Treatment of Lymphedema with Saam Acupuncture in Patients with Breast Cancer: A Pilot Study

Abstract

Lymphedema is a troublesome complication affecting quality of life (QoL) in many women after breast-cancer treatment. Recent studies have suggested that acupuncture can reduce symptoms of lymphedema in breast-cancer survivors. This was a pilot study. It was designed to assess the feasibility and the safety of acupuncture with the acupuncture method for treating lymphedema in Korean patients after surgical therapy for breast cancer. This was a prospective, single-arm, observational pilot study using before and after measurements. The study was conducted at the East-West Medical Center at the Daegu Catholic University Medical Center, in Daegu, Korea. The subjects were 9 patients with breast cancer who presented with lymphedema of the upper limb ipsilateral to surgery. acupuncture was administered 3 times per week for 6 consecutive weeks, for 30±5 minutes at each session.The primary outcome measure was severity of lymphedema as assessed by stages of lymphedema, a visual analogue scale (VAS), and by circumferential measurements of the upper extremity. The secondary outcome measure was QoL, which was assessed by a self-administered questionnaire using the Short Form-36 questionnaire. Acupuncture reduced severity of lymphedema significantly, as assessed by the VAS (<0.001) as well as by circumferential measurements of the upper extremity. Four weeks after the final treatment, symptoms were not aggravated. SF-36 scores remained significant for health status at the end of treatment. The acupuncture method appeared to provide reduction of lymphedema among women after they had undergone surgery for breast cancer. A randomized, controlled prospective study with a larger sample size is required to clarify the role of acupuncture for managing lymphedema in patients with breast cancer.

Current evidence of acupuncture for symptoms related to breast cancer survivors

“…[ 12 – 20 ] Among these, 3 were case series, [ 13 , 14 , 19 ] 5 were single-case reports, [ 12 , 15 – 18 ] and only 1 was a RCT. [ 20 ] Three studies investigated lymphedema, [ 12 , 14 – 15 ] 2 investigated chemotherapy-induced peripheral neuropathy (CIPN), [ 18 , 19 ] 1 investigated hot flushes, [ 13 ] 1 assessed constipation, [ 20 ] and 2 investigated miscellaneous symptoms (nausea, CIPN, dryness of mouth, etc., Table 1 ). [ 16 , 17 ] The excluded studies are listed in Supplementary 1.…”

“…[ 20 ] In most studies, fixed acupuncture points were selected; only 1 study involved semifixed points based on pattern identification in patients. [ 14 ] The selected acupuncture points also varied across the studies. In many studies, concomitant interventions such as herbal medications, [ 15 – 17 ] physiotherapy, [ 12 , 16 , 17 ] moxibustion, [ 16 , 17 ] or cupping therapies were offered to the patients during the treatment sessions (Table 2 ).…”

“…With regard to the quality assessment of the included case series, most items were appropriately reported in the included studies. [ 13 , 14 , 19 ] However, the aims of the studies were not appropriately reported in all case series, and study results were not presented with effect estimates with confidence intervals. In addition, there was inadequate information regarding whether the cases were collected from more than 1 center (Table 3 ).…”

“…In addition, there was inadequate information regarding whether the cases were collected from more than 1 center (Table 3 ). [ 13 , 14 ] Among the single-case reports, most did not report or insufficiently reported information regarding patient history, diagnostic methods, diagnostic challenges, diagnostic reasoning, changes in interventions during treatment, intervention adherence, adverse events, study strengths and limitations, relevant literature, rationale for the conclusions, patient's opinions on the received treatments, and informed consent (Table 4 ). [ 12 , 15 – 18 ] Regarding the risk of bias assessment in the 1 RCT, most domains exhibited a low risk of bias except incomplete outcome data, which had a high risk of bias because the data for 4 patients were excluded in the analysis after their withdrawal from the study.…”

Effects of Warm Acupuncture on Breast Cancer–Related Chronic Lymphedema: A Randomized Controlled Trial

“…Many methods of acupuncture focusing on bcrl have been explored, including simple acupuncture, moxibustion, electric acupuncture, drawn cans, and point injection, among others. Acupuncture is suggested to have favourable effects when used as a single therapy 23 . Heat can promote fluid circulation in the meridians and might therefore be able to further reduce the degree of lymphedema.…”