Acupuncture No Better Than 'Sham' Version in Breast-Cancer Drug Study

Findings suggest any benefit resulted from placebo effect

Monday, December 23, 2013

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MONDAY, Dec. 23, 2013 (HealthDay News) -- When it comes to easing the side effects of certain breast cancer drugs, acupuncture may work no better than a "sham" version of the technique, a small trial suggests.

Breast cancer drugs known as aromatase inhibitors often cause side effects such as muscle and joint pain, as well as hot flashes and other menopause-like symptoms. And in the new study, researchers found that women who received either real acupuncture or a sham variation saw a similar improvement in those side effects over eight weeks.

"That suggests that any benefit from the real acupuncture sessions resulted from a placebo effect," said Dr. Patricia Ganz, a cancer specialist at the University of California, Los Angeles School of Medicine who was not involved in the study.

The placebo effect, which is seen in treatment studies of all kinds, refers to the phenomenon where some people on an inactive "therapy" get better.

However, it's difficult to know what to make of the current findings, in part because the study was so small, said Ganz, who studies quality-of-life issues in cancer patients.

"I just don't think you can come to any conclusions," she said.

Practitioners of acupuncture insert thin needles into specific points in the body to bring about therapeutic effects such as pain relief. According to traditional Chinese medicine, acupuncture works by stimulating certain points on the skin believed to affect the flow of energy, or "qi" (pronounced "chee"), through the body.

The study, published online Dec. 23 in the journal Cancer, included 47 women who were on aromatase inhibitors for early-stage breast cancer. Aromatase inhibitors include the drugs anastrozole (Arimidex), letrozole (Femara) and exemestane (Aromasin). They help lower the body's level of estrogen, which fuels tumor growth in most women with breast cancer.

Half were randomly assigned to a weekly acupuncture session for eight weeks; the other half had sham acupuncture sessions, which involved retractable needles.

Overall, women in both groups reported an improvement in certain drug side effects, such as hot flash severity. But there were no clear differences between the two groups. And in an earlier study, the researchers found the same pattern when they focused on the side effect of muscle and joint pain.

Dr. Ting Bao, who led the study, agreed that "you could conclude that it's a placebo effect."

On the other hand, it's also difficult to design a placebo version of acupuncture, said Bao, an assistant professor of medicine at the University of Maryland School of Medicine in Baltimore.

During the sham procedure, the needles did not penetrate the skin, and they were placed on areas of the skin that are not considered traditional acupuncture points. But the stimulation may have some physiological effect, Bao explained.

"It might not be completely inert," she said.

Many studies have suggested that acupuncture can help ease various types of pain, such as migraines and back aches, as well as treat nausea and vomiting from surgery or chemotherapy.

Some recent research suggests that the needle stimulation triggers the release of pain- and inflammation-fighting chemicals in the body.

The current study was mainly designed to look at one side effect from aromatase inhibitors -- muscle and joint pain, which all of the participants had suffered from since starting the drugs. Bao's team looked at hot flashes, sleep problems and other menopause-like symptoms as "secondary outcomes."

That's another limitation, Ganz said, because the study was simply not set up to test those particular effects. Eleven of the 47 women, for example, had no hot flashes when they entered the study.

Larger studies are still needed, said Bao. And they should also include a patient group that receives no acupuncture -- to see whether the procedure is better than doing nothing.

Still, Bao said that because acupuncture carries a low risk of side effects, women could give it a shot -- even if any benefits come from a placebo effect.

"The data are not definitive," she said. "But I think it's OK to explore this as an option because it's low-risk."

There are other options for managing aromatase inhibitor side effects. For hot flashes, certain antidepressants and the anti-seizure drug gabapentin are often effective, Ganz said.

For muscle and joint pain, Bao said there's evidence that exercise helps -- if a woman can manage that. In some cases, the side effect clears up if a woman switches to a different aromatase inhibitor, Bao noted.

While acupuncture may be low risk, there is the issue of cost. Prices vary, but a typical session runs around $100, and insurance may not cover it.

SOURCES: Ting Bao, M.D., assistant professor, medicine, University of Maryland School of Medicine, Baltimore; Patricia Ganz, M.D., professor, University of California, Los Angeles, David Geffen School of Medicine; Dec. 23, 2013, online, Cancer

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