For women with breast cancer, hot flashes — sudden, short surges in body temperature — can be an unpleasant side effect of treatment. But new research from Jun Mao, MSK’s Chief of Integrative Medicine, may point toward a source of relief. He found that electro-acupuncture, a type of acupuncture that uses tiny needles gently activated by a current, could help reduce this symptom. We asked Dr. Mao to elaborate on his stimulating new study, which was published in the journal Menopause.
Why do women with breast cancer often experience hot flashes?
Hot flashes are a very common side effect for women with breast cancer. They can be induced by premature menopause due to either the surgical removal of the ovaries or chemotherapy. Also, many cancer drugs that affect the hormones, like tamoxifen or aromatase inhibitors, can make hot flashes worse and more persistent. The existing drug approaches for treating hot flashes are partially effective, but not for all patients, and some of them have quite bothersome side effects like weight gain and sexual side effects. I think patients need more options.
What did your study look at?
We know that hot flashes can result in a lot of sleep disruption. People’s sleep is very fragmented and they feel very tired. It’s like a snowball effect.
So we compared electro-acupuncture, an integrative medicine technique, with gabapentin, a drug that has been shown to be effective for hot flashes in people with breast cancer.
We found that electro-acupuncture actually produced a better overall sleep quality than gabapentin, and also produced better results in specific areas such as sleep latency — the time it takes to fall asleep — as well as sleep efficiency, meaning how much of the time in bed you’re actually sleeping. These data are very encouraging and offer the potential that women with breast cancer may have another tool to help them manage hot flashes, as well as sleep as related to hot flashes.
How is electro-acupuncture different from regular acupuncture? Would regular acupuncture have the same effect?
Our study can only demonstrate that electro-acupuncture, a type of acupuncture we offer at MSK, is helpful. The way it works is not just by putting needles in the skin — some of the needles are paired with electrodes to stimulate a current. Those currents provide very gentle stimulation; often patients say it feels like a gentle tapping of their skin.
How did you come up with the idea to study this?
Basic science in animals has shown that electro-acupuncture can make the brain release endorphins as well as influence a type of neurotransmitter called norepinephrine. Those types of neurotransmitters, which transmit signals from one neuron to another in the brain, have also been implicated in temperature regulation. I’d seen some studies demonstrating that acupuncture may be effective in reducing hot flashes, but often the number of people in the study was very small and the design was kind of problematic. So I set out to design my own study. When I wrote the trial, there was a study showing that in a large sample of breast cancer survivors, gabapentin was effective for hot flashes, so that’s why I picked it as an effective comparator.
Before you began your research, did you have any guesses about what the results might be?
I was thinking, at best, that acupuncture could be as effective as gabapentin, so it was a pleasant surprise to show that it may be even a little better.
What would you tell a patient who wanted to try acupuncture for hot flashes?
I would say it’s something worth trying. A course of acupuncture treatment — six to ten sessions — may stabilize the body’s ability to regulate its temperature. Ideally, someone could come twice a week, but once a week would probably be OK too.
How can these findings be taken from the lab to the bedside?
The next step is to do a large trial with a long-term follow-up to understand the effects of acupuncture versus the effects of conventional therapies, like drugs for hot flashes, sleep, and fatigue. We want to examine the long-term durability of those therapeutic effects because I think a lot of women want to know if it will work for them and if the effect lasts. Those are all really important, patient-centered questions that require research.