Roxanne Nelson

October 24, 2013

VANCOUVER, British Columbia — Dysphagia is a common adverse effect of chemoradiation therapy in patients with head and neck cancer (HNC). Although there have been previous reports of acupuncture providing some relief, a new pilot study that compared active with sham acupuncture found no significant improvement.

There was an improvement in quality-of-life scores after acupuncture, but it was not statistically significant.

The results of the pilot study were presented here at the 10th International Conference of the Society for Integrative Oncology (SIO) by lead author Weidong Lu, MB, PhD, MPH, an instructor in the Department of Medicine at Harvard Medical School and a staff acupuncturist at the Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, in Boston.

"Acupuncture is a safe intervention, and it is feasible for head and neck cancer patients," said Dr. Lu. "Improvements were observed in both arms of the study, and more studies are needed to establish the clinical benefit of acupuncture in head and neck cancer."

Dr. Lu explained that to more thoroughly investigate the efficacy of acupuncture in this setting, HNC patients might require more frequent or a longer duration of treatment.

In this study, patients were randomized to 12 sessions of either active or sham acupuncture, once every 2 weeks, starting during and continuing until 20 weeks after chemoradiation.

The fact that the sessions were biweekly "is among the weaknesses of the study," Dr. Lu said. However, he explained that this modification was made during the recruitment phase because prospective participants "did not like needles."

The difficulty we had recruiting patients led us to change the timing. "But in the next phase, it should be once a week in order to get better results." he said.

Earlier Data Hints at Benefit

In an earlier case series report, 9 of 10 patients with HNC reported various degrees of subjective improvement in swallowing functions, xerostomia, pain, and fatigue levels after acupuncture treatment (Integr Cancer Ther. 2010;9:284-290). In addition, after acupuncture, 6 of 7 patients dependent on percutaneous endoscopic gastrostomy tube feedings had their tubes removed a median of 114 days after chemoradiation.

In other studies, acupuncture improved subjective symptoms of dry mouth in patients with radiation-induced xerostomia, and was more effective than standard therapy in reducing chronic musculoskeletal pain, xerostomia, and dysfunction, as previously reported by Medscape Medical News.

Factors to Consider

Even though this was a negative study, it doesn't mean that there wasn't a benefit with acupuncture, said Richard Lee, MD, assistant professor of general oncology at the University of Texas M.D. Anderson Cancer Center in Houston.

"It may be the style of acupuncture — manual or electrostimulation — or the point selection. "These different factors could modify response," he told Medscape Medical News.

It is possible that a different group would use a different style or technique and find an effect, Dr. Lee explained. "It's the same with medicines, even within one category; you can have different response rates with different medicines. With acupuncture, everyone is using different points and different techniques, so that can account for the differences that are seen in studies."

"It may very well be that for dysphagia, there is not a specific effect," he added. "But it requires more research to determine whether that really is the case."

Sham acupuncture is used in randomized trials as a placebo, and the needles are either inserted superficially or do not penetrate the skin. Theoretically, they should not deliver the same effect as active acupuncture. The reason patients who received sham acupuncture showed similar improvement is a matter of speculation.

"With acupuncture, there are 'nonspecific effects' or placebo effects," explained Dr. Lee. "I suspect that part of that placebo response is related to the care and attention from the practitioner. That is why you get some response with sham acupuncture."

Study Details

Treatment of HNC with chemoradiation can be highly effective and curative, but it is associated with significant toxicity and adverse effects.

In this study, Dr. Lu and colleagues assessed the feasibility of recruiting HNC patients and collected preliminary data on the efficacy and safety of acupuncture for dysphagia and related quality of life.

The cohort involved 42 patients diagnosed with stage III or IV HNC who had no evidence of distant metastasis and who were receiving curative-intent chemoradiation.

Except for the treating acupuncturists, all study personnel and patients were blinded. The M.D. Anderson Dysphagia Inventory (MDADI) and other questionnaires were measured at baseline (end of chemoradiation), the end of acupuncture, and at 6-month follow-up (12 months postchemoradiation).

A total of 35 patients (83%) received at least 8 sessions of acupuncture, and 28 (67%) received all 12. Mean MDADI total scores improved from baseline in the treatment and the sham groups, but the difference in improvement was not significant (P =.12).

Median feeding tube duration did not differ between the treatment and sham groups (125 vs 147 days; P = .93).

Dr. Lu had has disclosed no relevant financial relationships.

10th International Conference of the Society for Integrative Oncology (SIO): Abstract 127. Presented October 20, 2013.

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