West Meets East: How Acupuncture Has the Potential to Support the Veterinary Oncology Patient

acupuntureThe practice of Traditional Chinese Veterinary Medicine (TCVM) is gaining in popularity. The past few decades have seen a surge in the popularity and acceptance of Eastern Medicine practices, specifically acupuncture, amongst physicians. As the practice of Traditional Chinese Medicine becomes more widely accepted for people, companion animal clients will look to these modalities to help alleviate aliments of their pets. In 1998, the National Institutes of Health (NIH) published a consensus report summarizing research findings on the usefulness of acupuncture for chemotherapy-induced nausea as well as post-operative pain secondary to tumor removal in people1. The findings confirmed that acupuncture is beneficial for these conditions1. This report sparked major interest in acupuncture as a compliment to physician-based Western Medicine. Since 1998 there has been a surge in funding to support research evaluating the molecular mechanisms and the clinical benefits of acupuncture for various diseases2. As more and more positive research is published, Western medicine practitioners are gaining more confidence in using this modality as a tool in their tool-belt. It is not surprising that the top tier, world-renowned U.S. Cancer Institutes such as, Dana-Farber in Boston, Sloan-Kettering in New York, and MD Anderson in Houston, all have integrative medicine programs closely associated with their cancer centers. As interest in acupuncture rises in physician-based medicine, veterinary medicine is not far behind.

Acupuncture has three key elements: the acupuncture point, the stimulating method, and the therapeutic effect. Research has demonstrated that the acupuncture point has high electrical conductivity, low electrical resistance, and contains large numbers of arterioles, lymphatic vessels, nerve endings, and mast cells. The most common stimulating techniques involve dry needle (placement of needle alone) or electroacupuncture (use of low level electricity connected to a needle in an acupoint). Human and veterinary studies have been reported showing the benefit of acupuncture for conditions including: alleviation of pain3-6, modulation of the immune system and anti-inflammatory response7,8, and alleviation of nausea9,10. Acupuncture modulates the activity of peripheral and central neural pathways. Acupoints overlie major neuronal bundles, for example the pericardial points (Pericardium Meridian) overlie the deep median nerve and the gastrointestinal points (Stomach Meridian) overlie the deep peroneal nerve. As the point is stimulated, there is activation of peripheral and central neural pathways, leading to an effect on hormones, cytokines, neurotransmitters, and other chemical mediators in the body.

How can acupuncture help the oncology patient (human or pet)? Research from physician-based medicine does support the use of this modality for the human oncology patient. Two studies (of many) were chosen to be summarized here. The first study is a three-armed, randomized, prospective clinical trial published in The Journal of the American Medical Association. Women with high grade mammary carcinoma, treated with high dose myeloablative chemotherapy, were randomly assigned to three separate groups: anti-emetic alone, anti-emetic with electroacupuncture, anti-emetic with sham acupuncture (acupuncture at non-therapeutic location). The study found that women in the electroacupuncture and anti-emetic treatment group had significantly less vomiting episodes compared to women in the two other groups10. The second study from The Journal of Clinical Oncology, a randomized, prospective, blinded clinical trial evaluated the benefit of acupuncture in alleviating joint pain secondary to aromatase inhibitor chemotherapy treatment in women with breast cancer5. Aromatase inhibitors are agents known to cause severe joint pain in patients. Women were divided into two groups, one group (‘treatment’) receiving true acupuncture and one group (‘control’) receiving ‘sham’ acupuncture (acupuncture needle placed in a non-therapeutic location)5. The women were blinded as to which group they were enrolled. The study found that women in the treatment group had significantly lower pain scores compared to women in the control group5.

In light of the positive research findings reported for acupuncture use in human oncology patients, we may theorize that this modality may help support the veterinary oncology patient as well. Looking back in veterinary medicine history, if data was lacking, our predecessors looked to research from our physician colleagues to help advance veterinary medicine. Many diagnostic techniques and therapeutic approaches determined to be helpful in people; have also been shown to be beneficial in our pets. Chemotherapy, surgery and radiation are the most common modalities used to treat cancer in veterinary patients. In general, these treatments are better tolerated in veterinary patients compared to human patients. Most chemotherapy protocols for veterinary patients are designed to result in less than 5% hospitalization rate and less than 1% mortality rate11,12. This is accomplished by reducing dose intensity, either by way of less frequent treatment, using single-agent protocols, or lower dose of chemotherapeutic agent11,12. In theory, these adjustments may negatively impact the overall efficacy of the treatment. In addition, despite these adjustments, side effects including gastrointestinal upset, cystitis and bone marrow suppression still occur11,12. Since acupuncture has been shown to help mitigate chemotherapy side effects in people, we may theorize that this modality may be just as useful in the veterinary oncology patient. Acupuncture may be used to help alleviate the severity and decrease the duration of side effects, therefore reducing the recovery and delay time between chemotherapy treatments. Furthermore, it should be evaluated that if the use of acupuncture reduces the risk of side effects, the dose intensity may be increased to potentially improve tumor cell death and benefit efficacy of cancer treatment. In addition, the tumor itself may cause symptoms in the patient which impact the overall quality of life and therefore decrease the survival time. For example: gastroenteritis and poor appetite in GI lymphoma patient, bone pain in osteosarcoma patient, and cystitis pain in patients with transitional cell carcinoma of the bladder. Just as acupuncture helps mitigate pain for human patients; it may help support our veterinary patients, thereby improving their overall quality of life, resulting in potentially longer survival outcomes. To the author’s knowledge, there have been no published studies evaluating acupuncture for issues which may arise for the veterinary oncology patient, specifically, treatment- or tumor-induced side effects. This is an area of study with a great deal of potential.

It is important to note that acupuncture is not a miracle cure-all any more than conventional medical interventions. Both conventional Western medicine and Traditional Chinese Veterinary Medicine have their strengths and weaknesses. The ideal situation is using a combination of both TCVM and Western medicine to complement the strengths of each system.

References:

NIH Consensus Conference. Acupuncture. J Am Medical Assoc. 1998. 280: 1518-24.
Weidong et al. Hematology Oncology Clinics North Am. 2008. 22(4): 631.
Xie, et al. Am J Trad Chinese Vet Med. 2009. 4: 17-29.
Wong, et al. Annals Thoracic Surgery. 2006. 81: 2031-36.
Crew, et al. Journal Clinical Oncology. 2010. 28: 1154-60.
Ju, et al. Neural Regeneration2013. Sep 5;8(25):2350-9.
Pais, et al. Evid Based Complement Alternat Med. 2014. 217397.
Da Silva, et al. Molecular Neurobiology. Jun 25.
Koh, et al. J Am Veterinary Medical Assoc. 2014. 244 (7): 820.
Shen, et al. J Am Medical Assoc. 2000. 284: 2755-61.
Vail. Veterinary and Comparative Oncology. 2007;5(1):38-46.
Chun, et al. Cancer Chemotherapy. In:Withrow MacEwen Sm An Clin Onco. p 163-192.

Submitted by: Kate Vickery, VMD, MS, DACVIM (Oncology)kate

Dr Vickery is studying to obtain Certification for Veterinary Acupuncture. In early January she will open the Acupuncture Service at Hope Veterinary Specialists, along with colleague Dr Jeff Wilson (anesthesiologist). Her goal is to use acupuncture on a daily basis to help support the oncology patient, as well as investigate the benefits this modality has for these patients through clinical research studies.

 

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