Acupuncture and Self Acupuncture for Long Term Treatment of Vasomotor Symptoms in Cancer Patients - Audit and Treatment Algorithm The association between nocturnal hot flashes and sleep in breast cancer survivors. Randomized, controlled trial of acupuncture for the treatment of hot flashes in breast cancer patients. Reducing vasomotor symptoms with acupuncture in breast cancer patients treated with adjuvant tamoxifen: a randomized controlled trial Acupuncture improves health-related quality-of-life (HRQoL) and sleep in women with breast cancer and hot flushes Acupuncture relieves menopausal discomfort in breast cancer patients: a prospective, double blinded, randomized study. Feasibility Study of Acupuncture for Reducing Sleep Disturbances and Hot Flashes in Postmenopausal Breast Cancer Survivors Randomized, blinded, sham-controlled trial of acupuncture for the management of aromatase inhibitor-associated joint symptoms in women with early-stage breast cancer. Acupuncture versus venlafaxine for the management of vasomotor symptoms in patients with hormone receptor-positive breast cancer: a randomized controlled trial. Psychological well-being improves in women with breast cancer after treatment with applied relaxation or electro-acupuncturefor vasomotor symptom Long-term follow-up of acupuncture and hormone therapy on hot flushes in women with breast cancer: a prospective, randomized, controlled multicenter trial Acupuncture for the treatment of hot flashes in breast cancer patients, a randomized, controlled trial
Introduction Since hormone replacement therapy given for long periods is now recognised to produce serious side effects , patients with troublesome vasomotor symptoms  are increasingly using non-hormonal treatment including acupuncture . Several r and omised controlled trials have shown that acupuncture reduces menopausal symptoms in patients experiencing the normal climacteric . It may have this effect by raising serotonin levels which alter the temperature set point in the hypothalamus . Vasomotor symptoms can be extreme in breast cancer patients and patients with prostate cancer who are undergoing anticancer therapy . The safety of some herbal medicines and phytoestrogens has been question ed , as they could potentially interfere adversely with the bioavailability of tumouricidal drugs . A previous study reports short term benefit from acupuncture , and the aim of this report is to describe our approach to long term treatment . Acupuncture Approach After piloting several approaches , six weekly treatments were given initially at LI4 , TE5 , LR3 and SP6 and two upper sternal points , but avoiding any limb with existing lymphoedema or prone to developing it . If there were no contraindications , patients were given clear instructions on how to perform self acupuncture using either semi-permanent needles or conventional needling at SP6 , weekly for up to six years , for long term maintenance . Audit Methods and Results A retrospective audit of electronic records was carried out by a doctor not involved in treatment . A total of 194 patients were treated , predominantly with breast and prostate cancer . One hundred and eighty two patients were female . The number of pre-treatment hot flushes per day was estimated by the patient : in the 159 cases providing adequate records , the mean was 16 flushes per day . Following treatment , 114 ( 79 % ) gained a 50 % or greater reduction in hot flushes and 30 ( 21 % ) a less than 50 % reduction . Treatment was ab and oned in those who responded poorly or not at all . The duration of treatment varied from one month to over six years with a mean duration of nine months . Seventeen patients ( 9 % ) experienced minor side effects over the six year period , mostly minor rashes ; one patient described leg swelling but this was likely to be due to a concurrent fracture . Conclusion Acupuncture including self acupuncture is associated with long term relief of vasomotor symptoms in cancer patients . Treatment is safe and costs appear to be low . An algorithm is presented to guide clinical use . We recommend the use of self acupuncture with needles at SP6 in preference to semi-permanent needles in the first instance , but poor responders use indwelling studs if they fail to respond adequately to self acupuncture with regular needles . Point location may be of less importance than the overall ‘ dose ’ , and an appropriate minimum dose may be required to initiate the effect This study examined the relationship between objective ly measured nocturnal hot flashes and objective ly measured sleep in breast cancer survivors with insomnia . Twenty-four women who had completed treatment for non-metastatic breast cancer participated . All were enrolled in a study of cognitive-behavioral treatment for chronic insomnia .  Nocturnal hot flashes and sleep  were measured by skin conductance and polysomnography  , respectively . The 10-minute periods around hot flashes were found to have significantly more wake time , and more stage changes to lighter sleep , than other 10-minute periods during the night . Nights with hot flashes had a significantly higher percentage of wake time , a lower percentage of Stage 2 sleep , and a longer REM latency compared to nights without hot flashes . Overall , hot flashes were found to be associated with less efficient , more disrupted sleep . Nocturnal hot flashes , or their underlying mechanisms , should be considered as potential contributors to sleep disruption in women with breast cancer who report poor sleep PURPOSE To determine the immediate and long-term effects of true acupuncture versus sham acupuncture on hot flash frequency in women with breast cancer . PATIENTS AND METHODS Seventy-two women with breast cancer experiencing three or more hot flashes per day were r and omly assigned to receive either true or sham acupuncture . Interventions were given twice weekly for 4 consecutive weeks . Hot flash frequency was evaluated at baseline , at 6 weeks , and at 6 months after initiation of treatment . Patients initially r and omly assigned to the sham group were crossed over to true acupuncture starting at week 7 . RESULTS The mean number of hot flashes per day was reduced from 8.7 ( st and ard deviation [ SD ] , 3.9 ) to 6.2 ( SD , 4.2 ) in the true acupuncture group and from 10.0 ( SD , 6.1 ) to 7.6 ( SD , 5.7 ) in the sham group . True acupuncture was associated with 0.8 fewer hot flashes per day than sham at 6 weeks , but the difference did not reach statistical significance ( 95 % CI , -0.7 to 2.4 ; P = .3 ) . When participants in the sham acupuncture group were crossed over to true acupuncture , a further reduction in the frequency of hot flashes was seen . This reduction in hot flash frequency persisted for up to 6 months after the completion of treatment . CONCLUSION Hot flash frequency in breast cancer patients was reduced following acupuncture . However , when compared with sham acupuncture , the reduction by the acupuncture regimen as provided in the current study did not reach statistical significance . We can not exclude the possibility that a longer and more intense acupuncture intervention could produce a larger reduction of these symptoms To evaluate true acupuncture to control acupuncture ( CTRL ) ( non-insertive stimulation at non-acupuncture points ) in breast cancer patients treated with adjuvant tamoxifen suffering from hot flushes and sweatings . Eighty-four patients were r and omized to receive either true acupuncture or CTRL twice a week for 5 weeks . Seventy-four patients were treated according to the protocol . In the true acupuncture group 42 % ( 16/38 ) reported improvements in hot flushes after 6 weeks compared to 47 % ( 17/36 ) in the CTRL group ( 95 % CI , −28 to 18 % ) . Both groups reported improvement regarding severity and frequencies in hot flushes and sweatings but no statistical difference was found between the groups . In a sub analysis regarding the severity of sweatings at night a statistically significant difference P = 0.03 was found in the true acupuncture group . Former experience of true acupuncture did not influence the perception of true acupuncture or CTRL . No significant differences in hormonal levels were found before and after treatment . In conclusion , convincing data that true acupuncture is more effective than CTRL  in reducing vasomotor symptoms is still lacking . Our study shows that both true and CTRL  reduce vasomotor symptoms in breast cancer patients treated with adjuvant tamoxifen Purpose Evaluate effects of electro-acupuncture ( EA ) and hormone therapy ( HT ) on health-related quality -of-life ( HRQoL ) and sleep in breast cancer survivors with vasomotor symptoms . Methods Forty-five women , r and omized to EA ( n = 27 ) for 12 weeks or HT ( n = 18 ) for 24 months , were followed for up to 2 years . Distress caused by , and numbers of , hot flushes , hours slept and times woken up/night , Psychological and General Well-being Index ( PGWB ) and Women ’s Health Question naire ( WHQ ) were registered before and during treatment and at 6 , 9 , 12 , 18 and 24 months after start of treatment . Results After 12 weeks of EA ( n = 19 ) , WHQ improved from 0.32 ( IQR 0.23–0.53 ) at baseline to 0.24 ( IQR 0.12–0.39 ; p < 0.001 ) and PGWB from 78 ( IQR 53–89 ) to 79 ( IQR 68–93 ; p = 0.002 ) . All sleep parameters improved and Hot Flush Score ( HFS ) decreased by 80 % . At 12 months , WHQ , PGWB and all sleep parameters remained significantly improved ( n = 14 ) and HFS decreased by 65 % . After 12 weeks of HT ( n = 18 ) , WHQ improved from 0.29 ( IQR 0.15–0.44 ) at baseline to 0.15 ( IQR 0.05–0.22 ; p = 0.001 ) , PGWB from 75 ( IQR 59–88 ) to 90 ( 62–97 ; p = 0.102 ) and three of five sleep parameters improved . Conclusion Both EA and HT  increased HRQoL and sleep , probably through decreasing numbers of and distress by hot flushes . Although flushes decreased less in the EA group than in the HT group , HRQoL improved at least to the same extent maybe due to other effects of EA , not induced by HT , e.g. on anxiety , vitality and sleep , supported by subscale analyses . EA should be further evaluated as treatment for women with breast cancer and climacteric complaints , since HT no longer can be recommended for these women BACKGROUND This study evaluates the effect of acupuncture on hot flashes and disturbed night sleep in patients treated for breast cancer . The effect of acupuncture was tested against a sham-acupuncture group and a no-treatment control group . Plasma estradiol was measured to rule out this as cause of effect . Side effects of the treatment were registered . METHODS We r and omized 94 women into the study : 31 had acupuncture , 29 had sham acupuncture and 34 had no treatment .  FINDINGS In the acupuncture group , 16 patients ( 52 % ) experienced a significant effect on hot flashes compared with seven patients ( 24 % ) in the sham group ( p < 0.05 ) . The effect came after the second acupuncture session and lasted for at least 12 weeks after last treatment . A statistically significant positive effect was seen on sleep in the acupuncture group compared with the sham-acupuncture and no-treatment groups . The effect was not correlated with increased levels of plasma estradiol . No side effects of acupuncture were registered . INTERPRETATION We find that acupuncture significantly relieves hot flashes and sleep disturbances and is a good and safe treatment in women treated for breast cancer Objectives : The present study was a feasibility study of a tailored acupuncture intervention in postmenopausal breast cancer survivors ( BCSs ) reporting sleep disturbances and hot flashes . Objectives were ( 1 ) to describe patterns of acupuncture point use ; ( 2 ) evaluate outcome expectancy , credibility , and acceptability relative to the intervention ; and ( 3 ) evaluate patterns of symptom change over time . Design : This was a single-group , nonr and omized , quasi-experimental 8-week study . Sample / Setting : Ten BCSs with both sleep disturbances and hot flashes were referred to any of 4 Midwestern community acupuncturists . Methods : Assessment s were done at baseline ( weeks 1 , 2 ) , during treatment ( weeks 3 , 4 ) , and after treatment ( weeks 5 , 8) . Acupuncture treatment was tailored to the individual by community acupuncturists and provided as 3 sessions within a 2-week period ( weeks 3 , 4 ) . Patients wore a wrist actigraph during weeks 1 , 2 , 3 , 4 , 5 , and 8 and a sternal skin conductance monitor for 24 consecutive hours during weeks 1 , 2 , 3 , 4 , 5 , and 8 . Subjective data were obtained by question naire at weeks 1 , 2 , 3 , 4 , 5 , and 8 . Findings : Women were a mean age of 53 years , with an average 6.75 years since diagnosis . A mean of 10 needles were used per session , with the most common points located in the lung or lung meridian . Breast cancer survivors had high expectancy that acupuncture would decrease their symptoms , believed it was a credible treatment , and felt it an acceptable form of treatment . Three significant patterns of symptom change were noted from baseline : an increase in the number of minutes it took to fall asleep after treatment ( from week 5 to 8 ; P = .04 ) , a decrease in the percentage of time awake after sleep onset from baseline to follow-up 2 ( week 8 ; P = .05 ) , and a decrease in the number of hot flashes from baseline to follow-up 1 ( week 5 ; P = .02 ) . Implication s for Nursing : Findings may be used by clinical nurse specialists to consider recommending acupuncture to improve sleep and reduce hot flashes in BCSs . Conclusions : Acupuncture treatment seems to be a feasible treatment option for highly motivated BCSs with sleep disturbances and hot flashes but needs to be further evaluated in a larger , r and omized , controlled clinical trial PURPOSE Women with breast cancer ( BC ) treated with aromatase inhibitors ( AIs ) may experience joint symptoms that can lead to discontinuation of effective therapy . We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC . METHODS We conducted a r and omized , controlled , blinded study comparing true acupuncture ( TA ) versus sham acupuncture ( SA ) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs .  TA included full body/auricular acupuncture and joint-specific point prescriptions , whereas SA involved superficial needle insertion at nonacupoint locations . Outcome measures included the Brief Pain Inventory-Short Form ( BPI-SF ) , Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , and Modified Score for the Assessment of Chronic Rheumatoid Affections of the H and s ( M-SACRAH ) obtained at baseline and at 3 and 6 weeks . Results Of 51 women enrolled , 43 women were r and omly assigned and 38 were evaluable . Baseline characteristics were comparable between the two groups . Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks , which was lower for TA compared with SA ( 3.0 v 5.5 ; P < .001 ) . We also found differences between TA and SA in pain severity ( 2.6 v 4.5 ; P = .003 ) and pain-related interference ( 2.5 v 4.5 ; P = .002 ) at 6 weeks . Similar findings were seen for the WOMAC and M-SACRAH scores . The acupuncture intervention was well-tolerated . CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness , which was not seen with SA . Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect PURPOSE Vasomotor symptoms are common adverse effects of antiestrogen hormone treatment in conventional breast cancer care . Hormone replacement therapy is contraindicated in patients with breast cancer .  Venlafaxine ( Effexor ) , the therapy of choice for these symptoms , has numerous adverse effects . Recent studies suggest acupuncture may be effective in reducing vasomotor symptoms in menopausal women . This r and omized controlled trial tested whether acupuncture reduces vasomotor symptoms and produces fewer adverse effects than venlafaxine . PATIENTS AND METHODS Fifty patients were r and omly assigned to receive 12 weeks of acupuncture ( n = 25 ) or venlafaxine ( n = 25 ) treatment . Health outcomes were measured for up to 1 year post-treatment . RESULTS Both groups exhibited significant decreases in hot flashes , depressive symptoms , and other quality -of-life symptoms , including significant improvements in mental health from pre- to post-treatment . These changes were similar in both groups , indicating that acupuncture was as effective as venlafaxine . By 2 weeks post-treatment , the venlafaxine group experienced significant increases in hot flashes , whereas hot flashes in the acupuncture group remained at low levels . The venlafaxine group experienced 18 incidences of adverse effects ( eg , nausea , dry mouth , dizziness , anxiety ) , whereas the acupuncture group experienced no negative adverse effects . Acupuncture had the additional benefit of increased sex drive in some women , and most reported an improvement in their energy , clarity of thought , and sense of well-being . CONCLUSION Acupuncture appears to be equivalent to drug therapy in these patients . It is a safe , effective and durable treatment for vasomotor symptoms secondary to long-term antiestrogen hormone use in patients with breast cancer The aim of this study was to evaluate the effect of applied relaxation and electro-acupuncture ( EA ) on psychological well-being in breast cancer-treated women with vasomotor symptoms . Thirty-eight breast cancer-treated postmenopausal women with vasomotor symptoms  were included in the study . They were r and omized to either treatment with electro-acupuncture ( EA ) ( n = 19 , three of them with tamoxifen ) or applied relaxation ( AR ) ( n = 19 , five of them with tamoxifen ) over a 12-week study period with six months follow-up . Vasomotor symptoms were registered daily . A visual analog scale was used to assess climacteric symptom , estimation of general well-being was made using the Symptom Checklist , and mood using the Mood Scale . These were applied during treatment and at follow-up . In total 31 women completed 12 weeks of treatment and six months of follow-up . Hot flushes were reduced by more than 50 % . Climacteric symptoms significantly decreased during treatment and remained so six months after treatment in both groups . Psychological well-being significantly improved during therapy and at follow-up visits in both groups . Mood improved significantly in the electro-acupuncture treated group . In conclusion psychological well-being improved in women with breast cancer r and omized to treatment with either AR or EA for vasomotor symptoms and we therefore suggest that further studies should be performed in order to evaluate and develop these alternative therapies Objective To evaluate the effects of electro-acupuncture ( EA ) and hormone therapy ( HT ) on vasomotor symptoms in women with a history of breast cancer . Methods Forty-five women were r and omized to EA  ( n = 27 ) for 12 weeks or HT ( n = 18 ) for 24 months . The number of and distress caused by hot flushes were registered daily before , during and up to 24 months after start of treatment . Results In 19 women who completed 12 weeks of EA , the median number of hot flushes/24 h decreased from 9.6 ( interquartile range ( IQR ) 6.6–9.9 ) at baseline to 4.3 ( IQR 1.0–7.1 ) at 12 weeks of treatment ( p < 0.001 ) . At 12 months after start of treatment , 14 women with only the initial 12 weeks of EA had a median number of flushes/24 h of 4.9 ( IQR 1.8–7.3 ) , and at 24 months seven women with no other treatment than EA had 2.1 ( IQR 1.6–2.8 ) flushes/24 h. Another five women had a decreased number of flushes after having additional EA . The 18 women with HT had a baseline median number of flushes/24 h of 6.6 ( IQR 4.0–8.9 ) , and 0.0 ( IQR 0.0–1.6 ; p = 0.001 ) at 12 weeks . Conclusion Electro-acupuncture is a possible treatment of vasomotor symptoms for women with breast cancer and should be further studied for this group of women Acupuncture has been used to treat the problem of hot flashes in healthy postmenopausal women . The object of this study was to investigate the efficacy of acupuncture in women with breast cancer suffering from hot flashes as a result of anti-oestrogen medication .  In a prospect i ve , controlled trial , 59 women suffering from hot flashes following breast cancer surgery and adjuvant oestrogen-antagonist treatment ( Tamoxifen )  were r and omized to either 10 weeks of traditional Chinese acupuncture or sham acupuncture ( SA ) .  Mean number of hot flashes at day and night were recorded prior to treatment , during the treatment period as well as during the 12 weeks following treatment . A vali date d health score ( Kupperman index ) was conducted at baseline , at the end of the treatment period and at 12 weeks following treatment . During the treatment period mean number of hot flashes at day and night was significantly reduced by 50 and almost 60 % , respectively from baseline in the acupuncture group , and was further reduced by 30 % both at day and night during the next 12 weeks . In the sham acupuncture group a significant reduction of 25 % in hot flashes at day was seen during treatment , but was reversed during the following 12 weeks . No reduction was seen in hot flashes at night . Kupperman index was reduced by 44 % from baseline to the end of the treatment period in the acupuncture group , and largely maintained 12 weeks after treatment ended . No corresponding changes were seen in the sham acupuncture group . Acupuncture seems to provide effective relief from hot flashes both day and night in women operated for breast cancer , treated with Tamoxifen . This treatment effect seems to coincide with a general health improvement measured with the vali date d Kupperman index
Hot flashes ( HFs ) are a common side effect of cancer treatment .
The purpose of this systematic review was to evaluate evidence related to the use of acupuncture for HFs in cancer patients .