The National Cancer Institute (NCI) maintains and regularly updates library that provides information on the effectiveness of "alternative and complementary treatments," or ACT's. Versions for professionals and the general public are available on line. For those who have been diagnosed with cancer, as well as those who are in treatment that includes chemotherapy, this information is definitely worth a look. Depending on where you live these complementary treatments may be readily available; alternatively, you may need to be assertive in order to find and access them.
What has become known as the new grief refers to an increasingly lengthy process that has been made possible by medical advances in diagnosis and treatment. These advances have literally transformed the nature of death and dying over the past 40 years, and we must assume that they will continue to do so. The stages that patients and their families can expect to go through, beginning when a diagnosis is rendered, are described in "Saying Goodbye: How Families Can Find Renewal through Loss." Beginning with the first stage of the new grief--Crisis--we advocate that families try as best they can to rally resources. As soon as the initial shock is absorbed (at least enough so that family members are not paralyzed) it is extremely helpful if someone in the family can step up and help to create a team.
Some family members, for example, can be asked to help out by attending doctors' appointments (with the consent of the patient) and taking notes. This is critical because we've found that patients forget much of what was said in such meetings soon afterward. Other family members may pitch in with chores and other responsibilities that the patient may have to relinquish, at least temporarily. And some may take on the responsibility for researching the particular disease that the patient has been diagnosed with, along with treatment options. This is where checking out ACT's comes in.
While oncologists, surgeons, and radiologists are expert in their respective areas, health care in the United States today remains fragmented. You should not, for example, expect the various medical specialists who treat you to communicate well with one another. That's another area where family can help: by pressing for more communication with respect to treatment planning. Similarly, do not expect doctors who are expert in a particular area (chemotherapy, surgery), to be able to educate you or make recommendations when it comes to ACT's.
Acupuncture is one ACT (others will be explored in future posts) that has been the subject of research. Not all of this research passes muster to qualify as definitive, but some of it does. Virtually all of it thus far has focused on patients diagnosed with some form of cancer. Typically, acupuncture treatments are given concurrently with other treatments such as chemotherapy. Standard acupuncture treatment involves one or more sessions per week, in which sterile needles are inserted in one or more points along what are thought to be meridians of energy that course through the body. The idea is to free up these meridians when they become blocked, thus relieving various symptoms.
According to the NCI there is no substantial evidence that acupuncture cures cancer itself. However, let's take a look at the results of studies that looked at acupuncture with respect to various symptoms.
The most common acupuncture treatment for pain involves embedding short acupuncture needles at various places on the ear. One study compared 20 cancer patients who received such acupuncture in addition to pain medication to a group that received only the medication. All 20 in the former group reported significantly less pain. A second study of 183 patients reported that 52% were significantly helped. They required multiple treatments at intervals ranging from 1 to 4 weeks to achieve this effect.
While promising, studies of the effectiveness of acupuncture for pain are limited in what can be said definitively because they do not include a comparison group, in other words, a group that received some other treatment, either real or placebo. That said, looking into acupuncture for relief of chronic pain may be worthwhile.
Nausea and Vomiting
It is with respect to these common side effects of chemotherapy that we have the best evidence of the effectiveness of acupuncture. Here the NCI has reported on the results of several "randomized clinical trials," which are generally considered to be the gold standard for evaluating the effectiveness of treatments. A number of studies have found that acupuncture treatment than runs concurrently with chemotherapy significantly reduces nausea and vomiting. For example, researchers studied the effects of acupuncture treatments that were delivered weekly for three months on women who were taking tamoxifen as part of their treatment for breast cancer and found that this group, as compared to a group who did not receive the acupuncture, reported not only less nausea but less anxiety and depression. In short, there is evidence that acupuncture enhances the control of these symptoms.
In one study cancer patients were randomly assigned to one of three treatment groups: standard acupuncture using needles; acupressure; and "sham acupressure" meaning applying pressure to random places on the body. The results showed the regular acupuncture to be superior to the other treatments with respect to increasing the patients' overall energy levels.
The term "terminal illness" does not mean what it once did. A generation or two ago a "terminal" diagnosis usually meant that death was imminent. Today, "terminal" is relative. Those who are diagnosed as having Stage 4 (metastatic) cancer know that the threat to them is very real. Yet they too can work with their doctors to contain or slow the progress of cancer, as Elizabeth Edwards did for several years. If more research dollars were to be devoted to studying means of containing (if not curing) these patients their life expectancy could increase dramatically.
For those who are diagnosed early with forms of cancer for which we have effective treatments (prostate cancer, early stage breast cancer) "terminal" is increasingly an almost abstract concept. This is good. Regardless of the degree of threat, we recommend that families approach a cancer diagnosis as a team. In fact, we have found that in many cases such a diagnosis, as threatening as it may be, can also set the stage for families to resolve longstanding grievances and come together as a more cohesive, resilient unit. In that way they can look collectively at treatment options and evaluate them, including alternative and complementary treatments such as acupuncture.
In response to my inquiry, David Rosenthal, M.D., former President of the American Cancer Society and Medical Director of Harvard University, wrote that many cancer patients receive concurrent acupuncture at the Dana-Farber Cancer Institute as well as at Massachusetts General Hospital. In addition, patients who reside (for free) at the Hope Lodge in Boston while they undergo cancer treatment are offered massage therapy and Reiki, two additional complementary therapies that we will look at later on.
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