Acupuncture for CancerFay-Meling von Moltke Pao March 1, 2007
Recently, the Globe and Mail published several articles and did an on-going feature on cancer and those it has affected. Indeed, Canadians are facing a true crisis in terms of accessibility to treatment options and timely care.
In the fall of 2003, the Canadian Cancer Society held its first symposium on the impact of Traditional Chinese Medicine in the treatment and prevention of cancer. The CCS spokesperson, Cheryl Rill, acknowledged that despite the advances of western medicine in treating cancer, there was still much more to be learned and that the evidence-based scientific community welcomed discussions about cancer from various perspectives.(1) These discussions are relevant now more than ever.Recently, the Globe and Mail published several articles and did an on-going feature on cancer and those it has affected. Indeed, Canadians are facing a true crisis in terms of accessibility to treatment options and timely care. In the fall of 2003, the Canadian Cancer Society held its first symposium on the impact of Traditional Chinese Medicine in the treatment and prevention of cancer. The CCS spokesperson, Cheryl Rill, acknowledged that despite the advances of western medicine in treating cancer, there was still much more to be learned and that the evidence-based scientific community welcomed discussions about cancer from various perspectives.(1) These discussions are relevant now more than ever.
THE MULTIPLE BENEFITS OF ACUPUNCTURE
As acupuncture and oriental medicine continue to gain acceptance in the west, they are increasingly being used in conjunction with western conventional medicine to treat a range of conditions, including cancer. Acupuncture in particular has received much attention for its use in cancer pain and post-operative and chemotherapy-induced nausea and vomiting. According to an article by Dr. N. Samuels (2002) published in the research journal, Harefuah:
THE MULTIPLE BENEFITS OF ACUPUNCTURE As acupuncture and oriental medicine continue to gain acceptance in the west, they are increasingly being used in conjunction with western conventional medicine to treat a range of conditions, including cancer. Acupuncture in particular has received much attention for its use in cancer pain and post-operative and chemotherapy-induced nausea and vomiting. According to an article by Dr. N. Samuels (2002) published in the research journal, Harefuah:
“Acupuncture's use in cancer patients has been recommended by the American Cancer Society (ACS) for the treatment of cancer and treatment-related symptoms. Pain, nausea, breathlessness, vasomotor symptoms and limb edema have all been found to respond to this treatment modality.” (2)
Dr. Samuels stated further that acupuncture can act against carcinogens (factors attributable to cancer development) through its ability to reduce stress and enhance immune function.(2) Indeed, several cancer centres have begun incorporating acupuncture for treating cancer-related symptoms such as pain(3) and many patients have had significant results in the reduction of their symptoms.(4)
Before describing how acupuncture can be effectively integrated into the care of a patient, it may be helpful to first gain an appreciation of what cancer is and the various western conventional therapies that are often used in its treatment.
WHAT IS CANCER?
As one of the leading causes of death in North America, cancer is a disease that few can ignore. It arises from abnormal changes in the genetic make-up of cells that cause them to multiply uncontrollably. The abnormal cells then spread locally or to other regions of the body via the lymphatic or blood circulation. Several factors are believed to trigger the cell mutations that give rise to cancer. These include hereditary susceptibility, immune dysfunction, increasing age, improper dietary intake, extreme stress, hormonal therapy and environmental, infectious, and therapeutic carcinogens (agents that are associated with cancer development).(5,6,7)
Common cancer therapies include surgery, chemotherapy, radiation therapy, immunotherapy, and hormonal therapy. While surgery involves the physical removal of tumours, other treatments such as chemotherapy work on inhibiting cell growth and multiplication. All these therapies can be very effective and are often critical components to helping a patient survive. Removing tumours through surgery and radiation can prevent further metastases (cancer spread to other areas of the body) and complications.
Unfortunately, these and other treatments can be very difficult for the body to process and recover from. Several of the drugs used in chemotherapy are not only toxic to cancer cells but to healthy cells as well and can cause mild to severe bouts of nausea. By depleting the bone marrow and thus inhibiting the production of white blood cells, red blood cells, and platelet cells, chemotherapies can increase a person's risk of infection, cause fatigue and dizziness, and impair wound healing respectively. Furthermore, chemotherapeutic agents can cause hair loss and skin rashes from damage to the cells of the hair follicles and skin.(5,6,7) Hormonal drugs such as tamoxifen (used in the treatment of breast cancer), have also been shown to increase the risk of thrombosis (blood clotting) and endometrial cancer.(7)
Therapies such as gamma knife radiotherapy and cyberknife involve focused radiation to a particular part of the body and are sometimes offered as an alternative to surgery. In addition, newer chemotherapeutic drugs promise less toxicity and fewer side effects than ever before. (5,6,7) These advances are indeed encouraging. So where, you might ask, does acupuncture and oriental medicine fit in?
TRADITIONAL CHINESE MEDICINE
Traditional Chinese Medicine (TCM), which consists of acupuncture, Chinese herbal medicine, tuina (Chinese massage therapy), nutrition, counselling, and physical exercise (such as Tai Qi and Qi Gong), is a comprehensive medical system based on over three thousand years of experience. The earliest drawings of tumours have been found on turtle shells and “oracle bones” from the eleventh century B.C. Texts dating from 200 B.C. have detailed descriptions of the quality of tumours and their cause.(8)
Similar to conventional western medicine, TCM attributes cancer to one or a combination of factors such as genetics, lifestyle, and environment. Cancer is the accumulation of external or internal factors or both, that create disharmony in the normal functioning of the body, and combine to produce a diseased state. (8,9) In ancient texts, it was believed that factors such as extreme cold and intense sadness could also lead to unhealthy conditions such as cancer.(8) When treating patients, the TCM physician takes a complete inventory of the person and considers such things as musculoskeletal abnormalities, energy level, body temperature, complexion, sleep, appetite, diet, digestive functioning, emotions, and overall lifestyle.
As described by Gordon and Curtis (2000) in Comprehensive Cancer Care, Traditional Chinese Medicine takes a holistic approach to the treatment of cancer:
The traditional Chinese medicinal treatment of cancer is based on the principle of fu zheng gu ben. Roughly speaking, fu zheng means strengthening what is correct, the qi, the forces in the body regulating normal healthy development. Gu ben refers to strengthening and enhancing the processes of regeneration and repair, which Chinese medicine locates in the kidney. Traditional treatment includes removing toxins that may contribute to cancer, increasing the flow of blood and qi, removing undesirable accumulations of tissue that are the tumour, and restoring self-regulation and balance among the jing, shen, and qi. The means that are used — acupuncture, herbal and nutritional therapies, tai chi, qi gong, tui na, and counselling — are each designed to further one or more aspects of this process.(8)
ACUPUNCTURE FOR VARIOUS STAGES OF CANCER
For conditions where the cancer is detected early, acupuncture can maintain and promote the normal functioning of the body.(10) Several studies done primarily on animals have shown its ability to boost the immune system and encourage the growth of healthy functioning cells.(3) This could be important for counteracting the results of radiation and chemotherapy that tend to attack both normal and abnormal cells. An additional benefit of acupuncture is that it can induce a state of deep calm and relaxation and alleviate physical and emotional tensions.
In cases where a tumour has formed, acupuncture can be used pre- and post-operatively where appropriate as an adjuvant therapy to surgery, radiation, or chemotherapy.(10) According to a study done by Poulain (1997) on 250 patients who underwent gynaecological surgery for cancer, acupuncture was shown to speed recovery time.(11) A recent study done by Aldridge (2001) on a series of 40 breast cancer patients, found that acupuncture could reduce nausea and vomiting following surgery and significantly reduce post-operative pain.(12)
For advanced stages of cancer, acupuncture can be used in conjunction with other forms of palliative care to significantly reduce the sensation of pain.(10) In some cases, patients may be able to reduce the dosage of pain medication substantially and thereby avoid the harsh side effects that are often associated with them.(11)
HOW DOES ACUPUNCTURE WORK?
According to Traditional Chinese Medicine, the body is composed of an intricate web of energy pathways known as “meridians”. The twelve regular and eight extra meridians help to maintain a balance of yin (substances which nourish the body) and yang (related to activity and function) within the body. Each meridian is named after the specific internal organ that it encompasses and through which it passes. Through these meridians, the internal and external aspects of the body are connected.
When “qi” (vital energy) and “xue” (blood) flow freely through the meridians, the body is in good health and can perform at its optimum. However, if a particular energy pathway does not function properly, the flow of “qi” and “xue” can become obstructed, hyperactive (excessive), hypoactive (deficient) or even flow in reverse. This can affect the function of the meridian's corresponding organs, which causes an imbalance of the body's yin and yang, and ultimately affects the functioning of the body as a whole.
From a TCM perspective, acupuncture stimulates specific points on the body where energy collects and flows through the meridians and regulates the overall flow of energy so that the body can return to a state of balance and health.
From a western medical perspective, the insertion of hair-fine sterile and disposable needles into subcutaneous layers of the skin can have profound influences on several regulatory systems. When used correctly, acupuncture has neurophysiological affects (3) that can release pain-reducing endorphins; effect the metabolism of serotonin, a neurotransmitter (brain chemical) that effects both pain perception and mood; and improve circulation and immune function.(8) Acupuncture specifically works to relieve nausea by releasing chemicals that control the vomiting centre in the brain as well as decreasing acid secretion and inhibiting abnormal gastric contractions.(13)
So why are the needles inserted in specific places? According to Bruera and Portenoy's Cancer Pain: Assessment and Management (2004), studies on acupoints have shown that:
“Many acupuncture points are also palpably detectable hollows or anatomical tissue planes, which in Western theory may signify easily influenced zones of lymphaticoneurovascular bundles in the subcutaneous tissue. Peripheral endings of cranial and spinal nerves, and penetrations of neurovascular bundles through superficial fascia, have been cited as morphological findings of acupuncture points.” (14)
WHAT TO EXPECT FROM ACUPUNCTURE TREATMENT
Though the insertion of needles under the skin might not sound appealing, the reality is that the fine needles cause little discomfort or pain since they are inserted below the skin layer. Once the needles are inserted, patients may feel a dull, heavy sensation accompanied by a slight tingling or numbness in the local area of insertion, that usually dissipates within a few moments. The needles are then retained for approximately twenty minutes. Most people find this experience to be quite relaxing and some may even fall asleep. After the acupuncture session, the practitioner may also use other modalities such as tuina (Chinese massage therapy) to complete the treatment. For chronic conditions such as cancer, treatments will be regular (at least once or twice a week) and adjusted according to the particular condition a person is in.
SOME FINAL THOUGHTS
Cancer is not a death sentence. It is a life-changing experience not only for those who have it, but for others as well. Educating ourselves as to what options are available for treatment and overall healing can only improve our opportunities to live a healthier and happier life. From providing adjuvant therapy for pain and associated emotional aspects relating to cancer, to treating side-effects such as nausea and decreased immunity arising from the more toxic and invasive conventional treatments, acupuncture and oriental medicine are invaluable resources that can guide the body towards a healthier state.
Our current medical system in the west comes from a background of reductionism, where we reduce a person to the sum of their body parts. This means that when treating a patient, there is a tendency to deal with the parts rather than the whole. Furthermore, our focus in health care has in large part been on treatment rather than prevention. While these views have their place, a more pronounced shift towards prevention, treating the whole person, and allowing an individual's natural healing abilities to take part in the healing process, is necessary if we truly want to promote health. Here is where the integration of eastern with western medicine can truly make a difference.
“Alas! The way of healing is so profound. It is deep as the oceans and boundless as the skies. How many truly know it?” – Huang Di Nei Jing (The Yellow Emperor's Classic of Internal Medicine).(15)
1) Vancouver Hosts Symposium on Traditional Chinese Medicine and Cancer http://www.Acupuncturetoday.com. Accessed February 18, 2004.
2) Samuels N (2002) Acupuncture for cancer patients: why not? (article in Hebrew) Harefuah. 141(7):608-610, 666. Accessed March 17, 2004.
3) Filshie J, Thompson JW. Acupuncture. In: Doyle D, Hanks G, Cherry N, Calman K editors. (2004) Oxford textbook of palliative medicine-3rd ed. NY: Oxford University Press. P. 410-424, 1093.
4) Johnstone PA, Polston GR, Niemtzow RC, Martin PJ (2002) Integration of acupuncture into the oncology clinic. Palliat Med. 16(3):235-9. Accessed March 6, 2004
5) What is Cancer? American Cancer Society. http://www.cancer.org. Accessed February 18, 2004
6) Holmes, HN (2001) Professional guide to diseases. 7th ed. Springhouse, PA: Springhouse Corporation.
7) Tierney LM, McPhee SJ, Papdakis MA (2004) Current medical diagnosis and treatment 2004. 43rd ed. NY: The McGraw-Hill Companies Incorporated.
8) Gordon JS, Curtin S (2000) Comprehensive cancer care: integrating alternative, complementary, and conventional therapies. NY: Persus Publishing.
9) Li P (2003) Management of cancer with chinese medicine. St. Albans, UK: Donica Publishing Limited.
10) Mak E. Acupuncture in Cancer Treatment. Accessed Feb. 18, 2004
11) Poulain P, Pichard Leandri E, Laplanche A, Montagne F, Bouzy J, and Truffa-Bachi J (1997) Electroacupuncture analgesia in major abdominal and pelvic surgery: a randomized study. Acupuncture in Medicine. XV (1), 10-13.
12) Aldridge S. Acupuncture helps breast cancer patients (abstract). American Society of Anaesthesiologists Annual Scientific Session, 2001.
13) Samuels N (2003) Acupuncture for nausea: how does it work? (article in Hebrew) Harefuah. 142 (4):297-300, 316. Accessed March 17, 2004.
14) Bruera ED, Portenoy RK (2004) Cancer pain: assessment and management. NY: Cambridge University Press.
15) Ni M (1995) They yellow emperor’s classic of internal medicine: a new translation of the neijing suwen with commentary. Boston, MA: Shambhala Publications, Inc.