Journal Sharing

Submitted by: Anna Dominique B. Santos BSN IV-A2 January 2014 Submitted to: Mr. Blas Blasil Purganan SLU HSH Palliative Ward

Is There a Role for Acupuncture in the Symptom Management of Patients Receiving Palliative Care for Cancer? A Pilot Study of 20 Patients Comparing Acupuncture with Nurse-led Supportive Care Jan T W Lim, Erin T Wong, Steven K H Aung

Distressing symptoms experienced in cancer decreases a persons quality of life. Most of the known symptoms that are not addressed in conventional medical therapies include fatigue, anxiety, depression, and lack of well-being. There are not many conducting studies in incorporating complementary and alternative medicine in treating cancer symptoms. Acupuncture involves inserting a very thin, solid, hair-like needles that help stimulate specific points of the body to positively affect the nervous system, increase proper blood flow to the symptomatic areas, and enhance overall healthy functioning of the body. The study aims to document the change in symptoms after acupuncture or nurse-led supportive care and to determine the feasibility of carrying out a randomised study in acupuncture for patients with advanced incurable cancer. Patients with commonly experienced symptoms such as pain, tiredness, nausea, depression, anxiety, drowsiness, anorexia, lack of well-being, and shortness of breath were investigated. They were made to answer The Edmonton Symptom Assessment System (ESAS) graph. Traditional Chinese Medical acupuncture was performed by the principle investigator. Acupuncture needles were connected to an electrical simulator (ITO Electroacupuncture UNIT ES160). In the nurse-led supportive care, patients met with an experienced palliative care nurse for 20-30 minutes weekly for 4 weeks. Results of the study showed a reduce of symptom scores by an average of 22% after each acupuncture visit and by 14% after each supportive care visit. ESAS scores at the end of the follow-up period were reduced by 19% for the acupuncture arm and 26% for nurse-led supportive care. The study suggests a benefit from incorporating acupuncture in helping with symptoms of advanced cancer. All nine symptoms were improved immediately after acupuncture with improvements continuing in six of these symptoms after 6 weeks. Six symptom scores improved immediately following nurse-led supportive care visits, with all nine symptoms showing improvement after 6 weeks. This pilot study confirms the feasibility of both acupuncture and nurse-led support for this patient population and justifies the need for future RCTs to confirm their efficacy in palliative cancer care. A supporting journal entitled CAM for depression, anxiety, grief, and other symptoms in palliative care by Karin Kraft said that anxiety and CRF may be successfully treated by

acupuncture and other selected CAM practices but not all may be helpful and may even severely reduce quality of life. Another supporting journal entitled Manual acupuncture as an adjunctive treatment of nausea in patients with cancer in palliative care a prospective, observational pilot study by Elisabeth Nystrom, Gunilla Ridderstrom, and Ann-Sofie Leffler claimed that acupuncture treatment in cancer patients can be associated with a significantly reduced intensity of nausea during a period of chemotherapy in their final phase of life. More studies must be conducted regarding the effectivity not only of acupuncture but also of other traditional Chinese medicine practices in treating the symptoms of cancer and the side effects of chemotherapy. Incorporation of these other treatments must be considered not only because of its possible cost effectiveness but also keeping in mind that as nurses and health care providers, we must do whatever we can to increase the quality of life of the patients under the palliative care.

References: Lim, J., Wong, E., Aung, S., (2011). Is there a role for acupuncture in the symptom management of patients receiving palliative care for cancer? A pilot study of 20 patients comparing acupuncture with nurse-led supportive care. Acupunct Med. 29 (), pp.173179 Kraft, K., (2012). CAM for depression, anxiety, grief, and other symptoms in palliative care. Progress in Palliative Care. 20 (5), pp.272-277 Nystrom, E., Ridderstrom, G., Leffler, A., (2008). Manual acupuncture as an adjunctive treatment of nausea in patients with cancer in palliative care a prospective, observational pilot study. Acupuncture in Medicine. 26 (1), pp.27-32 Noel Zosa L.Ac (). Acupuncture Treatment with a Licensed Acupuncturist in Manila. [ONLINE] Available at: http://www.acupuncturemanila.com/. [Last Accessed 24 January 2014].