Acupuncture offers relief from radiotherapy side effect, research shows
Patients suffering from a distressing side-effect of radiotherapy for head and neck cancers can benefit from acupuncture treatment, reveals a new study published today (Wednesday 24 October 2012).
Patients who have received radiotherapy for head and neck cancer often suffer from the unpleasant and distressing side-effect of a dry mouth, caused by damage to their salivary glands from the radiation.
Now, a new study has shown that acupuncture can relieve the symptoms of dry mouth (known as xerostomia). The findings from the largest trial yet to investigate the benefit of acupuncture to xerostomia sufferers are published in the cancer journal Annals of Oncology.
The study involved the work of University of Sussex-based senior research fellow Dr Valerie Jenkins, from the psychosocial oncology group – SHORE-C (Sussex Health Outcomes Research and Education in Cancer) at the Brighton and Sussex Medical School. Dr Jenkins managed the study alongside Royal Sussex County Hospital consultant clinical oncologist Dr Richard Simcock, who is also one of the study’s authors.
Around half a million people worldwide develop head and neck cancer each year and, at present, there are few effective treatments for dry mouth, which is a common side effect of radiotherapy; as many as 41 per cent of patients can still be suffering from it five years later.
Xerostomia affects a patient’s quality of life, interfering with taste, chewing, speaking and sleeping. Short-term solutions such as mouthwashes, gels and toothpastes provide some respite, while treatment with a drug called pilocarpine has its own unwanted side-effects.
Doctors at seven cancer centres in the UK1 (including the Royal Sussex County Hospital in Brighton) recruited 145 patients suffering from radiation-induced xerostomia to take part in a trial to compare acupuncture with education about oral care.
The patients in one group received group acupuncture sessions for 20 minutes every week for eight weeks, while those in the second group received two oral care educational sessions for one hour, one month apart. Four weeks after the end of these two different types of care, the patients swapped over to receive the other treatment.
Patients’ xerostomia symptoms were measured objectively by means of paper strips, called Schirmer strips, which measure the amount of saliva in the mouth.
In addition, patients were asked to fill in a questionnaire reporting on how their mouths felt, with questions about changes in individual symptoms such as sticky saliva, dry lips, needing to sip water to relieve a dry mouth, needing to sip water to help swallow food, and waking at night to sip water.
Patients who had received nine weeks of acupuncture were twice as likely to report improvements in their condition as patients receiving oral care, even though the researchers found there were no significant changes in saliva production.
Dr Simcock says: “Time had an important effect on key symptoms, with patients receiving acupuncture showing a quick response, which was sustained over several weeks.”
The researchers said that the subjective reporting of improvements in xerostomia was of more significance than the lack of changes in the objective test with the Schirmer strips.
Dr Simcock says: “There was no clear relationship between a patient indicating they had a very dry mouth and the measurement of saliva on the Schirmer strips. By definition these patients with chronic xerostomia produced little or no saliva, making objective measurements really difficult.
“Many studies have focused on the objective measurement of how much saliva is produced, but the amount of saliva produced does not necessarily influence the experience of a dry mouth. Xerostomia is therefore an entirely subjective symptom – it is what the patient says it is, regardless of salivary measurement.”
The researchers believe that the improvements in the experience of xerostomia were unlikely to be due to a placebo effect (perceived benefit from a treatment that actually offers no benefit).
Dr Jenkins says: “The profound impact that xerostomia exerts on functions such as eating, talking and sleeping, and which were relieved by the acupuncture, means that if it is entirely a placebo effect then this is a pretty powerful placebo. In addition, the results showed that patients were less likely to wake at night to sip water after treatment – this effect seems difficult to ascribe solely to placebo.
“The scepticism that exists about complementary therapies such as acupuncture is often due to inadequately designed and reported studies. This was a well-controlled, randomised trial conducted in major cancer centres throughout UK with good governance and reporting of adverse events.”
The researchers say that further studies are needed to refine the acupuncture technique and discover how long its effect lasts and whether booster sessions might be required. But they believe that the therapy could be easily incorporated into the care of patients with xerostomia.
Dr Simcock said: “This is a neglected group of patients suffering from a most unpleasant side-effect for which all other ameliorative interventions have failed to address adequately. The acupuncture can be delivered simply and cheaply in normal hospital surroundings and yet still produces a significant benefit for patients with a chronic symptom.”
Notes for editors
- ‘ARIX: a randomised trial of acupuncture v oral care sessions in patients with chronic xerostomia following treatment of head and neck cancer’, by R. Simcock, L. Fallowfield, K. Monson, I. Solis-Trapala, L. Parlou, C. Langridge, and V. Jenkins, on behalf of the ARIX Steering Committee. Annals of Oncology. doi:10.1093/annonc/mds515
- The seven UK centres involved in the study: Royal Sussex County Hospital, Brighton; Guy's & St Thomas's Hospital Trust, London; Mount Vernon Hospital, London; Maidstone Hospital, Kent; Queen Elizabeth Hospital, Birmingham; Royal Surrey County Hospital, Guildford; The Royal Marsden, Sutton.
Annals of Oncology is a monthly journal published on behalf of the European Society for Medical Oncology (ESMO) by Oxford Journals.
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