]. We learned that among these modalities the acupuncture is relatively less used, mainly because the efficacy of acupuncture is not widely recognized, therefore, it is rarely offered as an adjunct to standard care. We performed a study to evaluate the effect of acupuncture as a potential treatment modality for symptom-control. Acupuncture was provided by the licensed acupuncturist of the interdisciplinary team within the Lung Cancer Integrative Oncology Clinic at the Jewish General Hospital.
Thirty three patients with diagnoses of lung cancer had received four or more sessions of acupuncture. Each session lasted 45-minutes and typically patients were treated 1-2 times per week. They received in average 7 sessions each. During the session the acupuncturist observed patients for side effects, such as stinging sensation, bruising, fainting, muscle spasms, bleeding, and nerve damage. To evaluate the symptoms all patients were asked to complete a questionnaire, Edmonton Symptom Assessment System (ESAS), at the first visit to the acupuncturist and after the last treatment.
What did we learn from it? A significant improvement in pain, appetite, nausea, nervousness, and well-being was observed. At the end of the treatment, pain clinically improved in 61% of patients and remained stable in 33%. In addition the intensity of pain improved significantly following acupuncture treatment: prior to acupuncture 67% of patients reported moderate-to-severe pain, while after acupuncture only 33% reported moderate-to-severe pain. Even the patients who were on narcotics for pain during acupuncture treatment reported a statistically significant reduction in pain score from 5.75 pre-treatment to 2.25 post-treatment. Two patients, whose pain deteriorated, stopped acupuncture after 4 sessions, one due to cancer progression, and the other due to frailty.
Similar results were seen for well-being. A clinically important improvement in well-being was reported by 33% of patients. 64% patients remained stable and only one patient with clear cancer progression, felt worse. The change in well-being was correlated with the number of acupuncture sessions and our results suggest that a minimum of 6 sessions are needed to achieve a significant improvement in well-being. None of the patients reported any side effect related to acupuncture.
We focused specifically on two of these symptoms (pain and overall well-being) and showed that, as far as we could assess, the age, gender, performance status, concurrent cancer treatment and narcotic use had no significant impact on the effect of acupuncture.
This is the first study of a lung cancer population to demonstrate that acupuncture may be an effective approach to improving symptoms, in particular, pain and well–being. Acupuncture is a safe and minimally invasive procedure, and may have a particularly useful role for those patients who are undergoing anticancer treatment, who made up the majority of patients in this study. We hope that our study provides additional evidence to help health care professionals and patients make decisions about utilization of acupuncture.
1. Akin, S., et al., Quality of life, symptom experience and distress of lung cancer patients undergoing chemotherapy. Eur J Oncol Nurs, 2010. 14(5): p. 400-9.
2. Hopwood, P. and R.J. Stephens, Depression in patients with lung cancer: prevalence and risk factors derived from quality-of-life data. J Clin Oncol, 2000. 18(4): p. 893-903.
3. Zabora, J., et al., The prevalence of psychological distress by cancer site. Psychooncology, 2001. 10(1): p. 19-28.
4. Kasymjanova, G., et al., Prognostic value of the six-minute walk in advanced non-small cell lung cancer. J Thorac Oncol, 2009. 4(5): p. 602-7.
5. Larsson, M., L. Ljung, and B.B. Johansson, Health-related quality of life in advanced non-small cell lung cancer: correlates and comparisons to normative data. Eur J Cancer Care (Engl), 2012. 21(5): p. 642-9.
6. Maione P, et al., Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non–small-cell lung cancer receiving chemotherapy: a prognostic analysis of the multicenter italian lung cancer in the elderly study. J Clin Oncol, 2005. 23: p. 6865-6872.
7. Steinberg, T., et al., Prevalence of emotional distress in newly diagnosed lung cancer patients. Support Care Cancer, 2009. 17(12): p. 1493-7.
8. Lu, W., et al., The value of acupuncture in cancer care. Hematol Oncol Clin North Am, 2008. 22(4): p. 631-48, viii.
9. Molassiotis, A., et al., Complementary and alternative medicine use in lung cancer patients in eight European countries. Complement Ther Clin Pract, 2006. 12(1): p. 34-9.
10. O’Regan, D. and J. Filshie, Acupuncture and cancer. Auton Neurosci, 2010. 157(1-2): p. 96-100.
11. Pan, C.X., et al., Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life. A systematic review. J Pain Symptom Manage, 2000. 20(5): p. 374-87.