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You are here: Home / Archives for Conditions and Diseases

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

June 23, 2012 by Werner Absenger

Image Credit: See Reference List

Image Credit: See Reference List

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.

 

Filed Under: Acupuncture & Cancer Tagged With: Acupuncture, Alternative medicine, Blog, Breast cancer, CAM, Cancer, Clinical trial, complementary and alternative medicine, Conditions and Diseases, Head and neck cancer, Health, Lymphedema, lymphoedema, Management of cancer, mind-body medicine, Moxibustion, oncology, Quality of life, Survivorship, Symptom burden, Traditional Chinese Medicine, Werner Absenger

Shu-Chuan Lin & Ming-Feng Chen (2010). Increased Yin-Deficient Symptoms and Autonomic Nervous System Function in Patients with Metastatic Cancer

June 15, 2012 by Werner Absenger

Image of journal title ACEF-Yin-Deficient Symptoms and Autonomic Nervous System Function

Yin-deficient symptoms (YDS) and Metastatic Cancer

The objectives of this study were to investigate the differences in severity of yin-deficient symptoms (YDS) and function of the autonomic nervous system (ANS) between patients with cancer with metastasis and those without metastasis.

[Read more…]

Filed Under: Relaxation Therapies & Cancer Tagged With: A.C.E.F., Absenger Cancer Education Foundation, Alternative medicine, alternative medicine blog, American Cancer Society, Autonomic Nervous System, Cancer, Cancer and Mind-Body Practices, Conditions and Diseases, Health, Metastasis, mind-body medicine, Quality of life, Traditional Chinese Medicine

Andreescu, A. (2011). Rethinking Prayer and Health Research

June 14, 2012 by Werner Absenger

water&rocks

This post is based on an article submitted by the author of Rethinking prayer and health research: An exploratory Inquiry on prayer’s psychological dimension, Adrian Andreescu.

Click here to find out how you can share your work with the readers of the Alternative Medicine Blog.

In this paper Andreescu (2011) tackles various issues pertaining to cancer research in the realm of transpersonal psychology. The problem of current cancer research is that we do not know for certain if psychosocial intervention is attributable to increased survival. Psychoneuroimmunology researchers are working diligently on finding key ingredients and conditions that might reveal pathways related to outcomes in cancer care. Andreescu (2011) illustrates the difficulty in the following way.

He writes that in order to overcome the medical prognosis regarding a cancer patient’s survival expectations, a cancer patient would need to change a homeostatic equilibrium via psycho emotional resources, an equilibrium already compromised by cancer, a cancer that in turn has successfully adapted to the internal conditions of its host (Andreescu, 2011). I believe Andreescu (2011) very appropriately draws a parallel between healing from cancer and playing professional sports. He writes that recovery from such a serious illness requires for a cancer patient to maximize all their resources, certainly testing the limits of human capabilities, just as world-class sports events do.

He criticizes current trials that examine the effects of psychotherapeutic interventions in cancer survival, as not adequately addressing relevant research designs. He makes an extraordinarily valuable point for three key elements relevant to psycho-oncological trials. These three key elements are the participant’s “…worldview, intentional normative dissociation (IND), and psychosomatic plasticity proneness (PPP) (Andreescu, 2011, p. 25). He hypothesizes that these factors might impact final results of a clinical trial, especially those trials designed to explore potential health benefits associated with a variety of spiritual paths. He briefly expands into explaining “… curing (clinical recovery from disease) is not considered a synonym for healing (how regained health is subjectively experienced by the former patient)” (Andreescu, 2011, p. 25).

He also argues that a spiritual practice brings together worldview, IND and PPP. Let’s briefly define these three key elements.

Worldview

Worldview is defined by Andreescu (2011) as “… a set of beliefs and assumptions that describe reality and define the boundaries of what possibly can be done towards healing by the patient himself or herself with and without additional support (medical, spiritual, etc.) (p. 25).

Intentional Normative Dissociation (IND)

is described by Andreescu (2011) as a “… State of consciousness that is not induced organically, does not occur as part of a psychiatric disorder, and involves the alteration or separation of what are usually experienced as integrated mental processes lasting a limited amount of time (p. 27). He further explains that IND is “…accompanied by an increase in the cognitive and emotional functioning,” thus possibly responsible for “…inducing positive consequences on one’s consensus consciousness” (Andreescu, p.28). Interestingly enough, he elaborates that this consciousness is consistently influenced by the shared assumptions and cultural values of the society one lives in.

Psychosomatic Plasticity Proneness (PPP)

is the 3rd dimension Andreescu (2011) relates to the healing process. The author proposes PPP as a way to conceptualize “…personal psycho emotional content into bodily reality” (Andreescu, 2011). He argues that if this element is valid, then without PPP, psychosocial factors are unable to significantly alter the progression of disease, or for that matter play a role in regaining health.

Andreescu (2011) proposes that a spiritual practice brings together worldview, IND, and PPP in promoting health. But how?

Simply put, because of the intentional dimension and wide acceptance in cultures around the world, and due to social narratives, the sustained practice of any spiritual regimen might be able to piece into a single body the previously discussed elements of worldview, IND, and PPP as they relate to healing (Andreescu, 2011).

So what does that mean for the cancer patient?

While there is research indicating that psychosocial practices could prolong life in the oncological setting, the jury is still out. That is partly, because as Andreescu (2011) points out, that we have not developed and tested the relevant research protocol in the oncological setting as it pertains to spiritual practice and cancer. However, in the context described by Andreescu (2011), spiritual practice could certainly affect a cancer patient’s biopsychosocial factors and thus relate to disease outcome.

Not directly pertaining to spiritual practice, but loosely related to Andreescu’s (2011) paper, one research team is flat out calling for a discontinuation of research to answer this question (Coyne, Stefanek, & Palmer, 2007). This petition to inaction might be premature because other research teams found “…an RCT [Randomized controlled trial] accruing women with regional breast cancer found that a 1-year, 26-session psychologic intervention was associated with improved survival 11 years later” (Andersen et al., 2008, p. 3457).

More recently, Giese-Davis et al., (2010) showed that a decrease in the Center for Epidemiologic Studies-Depression Scale (CES-D) scores resulted in median survival time of 53.6 months compared to 25.1 months for women with increasing CES-D scores (p. 413).

If spiritual practice could employ the same effects as the above mentioned studies on bioscychosocial factors, then it is reasonable to speculate that spiritual practice could certainly prolong life. Unfortunately, we just do not know and more research is needed that specifically addresses shortcomings in clinical trials as pointed out by Andreescu (2011) in his paper.

In the meantime, there is probably no harm following your familiar spiritual practice or even adopting a new spiritual practice if the goal of the cancer patient is to deal with cancer in the “big scheme of things.”

Adrian Andreescu’s (2011) paper “Rethinking prayer and health research: An exploratory inquiry on prayer’s psychological dimension” can be retrieved from the International Journal of Transpersonal Studies website by clicking on the link.

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

APA: W Absenger. (2012.06.14). Andreescu, A. (2011). Rethinking Prayer and Health Research [Web log post]. Retrieved from The Alternative Medicine Blog at http://amacf.org/2012/06/andreescu-a-2011-rethinking-prayer-and-health-research.html

MLA: Absenger, Werner. “Andreescu, A. (2011). Rethinking Prayer and Health Research.” The Alternative Medicine Blog. The Alternative Medicine Blog., 14 JUNE. 2012. Web. Insert your date of access here.

References:

Andersen, B. L., Yang, H.-C., Farrar, W. B., Golden-Kreutz, D. M., Emery, C. F., Thornton, L. M., Young, D. C., et al. (2008). Psychologic intervention improves survival for breast cancer patients. Cancer, 113(12), 3450–3458. doi:10.1002/cncr.23969

Andreescu, A. (2011). Rethinking prayer and health research: An exploratory inquiry on prayer’s psychological dimension. International Journal of Transpersonal Studies, 30(1-2), 23–47. Retrieved from http://www.transpersonalstudies.org/ImagesRepository/ijts/Downloads/Andreescu.pdf

Coyne, J. C., Stefanek, M., & Palmer, S. C. (2007). Psychotherapy and survival in cancer: The conflict between hope and evidence. Psychological Bulletin, 133(3), 367–394. doi:10.1037/0033-2909.133.3.367

Giese-Davis, J., Collie, K., Rancourt, K. M. S., Neri, E., Kraemer, H. C., & Spiegel, D. (2010). Decrease in Depression Symptoms Is Associated With Longer Survival in Patients With Metastatic Breast Cancer: A Secondary Analysis. Journal of Clinical Oncology, 29(4), 413–420. doi:10.1200/JCO.2010.28.4455

Image Credit: Rubens, P. P. (n.d.). Ignatius von Loyola Besessene und Kranke heilend. Retrieved from http://ihm.nlm.nih.gov/luna/servlet/view/search?q=A024370

 

Filed Under: Spirituality & Cancer, Transpersonal Psychology-Finding Meaning & Cancer Tagged With: alternative medicine blog, Cancer, Clinical trial, Conditions and Diseases, Health, International Journal of Transpersonal Studies, mind-body medicine, Transpersonal Psychology

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