In the Clinic

On Cancer: Study Shows Acupuncture May Relieve Chronic Lymphedema after Breast Cancer Treatment

By Memorial Sloan Kettering  |  Wednesday, June 19, 2013
Acupuncture needles are placed in specific positions on the body called acupoints. Acupuncture needles are placed in specific positions on the body called acupoints.

A study from Memorial Sloan Kettering investigators has shown that acupuncture may help relieve lymphedema of the arm, a swelling that sometimes follows breast cancer treatment.

The research, led by Barrie R. Cassileth, Chief of Memorial Sloan Kettering’s Integrative Medicine Service, and Clifford A. Hudis, Chief of the Breast Cancer Medicine Service, was published April 10 in the journal Cancer.

“We have shown that acupuncture as a treatment for lymphedema is safe and well tolerated,” says Dr. Cassileth. “Furthermore, this study demonstrated reductions in lymphedema for the patients treated, providing strong impetus for the randomized controlled trial that is now under way to prove that the effect is real.”

A Need for New Treatments

Some breast cancer patients need to have lymph nodes surgically removed, either because cancer has spread to them or because the lymph nodes have been damaged by radiation therapy.

Normally, lymph nodes help filter and remove fluid from the body. When the lymph nodes are removed, the fluid can collect in the affected limb and cause painful swelling.

Lymphedema is most commonly seen in the arms of breast cancer patients who have had lymph nodes removed in their armpits, but can also occur in the legs of patients whose pelvic region lymph nodes were removed. The condition causes discomfort and restricts mobility and also can lead to infections requiring hospitalization.

Patients affected by lymphedema of the arm often receive regular and intensive physical therapy to reduce the volume of lymphatic fluid. They also may need to wear restrictive stockings on their arms to prevent the fluid from recollecting. The treatments can be time-consuming, expensive, and uncomfortable, and they do not reduce arm circumference in a sustained way.

“This is a condition for which there are currently no good treatment options,” Dr. Cassileth says. “There is a pressing need to develop more-effective means to treat this problem.”

Evaluating Acupuncture

In this early-stage study, Memorial Sloan Kettering researchers aimed to assess the safety and potential effectiveness of this approach as a treatment for lymphedema of the upper arm.

Study participants received acupuncture at Memorial Sloan Kettering twice weekly for four weeks, using a regimen developed by the Integrative Medicine Service. For each session, acupuncturists inserted 14 needles at sites on the affected and unaffected arms, legs, and torso.

The researchers measured the participants’ upper-arm circumference before and after the treatments. They found that among the 33 patients who received acupuncture, 11 had a significant reduction in swelling and another 18 had at least a small reduction. When contacted several weeks later for feedback, patients reported lasting improvement in swelling.

In addition, the study showed that acupuncture caused no serious side effects.

Although the researchers caution that it is difficult to draw firm conclusions from a small study, they are encouraged by the results. “I believe it is absolutely worth exploring for patients who are struggling with this difficult condition,” Dr. Cassileth says.

Next Steps

A larger study, a randomized clinical trial led by Dr. Cassileth and Memorial Sloan Kettering breast cancer specialists, is under way. This study compares patients receiving acupuncture with those undergoing only conventional treatments. Researchers hope that this more definitive trial will shed further light on the effectiveness of acupuncture as a treatment for upper arm lymphedema.

Dr. Cassileth cautions patients who might seek acupuncture for lymphedema on their own. “Because of the potential for complications,” she concludes, “it’s important that acupuncture treatment is received only from licensed practitioners who are also specifically trained to work with cancer patients.”

Comments

I have Lympadema in the left upper thigh after having lymph nodes removed. I wear a compression stocking every day but still exprience pain and swelling constantly. I am a MSK patient and very interested in this study.

Joanne, thank you for your comment.

We suggest you speak with your Memorial Sloan-Kettering physician about options that may be available for alleviating your lymphedema. You can also learn more about the condition at this link:

http://www.mskcc.org/videos/playlist/day-day-coping-lymphedema

To learn about acupuncture therapy you can call Memorial Sloan-Kettering’s Integrative Medicine Service at 646-888-0800

How do I find an LE accupuncturist in my area?

Nita, cancer patients and former cancer patients should seek acupuncture only from practitioners who are certified as trained to treat cancer-related problems.
Our Integrative Medicine Service keeps a registry of cancer-trained acupuncturists by location. You can call 646-888-0845 to find someone in your area of the country. Thank you for your comment.

my 23 yr old daughter just had all of her axillary lymphs removed due to reoccurrence, she has had acupuncture before the surgery and 2 sessions since, any help you can give on the length of treatment or methodology would be great. Her provider specializes in oncology. thank you.

Pamela, unfortunately we are not able to answer personal medical questions on our blog. If you would like to speak to someone on our Integrative Medicine Service about acupuncture, you can call 646-888-0845. Thank you for your comment.

I started acupuncture in Oct 2011 for neuropathy in my feet & after awhile I noticed a reduction in the swelling of my hand, I could see my knuckles again.
I was very excited to read about your study & would be interested in participating or at the very least being updated on your findings, I have had lymphedema in my left arm since 2004.

Irene, if you are interesting in participating in a clinical trial at Memorial Sloan-Kettering, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thank you for your comment.

Thank you for the information. I have read that "Red Clover Tea" has anioxidants that can help to metabolize lymphatic-clogging toxins and further purify your body. It may improve lymphatic drainage and kidney and liver functions as well. Could this be a possible treatment for lymphadema?

Joanne, we are not able to answer personal medical questions on our blog. However, if you are interested in learning about red clover and other herbal and botanical products, you might want to look at our database for such products at www.mskcc.org/aboutherbs. There is also an app for iPhones and iPads. Thank you for your comment.

This is very interesting.

Hello. I have been a patient in MSKCC lymphedema treatment office (now located on Madison Ave) for the last 6 years. I have arm lymphedema after surgery in 2006. I just learned recently that I was "discharged" from the office/ treatment because on the Department new policies. Since the beginning of this year I was not been able to even make an appointment. And there are basically no lymphedema therapists available anywhere else in the city. I have been going twice a year before to measure my arm, order new custom garments, and to learn about new treatments. I have been on "cold laser" treatment once it was available and it helped me tremendously. So far, my arm is swelling more little by little and I was declined an appointment for repeating laser treatment. I think its great to have new studies and see new horizons, but I believe that patients' care should be a priority. And at least some warning about department changes should have been send to the patients. Thank you so much to Dr. Cassileth for this study. Are the patients with metastatic cancer able to participate in this study? Thank you

Meira. someone from our Patient Representative office will contact you via the email address that you provided to discuss your concerns. Thank you for your comment.

My mother had a mastectomy in 1985. She has severe lymphedema in her right arm. Would the acupuncture be helpful for someone with long-standing swelling, or only for fairly recent cases?

Toby, the current trial is for patients who have a clinical diagnosis of lymphedema for at least six months and for no more than five years. If your mother has had lymphedema for more than five years, she would not be eligible for this study. Thank you for your comment.

I am a 58 year old woman and have lymphedema in my left arm since last summer of 2012. I tried lymphedema therapy for a couple of months. It would be great if I could afford to go 3 times a week for the rest of my life, but that is not possible. As soon as I stop the therapy my arm swells again.
I would be interested in trying the acupuncture to see if it would help. I need to know where I am out of state would I still qualify for this study. I am desperate to have a solution to this horrible problem.

If you are interested in participating in this study, you can call 646-888-0810 for more information. Thank you for your comment.

I have in my breast from a lumpectomy and radiation
Will this help relieve the pain and swelling?
Thank you.

Iris, unfortunately we are not able to answer personal medical questions on our blog. If you would like to speak to someone on our Integrative Medicine Service about acupuncture, you can call 646-888-0845. The Service also keeps a registry of cancer-trained acupuncturists by location if you are looking for someone in your area. Thank you for your comment.

I have lymphedema in my arm and hand from male breast cancer surgery in Sept of 2007. Dr Andrew Seidman of Sloan Kettering Breast Cancer examined me at request of my oncologist in Atlanta Ga Dr. David Dubovsky regarding a second opinion as to Chemo and radiation. do you know of any qualified Acupurnture cancer physicians in Atlanta. My surgery was performed at Northside Hospital in Atlanta. By the way I am at this point cancer free and the only side affect is my Lymphedema in my left arm and hand. Thank you for your research and time.

Hi, Jack, we're glad to hear that you're cancer free. Our Integrative Medicine Service keeps a registry of cancer-trained acupuncturists by location. You can call 646-888-0845 and they will help you find someone in your area. Thank you for your comment.

Are your practitioners MD's trained in acupuncture or Licensed Acupuncturists?

Flory, our acupuncture practitioners are licensed acupuncturists. Thank you for your comment!

I have lymphedema in both my legs. I was diagnosed with this when I was 13. I am now 41 and it is slowly getting worse. Would this also work for the legs? Would the study be something I would be able to do?

Hi Jennifer, this study was specifically for breast cancer patients who had lymphedema in the arm following breast cancer treatment. However, our Integrative Medicine Service keeps a registry of cancer-trained acupuncturists by location. You can call 646-888-0845 to find someone in your area. Thank you for your comment.

I had a lumpectomy in 1995. Had no trouble with lymphedema until 8 months ago when I realized I could not buckle my watch. I have had ultra sounds; MRI's; seen an oncologist, etc. and no one seems to have an explanation for this 18 years later.

How common is it for lymphedema to occur so many years later? and will seek an acupuncturist if there is a chance it might help.

I had a lumpectomy in 1995. Had no trouble with lymphedema until 8 months ago when I realized I could not buckle my watch. I have had ultra sounds; MRI's; seen an oncologist, etc. and no one seems to have an explanation for this 18 years later.

How common is it for lymphedema to occur so many years later? and will seek an acupuncturist if there is a chance it might help.

Judi, we are unable to answer specific medical questions on our blog. You might call the National Cancer Institute’s Cancer Information Service at 800-4CANCER (800-422-6237). In addition, our Integrative Medicine Service keeps a registry of cancer-trained acupuncturists by location. You can call 646-888-0845 to find someone in your area. Thank you for your comment.

Thank you so much for your research! I'm so tired of having this swelling in my arm and have thoughts now and then about "why can't somebody figure this out? medicine or something to make the fluid drain?" I don't know, but I am grateful that someone is at least looking into it.

I've been receiving acupuncture treatments once a week for a month now from Shauna Burton in Bloomington, Indiana. You gave me her name since she did the online study with you. some days I am down in some places 1/2 cm or 1 cm, then few days later I'm back up again. but I do not seem to be getting worse so I find that very encouraging.

I am going to read your link here now regarding herbs.

thank you!

Thank you for researching integrative management of lymphedema! Although our story does not involve cancer or post-surgical lymphedema, it may inspire others to persevere as they manage lymphedema. In 2004, my daughter, at age 2.5, was diagnosed with bilateral pleural and pericaridal effusions of lymphatic fluid secondary to lymphedema of the face and sclera (eyes). Etiology unknown. (She was suffocating because her lungs were crushed by fluid drainage). After two weeks of hospitalization and multiple tests, she was transported 8 hours in ambulance to Boston Children's Hospital where we spent three weeks, at Christmas time, with experts, not knowing if she would see another day. Very little was understood at that time, in the USA, about lymphedema. Nuclear med study confirmed unexplained blocked lymphatic flow in the neck, and, irregular lymphatic drainage into the pleura. Chest tubes, that frequently clogged, and diuretic therapy, were keeping her alive. Permanent surgical scaring of pleura to stop drainage into lungs was considered however risks of lung entrapment as she grew made this procedure risky, and, the questions were left unanswered: where would the lymphatic fluid drain instead? Stints might be strategically placed in various organs, however this would open her up to infection... She was not expected to make it, although all admitted that miracales do indeed happen, some times. Friends/relatives throughout the country prayed. We learned about lymphedema. Even if she lived, how would compression wraps work on her face (!?), what would the life-long effects of this incurable condition be, what of the proteins that are left behind in the skin, and would she become blind like Mary in her favorite "Little House" books? Her dear surgeons at last allowed her to return home with oxygen, chest tubes, and, a full-time integrative home care plan including: office visits to surgeon twice weekly, lymphatic drainage massage (three times weekly performed by an ICU pulmonary/cardiology surgical nurse who specialized in lymphatic drainage thearpy), acupuncture (daily by L.Ac. - two weeks on- two weeks off), cupping (Asian medicine suction technique applied on her back-daily), full body shiatsu meridian massage (TID), chinese herbal medicine (TID), allergen-free diet, castor oil (external app on face and neck), prescription strength pro-biotics (daily), ND prescribed western herbal formulation in tincture (to reduce diuretic requirements and strengthen immunity-TID), and, cranial sacral therapy to address limited ROM of neck (twice weekly performed by pediatric DC). She was re-hospitalized a month later in acute distress, however, she did return home again. Only two rounds of antibiotic therapy were required during her entire illness. Within one year, tubes had been permanently removed, she had successfuly weaned off of diuretics, all other supportive therapies continued. Follow up nuclear med study another year later tracked normal lymphatic flow throughout her body...the lymphatic vessel function appeared to be restored. Some (not all) of the integrative therapies continued for years, at less frequent intervals, as she did, and does continue to have, unexplained intermittent edema in the sclera of her eyes to varying degrees and interoccular pressures are monitored yearly by O.D. (juvenile gloucoma risk). Very mild facial edema continues intermittently as well. Pulmonolgist confirms lungs appear to be developing normally and previously detected post-infection scar tissue in pleura (on x-ray) is no longer detected. She appears these days to be a happy, healthy, bright, beautiful, loving, kind, calm, active, and creative middle-school-aged young lady (who likes to play basketball, piano, bike, hike, and garden). No one would ever suspect what she has been through, and may still deal with again someday. I have since met many adults (without cancer) suffering in pain unknowingly from post-surgical lymphedema... work like yours is making a difference in the daily lives of many. Thank you, from the bottom of my heart, for your research of lymphedema.

Thank you for your comment and for sharing your story.

My mother -in-law has been breast cancer free for 3 years and suffers from lymphodema on her left arm and wears the stocking for 10 to 12 hours a day. Is there anywhere in Southern Ontario that offers a trial for this as well?

Erika, our Integrative Medicine Service keeps a registry of cancer-trained acupuncturists by location and may be able to help you. You can call 1-646-888-0845 to find someone in your area. Thank you for your comment.

Is there any evidence that acupuncture in the affected area can CAUSE lymphedema?

Dear Marte, we consulted with Dr. Cassileth and she confirmed that acupuncture in the affected area does not cause lymphedema.

Thank you for your comment.

Can you please explain briefly how acupuncture is thought to work to relieve lymphadema swelling. Thank you.

Megan, thank you for your comment. We consulted with Dr. Cassileth on your question and she provides this response:

It is known that acupuncture works through the nervous system. How it may work to reduce lymphedema (which we found to be the case in two successive published pilot studies; a major RCT is underway), is purely speculative. The technology to confirm how it works may not even exist, but it may work as follows. Acupuncture in general stimulates the autonomic nervous system. In lymphedema, the nervous system may send signals to the lymphatic tract to release neurotransmitters that suppress inflammation. The signals may also increase lymph vessel peristalsis and speed up the transport of lymphatic fluid.

Bottom line, the precise mechanism is as yet unknown, but there is strong hope that it actually does what nothing else accomplishes: to reduce the swelling.

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