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By Faith Franz. Oncologists use several different factors to determine how well a patient will respond to treatment. Surgeons evaluate the stage and borders of a patient’s tumor to determine which patients are good candidates for surgery, while medical oncologists look for certain biomarkers to estimate how well a patient will respond to chemotherapy. Now, a new study indicates that doctors can predict quality of life (QoL) outcomes based on the patient’s nutritional status.
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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):
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.
This team of researchers looked at the effects of potentized cholesterinum used with another homeopathic remedy, Natrum Sulphuricum on carcinogen-induced hepatotoxicity. In other words, the researchers wanted to see if these two homeopathic remedies could reduce damage of cancer causing agents fed to mice.
The Abstract
The purpose of the study was to evaluate whether potentized cholesterinum (Chol) intermittently used with another homeopathic remedy, Natrum Sulphuricum (Nat Sulph) can provide additional benefits in combating hepatotoxicity generated by chronic feeding of carcinogens, p-dimethylaminoazobenzene (p-DAB), and phenobarbital (PB).
Mice were categorized into subgroups: normal untreated (Gr-1); normal + alcohol “vehicle” (Alc) (Gr-2), 0.06% p-DAB + 0.05% PB (Gr-3), p-DAB + PB + Alc (Gr-4), p-DAB + PB + Nat Sulph-30 (Gr-5), p-DAB + PB + Chol-200 (Gr-6), p-DAB + PB + Nat Sulph-30 + Chol-200 (Gr-7), p-DAB + PB + Nat Sulph-200 (Gr-8), and DAB + PB + Nat Sulph-200 + Chol-200 (Gr-9).
Hepatotoxicity was assessed through biomarkers like aspartate and alanine aminotransferases (AST and ALT), acid and alkaline phosphatases (AcP and AlkP), reduced glutathione content (GSH), glucose 6-phosphate dehydrogenase (G6PD), gamma glutamyl transferase (GGT), lactate dehydrogenase (LDH), and analysis of lipid peroxidation (LPO) at 30, 60, 90, and 120 days and antioxidant biomarkers like superoxide dismutase (SOD), catalase (CAT), and glutathione reductase (GR) were assayed.
Electron microscopic studies (scanning and transmission) and gelatin zymography for matrix metalloproteinases were conducted in liver. The feeding of the homeopathic drugs showed intervention in regard to the increased activities of AST, ALT, AcP, AlkP, GGT, LDH, and LPO and decreased activities of G6PD, SOD, CAT, GR, and GSH noted in the intoxicated mice, more appreciable in Groups 7 and 9. Thus, combined therapy provided additional antihepatotoxic and anticancer effects (Bhattacharjee & Khuda-Bukhsh, 2012, p. 1).
The Bottom Line:
If you are unfamiliar with homeopathy, here is a little more information to become familiarized with the principles of homeopathy. The Western medical tradition generally frowns up homeopathy. That is because remedies are usually diluted to the point at which one could say that too few molecules remain of the original substance in the heavily diluted remedy. In other words, the remedy has been subjected to trituration, dynamization and succession, sometimes beyond Avogadro’s limit (Bhattacharjee & Khuda-Bukhsh, 2012), thus causing great controversy among scientist.
The authors of this paper talk about Natrum Sulphuricum (Nat Sulph) -30 and 200 and cholesterinum (Chol) -200.
To put this in perspective here is a paragraph from Creighton University School of Medicine:
“Supposing 40g of calcium (one mole) were diluted by homeopathic principles starting from 100% pure substance. Avogadro’s number tells us that we have 6.02×1023 molecules per mole. By 7C the remedy would be expected to contain about 6 billion calcium molecules, and by about 11C, it would be expected to have only about 60 ((1/100)11 x 6.02×1023 = 60.2). At the 12C (or 24X) dilution, there is a 50/50 chance of one molecule being present. The dilution at which one would expect to have only one molecule does depend upon the starting number of molecules, but assuming that we started with all the atoms estimated to be in the universe, about 6×1079 then we end up with a 50% chance to have one molecule left at 40C (or 80X), still far more concentrated than the 200C dilutions that are commonly dispensed (Creighton University School of Medicine, n.d.).
To add to the dilemma of understanding and providing evidence for homeopathic remedies is the clinical trials are plagued with problems. Pitari (2007) points out that, amongst others, homeopathic research requires more rigorous trials and more specific trail methodology. The author presents and illustration in her paper on how to more effectively design research in homeopathic medicine in order to provide credible evidence either for or against efficacy.
Having show that homeopathy is not without controversy, lets look at the results from Bhattacharjee & Khuda-Bukhsh (2012). Because this research was performed on mice, it was possible to tightly control the experiment’s condition.
Observers were blinded as to whether the samples came from the homeopathic remedy groups or placebo treated group and mice were randomized into 9 groups (24 animals in each group), each group receiving a different diet consisting of (Bhattacharjee & Khuda-Bukhsh, 2012, p. 2):
In the result section Bhattacharjee & Khuda-Bukhsh (2012) report that on autopsy groups 1 and 2 showed healthy liver, while all the other animals showed tumor growth who received the carcinogens for 60 days or more.
Interestingly enough though the authors report that
As compared to all carcinogen fed mice showing distinct sign of tumor formation in the form of pale reddish multiple nodules, the incidence and intensity of tumor was found to be greater in the carcinogen fed mice (more pronounced in the p-DAB+PB and p-DAB+PB+Alc fed series) at 60, 90, and 120 days, the incidence and growth of tumors found in the drug fed series was less, both numerically and qualitatively. Further, in the conjoint drug fed series, the number of tumors was also lesser than in the single drug fed series (Bhattacharjee & Khuda-Bukhsh, 2012, p.5).
Differences were statistically significant and Nat Sulph-30 plus Chol-200 fed mice positive activities were most pronounced at the 90 day and the 120 intervals, with Nat Sulph-200 alone showing considerable ameliorative effect, while a combination of Nat Sulph-200 and Chol-200 showed the greatest effects (Bhattacharjee & Khuda-Bukhsh, 2012, p. 5).
Here is table 1 from their paper:
In their conclusion the authors reiterate that we don’t know the mechanism of action involved for homeopathic remedies, but proposed a hypothesis that
…Potentized homeopathic drugs might have the ability to act as a ‘molecular trigger’ for switching ‘on and ‘off’ certain relevant gene action/interaction, a series of biochemical changes could follow, that in turn could bring about the alteration observed in the parameters of the present study (Bhattacharjee & Khuda-Bukhsh, 2012, p. 9).
Furthermore the authors point towards nanoparticle research that demonstrated alteration of the “…physico-chemical property of the drug and its biological action during the process of homeopathic dynamization” (Bhattacharjee & Khuda-Bukhsh, 2012, p. 9).
Based on this research one could speculate that both homeopathic remedies could be used to treat human liver disorders associated with cancerous lesions (Bhattacharjee & Khuda-Bukhsh, 2012, p. 9).
But there is one caveat of course, more studies should be performed by other researchers to either confirm or refute these most peculiar findings.
Why peculiar? Remember, based on the tenets of classical physics, chemistry and other know facts about the universe these results should have NOT manifested in the first place.
References:
Bhattacharjee, N., & Khuda-Bukhsh, A. R. (2012). Two homeopathic remedies used intermittently provide additional protective effects against hepatotoxicity induced by carcinogens in mice. Journal of Acupuncture and Meridian Studies, In Press. doi:10.1016/j.jams.2012.05.004
Creighton University School of Medicine. (n.d.). Dynamization. Retrieved June 21, 2012, from http://altmed.creighton.edu/Homeopathy/philosophy/dilution.htm
Pitari, G. (2007). Scientific Research in Homeopathic Medicine: Validation, Methodology and Perspectives. Evidence-Based Complementary and Alternative Medicine, 4(2), 271–273. doi:10.1093/ecam/nel085
Image Credit:
Writing an essay, paper, or report? Cite this story:
APA: W Absenger. (2012.06.21). Bhattacharjee & Khuda-Bukhsh. (2012). Two homeopathic remedies provide protective effects against hepatotoxicity induced by carcinogens [Web log post]. Retrieved from The Alternative Medicine Blog at http://amacf.org/2012/06/bhattacharjee-khuda-bukhsh-2012-two-homeopathic-remedies-provide-protective-effects-against-hepatoto.html
MLA: Absenger, Werner. “Bhattacharjee & Khuda-Bukhsh. (2012). Two homeopathic remedies provide protective effects against hepatotoxicity induced by carcinogens ” The Alternative Medicine Blog. The Alternative Medicine Blog. 21 June. 2012. Web. Insert your date of access here.
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.
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.
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
In the health quote category you will find maxims of famous, and not so famous people about health and health care.
“We are a multidimensional creation with coexisting ‘bodies’.
…Our physical body is composed of matter; our subtle body is energy,
thought and emotions; and our causal body is a spiritual source of energy.
Health is the integration of all aspects of our being.”
Mirka Knaster (1)
If you enjoyed this health quote, get free updates by email.
1. Knaster M. Discovering the Body’s Wisdom. (1996). New York. Bantam Books quoted in Coughlin P. Principles and Practice of Manual Therapeutics. (2002) Elsevier Science: Philadelphia, PA. p 54
Darren Rowse from Problogger challenges bloggers from around the globe about the goals of blogging with a group writing project. Well, I think it is time to step out of my introvert comfort zone and actually participate in a good thing. Darren's group writing project. I almost passed this one up, filed under: no time, what's the use? and any other excuse I could think of. I started to blog in March of 2006 with one simple goal:
To keep the body in good health is a duty… otherwise we shall not be able to keep our mind strong and clear.
Buddha
The doctor of the future will give no medicine but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease.
Thomas Edison
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