Benjamen Clancy DAOM, L.Ac, Dipl. Ac.

Breast cancer, second to skin cancer is the most common cancer women face in the US.¹ According to Breastcancer.org, U.S. statistics show “about 1 in 8 U.S. women (about 12%) will develop invasive breast cancer over the course of her lifetime.”² The use of acupuncture to manage pain and stress are well documented. In addition, acupuncture can help patients with breast cancer in other ways. The purpose of this writing is to explore how acupuncture can help to manage the symptoms associated with breast cancer, as an adjunct therapy.

Breast cancer and the symptoms associated with treatment:

Current breast cancer treatment strategies include surgery, chemotherapy and radiation. Common symptoms associated with these treatments are fatigue, neuropathy (pain and numbness), lymphedema (swelling in the upper extremities), and hot flashes.³ Pain and lymphedema can occur with surgery, chemotherapy can cause both fatigue and neuropathy, and radiation treatment can cause itching, peeling skin and soreness.

Standard treatments to deal with these symptoms include: fatigue- acupuncture, massage, meditation, tai chi, and yoga. Also, eating a healthy diet and getting lots of rest. Neuropathy- acupuncture, exercise, vitamin A, calcium and magnesium, coco butter, menthol, anti-seizure drugs, antidepressants, and glutathione.⁴ Obviously, pharmaceutical approaches come with their own set of potential side-effects. Lymphedema- acupuncture, avoid alcohol and smoking, healthy diet and exercise. Hot flashes- acupuncture, reduce triggers (stress, alcohol, cigarettes, caffeine, etc.), weight reduction, healthy diet and exercise.

Current research:

Fatigue. A meta-analysis on the effects of acupuncture on cancer-related fatigue analyzed 10 randomized controlled studies which included 1327 patients. The meta-analysis reported acupuncture had a marked effect on fatigue in cancer patients, regardless of concurrent anti-cancer treatment, particularly among breast cancer patients. The meta-analysis also indicated that acupuncture could significantly mitigate cancer related fatigue compared with sham acupuncture or usual care.⁵

Neuropathy. Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of several commonly used cancer treatments, including taxanes, platinum agents, and vinca alkaloids. Sensory symptoms in the hands and/or feet, typically in a “stocking-glove” pattern, are common, and manifested as pain, numbness, and/or tingling. CIPN can result in chemotherapy dose reduction or discontinuation, and can also have long-term effects on quality of life. Acupuncture may be a helpful tool in reducing the symptoms associated with CIPN. A meta-analysis of “3989 retrieved papers, 8 relevant papers were identified. One was an experimental study which showed that electroacupuncture suppressed CIPN pain in rats. In addition, there were seven very heterogeneous clinical studies, one controlled randomized study using auricular acupuncture, two randomized controlled studies using somatic acupuncture, and three case series/case reports which suggested a positive effect of acupuncture in CIPN.” Only one controlled randomized study demonstrated that acupuncture may be beneficial for CIPN. All the clinical studies reviewed had important methodological limitations.⁶

Anecdotally, in my clinic I have seen benefit from the use of acupuncture for patients experiencing CIPN. Further research is warranted.

Acupuncture for the Treatment of Peripheral Neuropathy: A Systematic Review and Meta-Analysis included 13 randomized controlled studies and reported the effect of acupuncture on several types of neuropathy including diabetes, Bell's palsy, carpal tunnel syndrome, and human immunodeficiency virus (HIV). The review mentioned there was significant evidence that acupuncture is effective in the treatment of Bell's palsy, carpal tunnel syndrome, and human immunodeficiency virus (HIV). However, there was insignificant evidence to support the use of acupuncture in idiopathic neuropathy.7 That said, I see many types of neuropathy in my clinic and have found acupuncture and Chinese herbal medicine to be very effective in mitigating the burning sensations and pain associated idiopathic neuropathy and others.

Breast cancer-related lymphoedema (BCRL) is also common complication after breast cancer treatment. In this meta-analysis six RCTs with 318 patients were identified. The main analysis revealed a positive overall effect of acupuncture intervention on pre/post-treatment differences in the diameter of the elbow joint, reductions in upper limb lymphoedema and effectiveness index based on arm measurement data in patients with breast cancer. The two studies evaluating the outcome of acupuncture on the diameter of the elbow joint found a significant reduction in diameter between the acupuncture and control groups (weighted mean difference (WMD) 6 cm, 95% CI 5.11 to 6.89 cm; P<0.001). The same two studies investigated the effect of acupuncture on upper limb lymphoedema reduction and found a significant difference between the acupuncture and control groups (risk ratio 1.4, 95% CI 1.17 to 1.67; P<0.001).⁸

Hot flashes are a common symptom experienced by pre/menopausal women who have had cancer or not. Hormone replacement therapy (HRT) tends to be the gold standard in managing the symptoms of hot flashes. The use of HRT in women is controversial due to its potential of causing cancer. Survivors of breast cancer therefor are not recommended HRT for obvious reasons. An alternative non-hormonal treatment such as acupuncture is an effective solution. Acupuncture for the relief of hot flashes in breast cancer patients: A systematic review and meta-analysis of randomized controlled trials and observational studies included 18 randomized controlled studies. The authors of this meta-analysis reported acupuncture was an efficacious therapeutical strategy in managing hot flashes.⁹

As the above studies demonstrate, acupuncture can be an effective adjunctive therapy in managing the symptoms associated with the treatment of breast cancer including fatigue, neuropathy (pain and numbness), lymphedema (swelling in the upper extremities), and hot flashes. The side effects of acupuncture are few and mild in comparison to current standard treatment methods.

Resources:

1. Cancer Facts for Women | Most Common Cancers in Women. https://www.cancer.org/healthy/find-cancer-early/womens-health/cancer-facts-for-women.html. Accessed May 1, 2019.
2. U.S. Breast Cancer Statistics. Breastcancer.org. https://www.breastcancer.org/symptoms/understand_bc/statistics. Accessed May 1, 2019.
3. Day JA. Side Effects from Breast Cancer Treatment: Johns Hopkins Breast Center. https://www.hopkinsmedicine.org/kimmel_cancer_center/centers/breast_cancer_program/treatment_and_services/survivorship/side_effects.html. Accessed May 1, 2019.
4. Neuropathy from chemo: Remedies and treatments. Medical News Today. https://www.medicalnewstoday.com/articles/323481.php. Accessed May 2, 2019.
5. Zhang Y, Lin L, Li H, Hu Y, Tian L. Effects of acupuncture on cancer-related fatigue: a meta-analysis. Support Care Cancer. 2018;26(2):415-425.
6. Hwang M-S, Lee H-Y, Lee J-H, et al. Protocol for a systematic review and meta-analysis of the efficacy of acupuncture and electroacupuncture against chemotherapy-induced peripheral neuropathy. Medicine (Baltimore). 2019;98(14):e15098.
7. Dimitrova A, Murchison C, Oken B. Acupuncture for the Treatment of Peripheral Neuropathy: A Systematic Review and Meta-Analysis. J Altern Complement Med N Y N. 2017;23(3):164-179.
8. Zhang X, Wang X, Zhang B, Yang S, Liu D. Effects of acupuncture on breast cancer-related lymphoedema: a systematic review and meta-analysis of randomised controlled trials. Acupunct Med. 2019;37(1):16-24.
9. Wang. Acupuncture for the relief of hot flashes in breast cancer patients: A systematic review and meta-analysis of randomized controlled trials and observational studies. http://www.cancerjournal.net/article.asp?issn=0973-1482;year=2018;volume=14;issue=10;spage=600;epage=608;aulast=Wang. Accessed May 2, 2019.