Integrative Oncology is guest edited by Barrie R. Cassileth, MS, PhD, Chief of the Integrative Medicine Service and Laurance S. Rockefeller Chair in Integrative Medicine at Memorial Sloan-Kettering Cancer Center, New York.

The Integrative Medicine Service at Memorial Sloan-Kettering Cancer Center developed and maintains a free website—About Herbs (www.mskcc.org/aboutherbs)—that provides objective and unbiased information about herbs, vitamins, minerals, and other dietary supplements, and unproved anticancer treatments. Each of the 265 and growing number of entries offer health-care professional and patient versions, and entries are regularly updated with the latest research findings.

In addition, the About Herbs app, Memorial Sloan-Kettering Cancer Center’s very first mobile application, was launched last fall. In the week following its release on September 21, the app was downloaded more than 6,300 times, making it #4 on the top new medical apps chart. The app is compatible with iPad, iPhone, and iPod Touch devices, and can be downloaded at http://itunes.apple.com/us/app/about-herbs/id554267162?mt=8.

Arm lymphedema affects approximately 30% of breast cancer survivors, with rates increasing with longer follow-up and cases of lymphedema presenting well beyond the active treatment period. Lymphedema is observed even with the use of less-invasive surgical techniques for staging, and risk is further increased by such factors as radiation therapy, positive lymph node status, increased tumor burden, postoperative seroma or infection, obesity, and increased age.

Current treatments for lymphedema after breast cancer treatment are expensive and require ongoing intervention. As reported by Barrie R. Cassileth, MS, PhD, of the Integrative Medicine Service at Memorial Sloan-Kettering Cancer Center and colleagues in Cancer,¹ acupuncture may be an effective treatment.

Study Details

In a pilot study, women with breast cancer who had undergone axillary surgery and had unilateral arm lymphedema for 6 months to 5 years and an affected arm circumference ≥ 2 cm greater than the unaffected arm received acupuncture treatment twice weekly for 30 minutes for 4 weeks. Arm circumference was measured before and after each acupuncture treatment, with response defined as a ≥ 30% reduction in circumference difference. After the 4-week treatment period, follow-up calls were made monthly for 6 months to document complications and self-reported lymphedema status.

Women with previous acupuncture treatment for lymphedema or currently using diuretics were excluded from the study, as were those with metastatic disease, history of autoimmune or fibroproliferative disorders, history of primary lymphedema or bone marrow transplantation, or current treatment with corticosteroids or myelosuppressive or myelostimulatory drugs.

Patients had a median age of 55 years and most were white (76%) and had lymphedema of the left arm (64%). Primary surgery was mastectomy in 67% and breast-conserving surgery in 33%. Most patients had received chemotherapy (88%) and radiation therapy (85%) and had been on standard lymphedema treatment (88%) prior to the study. The median time from axillary surgery to start of acupuncture was 3.9 years.

Significant Improvement

Patients had a total of 255 acupuncture treatment sessions, with 25 (76%) receiving all eight sessions, 7 (21%) missing one session, and 1 (3%) missing two sessions. A 30% or greater reduction in circumference difference was observed in 11 patients (33%), and 18 (55%) had a reduction of ≥ 20%. The mean reduction in circumference difference was 0.90 cm (P < .0005), and reduction in circumference was observed across the full range of severity of lymphedema.

Thirty-one patients (94%) used other standard therapies during the study, with 28 (93%) of 30 reporting no change to their standard regimens during acupuncture treatment. Four of 11 responders reported sustained improvement for 4 months during the follow-up period. Three additional responders reported sustained improvement for at least 4 weeks after treatment.

During the treatment period, 14 (43%) of the 33 patients reported minor complaints, including mild local bruising or pain/tingling. There were no serious adverse events and no infections or severe exacerbations during the treatment period or during 6 months of follow-up.

The study authors concluded, “Acupuncture for breast cancer-related lymphedema appears safe and may reduce arm circumference. Although these results await confirmation in a randomized trial, acupuncture can be considered for women with no other options for sustained arm circumference reduction.”

The investigators are currently conducting a randomized trial of acupuncture in this setting. ■

Disclosure: The study authors reported no potential conflicts of interest.

Reference

1. Cassileth BR, Van Zee KJ, Yeung KS, et al: Acupuncture in the treatment of upper-limb lymphedema. Cancer 119:2455-2461, 2013.

Compiled by Barrie R. Cassileth, PhD, and Jyothi Gubili, MS, Memorial Sloan-Kettering Cancer Center. The About Herbs website is managed by K. Simon Yeung, PharmD, MBA, Lac, Memorial Sloan-Kettering Cancer Center.