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Cancer Treatment Side Effects & Supportive and Palliative Care

Acupuncture for dyspnea

Improvement of dyspnea by treatment with acupuncture have been reported by RCTs in patients with malignant breathlessness, chronic obstructive asthma and COPD. Some trials have yielded negative results, however, many other trials have shown that acupuncture and acupressure treatments may reduce dyspnea in cancer patients complaining of breathlessness.

A study of 20 metastatic cancer patients investigated the effect of acupuncture by measuring respiratory rate, oxygen saturation, pulse, self-reported breathlessness, pain, anxiety, and relaxation before and after a ten minute acupuncture treatment. Seventy percent of patients reported significant improvements in breathlessness, anxiety, and relaxation that lasted up to six hours after a single treatment. Improvements in respiration were sustained for 90 minutes.

Another RCT investigated the effects of acupressure therapy on dyspnea, anxiety and physiological indicators of heart rate and respiratory rate in patients with chronic obstructive pulmonary disease having mechanical ventilation support. The study had an experimental blocking design, using sex, age and length of ventilator use as a blocking factor. A total of 52 patients were randomly assigned to an acupressure group and a comparison group. Those in the experimental group received daily acupressure therapy and massage treatment for 10 days. Patients in the comparison group received massage treatment and handholding. The primary outcome measures were the visual analogue scales for dyspnea and anxiety, and physiological indicators of heart rate and respiratory rate. Data were collected every day from baseline (day 1), during the treatment (days 2-10) and follow-up (days 11-17). Dyspnea (P = 0.009), anxiety (P = 0.011) and physiological indicators (P < 0.0001) in the acupressure group improved statistically significantly over time when compared with those of the comparison group.

A recent randomized, partially blinded study examined the effects of acupressure on the perceived health-related quality of life of participants with bronchiectasis. Thirty-five out-patients were randomly assigned to one of three groups: standard care with supplemental acupressure for eight weeks (11 participants); standard care with supplemental sham acupressure for eight weeks (11 participants); and standard care alone (13 participants). Breathlessness was assessed by measuring six-minute walking distance and breathing difficulty (measured on the dyspnea visual analogue scale) and health-related quality of life (measured by the Saint George Respiratory Questionnaire). For acupressure participants, the Saint George respiratory questionnaire activity component scores improved over time, compared with controls (P = 0.01) after adjustment for covariates (treatment, time, age, sex and baseline values). Other variables did not differ between the standard care alone group and the other two groups. The authors concluded that eight weeks of self-administered acupressure could be useful in reducing the effects of bronchiectasis on a patient's daily activities.

In another randomized, block experimental design trial, 44 patients with chronic obstructive pulmonary disease (COPD) were randomly assigned to either the true acupressure or the sham acupressure groups. The true acupressure group received a program of acupressure using appropriate acupoints that promote relaxation and relieve dyspnea. The sham acupressure group received acupressure using sham acupoints different from the meridians and ganglionic sections of the true acupressure group. Both acupressure programs lasted 4 weeks, with five sessions per week that lasted 16 minutes per session. The Dyspnea Visual Analogue Scale (DVAS) was administered prior to the program as a baseline, and again following the completion of the 4-week program. Oxygen saturation and other physiological indicators were measured before and after each session. The results of this study showed that DVAS scores, oxygen saturation, and physiological indicators of the true acupressure group were significantly improved, compared to those of the sham acupressure group.

Safety

Acupuncture is considered a highly safe intervention in the hands of well-trained and licensed providers. Serious side effects from acupuncture are extremely rare. Minor side effects may include bruising in the needling area that usually disappears within 24 hours.

Recommendations

There is evidence from some RCTs in cancer patients that acupuncture may be useful as a co-adjuvant for the treatment of dyspnea in oncology populations.

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  • Schmitz B, Pither J, Neumann CM, Hanson J. The frequency and correlates of dyspnea in patients with advanced cancer. J Pain Symptom Manage. 2000;19:357-362.
  • Filshie J, Penn K, Ashley S, Davis CL. Acupuncture for the relief of cancer-related breathlessness. Palliat Med. 1996;10:145-150.
  • Jobst K, Chen J, McPherson K, et al. Controlled trial of acupuncture for disabling breathlessness. Lancet. 1986;2:1416-1419.
  • Maa SH, Sun MF, Hsu KH, et al. Effect of acupuncture or acupressure on quality of life of patients with chronic obstructive asthma: a pilot study. J Altern Complement Med. 2003;9:659-670.
  • Maa SH, Tsou TS, Wang KY, Wang CH, Lin HC, Huang YH. Self-administered acupressure reduces the symptoms that limit daily activities in bronchiectasis patients: pilot study findings. J Clin Nurs. 2007 Apr;16(4):794-804.
  • Wu HS, Lin LC, Wu SC, Lin JG. The psychologic consequences of chronic dyspnea in chronic pulmonary obstruction disease: the effects of acupressure on depression. J Altern Complement Med. 2007 Mar;13(2):253-61.
  • Tsay SL, Wang JC, Lin KC, Chung UL. Effects of acupressure therapy for patients having prolonged mechanical ventilation support. J Adv Nurs. 2005 Oct;52(2):142-50.
  • Vickers AJ, Feinstein MB, Deng GE, Cassileth BR. Acupuncture for dyspnea in advanced cancer: a randomized, placebo-controlled pilot trial. BMC Palliat Care. 2005 Aug 18;4:5.