Cancer treatment is finished! Now life can return to normal! Or can it? And why should acupuncturists be interested?
Earlier diagnosis and improved treatment mean more people are surviving longer after a cancer diagnosis. The American Cancer Society reports that in 2022, 69% of survivors had lived ≥ five years since their diagnosis; 47% had lived ≥10 years since their diagnosis; and 18% had lived ≥20 years since their diagnosis.1 Cancer is now regarded as a chronic, rather than a terminal, disease. This is good news.
However, the end of cancer treatment does not necessarily signal a return to good health. Cancer survivors report poorer health and well-being than people who have not had cancer; many suffer chronic consequences of cancer and its treatments. Some may also develop new symptoms many years after treatment has ended.
These long-term and late consequences of treatment may be physical and/or emotional and may impact quality of life. Survivorship has been described as “being disease-free, but not free of your disease.”2
Cancer Survivorship
There are many definitions of cancer survivorship. The National Cancer Institute defines cancer survivorship as a focus “on the health and well-being of a person with cancer from the time of diagnosis until the end of life,” and includes the “physical, mental, emotional, social, and financial effects of cancer that begin at diagnosis and continue through treatment and beyond … [including] issues related to follow-up care ... late effects of treatment, cancer recurrence, second cancers, and quality of life.”3
The definition encompasses family members, friends, and caregivers, who are also considered part of the survivorship experience. This covers a broad spectrum, and many definitions focus on the period following active or primary treatment, which deals with the aftermath or consequences of cancer treatments.
Examples of some of the many consequences include physical issues such as chronic pain (including chemotherapy-induced peripheral neuropathy, and joint and muscle pains associated with aromatase inhibitors), hot flushes and night sweats, lymphedema, fatigue, and sleep disorders.
Emotional consequences include fear of recurrence, anxiety, depression as well as isolation and loss of confidence. Social and professional roles may be affected, and cancer survivors experience more financial hardship than the general population.1
Late effects of cancer treatment include potential development of new primary cancers, heart disorders, and other serious conditions. These consequences can have a profound negative impact on quality of life.
The Missing Piece
In 1985, Dr Fitzhugh Mullan laid out three stages or seasons of survival in his seminal “Seasons of Survival: Reflections of a Physician with Cancer.”4 He defined “extended survival” as the time when treatment ends and the individual focuses on the consequences of treatment. The formation the following year of the National Coalition for Cancer Survivorship (https://canceradvocacy.org/) led to an increased focus on cancer survivorship.
Nevertheless, it is estimated that still as few as 1-2% of cancer survivors receive rehabilitation for cancer-related physical impairments.5
Furthermore, although research shows that psychological interventions may improve cancer survival, less than half of distressed cancer survivors receive professional care.1
What Does This Have to Do With Acupuncture?
In nearly 25 years of research into supporting people who have completed cancer treatment (surgery, chemotherapy, radiotherapy), I have observed how acupuncture can help them to recover and renew their lives and adjust to the “new normal.”6
Acupuncture can and should be considered part of the multidisciplinary care of cancer survivors. It has the capacity to address complex presentations commonly seen in this patient group: it is reported that up to 25% of cancer survivors experience long-term consequences of cancer and its treatments, and many suffer from multiple consequences, as well as pre-existing and newly arising comorbidities.7
Acupuncture offers a safe, evidence-based, non-pharmacological option for managing both the physical and emotional conditions arising in cancer survivorship, often within the same treatment. This is important because many of the consequences of cancer treatment have limited options for biomedical treatment.
Additionally, many cancer survivors do not wish to take further medications, and non-pharmacological options for managing pain are especially welcome in the age of the opioid crisis. Furthermore, randomized, controlled trials have shown acupuncture to be as effective as pharmacological interventions, but with fewer side effects, less rebound effect at the end of treatment, and with longer lasting and more wide-ranging benefits.8-9
Improving Our Approach to Caring for Cancer Survivors
Acupuncturists should be aware of the consequences of cancer treatment and how these affect any patient coming for acupuncture who has a history of cancer. Understanding the broader context of cancer survivorship enables a more profound approach to treatment.
For example, nearly 50% of survivors experience fear of recurrence up to and beyond five years post-treatment; awareness of this and the effect it can have on physical and emotions symptoms is an important aspect of supporting cancer survivors.6
An increasing number of clinical practice guidelines are being published, such as the SIO/ASCO (Society for Integrative Oncology / American Society of Clinical Oncology) pain management guidelines.10 These support the use of acupuncture in integrative oncology, and benefit acupuncturists, policymakers and cancer survivors.
With an estimated 18 million cancer survivors in the U.S., and 53.5 million globally, there is a great need for treatment options to address the consequences of cancer treatment.11 Acupuncture can be a valuable contributor to the multidisciplinary care for people living with and beyond cancer. In over two decades of research and practice, I have heard many cancer survivors say, “Acupuncture has given me my life back.”
Author’s Note: June is National Cancer Survivor Month, a good time to find out more about the issues cancer survivors face and how acupuncture can help them. Find out more about acupuncture and cancer survivorship at Beverleydevalois.com.
References
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The Oregon College of Oriental Medicine (OCOM) has announced it is closing after 41 years. Pending accreditor approval, OCOM will cease offering classes after September (fourth-year OCOM students graduate Aug. 26). All current / incoming OCOM students have the option of continuing their education at the National University of Natural Medicine or Five Branches University, or transferring to another school altogether.
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