According to results recently published in Cancer, acupuncture appears to reduce the severity of radiation-induced xerostomia in head and neck cancer patients.
The term head and neck cancer refers to any number of cancers that may occur in the head and/or neck region. These may include cancers of the tongue, mouth, salivary glands, pharynx, larynx, sinus and other sites located in the head and neck area. Radiation therapy is one standard treatment option for patients with head and neck cancer and may be given alone or following surgery.
Radiation therapy for head and neck cancers, however, often results in an unpleasant side effect known as xerostomia. Radiation aimed at the cancer cells also bombards the salivary glands, temporarily or permanently damaging them. Xerostomia, also known as dry mouth, results when the salivary glands fail to function properly. Normally, human salivary glands produce 4-6 cups of saliva a day. With xerostomia, little to no saliva may be produced, resulting in symptoms ranging from mild dryness to pain and burning inside the mouth. Patients with xerostomia often find it difficult to chew or swallow, or even to taste their food, and have more difficulty digesting their food as the enzymes present in saliva are not available. In addition, without saliva to wash debris from their teeth, they often experience frequent and severe bacteria growth problems that lead to tooth decay and mouth infections.
Xerostomia is typically treated with a drug known as pilocarpine. Pilocarpine may be administered concurrent with and following radiation therapy. However, many patients become resistant to pilocarpine and may experience side effects, such as profuse sweating. Another drug, Ethyol® is also available, but must be administered prior to and during radiation therapy by health care professionals. Another option for patients with xerostomia is sugar-free lozenges that stimulate the salivary glands. However, these effects do not last long and the most severe cases of xerostomia fail to respond to this simple treatment. As a result of these inadequacies, researchers are investigating novel treatment approaches.
Acupuncture is part of a complete medical system developed in China over 3,000 years ago known as Traditional Chinese Medicine (TCM). In the world view of TCM, all life is permeated by a universal force known as qi (pronounced “chee”). The human body contains meridians, energy pathways along which qi flows, and when energy becomes blocked at any location along one or more meridians, illness or disease results. Acupuncture needles are placed at specific points on a meridian, stimulating the points to release stagnant energy. According to TCM, this returns energy flow to the meridian, restoring balance to the patient on physical, emotional, mental and spiritual levels. Acupuncture has become increasing popular as a complementary medicine in the United States and several formal clinical trials of acupuncture were initiated as a result of a 1997 Consensus Conference convened by the National Institutes of Health. In some instances, acupuncture has yielded positive results. Some of these studies have suggested that acupuncture palliates patients with xerostomia after radiation therapy.
Researchers at the Naval Medical Center in San Diego and the University of California, San Diego conducted a clinical trial of 50 head and neck cancer patients receiving acupuncture for radiation therapy-induced xerostomia. In their protocol, eight needles were placed per treatment, three in each ear and one in the radial aspect of each middle finger. Concurrently, patients were given a piece of sugar-free candy or a lozenge. The needles were placed by certified physician acupuncturists in sessions lasting from 30-60 minutes. Treatments were repeated one week apart, at which time patients completed a Xerostomia Inventory (XI) to quantify perceived benefit. Patients underwent a total of 318 treatments, averaging five but ranging from 2 to 15. The average follow-up after first treatment was 224 days.
A palliative response, defined as an improvement of 10% or more over the baseline XI, occurred in 70% of patients. Nearly half of the patients reported significant palliative improvement on their XI. Duration of effect for 26% of the patients exceeded three months. No adverse events were linked to the acupuncture sessions.
These results suggest that acupuncture may reduce the severity of xerostomia in head and neck cancer patients that received radiation therapy. These researchers suggest that a regimen of three to four weekly treatments, followed by monthly sessions, may produce optimal results, although some patients achieve lasting response without further therapy. The researchers also acknowledge the need for a controlled, randomized trial to verify these findings. Individuals experiencing xerostomia may wish to speak with their physician regarding the risks and benefits of acupuncture or about participating in a clinical trial. Two sources of information regarding ongoing clinical trials include comprehensive, easy-to-use listing services provided by the National Cancer Institute’s Office of Complementary and Alternative Medicine (www3.cancer.gov/occam/trials.html).
(Cancer, Vol 94, Issue 4, pp 1151-1156, 2002)
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