Thursday, October 23, 2014
MSK medical oncologist and acupuncturist Ting Bao discusses the symptoms that arise during breast cancer treatment and how integrative medicine may help relieve them.
For many people undergoing treatment for breast cancer, troubling or painful side effects can feel like a fact of life. Some of these problems are temporary, but others may linger long after treatment is completed.
But complementary — also called integrative — medicine could offer some hope. The field has increasingly identified therapies that may alleviate some of these side effects. We spoke with Ting Bao, a physician on the Integrative Medicine and Breast Oncology Services at Memorial Sloan Kettering who is also a board-certified acupuncturist — about how people with breast cancer may benefit from some of these approaches.
Complementary Versus Alternative Medicine
“It’s important to distinguish between alternative and complementary medicine, two terms that are sometimes mixed up but actually mean different things,” notes Dr. Bao. “Alternative medicine purports to replace traditional Western medicine, but there is no evidence that any of these methods are effective against cancer.”
“Complementary or integrative medicine, as these terms imply, is used together with conventional therapy. The modalities practiced are frequently studied under rigorous, randomized controlled trials,” she continues. “And some of these therapies have been found to be more effective at relieving cancer side effects than placebos or standard care.”Back to top
Chemotherapy-Induced Peripheral Neuropathy
Chemotherapy drugs used to treat breast cancer can cause nerve damage. Some patients may experience tingling and numbness in their fingers and toes after only a few cycles. Eventually, the neuropathy may progress to the point where daily tasks such as fastening buttons and tying shoes become difficult. These problems may linger for months or years after chemotherapy is completed.
“For these patients, we are able to offer acupuncture treatments to potentially reduce these side effects,” Dr. Bao says. “We recently completed a single-arm pilot study that suggested acupuncture may reduce neuropathic pain by as much as 50 percent, while improving nerve function in some patients.” Her team is currently applying for funding to conduct a larger clinical trial in this area.Back to top
Nausea and Fatigue
Other common side effects patients undergoing chemotherapy may experience are nausea and fatigue. Several studies demonstrate that acupuncture is effective in treating nausea and vomiting after chemotherapy, but for patients who have concerns about needles, there are other options.
“I show all my patients who are interested how to do acupressure by applying finger pressure to corresponding acupoints on the forearm to reduce chemo-induced nausea,” Dr. Bao explains. “Many patients also get relief from wristbands that focus on these acupoints, such as Sea-Bands, which were originally developed to treat seasickness. Ginger can also help.”
“For fatigue, I always tell patients about the benefits of exercise,” she adds. “Some studies have shown it can be very helpful. It also improves a number of symptoms that can coexist, such as depression, anxiety, and loss of muscle tone.”
“There are also herbs such as American ginseng that may help with cancer-related fatigue,” she notes, “but it’s important for patients to speak with an integrative medicine physician before taking supplements, to make sure they’re doing it safely.”Back to top
Side Effects of Aromatase Inhibitors
Almost half of patients who take a class of drugs called aromatase inhibitors (AIs) as part of their treatment may develop mild to severe musculoskeletal symptoms. These may include pain and stiffness in the joints and muscles of the hands, wrists, feet, ankles, knees, and hips. For some, the discomfort is so severe that treatment must be discontinued.
Although early studies have been inconclusive about whether acupuncture provides relief in such cases, Dr. Bao says many of her patients have benefited. Based on these clinical experiences, she routinely recommends acupuncture for patients who are being treated with AIs and who suffer from joint or muscle discomfort. In addition, a recent study has shown that exercise can help this condition.Back to top
Hot flashes are common in people undergoing treatment for breast cancer. Younger women may go into early menopause, triggering symptoms, and drugs such as tamoxifen are directly linked to hot flashes.
“A number of trials have shown that acupuncture can decrease the number and severity of hot flashes,” says Dr. Bao. “The potential of using integrative medicine for hot flashes is appealing, because there are few side effects and many potential benefits.”Back to top
Lymphedema refers to swelling in the arms and hands that sometimes occurs in breast cancer patients who have had lymph nodes in their armpits surgically removed. The condition causes discomfort and restricts mobility, and also can lead to infections requiring hospitalization.
A 2013 MSK study found that among 33 patients who received acupuncture twice a week for four weeks, 11 had significant reductions in swelling and another 18 had at least small reductions. There is now a larger randomized, controlled trial under way that compares patients receiving acupuncture with those undergoing only conventional treatments.Back to top
Focus on Quality of Life
Particularly for patients receiving any kind of cancer treatment, Dr. Bao stresses the importance of discussing complementary therapies with their doctors first. “We tell patients undergoing chemotherapy not to take any herbal supplements, because there are too many unknowns about how they might interact with their cancer treatment regimens.”
“I also make an effort to discuss lifestyle changes such as diet, exercise, and stress management with my patients. I routinely recommend massage therapy for breast cancer patients who have mild lymphedema, pain, and other problems. And I recommend mind-body approaches such as meditation, yoga, and hypnosis to help patients with a range of stressors that may result from both the disease and necessary treatments,” she adds. “All of these modalities may give patients a better quality of life as well as improve their outcomes.”
Learn more about the acupuncture, massage, mind-body, and other services offered at our Bendheim Integrative Medicine Center.Back to top