After treatment for early-stage breast cancer, patients are eager to get back to their normal lives. Most, however, are prescribed five or more years of hormone therapy, such as estrogen-blocking medicines, to help keep the cancer from coming back.
These medicines can cause menopause-like symptoms even in people who are decades away from menopause. Symptoms include hot flashes, joint pain, mood swings, and difficulty sleeping.
Acupuncture could help alleviate those symptoms without the addition of more pharmaceuticals. According to new results from three parallel clinical trials led by Weidong Lu, MB, PhD, MPH, the lead oncology acupuncturist at the Zakim Center for Integrative Therapies and Healthy Living | Dana-Farber Cancer Institute, ten weeks of twice-weekly acupuncture can help relieve hot flashes and other symptoms and improve quality of life. The results were published in Cancer.
“Anti-estrogen therapy is a really important part of treatment, but side effects are very common and often lead to people not taking their medicines regularly,” says senior author and breast oncologist Jennifer Ligibel, MD, director of the Zakim Center. “Finding non-pharmaceutical ways to alleviate symptoms is really important.”
What is acupuncture?
Acupuncture is an ancient Chinese medicine that has been practiced for about 2500 years. A practitioner inserts fine-gauge needles into the skin at key points across the body to stimulate nerve, muscle, and connective tissues. Each point in the body contributes one or many stimuli that together induce holistic changes in the body and brain.
During an acupuncture treatment session, a licensed practitioner will place the needles and then allow the patient to rest for about 30 minutes before removing the needles.
Acupuncture is not fully understood but studies suggest that it can induce changes in the nervous system and brain and that it can also affect tissues where the needles are inserted. It has been shown to be an effective treatment for several types of pain and other conditions.
What results can I expect from acupuncture for hot flashes related to breast cancer treatment?
Lu’s trials included patients who had completed treatment for breast cancer and were taking anti-estrogen therapy to reduce the risk of recurrence. These patients were all identified as having frequent and severe hot flashes related to their treatment.
The trial tested two protocols. One group, the acupuncture group, received 10 weeks of twice-weekly acupuncture and was followed for 10 weeks after completion. The other group, the delayed acupuncture group, received normal treatment for 10 weeks, followed by 10 weeks of once-weekly acupuncture.
At week ten, across all three sites, 64% of the participants in the acupuncture group experienced fewer and less severe hot flashes compared to just 18% of participants in the delayed acupuncture group, which had not yet started acupuncture. A little more than half of the participants saw improvements in other hormonal symptoms. The improvements lasted through the 10 weeks of follow-up and might last longer.
“When symptoms return, patients might need to begin acupuncture again, but they might not need as many treatments,” says Lu.
If I am this type of patient, how often will I need to get acupuncture for improvement in hot flashes?
Twice-weekly acupuncture for 10 weeks reduced hot flashes and improved quality of life. The once-weekly acupuncture although showed similar improvement, this schedule was not the main results of the study and needs to be tested further. However, in practice, patients looking for relief from hot flashes during endocrine therapy could consider once- or twice-weekly acupuncture.
Is there a special acupuncture protocol for symptoms from anti-estrogen therapy?
There are over 350 standard needle insertion points recognized by the World Health Organization (WHO), so there are many possible ways to receive acupuncture.
In their trials, the Dana-Farber team identified a core set and an optional set of points for needle placement that, based on a review of past research, had been shown to address menopausal symptoms. The core points, which might be helpful to share with an acupuncture practitioner, included SP-6, LI-11, Yintang, GV-20, and Shenmen/ear. The six optional points included LR3, ST36, K3, PC7, CV6, and Heart/ear. At the three locations of the trials, in the U.S., South Korea, and China, acupuncturists were allowed to customize the needle placement slightly to align more closely with local customs.
It’s essential to remember that acupuncture is a deeply personalized practice. While the research identified a core set of points shown to be effective for menopausal symptoms, these are intended as guidelines. Patients should trust their acupuncturists to adapt the treatment based on their specific needs, ensuring the best possible outcome, and honoring the cultural practices inherent in acupuncture.
“Acupuncture is a practice, not a drug, and practices can vary culturally, so we needed to build in room for diversity,” says Lu. “Additionally, this approach represents a blending of traditional and modern methods, where both sides — Western medicine and Eastern medicine – are adapting and learning from each other to enhance outcomes while preserving the strengths of each tradition.”
Where can I go to get acupuncture treatment?
For patients who live near Dana-Farber, Lu recommends receiving acupuncture at the Zakim Center, where practitioners are specially trained to treat patients with cancer. He strongly recommends this for who are undergoing chemotherapy or other active treatment that could increase the risk of infection.
However, for healthy patients who no longer have cancer and are taking anti-estrogen therapy after treatment is complete, it is fine to receive acupuncture from a local community practitioner.
Learn more about the Leonard P. Zakim Center for Integrative Therapies and Healthy Living.
What other research is Dana-Farber doing related to acupuncture?
Lu is planning more studies of acupuncture for patients with breast cancer. He hopes to open a trial with the same protocol but in collaboration with Henry Ford Health in Detroit, MI, which will help further diversify the study population.
In a clinical trial, after 10 weeks of acupuncture, more participants in the acupuncture group had improvements in the number and severity of hot flashes compared with the control group.
“In our practice we see our African American patients suffer a lot from these symptoms,” says Lu. “This is a population that needs more options and more resources.”
The team is also running a trial with similar design but for patients who are currently undergoing chemotherapy. They want to see if acupuncture can reduce the risk of neuropathy.