DOI: 10.1097/01.COT.0000410206.14670.be
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Issn Print: 0276-2234
Publication Date: 2011/12/10
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Excerpt
The study, published in Cancer, reported findings from the first randomized controlled trial of acupuncture for the prevention of xerostomia.
The condition, characterized by reduced salivary flow, is a common side effect for patients receiving radiotherapy for head and neck cancer. Most current treatments are palliative and offer limited benefit, noted the study's principal investigator, Lorenzo Cohen, PhD, Professor in MD Anderson's Departments of General Oncology and Behavioral Science and Director of the Integrative Medicine Program.
The condition impairs quality of life for patients, as it creates difficulties eating, speaking, and sleeping, while also increasing the risk for oral infections, he noted in a news release.
“There have been a number of small studies examining the benefits of acupuncture after xerostomia develops, but no one previously examined if it could prevent xerostomia. We found that incorporating acupuncture alongside radiotherapy diminished the incidence and severity of this side effect.”
Dr. Cohen and his colleagues examined 86 patients with nasopharyngeal carcinoma treated at Fudan University Shanghai Cancer Center. Forty patients were randomized to have acupuncture and 46 received the standard of care. Those in the treatment arm received acupuncture therapy three times a week during the seven-week course of radiotherapy. Patients were evaluated before radiotherapy, weekly during radiotherapy, and then again one and six months later.
The results were based on data derived from two self-report questionnaires and measuring actual saliva flow. Patients completed the Xerostomia Questionnaire (XQ), an eight-item survey that assessed symptoms consistent with the condition. XQ scores under 30 corresponded to mild or no symptoms of xerostomia.
The second measure, the MD Anderson Symptom Inventory Head and Neck (MDASI-HN), ranked the severity of cancer-related symptoms other than xerostomia, and their interference with quality of life. The team also measured saliva flow rates using standardized sialometry collection techniques.
“What was quite remarkable was that we started to see group differences as early as three weeks into radiotherapy for the development of xerostomia, cancer-related symptoms that interfere with quality of life, and saliva flow rates—an important objective measure,” said the study's co-principal investigator Zhiqiang Meng, MD, PhD, Deputy Chair of the Department of Integrative Oncology at Fudan University Shanghai Cancer Center.
The largest group differences in XQ scores were seen by the end of radiotherapy, but the differences persisted over time. By one month after the end of radiotherapy, 54% of the acupuncture group reported XQ scores greater than 30, compared with the control group's 86%. By six months after radiotherapy, the numbers dropped to 24% and 64%, respectively. Saliva flow rates were also greater in the acupuncture group, starting at three weeks into radiotherapy and persisting through the one and six month follow-up.
Acupuncture also helped cancer-related symptoms, other than xerostomia, as measured by the MDASI-HN questionnaire, with differences that emerged in week three and continued through six months.
“The medical implications are quite profound in terms of quality of life, because while chronic dry mouth may sound benign, it has a significant impact on sleeping, eating, and speaking,” Dr. Cohen said. “Without saliva, there can be an increase in microbial growth, possible bone infection, and irreversible nutritional deficits.”
Additional studies are needed to determine the mechanisms for the benefits of acupuncture, and while the study didn't examine this issue, Dr. Cohen speculated that it may have an impact on local blood flux, specifically at the parotid gland.
