by NCI staff
A large, rigorous clinical trial showed that acupuncture may reduce joint pain caused by aromatase inhibitors in women with breast cancer.
Credit: iStock
Results from a large, rigorous study of this approach in postmenopausal women with early-stage breast cancer found that acupuncture may reduce joint pain caused by drugs called aromatase inhibitors. Ta.
Many women with early-stage hormone receptor (HR)-positive breast cancer rely on estrogen to promote tumor growth and take aromatase inhibitors after surgery to reduce the risk of cancer recurrence. These drugs, which inhibit estrogen production, are also used to prevent breast cancer in postmenopausal women who are at high risk for breast cancer and to treat HR-positive metastatic breast cancer.
“About 50% of patients taking these drugs complain of joint pain or stiffness, and about half of them say the pain is severe,” which may cause some women to stop taking the drugs. said Dawn Hirschman, MD, the study’s principal investigator. of Columbia University Medical Center.
Some small studies suggest that acupuncture may alleviate the joint pain and stiffness associated with aromatase inhibitors, but other studies have shown no effect. said Dr. Hirschman, who presented the results of the new study at the San Antonio Breast Cancer Symposium on Dec. 7. She and her colleagues designed a large-scale study to get a clearer answer to the question of whether acupuncture can reduce the pain associated with aromatase inhibitors.
“Identifying interventions to address joint pain caused by aromatase inhibitors is essential, but so far lacking. This trial shows that acupuncture, compared to a placebo, increases the impact these patients experience. “We have demonstrated this potential as a durable, non-pharmacological option to improve musculoskeletal symptoms,” said Raquel Reinbold, M.D., a breast cancer medical oncologist at The Ohio State University Comprehensive Cancer Center. said. People not involved in the research.
“Reducing the experience of drug toxicity may lead to improved adherence.” [to therapy]And ultimately improved breast cancer outcomes,” Dr. Reinbold said.
And as an alternative to, or in addition to, taking prescription painkillers, receiving acupuncture treatment and working with an acupuncturist can empower patients to manage joint pain that can occur as a side effect of cancer treatment. Anne O’Mara said it could help make people feel better. Ph.D., RN, Director of Palliative Care Research, NCI Division of Cancer Prevention.
A key strength of the study is that it was a multi-institutional trial and included many patients from academic medical centers as well as general medical oncology practices, Dr. O’Mara said. It pointed out. This means that the results are likely to be broadly generalizable to women in the community.
Pain relief continues even after treatment ends
The clinical trial was led by the NCI-funded SWOG Clinical Trials Group and conducted at 11 sites participating in the NCI Community Oncology Research Program. (NCORP). All 226 women in the trial were taking the third-generation aromatase inhibitor anastrozole (Arimidex®).®letrozole (Femara®)®or exemestane (Aromasin®)®– After surgery for early-stage HR-positive breast cancer, participants were randomly assigned to receive real acupuncture, sham acupuncture (placebo), or no treatment.
In sham acupuncture, short, thin needles are shallowly inserted into areas other than acupuncture points.
All acupuncturists who participated in this study were licensed and underwent rigorous on-site training by the acupuncturists on the research team. They were monitored for quality of care throughout the study.
To participate in the study, women must not have taken opioid or corticosteroid medications or received alternative or physical therapy for AI-related joint pain in the past four weeks. Of note, 80% of patients in the study were taking over-the-counter acetaminophen or ibuprofen for joint pain and did not experience relief, Dr. Hirschman said. be.
Roughly half of the study participants (110 people) received full-scale acupuncture twice a week for six weeks, followed by weekly maintenance sessions for an additional six weeks. The other half were in one of two control groups: 59 received sham acupuncture on the same schedule as the real acupuncture group, and the remaining 57 received no treatment.
Dr. Hirschman explained that the no-treatment group was included to control for possible benefits or negative effects of sham acupuncture.
The researchers followed the women for an additional 12 weeks after treatment ended. Patients reported on their pain before, during, and after treatment using a variety of methods, including a questionnaire that allowed women to rate their “worst pain” on a scale of 0 to 10.
After 6 weeks, “worst pain decreased by an average of 2 points” [in the true-acupuncture group compared with worst pain before treatment]This is a significant reduction.” Dr. Hirschman said these effects were maintained after 12 weeks.
Furthermore, “even at 24 weeks, women in the full-scale acupuncture group had less overall pain than women in either group.” [control] group,” Dr. Hirschman added.
The main side effect of true versus sham acupuncture was mild bruising, which was more common in the true acupuncture group than the sham acupuncture group.
Patients in both the sham acupuncture and no-treatment groups reported an average decrease of about 1 point in their worst pain at six weeks. It’s not clear why the control group also showed improvement, but Dr. Hirschman said that in symptom management studies, where patients are monitored and evaluated over time, researchers often observe improvement in symptoms in the control group. He said there are many.
Further investigation is planned
Dr. Hirschman said the new findings should make health care providers more likely to recommend acupuncture to their patients.
“Acupuncture is a safe and effective alternative approach to managing aromatase inhibitor-induced joint pain. The main limitations of this treatment at this time are cost and availability. Hopefully this will [new] Data may generate additional discussion regarding reimbursement [by medical insurance] And access to treatment,” Dr. Reinbold said.
Dr. O’Mara said a possible limitation of the study was that although it included patients from all over the United States, most participants (88%) were white. Only 5% and 7% of participants were black or Asian, respectively.
As always, some questions remain. “Should I go back to normal if it starts to hurt?” [for more acupuncture sessions]Should I continue treatment, say once a week, until I finish taking the aromatase inhibitor?? ” asked Dr. O’Mara.
The team does not intend to pursue these questions. However, Dr. Hirschman said, “We offered everyone 10 acupuncture sessions at the end of the 24 weeks, regardless of which group they were in. We looked at how many patients in each group accepted the offer. We plan to conduct another analysis to find out.” ”
The research team also tested patients throughout the clinical trial to better understand the causes of joint symptoms associated with aromatase inhibitors and “what the mechanism of acupuncture is in terms of reducing pain.” He said they plan to use tissue samples collected from. Hirschman said.
