Wednesday, June 19, 2013
A Memorial Sloan Kettering study suggests that lymphedema of the arm, a swelling that can occur following breast cancer treatment, may be reduced by acupuncture.
Update: As a follow-up to our previous, single-arm study in which acupuncture appeared to reduce breast cancer-related lymphedema, Ting Bao, the Director of Integrative Breast Oncology at MSK, led a randomized controlled trial. The study found that though acupuncture is safe, it did not offer any additional clinically meaningful reduction in lymphedema compared with usual care among patients who had received previous lymphedema treatment. The researchers concluded that this acupuncture regimen should not be recommended for breast cancer survivors with persistent lymphedema.
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.”Back to top
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.Back to top
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.”Back to top