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Colorectal cancer patients with end-stage disease often suffer from physical and psychological symptoms that negatively affect their quality of life (QOL) and require frequent hospital stays. The intensity of these symptoms can prevent patients from enjoying the remainder of their lives and taking full advantage of their limited time with family and friends.
Investigators at the University of Pittsburgh Cancer Institute (UPCI) are testing the use of acupuncture in alleviating symptom distress in people with advanced colon cancer. The study is supported by a $1.2 million grant from the National Institutes of Health. In order to determine whether acupuncture helps people with colon cancer, some study participants receive acupuncture and others do not.
"For many terminally ill colorectal cancer patients, their final months are marred by distressing physical symptoms," said Ellen M. Redinbaugh, Ph.D., principal investigator of the study and assistant professor of medicine in the department of behavioral medicine and oncology at the University of Pittsburgh. "These symptoms can be overwhelming for the more than 50,000 colorectal cancer patients who die every year in the United States. Their alarmingly high rates of hospitalization for symptom management near the end of life indicate a clear need for new interventions to ameliorate their distress and promote their quality of life. Acupuncture holds promise as one such technique."
Dr. Redinbaugh added that the physical symptoms of end-stage disease, which often include pain, appetite loss, shortness of breath, nausea and vomiting, also cause high levels of psychological distress for patients and contribute to a lessening of QOL.
Acupuncture is a treatment modality that has been used within traditional Chinese medicine for the past 2,500 years to prevent and treat illness. It is widely practiced within the United States as a therapeutic intervention for a variety of health conditions. The theoretical basis for acupuncture is that disruptions in energy flow (Qi) cause illness and disease, or an imbalance between the complementary life energies, Yin and Yang. Acupuncture is practiced to correct the imbalances of energy flow and promote optimal health and relies on the insertion of thin surgical needles into specific points close to the surface of the skin (acupoints) to stimulate energy flow.
"Acupuncture has been used successfully to reduce pain, but there is a lack of well-designed studies that compare it to other treatment modalities in this patient population," commented Andrew Baum, Ph.D., professor of psychiatry and psychology and UCPI's deputy director for cancer control and population sciences. "Studies such as this one are needed to increase scientific understanding of its true efficacy in providing comfort to terminally ill patients."
The current study will evaluate the efficacy of acupuncture to improve QOL, promote emotional well-being and decrease physical symptom distress among colorectal patients with a life expectancy of six months or less. One hundred and seventy patients with metastatic colorectal cancer will be recruited for the study through the UPCI's department of gastrointestinal oncology over a four-year period. Once enrolled, patients will be randomly assigned to one of three groups. The first group will receive "true" acupuncture in which needles will be inserted at acupoints associated with emotional well-being. A second group will receive "sham" acupuncture, or the insertion of needles at locations on the body that do not represent actual acupoints. The final group will receive usual care without acupuncture.
Colorectal cancer is second only to lung cancer in numbers of cancer-related deaths in the United States. It can begin with the development of non-cancerous polyps, or growths, on the lining of the colon and rectum. These polyps can develop into cancer, which can over time invade the colon wall and spread to other parts of the body. If detected early, colorectal cancer is highly curable.
Source: University Of Pittsburgh Medical Center March 2003
Acupuncture may help some cancer patients who have severe dry mouth as a side effect of treatment, California researchers report. Their study, which included mainly patients with head and neck cancers treated with radiation, showed that acupuncture to the ear and index finger improved dry mouth in a majority of patients.
An ancient therapy that arose in China more than 2,000 years ago, acupuncture involves placing fine needles in specific points on the body's surface. Traditional theory holds that these points connect with energy pathways that run through the body, and acupuncture helps keep this natural energy flow running smoothly.
Modern science as well has suggested that acupuncture can help ease a range of conditions, from arthritis pain and migraine to morning sickness. But researchers are still trying to understand why it works. "When we try to explain the relief of (dry mouth) using ear acupuncture, we presume it is a function of a subtle activation of the autonomous nervous system," the new study's lead author, Dr. Peter A. S. Johnstone of the Naval Medical Center in San Diego, told Reuters Health.
The autonomic nervous system regulates bodily functions that are not under conscious control, including activity in the glands. In the study, Johnstone's team followed 50 patients undergoing acupuncture. Most had received radiation for head and neck cancers and had dry mouth that did not respond to treatment with the saliva-inducing compound pilocarpine. One patient had dry mouth after chemotherapy, and two had Sjogren's syndrome--an autoimmune disease in which the immune system mistakenly attacks the salivary glands.
The researchers found that 70% of the patients improved with acupuncture, although the length of their responses varied. Most patients, they note, have required monthly or bimonthly treatments to sustain the benefit. For about one-quarter, though, the improvement has lasted more than 3 months, Johnstone's team reports in the February 15th issue of Cancer. "Different patients will require different maintenance," Johnstone explained, noting that most appear to need periodic "booster" treatments. During the acupuncture treatments, which involve three needles placed on the ear and one on the index finger, patients also get sugar-free candy to help stimulate salivation. According to the researchers, "frothy salivation" usually gets started within 15 to 20 minutes.
SOURCE: Cancer 2002;94:1151-1156.
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