Acupuncture and Chemotherapy: Contraindications & Guidelines. This article provides a straightforward guide for carrying our acupuncture treatment safely for a patient who is undergoing chemotherapy for the treatment of cancer.
In this article, there is an emphasis on treatment in a hospital or hospice setting, although this information equally applies to private clinic as regards acupuncture and chemotherapy.
This article contains references to various journal articles and studies carried out in cancer and palliative care as well as some of my own experience treating cancer patients with acupuncture and moxa in a hospice environment.
What is Chemotherapy?
Chemotherapy is a type of cancer treatment with drugs used to kill cancer cells. It is used if the cancer has spread or there is a risk it will. Curative cancer is used to kill cancer cells completely. Chemotherapy can be combined with radiotherapy or can be used before surgery. It can be used in a preventative way to reduce risk of cancer cells returning after surgery or radiotherapy. Palliative chemotherapy may be able to slow down or relieve symptoms.
Monotherapy is where one type of chemotherapy drug is used. Combination therapy is where a combination of chemotherapy drugs are used. Chemotherapy can be administered in tablets or injections into veins. Intravenous chemotherapy may be given though a cannula in a vein on the back of the hand or arm, a central line in the chest, a peripherally inserted central catheter (PICC) – a tube in the arm, or an implanted port (rubber chamber) surgically inserted under the skin. (Reference: NHS Website).
Chemotherapy is usually not recommended for patients in the first trimester of pregnancy, if they have low levels of blood cells, have severe kidney or liver disease, if they have had a recent surgery or wound as wound healing ability is impaired, if they have an ongoing infection. Patients under consideration will undergo blood tests to monitor kidney, liver and blood count. X-rays, CT and MRI scans may also be taken. A sudden fall in number of white blood cells means greater risk of serious infection. Cancer of blood cells and bone marrow may have an increased risk of severe infections due to reduced number of white blood cells.
Chemotherapy also destroys normal body cells. Side effects can lead to: feeling tired and weak all the time, sickness, nausea, vomiting, hair loss, Side effects can vary from minimal to severe and upsetting. Side effects will usually pass when chemotherapy is finished.
Other symptoms are tiredness, which may be caused by anaemia. Chemotherapy reduces red blood cells, leading too less oxygen in the body leading to tiredness and lack of energy.
Bruising and Bleeding – chemotherapy can make you more vulnerable to excess bleeding and bruising. Sleep Problems – insomnia, disturbed sleep. Diarrhoea and constipation. Depression – Living with effects of chemotherapy can be frustrating and can lead to anxiety and stress.
Acupuncture and Chemotherapy
Acupuncture has been used in palliative care and can be performed whilst undergoing chemotherapy. It can be carried out to help support chemotherapy and deal with side effects. However, unlike treating a relatively healthy member of the public, treatments of cancer patients should be adapted to the weaker state of the patient. There are a body of studies carried out on the use of acupuncture for chemotherapy side effects for things like vomiting and nausea, making acupuncture and chemotherapy a beneficial combination.
- Firstly, carry out acupuncture according to British Acupuncture Council (BAcC) – Code of Safe Practice. Available here.
- Treatments should be lighter. Avoid excessive needle manipulation (de-qi stimulation) as for some patients it can be draining. Avoid long needle retention – between 15 to 45 minutes is advisable. Use fewer needles.
- For patients at an increased risk of bleeding – use thinner gauge needles – 0.13 – 0.18.
- Do not use intradermal needles / semi-permanent needles during cycles of chemotherapy as there may be an increased risk of infection.
- Be aware of potential signs, which can indicate serious problem: high temperature of 38C or above, shivering, breathing difficulties, chest pain, flu-like symptoms, bleeding gums or nose, non-stop bleeding from another part of the body. Refer to patients care team immediately.
- Consent must be obtained. The treatment procedure must be explained. Without consent, no treatments can be performed.
- Contraindications: – Acupuncture may not be appropriate for patients with severe blood clotting dysfunction or who bruise spontaneously due to increased risk of bleeding. For patient with low levels of white blood cells, or after a splenectomy – no intra-dermal needles to be retained as there is a risk of infection. Patient who are allergic to needles may be at risk of a reaction. Electro acupuncture is prohibited in people with a pacemaker.
- Patients on high levels of blood thinner should be performed with greater care. Use thinner gauge needles e.g. up to 0.18. Apply pressure to site after withdrawing the needle.
- Take care over chest area to avoid pneumothorax.
- If the patient is confused, or disoriented, treatment is not advisable.
- Avoid needling into joints to reduce risk of haemarthrosis.
- Avoid arteries or veins.
- Cancer patients may also be on immunosuppressant’s and can be at greater risk of infection. Avoid cross infection. Cleans hands, use sterile needles, keep a clean sterile environment.
- Do not advise patients to abandon conventional treatment in favour of acupuncture alone.
Needling should be avoided:
- In lymphoedematous limbs – limbs prone to lymphoedema
- Directly over a tumour
- Into an area of ulceration
- In the ipsilateral arm of patients who have undergone axillary dissection – risk of swelling or lymphoedema
- Areas of spinal instability due to acupuncture’s relaxing effect and therefore risk of core compression
(Reference: Filshie & Hester 2006)
Practical Use of Acupuncture in Chemotherapy:
Nausea and Vomiting (pericardium 6 point)
Nausea and vomiting are common symptoms of chemotherapy. Acupuncture, electro acupuncture or acupressure has been found to be helpful at reducing these symptoms if applied to the point P6 and St 36 (Reference: Ezzo J et al 2006). Other studies have shown that P6 is useful for this.
Tiredness: Acupuncture and Chemotherapy
Acupuncture can be helpful for fatigue for post-chemotherapy fatigue. Points – ST36, SP6, CV6, CV4, KID3, and KID27, LI11 (ecept for axillary lymph node dissection) were found to be helpful in one study – (Reference: Vickers et al).
Other studies may indicate that acupuncture is beneficial for depression, which is not related to chemotherapy – (Reference: Roschke et al)
Relaxation: Acupuncture and Chemotherapy
From personal experience, it is quite apparent that patients with cancer are under a tremendous amount of worry and anxiety. There are fears for the future, concerns for family and financial implication of stopping work. If they are taking chemotherapy, they must also deal with the strong side effects of these drugs. Patients may be under a rather large amount of stress. Acupuncture offers something that conventional medicine cannot provide – a therapy that is able to create a state of relaxation for the patient which can continue after the treatment has finished.
In this case, do not underestimate the value of a point like Yintang. This point can bring about a strong state of relaxation. Also it is highly versatile in cases, where a patient’s condition is very weak, this single point can be useful. In this way acupuncture and chemotherapy can be a beneficial combination to help deal with the mental and emotional strains of going through this phase of treatment.
Awareness of Adverse Reactions
Adverse reactions can occur during or after a treatment. These may be feelings of dizziness, fainting, spontaneous sweating, bruises to the needled area. If reactions occur during needling, quickly remove needles and encourage the patient to lie or sit for 20-30 minutes or until they feel better and offer water. Bruising typically looks unpleasant, but will heal within a few days. This will need to be explained to the patient. If any symptoms persist or there is pain or other concerning signs, consider sending to A&E.
Additionally, moxa can be used to treat patients with acupuncture and chemotherapy. Moxa may be prohibited from use on wards due to the smell but may be permissible in private treatment rooms and in-group activities.
Moxa – Fire Alarms and Evacuation
Check the status of fire alarms and ventilation before using loose /rolled moxa. Hospices and hospitals may have strict evacuation protocols. The last thing a therapist wants is to be responsible for half the hospital being evacuated because they used a little moxa directly under a fire alarm. Usually a smokeless variety should be usable without setting off alarms.
Moxa can be very effective for treating patients with cancer. I have particularly found smokeless moxa on the Stomach 36 point to be very effective at lifting energy levels. Also on back shu points may help. Avoid applying moxa directly over tumour areas. I have not found tumour to be particularly effective in reducing cancer related pain. However, it may have secondary beneficial effects – e.g. reducing shoulder stiffness due to stress or back-pain for other non-cancer related issues as well as generally enhancing energy levels and the immune system.
- Smokeless moxa sticks, stick on moxa, or needle tip moxa can usually be used in a hospital or hospice environment. In private practice or where smoke is not an issue, normal loose/rolled moxa can be used.
- Always have a container of water nearby to extinguish it in.
- Storage: Keep flammable liquids separate from lighters and other combustibles.
- Never leave the patients unattended whilst using moxa. Be very weary of burning skin.
- Ensure you are properly trained to use moxa before using.
- For stick on moxa – never burn all the way down to the base to avoid scarring. Burn halfway to two-thirds max, then remove. Remove firmly with pincers or use your fingers.
- If patients feel uncomfortable at any point, remove immediately.
- Be wary of dropped ash from needle tip moxa. Use shields if necessary.
- If a patient has fever, do not use moxa.
Moxa Studies: Acupuncture and Chemotherapy
There is currently a study being undertaken to study the effects of moxa on St36 on reducing chemotherapy-induced pancytopenia – lack of red and blood white cells (Reference: B de Valois et al 2016).
Author: John Dixon, Lead Acupuncturist at St Joseph’s Hospice, London UK, from 2014-2017
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NHS Website – Chemotherapy: http://www.nhs.uk/conditions/chemotherapy/
British Acupuncture Council (BAcC) – Code of Safe Practice: https://www.acupuncture.org.uk/public-content/effective-practice/bacc-professional-codes.html
Filshie J. Hester J. Guidelines for providing acupuncture treatment for cancer patients – a peer-reviewed sample policy document, Jacqueline Filshie, Joan Hester. ACUPUNCTURE IN MEDICINE 2006;24(4): 172-182.www.medical-acupuncture.co.uk/aimintro.htm
Ezzo J et al 2006. Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting (Review) – Cochrane Collaboration, Ezzo J et al 2006, The Cochrane Library, Issue 2).
Vickers et al. Acupuncture for Postchemotherapy Fatigue: A Phase II Study, Journal of Clinical Oncology, Vickers et al
Roschke et al. The benefit from whole body acupuncture in major depression, Journal of Affective Disorders, vol 57, Roschke et al
Valois et al. Limiting Side Effects by Using Moxa, The European Journal of Oriental Medicine, B de Valois et al 2016
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