Page 2533 - Hematology_ Basic Principles and Practice ( PDFDrive )

2256 Part XIII Consultative Hematology

Studies have shown that prayer is good medicine and is considered imaging signals during acupuncture. Acupuncture was confirmed as
by many to be a mind–body therapy. Dr. Harold Koenig, director of an effective intervention for CINV at an NIH consensus conference
Duke University’s Center for Spirituality, Theology and Health, in 1997. Whether this beneficial effect is attributable to an induced
studied the connection between spirituality and well-being. Prayer is relaxation response or a direct antiemetic effect is not known.
associated with less depression, anxiety, better physical health and Randomized clinical trials on acupuncture have been used in a
well-being. People who have a prayer practice have less cardiac disease variety of settings. As mentioned earlier, only individuals who are
and hypertension and better measurable immune functioning. naive to acupuncture can take part in acupuncture studies because
Mind–body therapies, such as hypnosis, give people hope and foster they will note the difference between active acupuncture and its sham
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acceptance of one’s physical condition. Yoga and physical activity component. Acupuncture has been shown to be effective in random-
have been studied to determine whether there is a related reduction ized clinical trials in cancer-related fatigue, cancer-related pain, and
in symptoms of depression and anxiety. In general, the practice of postoperative pain as well as reduced CINV in adults and children.
yoga has increased from 5.2% of the 45–64 age population in the In addition, acupuncture can improve radiation-induced xerostomia,
year 2000 to 7.2% in 2012. A number of yoga practices may be vasomotor symptoms such as hot flashes, and chemotherapy-induced
helpful for people with cancer in reducing stress and managing side neuropathies.
effects, both during and after chemotherapy and medical procedures. Several randomized clinical trials conducted in China have sug-
Restorative yoga postures can be both energizing and relaxing, requir- gested that acupuncture could be effective in reducing the marrow
ing almost no physical effort. Yoga can also help with pain. Yoga also suppression in patients on aggressive chemotherapy. Analysis of these
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stresses the value of community. There is evidence that participating trials performed by Lu et al suggest that acupuncture is associated
in a cancer support group may increase odds of survival. So far, there with an increase in neutrophils and total white blood cell count in
are no scientific studies on whether yoga can improve survival rates. patients during chemotherapy or chemoradiation therapy. The
However, suggestive evidence comes from Dr. Dean Ornish, best weighted mean difference of over 1000/µL white blood cells on
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known for his work using a comprehensive lifestyle program that average is a statistically significant difference. Lu et al carried
included yoga for heart disease. Dr. Ornish has been studying a out a small, randomized, sham-controlled clinical trial in the United
similar approach for prostate cancer. In a 12-week yoga intervention States exploring this issue in ovarian and breast cancer patients receiv-
in healthy subjects, it was demonstrated that there was greater ing aggressive chemotherapy. Using manual and electrostimulation
improvement in mood and anxiety than a metabolically matched two to three times per week for a total of 10 sessions beginning
walking exercise. The authors demonstrated an acute increase in 1 week before the second cycle of chemotherapy, the median leuko-
thalamic GABA (γ-aminobutyric acid) levels alongside the improve- cyte count in the active acupuncture arm at the first day of the
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ment in mood and anxiety scales. White et al demonstrated the next cycle was significantly higher than in the sham arm. The
potential benefits of physical activity for children with acute lympho- median leukocyte nadir, neutrophil nadir, and recovering absolute
cytic leukemia. neutrophil counts were all higher but not statistically different. The
In summary, it is evident that mind–body therapies can reduce result showed improved neutrophil counts both at the nadir and
anxiety, temper the adverse effects of chemotherapy and radiation rebound points during chemotherapy, but the sample size of the study
treatments, relieve pain, and possibly stimulate immune responses. was underpowered.
By reducing stress and anxiety, these therapies can help patients deal Uncontrolled pilot studies of acupuncture have shown effective-
with a wide range of relationship issues and decision making as they ness in reducing anxiety and improving mood and other quality-of-
move through the diagnostic and therapeutic phases of their malig- life measures in patients with both oncologic and hematologic
nancy. Mind–body approaches have very minimal risk and potentially disorders. These studies have shown improvement in sleeplessness,
significant benefits. Most importantly, they are often self taught and depression, and xerostomia. Acupuncture improved xerostomia
therefore low cost. Mind–body practices should be considered as an inventory scores in 18 patients who received radiation therapy and
adjunct to usual care regardless of whether patients are beginning or had pilocarpine-resistant xerostomia. In patients with hot flashes and
recovering from chemotherapy. vasomotor symptoms caused by chemotherapy, acupuncture attenu-
ated some of the hot flashes. In a controlled study comparing venla-
Acupuncture faxine and acupuncture, no statistical difference was found between
the favorable response to acupuncture and the medication. One study
suggested that acupuncture may be useful for drug-induced neuropa-
Overview and Definitions thy from thalidomide/bortezomib therapy for multiple myeloma. Ear
acupuncture was shown to be effective for phantom pain in a 16 year
One of the major components of traditional Chinese medicine has old after an amputation for osteosarcoma
been the use of acupuncture. For more than 2000 years, this tradi-
tional practice has been used in the Far East to “correct an imbalance
in yin-yang and qi (energy).” It is believed that with acupuncture, Safety
“blocked” channels can be unblocked, reducing symptoms. Acupunc-
ture is the stimulation of certain points on the body by needles or With the increasing use of acupuncture in the United States because
alternatively by pressure called acupressure. Both techniques take of evidence of its effectiveness, there are concerns about its
advantage of the meridians described by traditional Chinese medi- safety when used in the community, especially with hematology
cine. Acupuncture points are situated along meridians, which are patients and those getting chemotherapy and radiotherapy. However,
channels for “qi.” Sham or “fake” acupuncture implies the use of reports of major side effects of acupuncture are rare and usually are
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needles that are not inserted to the same depth, not put in the evident when performed by untrained practitioners. In closely
meridian points, and not given stimulation. Electroacupuncture monitored clinical trials, there is a low incidence of adverse events.
implies the use of added electric pulses to create additional or accen- In one study, the rate of minor adverse events was 14 per 10,000
tuated stimulation. Several studies have shown that electroacupunc- sessions; serious events were 0.05 per 10,000 treatments and 0.55 per
ture provides greater symptom relief than regular acupuncture. 10,000 individual patients. Common adverse events include blood-
borne infections and internal organ and tissue injury. In general,
acupuncture should be avoided in patients with severe neutropenia
Research on Usage and Effectiveness and thrombocytopenia (absolute neutrophil count <500/µL and
platelets <25,000/µL). However, in one study of acupuncture
Most acupuncture in the Western world is used to manage symptoms, given during stem cell transplantation, there were no bleeding side
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not treat disease. Research studies have demonstrated release of effects in individuals with severe thrombocytopenia (platelet counts
neurotransmitters and change of brain functional magnetic resonance <20,000/µL). Another study in children and adolescents undergoing