Acupuncture decreased joint symptoms in women with early-stage breast cancer treated with aromatase inhibitors, according to a randomized, multicenter clinical trial led by researchers at NewYork-Presbyterian, Columbia University Irving Medical Center, and Columbia University Mailman School of Public Health. The study was developed and managed by SWOG, the global cancer trials network funded by the National Cancer Institute, and the findings were presented at the San Antonio Breast Cancer Symposium, held in early December.
[Photo: Dr. Dawn L. Hershman]
Each year, tens of thousands of postmenopausal women with hormone receptor-positive breast cancer, a type of cancer that is fueled by estrogen, are treated with aromatase inhibitors, which block the effects of estrogen to prevent a recurrence of the disease. While these drugs are effective and reduce the rate of recurrence, up to 50 percent of women who take them experience significant joint pain and stiffness.
“Two-thirds of all breast cancers are hormone receptor-positive, and the treatment for it is to lower estrogen levels with aromatase inhibitors,” said Dr. Dawn L. Hershman, leader of the Breast Cancer Program at the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian/Columbia University Irving Medical Center, and professor of epidemiology at Columbia. “Despite the well-proven effectiveness of this treatment, many patients experience side effects that cause them to miss treatments or stop their therapy altogether. By controlling side effects and keeping patients on their medication, we may be able to improve breast cancer outcomes.”
Acupuncture is a traditional Chinese medicine technique in which thin needles are inserted through the skin to stimulate specific points in the body. Previous, smaller studies have shown that acupuncture can reduce joint pain and swelling related to aromatase inhibitor treatment, according to Dr. Hershman, but these studies provided uncertain interpretations due to their small size and the fact that they were conducted at single institutions.
Dr. Hershman and her colleagues designed a large, multicenter study to determine whether acupuncture would decrease joint pain associated with the use of aromatase inhibitors. In their study, true acupuncture was compared with sham acupuncture (needling at non-acupoints) or no acupuncture in 226 women with early-stage, hormone receptor-positive breast cancer who were being treated with aromatase inhibitors, all of whom had reported having significant joint pain on the Brief Pain Inventory-Short Form (BPI). The BPI is a self-administered 14-item questionnaire designed to assess pain on a scale from zero to 10, where higher scores indicate more pain. The researchers used the patients’ reported “worst pain” as the primary endpoint measure.
The patients assigned true acupuncture or sham acupuncture had twice-weekly sessions for six weeks; and then once a week for an additional six weeks. The patients were monitored for another 12 weeks after stopping acupuncture treatments, and reported on their pain using various methods, including the BPI, throughout this 24-week period.
Data from the study showed that on average, patients who received true acupuncture reported experiencing less pain and stiffness – even after they stopped receiving acupuncture. After six weeks, patients in the true acupuncture treatment group reported significantly lower BPI “worst pain” by nearly a point compared with those receiving sham acupuncture and no acupuncture. The improvement in mean BPI “worst pain” score for those receiving true acupuncture remained significant compared to the other two group’s scores over 24 weeks. The most common adverse event reported among those receiving true and sham acupuncture was bruising.
The study shows that when assessing pain and stiffness, true acupuncture is effective in reducing pain: when it’s given twice a week, when it is maintained afterwards at once a week, and it is effective even after patients stop the acupuncture treatment, according to the researchers. Also, there are so few side effects and it is non-addictive which has real implications in how patients can address their pain. The goal is to make sure patients have access to it and that insurance will cover it, just like they would for a pain medication.
“Our goal was to provide an alternative to pain medications to control this side effect,” said Dr. Hershman. “We have a huge problem in this country with pain medications, and it’s imperative to find alternative ways of controlling pain and discomfort so that individuals with breast cancer can stay on their treatment.”
“Given these results, healthcare practitioners may want to discuss the possibility of acupuncture with patients experiencing treatment-related joint pain and stiffness because it has the potential to improve their quality of life,” said Dr. Hershman, who is also Vice Chairman of SWOG. “We know from taking care of patients that it’s heartbreaking to see them struggle about taking a medication they know can prevent their cancer from coming back, but experiencing painful symptoms that make them question whether or not they want to stay on it. To be able to give someone an option that may be able to keep them on their medication is very meaningful.”