January 5, 2010 — Acupuncture appears to be as effective as venlafaxine (Effexor), a standard drug therapy for relieving vasomotor symptoms in breast cancer patients. As an added bonus, acupuncture treatment also boosted libido, improved mental clarity, and did not have any adverse effects.
Overall, the results of the study, published online December 28 in the Journal of Clinical Oncology, showed acupuncture to be a "safe, effective, and durable treatment for vasomotor symptoms secondary to long-term antiestrogen hormone therapy in breast cancer patients."
Offered as an Alternative Therapy
This is the first randomized controlled trial to compare acupuncture with standard pharmaceutical therapy for the treatment of vasomotor symptoms in breast cancer patients who receive antiestrogen hormone therapy. Even though the number of patients in this trial was small (n = 50), senior author Eleanor M. Walker, MD, feels that acupuncture should be offered as an alternative therapy, even without the benefit of data from a larger trial.
Aside from the fact that no adverse effects were associated with acupuncture, Dr. Walker, who is director of Breast Radiation Oncology at Henry Ford Hospital in Detroit, Michigan, pointed out that there is a large body of literature showing its benefit in menopausal women experiencing hot flashes, and the results are similar.
It is unlikely that this is due to a placebo effect.
"Also, since this was compared with drug therapy, which is what most patients are treated with, and produced similar results, I don't think that there is a placebo effect," she told Medscape Oncology. "The duration of the acupuncture was also longer and, therefore, it is unlikely that this is due to a placebo effect."
Many physicians are still somewhat resistant to alternative therapies, despite the growing number of hospitals and institutions that are offering these treatments to patients. However, Dr. Walker does believe that the barriers can be broken. "I think that if more physicians researched these therapies and more randomized controlled trials were done, then this would help to break barriers," she explained.
Noncompliance Common With Drug Therapy
Vasomotor symptoms are common adverse effects of antiestrogen hormone treatment and, since the recommended duration of therapy is 5 years, these adverse effects can become a major cause of decreased quality of life and treatment discontinuation, according to the study authors.
Treatment with hormone replacement therapy is contraindicated in estrogen-sensitive breast cancer patients, and patients are frequently noncompliant with pharmacologic agents used to decrease vasomotor symptoms because of their adverse effects.
Venlafaxine, a selective serotonin reuptake inhibitor, has been shown to be effective in treating these symptoms and is currently the pharmacologic agent of choice for hot flashes. However, the authors note, many women refuse this treatment because of potential adverse effects or because they do not want to take any more medication.
Therefore, effective nonpharmacologic treatment strategies with minimal or no adverse effects are urgently needed, say the authors, to improve quality of life in these patients and to support conventional breast cancer therapy.
No Adverse Effects and Additional Benefits
Dr. Walker and colleagues conducted a randomized controlled trial that compared the efficacy of acupuncture with that of venlafaxine in reducing vasomotor symptoms, and compared the related adverse effects.
The cohort included 50 breast cancer patients (stage 0 to III) who ranged in age from 35 to 77 years (median, 55 years). Of this group, 82% were postmenopausal. The patients were randomized to receive either venlafaxine (n = 25) or acupuncture (n = 25). Patients in the venlafaxine group received 37.5 mg orally at night for 1 week, then 75 mg at night for the remaining 11 weeks. Those in the acupuncture group received treatments twice per week for the first 4 weeks, then once per week for the remaining 8 weeks. After 12 weeks of treatment, all therapy was stopped and patients were observed for 1 year.
Both groups of patient experienced significant decreases in hot flashes, depressive symptoms, and other quality-of-life symptoms, and there were significant improvements in mental health. These changes were similar in both groups, indicating that acupuncture is as effective as venlafaxine, say the authors.
Although both groups experienced a 50% decrease in hot flashes, differences began to emerge at 2 weeks posttreatment. Patients in the venlafaxine group began to experience significant increases in hot flashes, whereas the incidence of hot flashes remained at low levels in the acupuncture group.
Patients in the venlafaxine group reported 18 incidents of adverse effects, including nausea, dry mouth, headache, difficulty sleeping, and dizziness; none were reported in the acupuncture group.
In addition, about 25% of patients reported that acupuncture had the additional benefit of increasing their sex drive. Most of the patients also reported that they experienced an improvement in energy, clarity of thought, and sense of well-being.
Dr. Walker told Medscape Oncology that she would like to follow up with a larger study in breast cancer patients, and study the efficacy of acupuncture as a therapy for vasomotor symptoms related to androgen-deprivation therapy in prostate cancer patients.
"Actually, we are using it to treat both men and women for vasomotor symptoms and pain in a pilot study that looks at comprehensive lifestyle changes during and after cancer treatment for prostate and breast cancer," she said.
The study was supported by the Susan G. Komen Foundation. The authors have disclosed no relevant financial relationships.
J Clin Oncol. 2009. Published online December 28, 2009. Abstract
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Cite this: Acupuncture Reduces Vasomotor Symptoms in Breast Cancer Patients - Medscape - Jan 05, 2010.