Acupuncture Alleviates Xerostomia Conditions In Cancer Patients.
Researchers from the University of Texas MD Anderson Cancer Center have demonstrated in a new study that after receiving acupuncture
treatment three days a week during the course of radiation treatment, head and neck cancer
patients experienced less dry mouth or xerostomia
The clinical trial results, published in JAMA Network Open
, is the first randomized, placebo-controlled, Phase III trial to evaluate the use of acupuncture
during radiation therapy to reduce the incidence and severity of radiation-induced xerostomia
, or dry mouth. Acupuncture
treatment has very few side effects and is relatively low cost compared to standard treatments such as medication and saliva substitutes. These results support a 2011 study that found symptoms improved up to six months after radiation treatment with concurrent acupuncture
or Dry mouth is a serious concern for head and neck cancer
patients undergoing radiation therapy. The condition can affect up to 80% of patients by the end of radiation treatment," said the study's principal investigator, Dr Lorenzo Cohen, Ph.D., professor of Palliative, Rehabilitation, and Integrative Medicine and director of the Integrative Medicine Program during a phone interview with Thailand Medical
News. "The symptoms severely impact quality of life and oral health, and current treatments have limited benefits."
had significantly lower xerostomia
scores than standard care control (SCC) and marginally lower than the sham acupuncture
(SA), with no differences between SA and SCC. One year after the end of radiation therapy, the incidence of clinically significant xerostomia
was 35% in the TA(true acupuncture
) group, 48% in the SA group and 55% in the SCC group.
The recent study included 339 head and neck cancer
patients undergoing radiation treatment at MD Anderson and Fudan University Cancer
Center in Shanghai between December 16, 2011 and July 7, 2015. The patients were divided into three groups. One group received true acupuncture
, another group received sham acupuncture
and the third group, the SCC group, received radiation and oral health education but no acupuncture. None had received acupuncture
prior to participating in the study.
patients assigned to either TA or SA received acupuncture three days a week on the same day as their radiation treatment, which lasted six to seven weeks. The sham procedure involved a real needle at a point not indicated for xerostomia
, real needles at sham points and placebo needles at sham points.
Study results were based on data derived from a self-report questionnaire. Patients completed the Xerostomia
Questionnaire (XQ), an eight-item survey assessing symptoms of
the condition. XQ scores under 30 corresponded to mild or no symptoms of xerostomia
. The data was collected at baseline, at the end of radiotherapy, and three, six and 12 months after radiation treatment.
resulted in significantly fewer and less severe dry mouth symptoms one year after treatment. The xerostomia
score in the TA group was 26.6 vs 31.3 in the SA group and 34.8 in the SCC group.
The AES or Acupuncture
Expectancy Scale was used to measure the relationship between expectations related to acupuncture
and clinical response. Patients completed the AES at baseline, after four acupuncture
sessions and at the end of acupuncture
treatment. There were no group differences or differences between sites.
Dr Cohen added, "The evidence is to a point where patients should incorporate acupuncture
alongside radiation treatment as a way to prevent the severity of dry mouth symptoms. I think with this study we can add acupuncture to the list for the prevention and treatment of xerostomia
, and the guidelines for the use of acupuncture in the oncology setting should be revised to include this important chronic condition."
A further analysis showed a significant difference between sites in response to placebo. The Chinese patients had little to no placebo response to sham acupuncture
whereas the MD Anderson patients had a large placebo response, showing both forms of acupuncture
worked. More studies are needed to understand these site differences, but it has been suggested that it could be due to the environment in which the acupuncture
is delivered, cultural influences or the relationship between patient and practitioner.
The team plans studies that will focus on ensuring acupuncture
delivery is well controlled and will evaluate inconsistencies in response to sham acupuncture.
Additional studies are needed to confirm the trial results and better understand the neurological mechanisms of acupuncture
Reference: Effect of True and Sham Acupuncture on Radiation-Induced Xerostomia Among Patients With Head and Neck CancerA Randomized Clinical Trial M. Kay Garcia, DrPH1; Zhiqiang Meng, MD2; David I. Rosenthal, MD3; etalYehua Shen, MD2; Mark Chambers, DMD4; Peiying Yang, PhD1; Qi Wei, MS1; Chaosu Hu, MD5; Caijun Wu, BS2; Wenying Bei, BS2; Sarah Prinsloo, PhD1; Joseph Chiang, MD6; Gabriel Lopez, MD1; Lorenzo Cohen, PhD1
JAMA Netw Open. 2019;2(12):e1916910. doi:10.1001/jamanetworkopen.2019.16910