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Breathing Better Under Pressure

Slide-image-3The prick of a strategically placed needle is felt by nearly two million Americans every year looking to reap the benefits of acupuncture. Back problems, migraines, allergies: The 2,500-year-old Eastern medical technique has been shown to help relieve pain or discomfort stemming from a host of ailments. At Penn’s Abramson Cancer Center, patients use it to combat dry mouth related to radiation therapy, nausea and vomiting, and even depression.

Now, new research suggests acupuncture may also help lung cancer patients suffering from dyspnea, otherwise known as shortness of breath, a widespread condition with few effective treatment options.

“It’s is a major problem for patients with lung cancer,” said Joshua Bauml, MD, an assistant professor of Hematology/Oncology, who led a pilot study to investigate the feasibility of the technique in patients. “Even a small amount of shortness of breath has a significant impact on patients’ quality of life.”   

“It affects how they walk, talk, and live,” he added. Nearly 90 percent of lung cancer patients have dyspnea, which is also very common in COPD patients. However, clinicians treat shortness of breath in lung cancer much less aggressively than it’s treated in COPD—and it’s far less studied in cancer patients, Bauml said.

In the study of 12 patients, published last week in the journal Integrative Cancer Therapies, Bauml and his colleagues from Hematology/Oncology and the ACC’s Integrative Oncology Group showed that acupuncture led to a significant improvement in shortness of breath, quality of life, and fatigue. 

While it is not fully understood, the mechanism of acupuncture for pain and symptom distress may involve helping the brain to release neurochemicals, such as endorphins, and regulating the autonomic nervous system.

The needles are very thin, and most people feel little to no pain when they are inserted into “acupuncture points” on the body. There are several hundred located all over the body—for a closer look, check out this body diagram.

In the dyspnea study, needles were first placed in the chest area and then the back area of the patients by two licensed acupuncturists at the ACC for 15 to 20 minutes. Numeric rating scores for dyspnea were then recorded in the patients for seven days after each treatment and four weeks after their last treatment, from 0 (no shortness of breath) to 10 (most severe  shortness of breath imaginable).

Patients who underwent 10 sessions of acupuncture had a 50 percent reduction in severity of the disease: the mean dyspnea severity score before treatment was 6.3, 3.6 at the end of treatment, and 3.2 four weeks after treatment.  Their overall quality of life scores also improved and most reported feeling less fatigued.

The study, which was funded by the American Cancer Society, and included senior author Jun J. Mao, MD, MSCE, formerly of the ACC, now at Memorial Sloan Kettering Cancer Center, Andrew Haas, MD, PhD, Charles B. Simone, MD, Susan Q. Li, MS, Roger B. Cohen, all from Penn, is the latest on acupuncture to come from the ACC’s Integrative Oncology Working Group.

A study published in the Journal of Clinical Oncology last year showed that acupuncture may be a viable treatment for women experiencing hot flashes as a result of estrogen-targeting therapies to treat breast cancer.  That trial, led Mao, enrolled 120 breast cancer survivors. After an eight-week treatment period, the subjects in the electroacupuncture group showed the greatest improvement in a standard measure of hot flash frequency and severity, compared to those that received “sham” acupuncture, when needles are placed in areas not identified as acupuncture points.

Acupuncture has been available to patients at the ACC since 2014. They also have access to yoga, reiki, and mindfulness-based stress reduction therapy.

While the dyspnea trial is a preliminary study, it’s a promising one that surprised the researchers.

“Improving any one of these variables among patients with lung cancer is difficult, so it is even more impressive that we saw a significant improvement in all three variables in this small study,” Bauml said. “The next step would be to confirm these findings in a larger, randomized study.”

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