Support for people with Oral, Head and Neck Cancer with Traditional Chinese Medicine
By Matthew Enright, AP, DOM
Traditional Chinese Medicine (TCM) is based on traditional medical practices originating in China. TCM stems from the belief that what happens to one part of the body affects every other part of the body. Similarly, organs and organ systems are viewed as interconnected structures that work together to keep the body balanced and harmonious.
TCM is a complete medical system that recognizes true healing is a multi-dimensional process. This ancient holistic medical system, understands that the mind, body, spirit and emotions must all be focal points during the healing journey.
The mind and the emotions play an influential role in creating wellness or illness and attracting disease. All of these aspects and their relationships are mapped out in the theories that form the foundation of TCM: the Theory of Yin/Yang, the Theory of Qi or vital energy, Meridian Theory and the Five-Element Theory. TCM has used these time-tested theories to understand, diagnose and effectively treat health problems and conditions in continuous practice for thousands of years.
Acupuncture is the most commonly used system of healing in the world as it is one of the oldest systems of medicine dating back 4,000 years.
Treatment For Oral, Head And Neck Cancer Patients
Typically cancers of the head and neck begin in the squamous cells in the mucosal lining inside the head and neck (for example, inside the mouth, the nose and the throat). These squamous cell cancers are commonly referred to as squamous cell carcinomas of the head and neck. While relatively uncommon, cancers of the head and neck can also begin in the salivary glands. There are several types of salivary gland cancers as these glands contain a variety of different types of cells that can become cancerous.
The integration of Traditional Chinese Medicine and Western medicine and their clinical effects have been widely evaluated. Studies have shown that using a combination of both Traditional Chinese Medicine and Western medicine has resulted in better outcomes versus using only one of them. Acupuncture is a Traditional Chinese Medical modality, which plays an important role in pain management, functional improvement, overall wellness and prevention.
Acupuncture is currently being utilized in the treatment of cancer patients for pain management, fatigue, reduction of post-operative and chemotherapy-induced side effects and to increase saliva production in patients suffering from xerostomia (dry mouth) which is commonly experienced by cancer patients following radiation of the head and neck regions.
Acupuncture has also alleviated joint pain and stiffness, reduced stress and improved overall physical and mental well-being in patients. Acupuncture is generally safe, painless and well tolerated by patients. It is noted that particular conditions require continuous treatments in order to achieve long-term effect. Current research available through Memorial Sloan-Kettering Cancer Center in New York supports the efficacy of acupuncture in the following areas: – acupuncture for the treatment of pancreatic cancer pain – acupuncture for hot flashes in breast cancer patients – acupuncture for post-thoracotomy pain – functional magnetic resonance imaging (fMRI) and acupuncture for pain and dysfunction after neck dissection, acupuncture for xerostomia (dry mouth).
Further research, education and clinical trials are required to continue the validation and integration of acupuncture and integrative oncology treatments in conjunction with conventional treatments currently available.
Post Operative Pain Management
Acupuncture is most commonly known for its ability to successfully manage and treat pain. Pain is typically an indication, forewarning or a direct result from a problem or condition that exists somewhere in the body. The intensity of the pain (typically measured on a VAS pain scale of 1-10) can usually indicate the severity of the problem and the quality of the pain can also give insight as to the underlying cause of the pain. Typically acupuncturists will note two types of pain qualities; "dull and achy" or "sharp and stabbing." Dull and achy pain refers to "energy" related pain or qi stagnation; sharp and stabbing pain refers to blood stagnation or stasis (specific acu-points will be utilized depending upon the quality of the pain). Both can be ameliorated with local and distal acupuncture treatments which will stimulate a series of reactions along the pain pathway (the previous mentioned phenomena of improved circulation, reduced inflammation and endorphin release).
By increasing the blood supply to a post operative area and surrounding tissue(s), acupuncture treatments are able to accelerate the recovery process following surgical procedures and provide short term symptomatic pain relief as well as long term chronic pain relief. Other factors which also have importance in determining the appropriate treatment protocol would be a specific time of day the pain is better or worse, whether the pain is affected with climatic changes, whether the pain better or worse with ice or heat, movement or rest etc.
As noted in a 2004 study by the American Society of Clinical Oncology, Acupuncture for Post Chemotherapy Fatigue: A Phase II Study; Generalized fatigue and chronic fatigue symptoms are often experienced by both cancer patients and cancer survivors. Currently, chronic fatigue is not diagnosed with a specific test nor is there a specific treatment available with conventional medicine. Through a differential diagnosis, Acupuncturists are able to determine a syndrome or organ system specific cause of the patients' symptoms.
The goal of the treatment is to provide the patient with long term relief by addressing the underlying problem and not simply masking the symptom. This is often referred to as treating the "root vs. the branch" or the "core vs. the symptom." While addressing the patient's complaint(s) or disorder(s), we want to offer symptomatic relief while working on and addressing the root of the problem or core issue(s) to prevent or decrease the likelihood of the symptoms returning. Typically in TCM, chronic fatigue symptoms and syndromes stem from a deficiency or weakness of qi. By utilizing acu-points that specifically regulate the movement of qi and restoring the healthy circulation of qi and blood throughout the body, patients are able to feel an overall increase in energy, vitality and general well being.
Post Operative and Chemotherapy-induced Side Effects
The NIH Consensus Panel on acupuncture in 1997 concluded that there is evidence that acupuncture is effective for adult postoperative and chemotherapy induced nausea and vomiting. Research supports the use of the acupuncture point PC-6 (Neiguan) which is located on the palmar side of the forearm, approximately three fingers above the crease of the wrist, to counteract the adverse flow of qi, which is typically associated with nausea and vomiting. Acu-pressure can be applied to this point by the patient and is often encouraged during treatment to increase the efficacy of the acupuncture treatments and provide patients with relief on their own.
While multiple acupuncture points can help the overall post operative and chemotherapy-induced side effects, other variables will determine the specific treatment protocols and selected acupuncture points for each individual patient. Although many patients may present with comparable signs and symptoms, treatments, selected acupuncture points and additional therapies warranted can and will vary based on the differential diagnosis performed by the acupuncturist.
Xerostomia is the condition of abnormal dryness of the mouth due to decreased secretion of saliva or spit to keep the mouth wet. It is a disheartening condition which can significantly impair quality of life in sufferers. As per the National Cancer Institute, Head and neck cancers account for approximately three percent of all cancers in the United States and their treatment by radiotherapy gives rise to xerostomia in most cases.
Cancer patients typically exhibit a high prevalence of xerostomia. According to a 1999 study, roughly 70 percent of seriously ill cancer patients suffered from xerostomia. Studies show a significant increase in saliva both during and after acupuncture treatments, which involve manual or electrical stimulation. Patients are typically treated with specific acupuncture protocols involving points to calm the mind, reduce inflammation and hypersensitivity, increase saliva and additional support to other acu-points based on symptom variables. Treatments include both body acupuncture and auricular (ear) acupuncture. Acu-pressure treatments may also be included in the patients' treatment plan as this will allow patients to treat themselves while not in the office in an effort to maximize treatment efficacy and results.
Studies also show improvement with saliva output in patients that are given sugarless mints during treatment to help stimulate salivary flow, although the mints usually produced little, if any, saliva without the use of acupuncture. In 2011, a randomized controlled trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma showed acupuncture given concurrently with radiotherapy significantly reduced xerostomia and improved quality of life.
Patients are usually treated once or twice a week for six to eight weeks with continued treatments as necessary. The number of treatment sessions will vary from patient to patient dependent upon other variables the patient may be dealing with (insomnia, digestive disorders, emotional strains and stressors etc.) In certain instances, increase in salivary flow can be seen as soon as the first visit and the duration of improvement typically increases as the treatments continue, while other patients may need several treatments to receive an improvement.
The focus of the treatments is to get patients into what is known as the "wellness phase" where the patient's protocol will be dictated by how the overall patient response is. Meaning, once the patient reaches this wellness phase, if they feel good for 15 days, we want to see them in 15 days, if the patient feels good for 30 days, we want to see the patient in 30 days etc., ultimately coming in for treatments and follow-ups for overall maintenance and well being.
Matthew Enright, AP, DOM is a Diplomate in Oriental Medicine and currently practices acupuncture in Manhattan and Long Island, New York. Matthew is a wellness-driven acupuncture Physician, with 12 years experience serving diverse populations with an emphasis on pain management, sports medicine, neurological disorders, women’s health issues, cosmetic acupuncture and integrative oncology with an impressive background offering integrative care for both acute and chronic conditions. For more information, please visit www.westislipacupuncture.com or www.phlexnyc.com.