Acupuncture for Cancer: Extra Training is Optimal

Nick Mulcahy

September 17, 2010

September 17, 2010 — Acupuncture, once deemed a marginal practice despite its long history of use in other parts of the world, has made major inroads into mainstream cancer care in the United States.

A list of American cancer centers that offer acupuncture reads like a Who's Who of clinical oncology: Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City; the Dana-Farber Cancer Institute in Boston, Massachusetts; the University of Texas M.D. Anderson Cancer Center in Houston; the Abramson Cancer Center at the University of Pennsylvania in Philadelphia; and the Masonic Cancer Center at the University of Minnesota in Minneapolis. Industry behemoths like Cancer Treatment Centers of America also now offer acupuncture.

Furthermore, community-based acupuncture practices all over the country see cancer patients seeking relief from symptoms such as pain, and treat related adverse effects such as hot flashes and xerostomia, according to an expert in the field.

However, acupuncturists working on cancer patients need extra education, said that expert, Barrie Cassileth, PhD, chief of the integrative medicine service at MSKCC.

Only acupuncturists trained in cancer should work with cancer patients.

"We strongly believe that only acupuncturists trained in cancer should work with cancer patients," said Dr. Cassileth. "Acupuncture schools teach acupuncture for the average patient," she said.

"We generally modify acupoints to make them effective and more appropriate for cancer patients," she explained in an interview with Medscape Medical News.

For example, the acupoints — which are predetermined places on the body where needles are inserted for therapeutic effect — for hot flashes for normal menopause are "not necessarily the same ones for early menopause due to chemotherapy."

Clinicians at MSKCC pioneered this insight, having extensively studied acupuncture for women undergoing treatment-induced menopause, said Dr. Cassileth. 

MSKCC offers a one-of-a-kind program for acupuncturists who want to become certified cancer care providers. "We have trained thousands of acupuncturists from all over the world," Dr. Cassileth said.

The 20-hour program, which until recently required classroom attendance in New York City, is now exclusively offered on the Internet.

For clinicians who cannot find a trained cancer acupuncturist with whom to work, Dr. Cassileth suggests that you "ask for experience."

For example, she said that clinicians should only refer a patient treated for head and neck cancer to an acupuncturist who has worked with patients with swallowing difficulties and xerostomia, 2 of the most common adverse effects in these patients.

Where to Find an Acupuncturist

Clinicians interested in reaching out to an acupuncturist can use a number or resources.

The National Certification Commission for Acupuncture and Oriental Medicine provides a list of practitioners who are nationally certified in acupuncture and in Oriental medicine, Chinese herbology, and Asian bodywork therapy.

Acufinder.com provides an online database of licensed acupuncture providers. Visitors can search for a practitioner by state in the United States, or by country — Canada, Australia, and the United Kingdom are among the countries in the database.

However, only MSKCC has a listing of acupuncturists trained in cancer care, said Dr. Cassileth. For privacy reasons, the list is not public. But clinicians and patients can contact MSKCC's integrative medicine service for a referral. "We get calls all of the time from doctors and patients looking for a cancer-trained acupuncturist, she said.

Growing Validation

Acupuncture is for treating adverse effects and symptoms related to cancer and not the disease itself, reminded Dr. Cassileth.

Acupuncture works with the idea that energy flows throughout the body along channels, or meridians. Specific acupoints are stimulated with needles to increase energy flow throughout the body to a particular tissue, organ, or organ system, according to a press statement from MSKCC.

According to the Centers for Disease Control and Prevention, more than 8 million Americans annually are treated with acupuncture for a variety of ailments, including back pain, chronic headaches, osteoarthritis, high blood pressure, infertility, and hot flashes. There is no tally on the number of cancer patients receiving such treatments.

Still, the validations of acupuncture for the treatment of adverse effects and symptoms related to cancer have been accumulating for some time.

Perhaps most notably, in 1997, the National Institutes of Health (NIH) issued a consensus statement endorsing the effectiveness of acupuncture in treating chemotherapy-induced nausea and vomiting.

In 2007, a licensed senior acupuncturist at the Dana-Farber Cancer Center, Weidong Lu, MPH, became the first integrative therapy practitioner in the United States to receive a 5-year Career Development Award from the NIH. The grant is for studying the benefits of acupuncture on head and neck cancer patients dealing with dysphagia — one of the most vexing adverse effects of any cancer treatment.

Practitioners and researchers of acupuncture are now exploring its use for conditions that have established drug treatments.

For instance, acupuncture was as effective as the standard drug treatment — venlafaxine (Effexor) — for vasomotor symptoms secondary to long-term antiestrogen hormone therapy in breast cancer patients, according to a recent study reported by Medscape Medical News.

The evidence base is fair but growing.

Research into acupuncture continues to develop. "The evidence base is fair but growing," according to Dr. Cassileth. Not all of it affirms its effectiveness; as reported by Medscape Medical News, a 215-patient study indicated that acupuncture does not reduce radiotherapy-induced nausea.

Nevertheless, acupuncture is approved by the US Food and Drug Administration (FDA) for use in cancer-related treatment, according to the National Cancer Institute. The FDA approved acupuncture needles for use by licensed practitioners in 1996. The FDA requires that sterile, nontoxic needles be used and that they be labeled for single use only by qualified practitioners.

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