Acupuncture reduces hot flashes in women receiving treatment for breast cancer
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Key takeaways:
- Women with breast cancer receiving endocrine therapy had fewer, less severe hot flashes after receiving early acupuncture.
- Immediate acupuncture also improved quality-of-life scores.
Acupuncture significantly reduced hot flashes and improved quality of life in women receiving endocrine therapy for breast cancer in three parallel randomized trials, according to results published in Cancer.
The hot flash score — derived from the frequency and severity of a patient’s hot flashes — decreased by 50% or more in 64% of women who received immediate acupuncture at the start of endocrine-based therapy compared with 18% among a control group who received delayed acupuncture.
“Unlike many medications that target only single symptoms, acupuncture has demonstrated the ability to address multiple symptoms simultaneously,” Weidong Lu, MB, MPH, PhD, lead oncology acupuncturist at Dana-Farber Cancer Institute’s Leonard P. Zakim Center for Integrative Therapies and Healthy Living, told Healio. “It improved not just hot flashes, but also a group of hormonal symptoms and overall quality of life. This holistic approach is particularly valuable for managing the complex side-effect profile of endocrine therapy.”
Background and methodology
Approximately 2.3 million new breast cancer diagnoses are made globally every year and 685,000 die of the disease, according to background information researchers provided.
Endocrine therapy can reduce the risk for recurrence and mortality in women with hormone receptor-positive breast cancer, but it can come with adverse effects.
Roughly 80% of patients who receive endocrine therapy experience hot flashes. It can also impact their mood and quality of life, which can cause them to stop treatment or medication.
“The dilemma lies in balancing the need for long-term medication use — typically 5-plus years — with managing these debilitating side effects,” Lu said.
“Although there are some pharmaceutical options to mitigate these effects, they often come with their own set of side effects,” he added. “Here, acupuncture enters as a promising nonpharmaceutical approach.”
Prior studies have evaluated acupuncture as a potential remedy for hot flashes, but they have produced mixed findings.
Lu and colleagues aimed to produce more consistent results with a multinational study involving three trials, one each in the U.S., China and South Korea, which had the same eligibility criteria and treatment protocol.
The trials, conducted between January 2019 and February 2022, included women with stage 0 to stage III hormone receptor-positive breast cancer who completed chemotherapy or radiation therapy, had current endocrine therapy for at least 4 weeks, and experienced at least 14 hot flashes per week for 4 weeks.
The immediate acupuncture cohort received two sessions of acupuncture per week for 10 weeks, followed by 10 weeks of observation. The delayed acupuncture control group did not receive acupuncture the first 10 weeks, but they did get one session per week over the following 10 weeks.
Researchers randomly assigned 158 women (median age, 48 years; 52.5% Asian; 39.9% white) to the immediate (n = 81) or delayed acupuncture (n = 77) group.
The U.S. trial had 78 participants, whereas South Korea and China had 40 each.
Study participants averaged 6.3 daily hot flashes at baseline.
Researchers evaluated endocrine symptom subscale (ESS) scores as the study’s primary endpoint and weekly changes in hot flash scores as a secondary endpoint.
Results and next steps
Women in the immediate acupuncture cohort had significantly improved ESS scores compared with the delayed group at week 10 (P = .0003).
Of the 136 participants who finished week 10 of the trial, 55 achieved clinically significant improvement (54% of investigated group; 26% control; P = .0009).
Individuals in South Korea (change in ESS score: +8.5) had the greatest improvement, then followed by the U.S. (+5.3) and China (+1.7). These results surprised investigators.
“The observed differences in symptom profiles between Chinese and Korean patients highlight the importance of considering individual and cultural factors in treatment plans,” Lu said.
Researchers observed significant differences in hot flash scores at week 5.
Women in the immediate acupuncture group also derived substantial improvements in quality-of-life scores compared with women in the control.
Participants in the delayed cohort who received acupuncture had significant improvements in ESS and hot flash scores after starting therapy in week 10.
Lu and colleagues did not report any serious adverse events associated with the interventions.
Study limitations, researchers noted, included using delayed acupuncture as the control rather than an active control, which increases the odds of a “placebo effect,” they wrote, as well as the lack of diversity in the cohort, and the trial being conducted at multiple sites, causing some differences including needle sizes and device selection.
Lu said future research could address multiple questions, including whether acupuncture impacts adherence to endocrine therapy, how it affects different racial and ethnic groups, and the underlying mechanisms that make acupuncture effective.
“Acupuncture should be viewed as a complement to, not a replacement for, conventional cancer treatments,” Lu said. “It is about enhancing the overall care package to improve patient well-being and potentially treatment outcomes. As evidence accumulates, we should consider how to effectively integrate acupuncture into standard oncology care pathways, ensuring that all suitable patients have access to this beneficial therapy.”
For more information:
Weidong Lu, MB, MPH, PhD, can be reached at weidong_lu@dfci.harvard.edu.
Perspective
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Erin Roesch, MD
Endocrine therapy reduces risk for recurrence and improves survival in hormone receptor-positive early breast cancer, representing an integral component of systemic treatment for many women.Along with these important benefits comes the potential risk for various adverse effects that can affect quality of life and adherence to endocrine therapy. Hot flashes — which can be associated with tamoxifen, aromatase inhibitors and gonadotropin-releasing hormone analogues — can have varying degrees of severity among both pre- and post-menopausal women.
Both pharmacologic and non-pharmacologic approaches can be used to manage hot flashes. Examples of medical therapy include selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors, gabapentin, oxybutynin and neurokinin 3 receptor antagonists (ie, fezolinetant). However, each of these agents has its own list of possible adverse effects, and some women prefer to avoid additional medications.
Acupuncture is an example of complementary therapy; however, data on its effectiveness to treat hot flashes has been inconsistent.
Lu and colleagues evaluated the role of immediate vs. delayed acupuncture in managing hot flashes among women with hormone receptor-positive early breast cancer. A higher percentage of women in the immediate acupuncture group than delayed acupuncture group experienced at least 0% improvement in frequency and severity of hot flashes (64% vs. 18%).
When discussing various options to address hot flashes in the clinic, it is essential that we consider an individual’s co-morbidities, the other medications they are taking, and their preferences. Future research should aim to investigate the mechanism of action by which acupuncture exerts an effect on hot flashes, whether there are select patients who may derive more benefit from this approach, and how it can affect patient outcomes, including endocrine therapy compliance.
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