In the third and last post of this three post series (read part one here and part two here), “Ayo,” a head and neck cancer patient, continues to discover essential questions to discern whether acupuncture, a mind-body medicine modality, might be a treatment option for dysphagia (difficulty swallowing), a common chemoradiation side effect for head and neck cancer patients.
So far Ayo asked and found answers to the following five questions:
- What is the existing evidence that acupuncture treatment works?
- Are the findings relevant to his situation?
- Did the data clearly show that acupuncture is responsible for the results? In other words, did the results not just happen by chance.
- Was there a clearly defined treatment protocol in place?
- What exactly did the researchers measure?
In the third and last post in the “Acupuncture and Cancer: What cancer patients learn from a study protocol” series, Ayo discovers and finds answers to an extra six questions. In post two, I mentioned that Ayo will want to read up on the basics of statistics.
Question 6: What about the three lies? Lies, damned lies, and statistics?
Well. This is where it can get complicated. Especially since there are different schools of thought in what should be reported. Major associations, like the American Psychological Association have clear guidelines on how to report mind-body medicine research findings. The following link is a pretty good website for Ayo to get started with statistics. A companion website to “Discovering Statistics Using SPSS”1. For Ayo, the first two chapters might be an excellent source to ease himself into the research process, why and how it is done, from a statistics perspective.
Here is some general guidance on what to look out for in a research report.
- Results should be presented in a clear and concise manner2.
- Look for tables and figures: Researchers can present information very accessible to reader in a table or figure2.
- In the analyses, researchers need to include all variables that they described in the method section. This should be easily identifiable to readers2.
- Findings from all analyses performed should be presented in the text or tables, not only the significant findings2.
Question 7: Was anyone harmed (adverse events)? Did anyone die from treatment? Did people just drop out (for whatever reason)?
Did the researchers report any adverse events or offer a number and reasons why participants did not complete an acupuncture study (attrition rate)? In mind-body medicine research, this happens. Participants withdraw, or researchers withdraw participants. Participants miss acupuncture appointments. Participants show, but do not give enough data. Participants do not complete diaries or questionnaires. Researchers lose participants to follow-up. Data or records can be lost or are unavailable for other reasons. Participants experience adverse events.
An unusually high number of participants not completing a study is indicative of poor study quality and calling into question the results. A whole host of things might have gone wrong. Treatment side effects may have caused participants to drop out. A too strenuous study protocol might have made unrealistic demands on participants. Either way, it is probably a good idea to be aware of this ratio or number. While there is not an overall consensus on what is an ideal percentage, look for studies reporting a 75-80% or higher completion rate.
Question 8: Ayo should ask always about the limitations and implications of acupuncture research findings?
Usually researchers elaborate in the discussion section of a research report on the limitations and implications of their research. This could be phrased “Study Limitations” and “Implications for Practice.” Ayo can glean much information about the mind-body medicine research discussed. For example, Deng et al.3 have a section that starts with “There are several limitations in our study.”(p. 6)
Question 9: Do the researchers show a conflict of interest and funding sources?
When evaluating acupuncture and cancer research (or any novel research), Ayo needs to get an answer to pertaining the money trail. In any research report, authors should state and clearly identify a possible conflict of interest, as well a disclosure of all funding sources.
Question 10: Should Ayo tell his oncologist and healthcare providers that he is considering acupuncture for chemoradiation treatment side effects?
This can be answered with a resounding, yes! Ayo needs to keep his primary healthcare provider or oncologist in the loop of any Complimentary & Alternative Medicine (CAM) and/or mind-body medicine he is using, or plans on using while in their care.
Here are tips on how Ayo could go about integrating mind-body medicine into his healthcare:
- Giving his health care providers a full picture of what he does to manage his health helps Ayo stay in control.
- Some complementary health practices can have an impact on conventional medicine. Talking to his healthcare providers will help make sure that Ayo receives coordinated and safe care.
- Talking to his providers helps them to be fully informed and his partners in health care.
- When completing patient history forms, Ayo needs to be sure to include all therapies and treatments he uses. He could make a list in advance.
- Ayo needs to tell his health care providers about all therapies or treatments—including over-the-counter and prescription medicines, as well as dietary and herbal supplements.
- Ayo should not wait for his providers to ask. He needs to be proactive.
- If Ayo is considering a mind-body medicine health practice, he needs to ask his health care providers about its potential value and/or drawbacks for his situation.
A side note: One comment I sometimes hear from cancer patients is that many healthcare providers do not want to discuss mind-body medicine adjuncts in the oncological setting. Worse yet, some patients flat-out think that their healthcare providers do not like them.
Dr. Allan Hamilton, M.D., FACS, a highly well-respected neurosurgeon and author of “The Scalpel and the Soul” (a book review coming in May) writes that he is dumbfounded when patients confess that they do not like their physicians or that their physicians do not like them. Dr. Allan writes “You feel that about your physician but you are still going to let that person share life-transforming events with you? You are putting your very life in someone’s hands, thinking that person does not care about you? It makes absolutely no sense.” Dr. Allan continues to write “Find a doctor who cares about you”4 (pp. 217-18 uncorrected advance proof).
One last basic question Ayo discovers on his quest of learning about the mind-body medicine modality of acupuncture and becoming an informed, proactive participant in his healthcare.
Question 11: Where would Ayo find a qualified acupuncturist and an oncologist open to mind-body medicine?
Ayo did his homework, and he decides that based on everything that he has learned, he is ready to give acupuncture a try. If he did talk to his oncologist and his oncologist was supportive of Ayo receiving acupuncture, his oncologist might be an excellent source to ask for a referral.
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), as well as the Society for Integrative Oncology (SIO), are excellent sources to start a search for qualified acupuncturist, as well as oncologists. SIO members are oncologists and health professionals committed to the study and application of complementary therapies and botanicals for cancer patients.
Here is a quick summary of the questions Ayu possibly could have come up with while immersing himself into Lu et al.’s5 study proposal. These questions can be applied to ask about any treatment for just about any condition.
- What is the existing evidence that the treatment works?
- Are the findings relevant to your situation?
- Does the data clearly show that the intervention you are considering was responsible for the results. In other words, did the results not just happen by chance.
- Did researchers have a clearly defined study protocol in place?
- What exactly did the researchers measure? Again, always know what you are looking for. If you are looking for acupuncture to cure cancer, you will not find the necessary data in a paper that reports on novel research about acupuncture and dysphagia.
- What about the three lies? Lies, damned lies, and statistics? It does not take much time or effort to learn just enough about statistics to understand the basics of statistical reporting.
- Was anyone harmed (adverse events)? Did anyone die from treatment? Did people just drop out (for whatever reason)? Did researchers report how many people finished a given study? Is it expressed as a percentage? Are adverse events reported and do researchers explain why study participants did not complete the study?
- Van you find out about the limitations and implications of a study or research? Usually found in or in proximity to the discussion section of a paper.
- Do the researchers show a conflict of interest and funding sources?
- Should you tell your oncologist that you are considering mind-body medicine as an adjunct? A resounding yes! Always tell your healthcare providers about any treatments you are considering or undertaking.
- Where would you find a qualified practitioner?
Now it’s your turn…
Let me know in the comments what you thought of this three-part series. Leave a comment below telling me which questions surprised, inspired, or taught you the most. Have any other questions? Anything you find helpful? A simple question can help you feel better, let you take better care of yourself, or save your life. Please let me know what questions made a difference for you and in your healthcare.
Thank you for reading, and I’ll see you in the comments!
1. Field A. Discovering statistics using SPSS : (and sex and drugs and rock “n” roll). 3rd ed., [Students ed.]. London: SAGE; 2009.
2. Lovejoy TI, Revenson TA, France CR. Reviewing Manuscripts for Peer-Review Journals: A Primer for Novice and Seasoned Reviewers. Ann. Behav. Med. 2011;42(1):1–13. doi:10.1007/s12160-011-9269-x.
3. Deng G, Hou BL, Holodny AI, Cassileth BR. 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. 2008;8(1):37. doi:10.1186/1472-6882-8-37.
4. Hamilton AJ. The scalpel and the soul: Encounters with surgery, the supernatural, and the healing power of hope. New York: Jeremy P. Tarcher/Putnam; 2008.
5. Lu W, Wayne PM, Davis RB, et al. Acupuncture for dysphagia after chemoradiation in head and neck cancer: Rationale and design of a randomized, sham-controlled trial. Contemp. Clin. Trials. 2012;33(4):700–711. doi:10.1016/j.cct.2012.02.017.