A new survey has been undertaken in the US, to try to learn more about the extent to which acupuncture and Chinese herbal medicine are being used in cancer care. Collaborating authors were drawn from: Dana-Farber Cancer Institute, Harvard Medical School, Boston; Memorial Sloan Kettering Cancer Center, New York; Fred Hutchinson Cancer Center, Seattle; Indiana University School of Medicine, Bloomington; Refuot Integrative Medical Center, Tel Aviv.
Demographic and usage data was gathered from five clinics, each giving between 1100 and 4500 acupuncture treatments per year. In addition, to better understand the barriers faced by acupuncture and herbal medicine clinics in implementing their treatment modalities, over 2000 members of the Society for Integrative Oncology were approached worldwide for a survey. The authors knew that as of 2016, 73% of National Cancer Institute-designated cancer centres offered acupuncture, and that numerous clinical guidelines now include acupuncture for the management of symptoms in cancer care.
Key reasons for referral to acupuncture in the oncology centres surveyed here included pain/neuropathy, fatigue, low blood counts, insomnia, hot flushes and nausea/digestive dysfunction. A significant barrier to accessing acupuncture is cost: a review of covered nonpharmacologic pain options among 15 US insurance plans found only 1 in 5 offered acupuncture cover. Geographic accessibility is another barrier, with more than 50% of licensed acupuncturists concentrated in California, Florida and New York alone.
The authors say it was not surprising that pain and neuropathy were the primary reasons for a medical oncologist to refer a patient for acupuncture. There was a lack of referrals for immune support, despite some evidence in the literature on effects of acupuncture on neutropenia in patients receiving myelosuppressive chemotherapy.
In 1997 a 12-member panel at a National Institutes of Health Consensus Conference concluded there is clear evidence that acupuncture treatment is effective for postoperative and chemotherapy nausea and vomiting. Numerous clinical trials have since demonstrated the effectiveness of acupuncture for other cancer-related symptoms including cancer related pain, chemotherapy-induced peripheral neuropathy, fatigue, hot flushes, xerostomia, lymphedema, dyspnoea, cachexia, dysphagia, post-operative pain, anxiety, depression, insomnia, constipation, diarrhoea and the joint pains associated with aromatase inhibitors. The growth in data on the safety and efficacy of acupuncture in the treatment of cancer-related symptoms and treatment side effects, has been a driving factor behind the inclusion of evidence-based recommendations of acupuncture in public health statements by national and state governments, health departments and clinical practice guidelines for patients with lung and breast cancers. The inclusion of acupuncture in these clinical practice guidelines indicates broad support for acupuncture and an increasing acceptance of including acupuncture in standard cancer care by oncologists, conventional medical providers, and health systems including cancer centres.
In addition to the recommendations in clinical practice guidelines, acupuncture is recommended by the American Cancer Society (ACS) for the treatment of side effects associated with conventional cancer therapy and cancer-related ailments.
The authors conclude that among other things, an organised strategy for implementation of acupuncture and Chinese herbal medicine in oncology settings, involving a diverse group of federal and private payers and policymakers, is needed.
(Characteristics and Challenges of Providing Acupuncture and Chinese Herbal Medicine in Oncology Treatment: Report of Survey Data and Experience of Five Unique Clinical Settings. Integrative Cancer Therapies, 30 January 2024.)