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Abstract
Oncology acupuncture has become a new and promising field of research because more and more cancer patients have sought non-pharmacological alternatives for symptom management. While different mechanisms have been proposed to explain its efficacy, including theories of the neural system, endocrine cytokine or immunological regulation, its eventual role has become that of alleviating the side effects induced by chemotherapy or radiotherapy. In this paper, we have reviewed the related articles focusing on acupuncture mechanisms and applications in cancer care to provide a quick sketch of acupuncture in cancer care. A detailed search was performed to identify the randomized controlled trials (RCTs) and systematic reviews on acupuncture in oncology, using PUBMED and Cochrane. The search terms included: Acupuncture, acupressure, and cancer. Additional terms were used to target specific symptoms (i.e., breast cancer, hot flash, xerostomia, nausea, vomiting, cancer pain, insomnia, fatigue). Two authors independently extracted data for analysis and review. Ultimately, 25 articles underwent full-text review. Recent trials made efforts in studying (a) hot flashes in breast cancer, (b) xerostomia induced by radiotherapy in head and neck cancer, (c) nausea and vomiting post-chemotherapy, (d) cancer pain, and (e) fatigue and insomnia in cancer patients. Controversial results for acupuncture application in cancer care appeared in different categories, but a trend emerged that acupuncture can palliate cancer-related symptoms. The research to date certainly offers us a valid complementary therapy in treating cancer-related symptoms. Meanwhile, practical strategies with safe measures for enhancing the efficacy are needed in further interventions, as well as continuing research with a validated methodology.
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Affiliation(s)
- Tsai-Ju Chien
- Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan. ; Department of Internal Medicine, Division of Hemato-Oncology, Branch of Zhong-xing, Taipei City Hospital, Taipei, Taiwan
| | - Chia-Yu Liu
- Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan. ; Department of Traditional Chinese Medicine,Branch of Linsen and Chinese Medicine, Taipei City Hospital, Taipei, Taiwan. ; Taiwan International Traditional Chinese Medicine Training Center, Taiwan
| | - Chung-Hua Hsu
- Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan. ; Department of Traditional Chinese Medicine,Branch of Linsen and Chinese Medicine, Taipei City Hospital, Taipei, Taiwan. ; Taiwan International Traditional Chinese Medicine Training Center, Taiwan
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55
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Glare PA, Davies PS, Finlay E, Gulati A, Lemanne D, Moryl N, Oeffinger KC, Paice JA, Stubblefield MD, Syrjala KL. Pain in cancer survivors. J Clin Oncol 2014; 32:1739-47. [PMID: 24799477 DOI: 10.1200/jco.2013.52.4629] [Citation(s) in RCA: 204] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Pain is a common problem in cancer survivors, especially in the first few years after treatment. In the longer term, approximately 5% to 10% of survivors have chronic severe pain that interferes with functioning. The prevalence is much higher in certain subpopulations, such as breast cancer survivors. All cancer treatment modalities have the potential to cause pain. Currently, the approach to managing pain in cancer survivors is similar to that for chronic cancer-related pain, pharmacotherapy being the principal treatment modality. Although it may be appropriate to continue strong opioids in survivors with moderate to severe pain, most pain problems in cancer survivors will not require them. Moreover, because more than 40% of cancer survivors now live longer than 10 years, there is growing concern about the long-term adverse effects of opioids and the risks of misuse, abuse, and overdose in the nonpatient population. As with chronic nonmalignant pain, multimodal interventions that incorporate nonpharmacologic therapies should be part of the treatment strategy for pain in cancer survivors, prescribed with the aim of restoring functionality, not just providing comfort. For patients with complex pain issues, multidisciplinary programs should be used, if available. New or worsening pain in a cancer survivor must be evaluated to determine whether the cause is recurrent disease or a second malignancy. This article focuses on patients with a history of cancer who are beyond the acute diagnosis and treatment phase and on common treatment-related pain etiologies. The benefits and harms of the various pharmacologic and nonpharmacologic options for pain management in this setting are reviewed.
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Affiliation(s)
- Paul A Glare
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Pamela S Davies
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Esmé Finlay
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Amitabh Gulati
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Dawn Lemanne
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Natalie Moryl
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kevin C Oeffinger
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Judith A Paice
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michael D Stubblefield
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Karen L Syrjala
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Bao Y, Kong X, Yang L, Liu R, Shi Z, Li W, Hua B, Hou W. Complementary and alternative medicine for cancer pain: an overview of systematic reviews. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2014; 2014:170396. [PMID: 24817897 PMCID: PMC4003746 DOI: 10.1155/2014/170396] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 02/25/2014] [Accepted: 03/07/2014] [Indexed: 12/22/2022]
Abstract
Background and Objective. Now with more and more published systematic reviews of Complementary and Alternative Medicine (CAM) on adult cancer pain, it is necessary to use the methods of overview of systematic review to summarize available evidence, appraise the evidence level, and give suggestions to future research and practice. Methods. A comprehensive search (the Cochrane Library, PubMed, Embase, and ISI Web of Knowledge) was conducted to identify all systematic reviews or meta-analyses of CAM on adult cancer pain. And the evidence levels were evaluated using GRADE approach. Results. 27 systematic reviews were included. Based on available evidence, we could find that psychoeducational interventions, music interventions, acupuncture plus drug therapy, Chinese herbal medicine plus cancer therapy, compound kushen injection, reflexology, lycopene, TENS, qigong, cupping, cannabis, Reiki, homeopathy (Traumeel), and creative arts therapies might have beneficial effects on adult cancer pain. No benefits were found for acupuncture (versus drug therapy or shame acupuncture), and the results were inconsistent for massage therapy, transcutaneous electric nerve stimulation (TENS), and Viscum album L plus cancer treatment. However, the evidence levels for these interventions were low or moderate due to high risk of bias and/or small sample size of primary studies. Conclusion. CAM may be beneficial for alleviating cancer pain, but the evidence levels were found to be low or moderate. Future large and rigor randomized controlled studies are needed to confirm the benefits of CAM on adult cancer pain.
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Affiliation(s)
- Yanju Bao
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5, Xicheng District, Beijing 100053, China
| | - Xiangying Kong
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Nanxiaojie, Dongzhimennei Avenue, Beijing 100700, China
| | - Liping Yang
- Department of Nephrology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5, Xicheng District, Beijing 100053, China
| | - Rui Liu
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5, Xicheng District, Beijing 100053, China
| | - Zhan Shi
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5, Xicheng District, Beijing 100053, China
| | - Weidong Li
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5, Xicheng District, Beijing 100053, China
| | - Baojin Hua
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5, Xicheng District, Beijing 100053, China
| | - Wei Hou
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beixiange 5, Xicheng District, Beijing 100053, China
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