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Lymphedema is caused by damage to the lymphatic system due to cancer treatment and is a common side effect for breast and head & neck cancers. Due to the generally considered incurable nature of lymphedema, the authors of this paper argue for multi-disciplinary strategies to reduce onset, progression and complications of lymphedema.
The Abstract (de Valois et al., 2012, p. 301).

Purpose: Within a three-step mixed-methods study to investigate using acupuncture and moxibustion (acu/moxa) in the management of cancer treatment-related upper body lymphoedema, Step 2 obtained preliminary data about: 1) whether acu/moxa can improve quality of life, 2) the most troublesome symptoms, and 3) adverse effects.

Methods and sample: An exploratory single-arm observational clinical study included breast (BC) and head and neck cancer (HNC) survivors with mild-to-moderate uncomplicated lymphoedema for ≥3 months, ≥3 months post active-cancer treatment, no active cancer disease, undergoing routine lymphoedema maintenance. Participants received seven individualised treatments (S1), and six optional additional treatments (S2). MYMOP, SF-36 and PANAS were administered at baseline, during each series, and at follow-up 4 and 12 weeks after end-of-treatment. The primary outcome was change in MYMOP scores at the end of each series.

Key results: Of 35 participants recruited, 30 completed S1 and S2, 3 completed S1, 2 were lost to the study. Mean MYMOP profile change scores for BC participants were 1.28 points improvement on a 7-point scale (sd = 0.93, p < 0.0001, n = 25) for S1; and 1.41 for S2 (sd = 0.94, p < 0.0001, n = 24). S1 HNC change scores were 2.29 points improvement (sd = 0.62, p < 0.0001, n = 7); and 0.94 for S2 (sd = 0.95, p = 0.06, n = 6). Changes in some SF-36 scores for BC participants were significant to 4 weeks after treatment. No serious adverse effects were reported.

Conclusion: This small study suggests acu/moxa is an acceptable adjunct to usual care for cancer survivors with lymphoedema. Further rigorous research is warranted to explore the effectiveness of acu/moxa in reducing the symptom burden.

de Valois et al. (2012). Assessing the Feasibility of Using Acupuncture and Moxibustion to Improve Quality of Life for Cancer Survivors with Upper Body Lymphoedema

Lymphedema is caused by damage to the lymphatic system due to cancer treatment and is a common side effect for breast and head & neck cancers. Due to the generally considered incurable nature of lymphedema, the authors of this paper argue for multi-disciplinary strategies to reduce onset, progression and complications of lymphedema.

The Bottom Line:

Cancer patients at risk of developing lymphedema want to learn how to recognize early signs and symptoms, and once diagnosed, treatment aims to reduce size, physical dysfunction and complications (de Valois et al., 2012).

de Valois et al. (2012) cites research showing that lymphedema has negative psychosocial effects for women and is “One of the most troublesome and feared consequences of breast cancer surgery” (Ganz 1999, as cited in de Valois et al., 2012, p. 302).

The treatment should address quality of life, physiological and psychosocial problems associated with lymphedema. Complementary and Alternative Medicine (CAM) is increasingly desired by cancer patients (de Valois et al., 2012).

Acupuncture, part of Traditional Chinese Medicine, is a CAM modality cancer patients are drawn to for improvement of symptoms and better physiological and psychosocial coping (de Valois et al., 2012).

Based on previous research by one of the authors with breast cancer patients that demonstrated “…measurable improvements in wellbeing, improved quality of life, and symptom relief…” when using acupuncture de Valois et al. (2012) set out to investigate if acupuncture could be successful in the management of lymphedema asking the questions (p. 302):

1. Can acu/moxa improve wellbeing in cancer survivors with lymphoedema?
2. What symptoms are most troublesome for these individuals?
3. Is acupuncture a safe intervention for people with lymphoedema?

Because of the nature of lymphedema, acupuncture is considered a controversial treatment. People with lymphedema should focus on reducing the possibility of further infection and swelling via accidental or non-accidental (as in acupuncture) skin punctures in the affected area (de Valois et al. 2012). Many practitioners suggest that it is considered a good idea for lymphedema patients to avoid acupuncture altogether. However, this is not the case according to de Valois et al. (2012, p. 302) who state “In lymphoedema and cancer policy documents, acupuncture is not contraindicated, and guidance is the same as for all NASP [non-accidental skin punctures] interventions, in that needling the affected area should be avoided.”

De Valois et al. (2012) selected to use the following three validated instruments to use as outcome measures:

Medical Outcome Profile (MYMOP) “…is widely used for evaluating interventions based on holistic and participative principles, and allows patients to define and evaluate outcomes that are pertinent to them” (de Valois et al., 2012, p. 303).

The Medical Outcomes Study Short Form (SF-36) “…is a generic 36- item functional status questionnaire that assesses eight domains of physical and psychological health” (de Valois et al., 2012, p. 303).

The Positive and Negative Affect Schedule (PANAS) “…is a 20-item validated measure used to assess mood states” (de Valois et al., 2012, p. 303).

The acupuncture protocol was designed to replicate “usual clinical practice,” (de Valois et al., 2012, p. 303) with treatments focusing on “presenting signs, symptoms and priorities” (de Valois et al., 2012, p. 303) of the patients, as this “real-world” acupuncture study design has high external validity.

de Valois et al. (2012) mention in their paper that, for further studies, they will eliminate the PANAS questionnaire due to higher than expected proportion of missing data. The authors also make a note of some limitations of their study, which are: uncontrolled study design, single setting, small number of head & neck cancer patients participants, and research acupuncturist acted as principal investigator as well (de Valois et al., 2012).

The authors also point out that they never set out to cure lymphedema, rather they wanted to show that patients with lymphedema can use acupuncture safely to address “…a range of physical and emotional conditions, and reduce symptom burden (de Valois et al., 2012, p. 307).

Because of the significant improvements (as mentioned in the abstract) further research is warranted to investigate the effects of acupuncture in lymphedema. The authors have plans for a randomized controlled trial investigating the effects of acupuncture in breast cancer related lymphedema.

What do the study results mean for a cancer patient wanting to use acupuncture addressing lymphedema?

This trial can not be generalized, due to some of the limitations mentioned above. It was simply not designed to this. It was designed as a pilot trial to determine if further research might be warranted.

That does not mean you should not discuss this option with your primary health care provider. She/he might be open to working with an expert acupuncturist to see if acupuncture could be a viable treatment, to address the physical and emotional conditions and to reduce the symptom burden you might be experiencing, especially if lymphedema is the result of breast cancer treatment.

References: 

de Valois, B. A., Young, T. E., & Melsome, E. (2012). Assessing the feasibility of using acupuncture and moxibustion to improve quality of life for cancer survivors with upper body lymphoedema. European Journal of Oncology Nursing, 16(3), 301–309. doi:10.1016/j.ejon.2011.07.005

Ganz, P.A. (1999). The quality of life after breast cancer – solving the problem of lymphedema. New England Journal of Medicine 340 (5), 383-385.

Image Credit:

École supérieur d’acupuncture française. (n.d.). Images from the History of Medicine (NLM): Acupuncture. Retrieved from Images from the History of Medicine (NLM) website at http://ihm.nlm.nih.gov/luna/servlet/view/all.

Writing an essay, paper, or report? Cite this story:

APA: W Absenger. (2012.06.23). de Valois et al. (2012). Assessing the feasibility of using acupuncture and moxibustion to improve quality of life for cancer survivors with upper body lymphoedema [Web log post]. Retrieved from The Alternative Medicine Blog at http://amacf.org/2012/06/de-valois-et-al-2012-assessing-the-feasibility-of-using-acupuncture-and-moxibustion-to-improve-quali.htm

MLA: Absenger, Werner.  “de Valois et al. (2012).  Assessing the Feasibility of Using Acupuncture and Moxibustion to Improve Quality of Life for Cancer Survivors with Upper Body Lymphoedema.”  The Alternative Medicine Blog. The Alternative Medicine Blog.  23 June.  2012.  Web.  Insert your date of access here.