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Acupuncture reduces joint pain during treatment for early-stage breast cancer
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SAN ANTONIO — Real acupuncture significantly reduced patient-reported joint pain among women treated with an aromatase inhibitor for early-stage breast cancer, according to data from the randomized phase 3 SWOG S1200 clinical trial presented at the San Antonio Breast Cancer Symposium.
“We were motivated to think of ways of reducing joint pain caused by aromatase inhibitors because so many patients suffer with this side effect and often patients do not want to take more medications,” Dawn L. Hershman, MD, leader of the Breast Cancer Program at the Herbert Irving Comprehensive Cancer Center at New York-Presbyterian/Columbia University Medical Center, told HemOnc Today. “Many women were doing acupuncture on their own and reporting benefits, so we wanted to see if we could show if this was true in a randomized trial.”
The study cohort included 226 postmenopausal women (median age, 60 years; 88% white) with early-stage, hormone receptor-positive breast cancer treated with a third-generation aromatase inhibitor for at least 30 days before the start of the study with symptoms that started or increased since treatment initiation.
Other eligibility criteria included no use of opioids, corticosteroids or alternative/physical therapy to treat joint pain within 28 days before the start of the study and no prior acupuncture treatment for joint symptoms at any time, except for more than 1 year before the study for reasons other than joint pain.
Researchers randomly assigned women to real acupuncture (n = 110), sham acupuncture (n = 59) or no treatment (controls; n = 57). The real and sham acupuncture arms consisted of twice-weekly sessions for 6 weeks, followed by one session per week for 6 additional weeks.
Patients completed a self-administered, 14-item questionnaire to evaluate the severity of joint pain and the impact of this pain on daily functioning at baseline and during and after treatment.
Change in Brief Pain Inventory (BPI) worst pain scores at 6 weeks — for which lower scores correlated with less pain — served as the study’s primary endpoint.
According to study results, a true statistical difference occurred between BPI scores for real acupuncture vs. sham acupuncture (mean BPI score 0.92 points lower; 95% CI, 0.2-1.65; P = .01) and for real acupuncture vs. no treatment (mean BPI score 0.96 points lower; 95% CI, 0.24-1.67; P = .01). However, no significant differences occurred between pain scores for sham acupuncture vs. no treatment (mean BPI score 0.05 points lower; 95% CI, –0.81 to 0.9).
When the researchers assessed the proportion of women with a clinically meaningful 2-point change in pain scores, they found that 58% of women in the real acupuncture arm had a 2-point change vs. 31% in the sham acupuncture arm and 30% in the control arm.
Common adverse events included grade 1 bruising in 47% of women in the real acupuncture arm vs. 25% of those in the sham acupuncture arm.
“Our study gives both patients and providers confidence that this approach to treating symptoms can be effective and safe. However, not all acupuncture is the same, and we would encourage the acupuncture community who treat patients with breast cancer to read our prior publications describing the methods we used,” Hershman said. “Also of importance is that the cost of the 12-week intervention was roughly $1,250. We now feel that there is sufficient evidence to support insurance coverage of acupuncture for arthralgia caused by aromatase inhibitor treatment.”
Hershman said that future research will assess whether adherence is improved with the intervention and evaluate serum biomarkers to better understand why acupuncture provides benefit. – by Jennifer Southall
Reference:
Hershman DL, et al. Abstract GS4-04. Presented at: San Antonio Breast Cancer Symposium; Dec. 5-9, 2017; San Antonio.
Disclosures: The study was supported by grants from the NIH, NCI and the Office of Research on Women’s Health. Hershman and the other study authors report no relevant financial disclosures.
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Halle C.F. Moore, MD
We know that for postmenopausal women on aromatase inhibitors, one of the risk factors that leads to discontinuation of therapy is joint pain and stiffness. There have been single-institution pilot studies suggesting that real acupuncture compared with sham acupuncture could actually reduce joint pain symptoms.
Hershman and colleagues found that compared to either control arm, the real acupuncture arm had a significant further reduction in pain scores. Even when looking at a variety of other endpoints, all favored the real acupuncture arm.
This is an exciting, nonpharmaceutical approach for women who are experiencing this debilitating side effect from these medications. Additionally, the cost of the 12-week real acupuncture program was nearly $1,200. Interestingly, given these findings, the thought is that health insurance companies may now cover this form of treatment given these study results.
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