Complementary Therapies in Cancer Care

Complementary Therapies in Cancer Care:

An ongoing series highlighting complementary therapies
By Barrie R. Cassileth, MS, PhD

Complementary therapies are noninvasive, nonpharmacologic adjuncts to mainstream treatment.  They improve patients’ strength and control the physical and emotional symptoms associated with cancer and other serious illnesses. They provide self-help guidance to enhance body and soul at times when one feels vulnerable and life seems out of control.  Complementary therapies are used as adjuncts to mainstream care of cancer and other illnesses, not as substitutes. They improve physical and emotional function, and manage stress and symptoms of aging, regardless of health status.  Complementary therapies are rational, evidence-based practices delivered or taught by trained practitioners.  They include: mind-body practices such as meditation and self-hypnosis; massage therapies; nutritional counseling; physical fitness, including programs such as aerobic exercise, Chi Gong, tai chi, yoga and many other practices.
We begin this series with acupuncture, a two-to three-thousand-year-old practice known to relieve difficult, often otherwise untreatable symptoms and effect important improvements in physical function and well-being.......



ACUPUNCTURE
One of the most studied of complementary therapies, modern acupuncture is accepted by mainstream medicine for the management of various types of pain, for addiction control, and for the treatment of several physical and emotional symptoms experienced by cancer patients and others. For this reason, acupuncture is a good example of the few complementary treatments that sit on the cusp of mainstream medicine.  It is available today in many mainstream hospitals, clinics, and cancer centers.
Acupuncture was popular in ancient China, banned in 1822 by the Chinese Imperial Medical College, which prohibited disrobing as indecent, and rediscovered in the twentieth century. Today, herbal remedies and other traditional techniques, such as tai chi and qi gong and acupressure, join acupuncture as central components of Traditional Chinese Medicine.
What It Is
Acupuncture is a medical therapy developed in China more than two thousand years ago. It involves the placement of hair-thin, disposable needles into the skin. Ancient acupuncture needles were made of bone, stone or metal, including silver and gold. Modern needles are made of stainless steel. The needles penetrate just deep enough into the skin to keep from falling out, and skilled practitioners accomplish virtually painless insertion. Unlike needles used to give injections, modern acupuncture needles are not hollow, and are therefore very thin, about the width of a human hair.  They are sterile, disposable, and safe.
Needles are placed at specific points along meridians, or channels. These channels are like rivers with tributaries that flow into increasingly narrow rivulets, mimicking nature’s flow of water to increasingly smaller streams.  The twelve main meridians, like the twelve main rivers of ancient China, represent an internal system of communication and transport, just as actual waterways permit communication and transport in the outer world. The human body is viewed as a miniature model, or microcosm, of the universe.
Each channel is believed to be connected to a specific networked area or organ system of the body. By needling acupoints along a particular meridian, a problem in a distant area of the body can be treated. Acupoints are used in both acupuncture and acupressure.  In modern acupuncture, more than 1,000 acupoints (some experts say more than 2,000) are recognized, but most treatments require needles in only ten or twelve points. Typically, needles are kept in place for less than one-half hour. Determining the exact size and placement of the needles is essential. Twirling or setting them or using “electro-acupuncture,” where a small amount of electricity goes through the needle from a source clipped to the top, enhances the result.
Sometimes acupuncture is augmented by moxibustion, the placement of a smoldering plug of the herb mugwort on a meridian acupoint. This practice is as old as acupuncture. Cupping is another ancient Chinese and Indian remedy in which heated cups are placed on the skin, sometimes after small punctures are made at the intended location. This process produces a suction force that is thought to boost circulation and improve health. Insertion of acupuncture needles only in the outer ear is a relatively new variation, in which the ear serves as a miniature map of the entire body and its acupoints.
Modern Acupuncture
Modern versions of acupuncture use electricity, heat, laser beams, sonar rays, and other non- needle acupoint stimulators.  In use since the 1930s, electroacupuncture is considered less tiring and time-consuming than the manual version. Needles are connected to a supply of weak electric power. Therapeutic reactions are said to be just as effective.
What Practitioners Say It Does
In China, acupuncture is still applied to treat ailments and cure disease, including serious illnesses such as cancer and diabetes, but careful investigations find no benefit against disease. In modern Chinese hospitals, acupuncture sometimes is used as a secondary surgical anesthetic. In Asia and in the West, acupuncture is used and has been found effective to relieve arthritis, menstrual symptoms, and chronic pain caused by other problems.  It also assists withdrawal from addictions such as drug and alcohol dependency. Of greatest significance here, acupuncture effectively treats many physical and emotional symptoms associated with cancer and cancer treatment.
Beliefs on Which It Is Based
Classic, traditional acupuncture is based on ancient Chinese medicine and its understanding of health. The origins of acupuncture illustrate how the earliest civilizations sought to understand the world and its various components, including seasons, nature, wellness, and disease. All were seen as parts of a single whole. Each aspect of life, including health and disease, was conceptualized as a polarity, manipulated by two opposing forces in nature. These forces are the yin, or dark female force, and the yang, or light male force. Illness was said to occur when opposing yin-yang energies were not in harmony. Acupuncture and all other healing interventions, such as herbal tonics and qi gong, aimed to rebalance these energies.
This deceptively simple idea is actually an extremely complex, detailed set of interactions and connections among bodily organs, forces, and pathways. A central component of the belief system is the concept of vital energy, or the life force. In classic Chinese medicine, the life force is termed chi or ch’i, or in modern transliteration qi (all pronounced “chee”).
When there is a balance of qi—not too much or too little flow of energy—there is good health. An excess or deficiency in the flow of energy, however, represents an imbalance that causes pain and illness. Acupuncture is applied to correct that imbalance. An uneven flow of qi is returned to equilibrium by the placement of acupuncture needles along or at the intersections of appropriate meridians, or energy pathways along which qi circulates throughout the body.
Research Evidence to Date
Numerous publications in the medical literature support the effectiveness of acupuncture for pain, hot flashes, and other problems experienced by people regardless of any particular diagnosis. Recent research also documents its ability to reduce cancer-related problems such as muscle dysfunction, nausea, xerostomia (extreme dry mouth associated with head and neck cancer treatment), pain, anxiety and depression, constipation, and fatigue.  It is effective against yet other problems that patients with cancer face, including shortness of breath, chronic fatigue, and neuropathy, or nerve-related distress.
Just how acupuncture works remains only partially understood. We know from modern research,   including Functional Magnetic Resonance Imaging (fMRI) brain studies reported in the medical literature, that acupuncture works at least in part through the nervous system. Areas of the brain light up to show that acupuncture elicits responses in areas of the brain that are related to the treatment goal.
The existence of meridians remains unproven. The fundamental idea of a vital life force that can become unbalanced and rechanneled as it courses through the body also remains an ancient concept in which many continue to believe. However, there is no scientific evidence that supports its existence.
Although acupuncture effectively controls many symptoms, it does not cure disease. It is applied today to treat disease primarily in underdeveloped areas of the world where access to modern medicine is unavailable.
What It Can Do for You
If you have unexplained symptoms or a serious medical illness, see a conventional physician and take advantage of modern diagnostic and treatment techniques. These can catch a serious problem early when it is most treatable, rule out the existence of a serious problem, or provide the best chance of cure. Acupuncture is not a realistic alternative to modern diagnostic or therapeutic techniques.
However, if your sore knee still leaves you limping or your pain persists, acupuncture might well be your best bet. Its simplicity, lack of toxicity or complications, low cost, and frequent effectiveness make acupuncture a therapy of choice for various kinds of chronic pain (when the reason for it has been uncovered and conventional treatment is not preferred). Try it also to help relieve the difficulties of stress and anxiety, arthritis, headaches, and other problems as noted above. If it works for you, it hardly matters that we cannot find qi or that skeptics think it might be a placebo response.
Where to Get It
There are approximately 15,000 acupuncture practitioners in the United States today.  Many conventional physicians, cancer centers, and other medical centers refer patients to well-trained and experienced acupuncturists.
Qualified acupuncturists may be recommended by the National Commission for the Certification of Acupuncture and Oriental Medicine (NCCAOM) in Washington, D.C. (www.NCCAOM.org).  This non-profit organization was established in 1982 to promote standards of competence and safety in acupuncture and Oriental medicine.
Licensure and regulations regarding the practice of acupuncture vary across states in the United States.  Requirements and regulations differ broadly across states and in other countries. It is important that patients use a certified or licensed acupuncturist who is also training in the care of people with cancer.
Adapted with permission from The Complete Guide to Complementary Therapies in Cancer Care: Essential Information for Patients, Survivors, and Health Professionals. Copyright © 2011 by World Scientific Publishing Co. Pte. Ltd.
Barrie R. Cassileth, MS, PhD is Laurance S. Rockefeller Chair and Chief of the Integrative Medicine department at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City.  She has an extensive medical leadership career and is a foremost authority on complementary therapies and Integrative Medicine in oncology.  Her work includes more than 170 publications in the medical literature, more than 40 medical textbook chapters, and 22 books for physicians, patients, and families.  She was a founding member of the Advisory Council to the U.S. National Institutes of Health Office of Alternative Medicine, now the National Center for Complementary and Alternative Medicine; she served previously on the National and the NY-NJ Regional Boards of the American Cancer Society, and on multiple national and international committees.  She is a staunch opponent of cancer quackery.  She is Founding President of the Society for Integrative Oncology. Since joining MSKCC in 1999, Dr. Cassileth has established prototypic research, education, and clinical programs in Integrative Medicine.  Her most recent book, The Complete Guide to Complementary Therapies in Cancer Care: Essential Information for Patients, Survivors and Health Professionals, was published in 2011 by World Scientific Publishing Company, Singapore and UK.

Prescribed Reading

To read the full “Acupuncture” chapter and more about complementary therapies, purchase The Complete Guide to Complementary Therapies in Cancer Care: Essential Information for Patients, Survivors, and Health Professionals online at
The Cancer Care Store (www.cancercarestore.com).