Meet “Ayo.” Ayo, could be a real cancer patient, much like the 52,000 men and women who in 2012, were diagnosed with head and neck cancer. How could an individual in his fifties, dealing suddenly with cancer, find out if acupuncture is an effective treatment for dysphagia? How could Ayo evaluate recommendations from pros like doctors and clinicians? How could Ayo separate the weed from the chaff, the clinical relevant from the well-meant advice given by caring family and friends? How would Ayo judge the advice from his barber, his favorite sales person at the local cigar shop, or perhaps his bookie (who has a stout monetary stake to keep the cancer stricken Ayu from his demise)?
Ayo will find out the hard way that once a malignant tumor hijacks a person’s life, either as a cancer patient, loved one or care provider for a cancer patient, sooner or later, helplessness will jack up its ugly head. During these chaotic and stressful times, Ayo will benefit from having someone in his corner to keep a clear mind to ask the right questions. A person he can trust, a person with his best interest at heart. A person answerable solely to him and his newly found role of cancer patient. Ayo has use for a patient advocate.
Unless Ayo’s patient advocate is a medical professional, asking the right questions for him, and his advocate can be tricky. Especially when Ayo considers mind-body medicine as an adjunct treatment. What if Ayo, the cancer patient, were to consider acupuncture for dysphagia brought on by chemotherapy during head and neck cancer treatment? For starters, he could look into the expert literature.
As a mind-body research scientist, I am fascinated I think the correct term would be enamored, by advanced research design in mind-body medicine and the questions researchers ask and are trying to answer through clinical trials. ClinicalTrials.gov could prove to be a goldmine for cancer patients like Ayo. Reading a clinical trial’s descriptive data provides clues about the questions Ayo and many cancer patients like him want to be asking. Especially when evaluating mind-body medicine modalities for head and neck cancers. With the help of the local librarian, Ayo and his advocate might even be able to get a journal titled Contemporary Clinical Trials. Contemporary Clinical Trials provides a wealth of information on innovative design features of clinical trials and their rationale.
How would Ayo know in what way to check the professional mind-body medicine literature? What questions does he want to ask while darting paper after paper reporting on acupuncture research, head and neck cancer and dysphagia?
Ayo could take clues from a paper by Lu et al.1. Lu et al.1 extremely elegantly outline an argument and design for a clinical trial. The purpose of their investigation is to evaluate acupuncture for dysphagia after chemoradiation in cancer patients with malignant tumors of the head and neck.
Reading Lu et al.1 Ayo and his advocate would find out that dysphagia, or difficulty swallowing, is a common side effect of chemoradiation treatment experienced by nearly half of all head and neck cancer patients. Current treatment for dysphagia consists of swallowing therapy and dilation procedures. These treatments have some limitations.
Lu et al.1 also tell Ayo that acupuncture for dysphagia can be of benefit by helping swallowing function and improving the quality of life (QOL) in head and neck cancer patients. Ayo also learns that information to make a concise clinical, population wide recommendation on the efficacy of acupuncture for dysphagia is just not there, yet. Does this mean Ayo needs to dump acupuncture? No, not at all. It just means that he seriously needs to do his homework before accepting anyone’s advice about mind-body medicine and acupuncture and cancer.
So what questions does Ayo need to ask? Again, Ayo can gather clues from Lu et al.1 by paying attention to the questions the researchers are asking themselves as they develop their study.
Question 1: What is the existing evidence on acupuncture for dysphagia?
First, Ayo finds that the researchers ask about the existing evidence about acupuncture for dysphagia. Looks like a reasonable thing to do. Ayo wants to note that Lu et al.1 consider only data from reliable sources. While it is clear, it is noteworthy, however, to point out that information from bookies and lip service from friends and family never enter the picture in the investigations of the researchers.
Ayo might dig a little deeper to find out that Lu et al.1 found at lest six credible sources reporting on research dealing with acupuncture, dysphagia and xerostomia (dry mouth). If Ayo was to Google some of the titles mentioned, he would find out the following:
“The results of the present study indicate that acupuncture may be a useful adjunct for the stimulation of salivary flow in some patients with xerostomia”2 (abstract).
“According to the results of the present study, acupuncture showed a significant effect on saliva production, suggesting this therapy as a useful treatment for patients suffering from radiation-induced xerostomia”3(abstract).
“It is possible that the salivary secretion is influenced by the augmented release of neuropeptides caused by acupuncture”4(abstract).
“Acupuncture at LI-2 was associated with neuronal activations absent during sham acupuncture stimulation. True acupuncture induced more saliva production than sham acupuncture”5(abstract).
The next question Ayo needs to address is one of relevance. He needs to find out if what he is reading about is actually going to help his quest for information.
Question 2: Are Lu et al.’s1 findings related to Ayu’s situation?
Were all the study participants even human? Yes, they were. Ayo would discover that not all the participants were cancer patients. Some included healthy volunteers, some included stroke patients. Continuing reading Lu et al.1 Ayo would find that their paper addresses study population. Lu et al.1 are looking for research participants who meet specific inclusion criteria. The inclusion criteria can some times be a list that is extraordinarily long. Defining inclusion criteria ensures that the results apply to a well-defined study population. E.g. Head and neck cancer patients with malignant tumors stage II, III, or IV, receiving chemoradiation, Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 and so forth1.
It is imperative for Ayo to recognize that a given treatment must be efficacious in a population similar to his personal circumstances. Ayo needs to find always evidence that is a specific as possible.
The next post in this series will deal with three more questions Ayo will want to find out the answers to.
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Continue reading part two…
1. Lu, W. et al. Acupuncture for dysphagia after chemoradiation in head and neck cancer: Rationale and design of a randomized, sham-controlled trial. Contemp. Clin. Trials 33, 700–711 (2012).
2. Blom, M., Dawidson, I. & Angmar-Månsson, B. The effect of acupuncture on salivary flow rates in patients with xerostomia. Oral Surg. Oral Med. Oral Pathol. 73, 293–298 (1992).
3. Braga, F. P. F. et al. The effect of acupuncture on salivary flow rates in patients with radiation-induced xerostomia. Minerva Stomatol. 57, 343–348 (2008).
4. Dawidson, I., Blom, M., Lundeberg, T. & Angmar-MåNsson, B. The influence of acupuncture on salivary flow rates in healthy subjects. J. Oral Rehabil. 24, 204–208 (1997).
5. Deng, G., Hou, B. L., Holodny, A. I. & Cassileth, B. R. Functional magnetic resonance imaging (fMRI) changes and saliva production associated with acupuncture at LI-2 acupuncture point: a randomized controlled study. Bmc Complement. Altern. Med. 8, 37 (2008).