Jun J. Mao, M.D.
Pain, a debilitating consequence of cancer and its treatment, is very common among patients with advanced cancer.1 It is persistent and often undertreated, and is associated with a decline in functional and mental health, usually accompanied by insomnia and fatigue.2 The use of opioids, a mainstay of cancer pain management, is facing increasing scrutiny as their potential for abuse has reached epidemic proportions. Patient concern about opioid side effects is also increasing, and as a result, non-pharmacological approaches to pain relief are often preferred.3
An integral part of traditional Chinese medicine, acupuncture involves inserting thin needles at predetermined points on the body. The needles may be stimulated with electricity to enhance the effectiveness of the treatment. Massage involves manipulating the body’s muscles and soft tissues to increase blood circulation and promote relaxation.
Dr. Andrew S. Epstein
Acupuncture has been proven to improve pain in cancer patients.Four Studies of cancer survivors have reported long-term reductions.5,6 Massage therapy has also been shown to be effective for pain in cancer patients.7 including those receiving hospice care,8 However, the improvement did not last long. Of note, ASCO and the Society of Integrative Oncology released joint guidelines in 2022 recommending acupuncture and massage for the management of cancer pain.9 However, the long-term effects of these treatments and their comparative effectiveness in patients with advanced cancer are unknown.
impact trial
The IMPACT study was conducted at Memorial Sloan Kettering Cancer Center and regional facilities in New York, New Jersey, and Florida to evaluate the long-term comparative effectiveness of acupuncture and massage for pain in patients with advanced cancer. . The study included 298 participants who had had pain for at least one month and for at least 15 of the past 30 days. These patients were considered by the clinician to have a predicted prognosis of at least 6 months. They were randomly assigned to receive 10 acupuncture or massage sessions per week, with monthly booster sessions for up to 26 weeks.
The primary endpoint, change in worst pain intensity score from baseline to 26 weeks, was measured using the Brief Pain Inventory (BPI range 0 to 10, with higher numbers indicating worse pain intensity or interference). (shown). Secondary outcomes included fatigue, insomnia, and quality of life.
Demographic and clinical characteristics of participants in both groups were similar at baseline. A total of 78% of patients had solid tumors, with the top cancer types being hematologic, breast, gynecologic, and gastrointestinal. The mean age of the patients was 58.7 years. A total of 200 patients were female, 220 were white, 33 were black, and 46 were Hispanic. Ninety-eight patients received opioids at baseline, with mean BPI pain severity scores and pain durations of 6.9 points and 3.8 years, respectively.
Findings showed that both acupuncture and massage reduced worst pain scores from baseline to week 26. The mean change for acupuncture treatment was -2.53 (95% confidence interval). [CI] = -2.92 to -2.15) points. Massage resulted in a mean change of -3.01 (95% CI = -3.38 to -2.63) points, with no significant difference between treatments (-0.48; 95% CI = -0.98 to 0.03; 95% CI = -0.98 ~ 0.03; P = .07). Both groups also reported improvements in pain-related dysfunction, fatigue, insomnia, and physical quality of life. Of note, the number of patients using pain medication at week 26 increased from 54.7% (95% CI = 40.6% to 68.1%) at baseline to 27.5% (95% CI = 14.1%) in the acupuncture group. ~46.7%). in the massage arm he was 35.6% (95% CI = 19.7% to 55.4%).
Adverse events were mostly mild, including bruising, localized pain, and bleeding in the acupuncture group.Ten Temporary pain and headache were observed in patients receiving massage.Ten
summary
Innovative treatments to extend the lifespan of patients with advanced cancer and the myriad challenges associated with the use of opioids for pain relief, there is a critical need for safe and effective options. New data from the IMPACT trial shows for the first time the benefits of both acupuncture and massage in providing lasting pain relief in patients with advanced cancer. These treatments were delivered safely during the COVID-19 pandemic. Given the increasing availability of these treatments in the majority of cancer centers, oncology care providers will need to increase their overall You should consider incorporating these treatments into your pain treatment plan. To use these treatments, it is important to find a qualified doctor with training or experience in treating cancer patients.
Disclosure: Dr. Mao Receives institutional research funding from Tibet Cheezheng Tibetan Medicine Co Ltd. Dr. Epstein Receives royalties from Up-To-Date for peer review of topical reviews in Gastrointestinal Oncology and Palliative Care and “Integrating Supportive Care in Oncology” in the HMP Global Learning Network’s Great Debate and Update on Gastrointestinal Malignancies ” received an honorarium for publication in 2023.
References
1. van den Beuken-van Everdingen MHJ, et al.: J Pain Symptom Manage 51:1070-1090.e9, 2016.
2. Dong ST, et al.: J Pain Symptom Manage, 48:411-450, 2014.
3. Liou KT et al.: Support Care Cancer 29:427-435, 2021.
4. He Y, et al.: JAMA Oncol 6:271-278, 2020.
5. Mao JJ, et al.: JAMA Oncol 7:720-727, 2021.
6. Hirschman DL, et al.: JAMA 320:167-176, 2018.
7. Boyd C, et al.: Pain Med 17:1553-1568, 2016.
8. Kutner JS et al.: Ann Intern Med 149:369-379, 2008.
9. Mao JJ, et al.: J Clin Oncol 40:3998-4024, 2022.
10. Epstein AS, et al.: JAMA Netw Open 6:e2342482, 2023.
Dr. Maoguest editor ASCO post‘s integrative oncology Series Lawrence S. Rockefeller is Chair of Integrative Medicine and Chief of Integrative Medicine Services at Memorial Sloan Kettering Cancer Center in New York. Dr. Epstein He is a medical oncologist and palliative care clinician researcher at Memorial Sloan Kettering Cancer Center in New York.
