Acupuncture, which has been used for thousands of years in China and elsewhere in Asia, entails the placement of very thin needles at various stimulation points in the body; sometimes these needles are combined with moxibustion (local heating of herbs), but this was not done in the current study. Dr. Pfister said that in this study, acupuncture was provided by licensed practitioners from the Integrative Medicine Service at Memorial Sloan-Kettering, and he added that it is always advisable to use a licensed practitioner for acupuncture. The main licensing agency is the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).
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September 2008Study Details
The study enrolled 70 patients with treatment-related pain or dysfunction, as reflected by a Constant-Murley Shoulder Outcome Score (CMS) <70. All patients had a greater than three-month interval between surgery/radiation and study entry. Median age of patients was 59 years, and 63% were men. Modified radical neck dissection was performed in 83%, and 60% had squamous cell carcinoma.
Dealing with the toxicities of cancer treatments is as important [for patients] as treating the underlying cancer. We need to pay as much attention to toxicities as to the treatment itself. This study underscores the shift in direction toward paying closer attention to symptom control.-Barbara Murphy, MD
The primary endpoint was pain or dysfunction measured by the CMS. This instrument, which is commonly used to assess shoulder function, goes up to 100 points, with higher scores reflecting increased function. The secondary endpoint was xerostomia relief, as measured by the Xerostomia Inventory, an 11-item summation rating scale normalized to a 0-100 point scale in this trial, with lower values meaning better results.
The four-week study randomized 34 patients to weekly acupuncture, and 36 to usual care (the control arm, which included pain medications, anti-inflammatory medications, and physical therapy when indicated). Patients treated with acupuncture received needles at specific acupoints: two in the hand, one in the leg, one in the ear, and one in the hairline, as well as needles placed at other sites according to the patient’s symptoms.
At baseline, the mean CMS was 41.9 in the acupuncture arm and 48.1 in controls. Efficacy data were reported for 58 of 70 patients. After four weeks of treatment, the mean difference between the two groups was 11.2 points, favoring the acupuncture group. Thirty-nine percent of patients treated with acupuncture reported at least a 33% improvement in pain and shoulder function, compared with 7% of controls. Patients in the acupuncture arm also reported a significantly greater improvement in xerostomia, with a difference of 5.8 points on the Xerostomia Inventory favoring the acupuncture group.
Acupuncture has a favorable side-effect profile, and you can generally tell whether a patient is responding after four treatments. The available data support offering acupuncture as an option to patients who experience post head and neck dissection pain.-David Pfister, MD
Important Area of Research
Acute and late toxicities related to treatment of head and neck cancer are an important area of research, according to Barbara Murphy, MD, Director of the Cancer Supportive Care Program and Director of the Head and Neck Research Program at Vanderbilt-Ingram Cancer Center in Nashville, TN.