Acupuncture mitigates adverse effects resulting from chemotherapy. Chongqing Tumor Institute (Oncology Department of Traditional Chinese Medicine) researchers conducted a controlled clinical trial consisting of rectal cancer patients receiving chemotherapy. Acupuncture significantly reduced the severity of hand-foot syndrome, a known side effect of chemotherapy characterized by redness, swelling, tingling, numbness, itching, and pain of the palms and soles.
Acupuncture achieved a 70% total effective rate with a 16.67% complete cure rate and a 53.33% markedly effective rate for rectal cancer patients receiving chemotherapy utilizing capecitabine as part of the treatment regimen. [1] A total of 60 patients with rectal cancer were recruited for the study and were randomly assigned to receive treatment with acupuncture (n=30) or vitamin B6 (n=30).
The acupuncture group was comprised of 13 male and 17 female patients, ages 45–80 years (mean age 62.29), with a disease duration of 9–20 months (mean duration 16.4 months). The vitamin B6 group was comprised of 16 male and 14 female patients, ages 51–73 years (mean age 61.25), with a disease duration of 10–19 months (mean duration 15.8 months). The severity of the participants’ symptoms were graded using two scales, the Common Toxicity Criteria of the National Cancer Institute of Canada (CTC) and the Karnofsky Performance Scale (KPS). The CTC grades symptoms using a scale of 1–4, with higher scores indicating increased severity. The KPS is on a scale of 0–100, with higher scores indicating an increased ability to perform daily activities and lower scores indicating increased levels of disability.
For inclusion in the study, participants were required to have a CTC score of >1 and a KPS score of ≥60. Further criteria limited participants to ages 18–80 years, with an anticipated survival period of at least three months. Informed consent and ethical approval were required for all participants. Exclusion criteria included pregnancy, lactation, serious heart, liver, kidney, or brain dysfunction, psychiatric disorders, inability to cooperate with the study requirements, and refusal of acupuncture treatment.
Acupuncture
According to TCM (Traditional Chinese Medicine) principles, hand-foot syndrome is a type of bi syndrome involving obstruction of qi and blood circulation, deficiency of qi and blood, or dampness leading to a blockage of yang qi that is consequently unable to nourish the skin and muscles, thereby causing the symptoms of numbness and pain. Historically, the term “bi referred to the pathogenesis, or the symptoms as well as the name of the disease.” [2] Treatment principles were to tonify qi, promote blood circulation, promote yang qi, and remove stagnation. Patients allocated to the acupuncture group received treatment at the following acupoints:
- Baihui (GV20)
- Hegu (LI4)
- Waiguan (TB5)
- Zusanli (ST36)
- Ashi points
For constitutionally weak patients, the following supplementary acupoints were added:
- Taixi (KD3)
- Sanyinjiao (SP6)
- Yanglingquan (GB34)
Treatment was administered with patients in a supine position. Following standard disinfection, 0.35 × 40 mm filiform needles were inserted into each acupoint. Baihui was needled obliquely toward the occiput to elicit a distending sensation in the local area. Hegu and Waiguan were needled obliquely towards the palm, to a depth of 0.2–0.3 cun. The needle sensations were transmitted towards the palms.
Zusanli was needled perpendicularly using a reinforcing-reducing method. The needle was first rotated clockwise to elicit deqi, with sensations transmitted along the medial edge of the tibia toward the thigh. The needle was then rotated counter-clockwise, while applying finger pressure to the upper part of the acupoint with the aim of transmitting needle sensations back toward the toes.
Ashi points were selected according to the most painful areas on the hands and feet. These were needled perpendicularly to a depth of 0.1–0.2 cun. After the arrival of deqi, the needles were manipulated with a rapid, low-amplitude lifting and thrusting techniques for two minutes to elicit a strong distending sensation. The supplementary points, if used, were stimulated using an even technique with rapid, low-amplitude lifting and thrusting to elicit needle sensations in the local area. All needles were retained for 30 minutes and treatments were administered daily for two weeks.
Vitamin B6
Participants allocated to the vitamin B6 group were treated with 300mg of oral vitamin B6, taken daily for a total of two weeks.
Outcomes
Outcome measures included changes in CTC and KPS scores, and the QLQ-C30 (Quality of Life Questionnaire Core), a 30-item functional scale covering the areas of PF (physical function), RF (role function), CF (cognitive function), EF (emotional function), and SF (social function). Patients whose CTC scores were downgraded to grade 1 after treatment, with a disappearance of symptoms and a KPS score of ≥ 90 were classified as cured. For patients whose CTC scores were downgraded to ≥ grade 1, with an improvement in symptoms, and a KPS score of 80–89, the treatments were classified as effective. For patients showing no obvious improvements and had KPS scores of < 80, the treatments were classified as ineffective.
Mean pre-treatment KPS scores were 67.23 in the acupuncture group and 68.07 in the vitamin B6 group. Following treatment, these scores rose to 84.23 and 77.84 respectively. Although both groups showed improvements, positive patient outcomes were significantly greater in the acupuncture group (p<0.05). In the acupuncture group, there were 5 cured, 16 effective, and 9 ineffective cases, yielding a total effective rate of 70.0%. In the vitamin B6 group, there were 4 cured, 7 effective, and 19 ineffective cases, yielding a total effective rate of 36.7%.
Mean pre-treatment QLQ-C30 scores in the acupuncture group were 40.72, 44.53, 34.35, 39.23, and 33.19 in the areas of PF, RF, EF, CF, and SF respectively. In the vitamin B6 group, the equivalent pre-treatment scores were 41.13, 40.87, 33.89, 40.75, and 32.07. Following treatment, these scores fell to 7.13, 18.77, 4.89, 6.32, and 10.16 in the acupuncture group and 16.72, 20.77, 11.76, 18.17, and 12.88 in the vitamin B6 group. Both groups showed improvements across all areas, but positive outcomes were greater in the acupuncture group, with improvements in PF, EF, and CF being of statistical significance (p<0.05).
The results of this study indicate that acupuncture is an effective treatment for hand-foot syndrome, with the ability to alleviate symptoms and improve overall quality of life. The results demonstrate that an integrative model of patient care utilizing acupuncture as a treatment modality produces significantly less adverse effects associated with chemotherapy.
References:
1. Li Fangfei, Chen Hong, Li Guosen (2018) “Chemotherapy-induced hand-foot syndrome in rectal cancer treated with acupuncture” World Journal of Acupuncture-Moxibustion Vol.28 pp. 151-155.
2. Dai, J. H., Y. J. Shi, H. B. Yin, and H. Du. "The evolution of related names of Bi syndrome and the theory of etiology and pathogenesis." Zhonghua yi shi za zhi (Beijing, China: 1980) 39, no. 4 (2009): 214-217.
