Acupuncture, a complementary and alternative (CAM) therapy used in cancer management,[1-4] has been used clinically to manage cancer-related symptoms, treat side effects induced by chemotherapy or radiation therapy, boost blood cell count, and enhance lymphocyte and natural killer (NK) cell activity. In cancer treatment, its primary use is symptom management; commonly treated symptoms are cancer pain,[4,5] chemotherapy-induced nausea and vomiting, [6] and other symptoms that affect a patient’s quality of life, including weight loss, anxiety, depression, insomnia, poor appetite, and diarrhea. [7-9] Acupuncture is generally accepted by children aged 10 years and older.[10]

More than 40 states and the District of Columbia have laws regulating acupuncture practice. The National Certification Commission for Acupuncture and Oriental Medicine offers national certification examinations for practitioners of acupuncture and traditional Chinese medicine (TCM) (www.nccaom.org); most, but not all, states require this certification. More than 50 schools and colleges of acupuncture and Oriental medicine operate in the United States, many of which offer master’s-level programs and are accredited by or have been granted candidacy status by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM). ACAOM standards for a master's-level degree require a 3-year program (approximately 2,000 hours of study) for acupuncture and a 4-year program for Oriental medicine, which includes acupuncture and herbal therapy (www.ACAOM.org). Some Western medical training, including the study of anatomy, physiology, and clean-needle technique is included in the curriculums of these schools. Postgraduate training programs in medical acupuncture for physicians also exist. In the United States, training to be a licensed acupuncturist (LAc) is regulated according to individual state law. Because the educational and licensing requirements for acupuncture practice vary from state to state, one should inquire from each state board of acupuncture (or other relevant board) for particular information.[11] Third-party reimbursements also vary from state to state. Some insurance companies cover acupuncture or limited acupuncture treatment. Federal payers such as Medicaid and Medicare do not generally reimburse for acupuncture treatment.

Acupuncture has been practiced in China and other Asian countries for more than 4,000 years.[12-14] In China, acupuncture is part of a TCM system of traditional medical knowledge and is practiced along with other treatment modalities such as herbal medicine, tui na (massage and acupressure), mind/body exercise (e.g., qigong and tai chi), and dietary therapy.[15,16] In the United States, several different acupuncture styles are practiced in addition to TCM. These include Japanese acupuncture (e.g., meridian therapy), English acupuncture (e.g., five element or traditional acupuncture), French acupuncture (e.g., French energetic acupuncture), Korean acupuncture (e.g., constitutional acupuncture), and American medical acupuncture. Most of these are derived from ancient Chinese medical philosophy and practices. All are based on the view that the human body must be perceived and treated as a whole and as part of nature; health is the result of harmony among bodily functions and between the body and nature, and disease occurs when this harmony is disrupted. TCM therapeutic interventions, including acupuncture are used to restore the state of harmony.

Acupuncture is closely associated with Chinese meridian theory. According to this theory, there are 12 primary meridians, or channels, and eight additional meridians, each following a particular directional course along the body. A vital energy known as qi flows through these meridians and participates in the homeostatic regulation of various bodily functions. Some 360 points distributed along the meridians serve as both pathognomonic signs of disorder and as loci for acupuncture treatments.[14,17] When the normal flow of energy over a meridian is obstructed (e.g., as a result of tissue injury or a tumor), pain or other symptoms result.

The purpose of acupuncture therapy is to re-open the normal energy flow, thereby relieving the symptoms by stimulating specific sites (acupuncture points) on the meridians.[18] In acupuncture treatment, stainless steel needles, usually ranging from 0.22 to 0.25 mm in diameter, are inserted into relevant acupuncture points to stimulate the affected meridians. A needling sensation known as de qi sensation, in which the patient feels heaviness, numbness, or tightness, is often required during an acupuncture treatment. Length and frequency of treatment vary according to the condition being treated. Chronic conditions usually require a longer treatment period. Typically, two or three sessions per week are required initially and may decrease to once a week after several weeks of treatment. Needles are typically left in place for 15 to 30 minutes after insertion, and their effects may be augmented with manual or electrical stimulation and/or heat (e.g., moxibustion).

Classical techniques of acupuncture include needling, moxibustion, and cupping. Acupressure, using fingers to apply pressure on acupuncture points, is also considered a form of acupuncture treatment. Moxibustion is a method in which an herb (Artemisia vulgaris) is burned above the skin or on an acupuncture point for the purpose of warming it to alleviate symptoms. Cupping promotes blood circulation and stimulates acupuncture points by creating a vacuum or negative pressure on the surface of the skin.[18] During the past several decades, various new auxiliary devices have been developed. Acupuncture devices such as electroacupuncture (EA) machines and heat lamps are commonly used to enhance the effects of acupuncture.

In addition to classical acupuncture techniques, other techniques have been developed and are sometimes used in cancer management. These include trigger point acupuncture, laser acupuncture, acupuncture point injection, and techniques focusing on particular regions of the body: auricular acupuncture, scalp acupuncture, face acupuncture, hand acupuncture, nose acupuncture, and foot acupuncture. Of these, auricular acupuncture is the most commonly used.

Although acupuncture has been practiced for millennia, it has come under scientific investigation only recently. To date, most studies and clinical trials of the mechanisms and efficacy of acupuncture in cancer management have been carried out in China. In 1976, however, the U.S. Food and Drug Administration (FDA) classified acupuncture needles as investigational devices (Class III) (www.fda.gov). This resulted in a number of research studies on the effectiveness and safety of acupuncture.[19] In November 1994, the Office of Alternative Medicine (the predecessor of the National Center for Complementary and Alternative Medicine) at the National Institutes of Health (NIH) sponsored an NIH-FDA workshop on the status of acupuncture needle usage. Two years later, the FDA reclassified acupuncture needles as medical devices (Class II) without, however, giving specific indications for their use (www.fda.gov). In 1997, NIH held a Consensus Development Conference on Acupuncture to evaluate its safety and efficacy. The 12-member panel concluded that promising research results showing the efficacy of acupuncture in certain conditions have emerged and that further research is likely to uncover additional areas in which acupuncture intervention will be useful. The panel stated that “there is clear evidence that needle acupuncture treatment is effective for postoperative and chemotherapy nausea and vomiting.” It also stated that there are “a number of other pain-related conditions for which acupuncture may be effective as an adjunct therapy, an acceptable alternative, or as part of a comprehensive treatment program,” and it agreed that further research is likely to uncover additional areas in which acupuncture intervention will be useful.[19]

These actions by the FDA and NIH have resulted in the establishment of a number of active programs of research into the mechanisms and efficacy of acupuncture, much of which is, or is potentially, relevant to cancer management. To date, the most extensively investigated aspect of these mechanisms has been the effect of acupuncture on pain management. The NIH Consensus Panel concluded that “acupuncture can cause multiple biological responses,” local and distal, “mediated mainly by sensory neurons…within the central nervous system.” Acupuncture “may also activate the hypothalamus and the pituitary gland, resulting in a broad spectrum of systemic effects,” including “alterations in peptides, hormones and neurotransmitters and the regulation of blood flow.”[19] Recent studies show the effect of acupuncture on chronic inflammatory pain.[20,21] Evidence suggests that acupuncture operates through the autonomic nervous system to balance the sympathetic and parasympathetic systems and suggests that the anti-inflammatory effects of acupuncture are mediated by its electrophysiologic effects on neurotransmitters, cytokines, and neuropeptides.[21-30] Reviewed in [1] Many studies provide evidence that opioid peptides are released during acupuncture and that acupuncture analgesia is mediated by the endogenous opioid system.[31,32]

Laboratory and animal cancer studies exploring the mechanisms of acupuncture have focused mainly on the activation and modulation of immune functions. Acupuncture treatment points are located by using standard anatomic landmarks and comparative anatomy. EA is the most commonly used treatment intervention; a few studies have used moxibustion.[33] These studies show that acupuncture may boost animal immune function by increasing blood cells and enhancing NK cell and lymphocyte activity.[33-35] According to one animal behavioral study, acupuncture may be a useful adjuvant for suppressing chemotherapy-induced emesis. [36]

Although several studies published in China examined the effect of acupuncture on the human immune system,[7,28,31,37-40] most cancer-related human clinical studies of acupuncture evaluated its effect on patient quality of life. These investigations mainly focused on cancer symptoms or cancer treatment–related symptoms, predominantly cancer pain [9,22,41-45] and chemotherapy-induced nausea and vomiting.[24,26,46-54] Studies have also been done on the effect of acupuncture on radiation -induced xerostomia (dry mouth), rectitis, dysphonia, weight loss, cough, thoracodynia, hemoptysis, fever, esophageal obstruction, poor appetite, night sweats, hot flashes, dizziness, fatigue, anxiety, and depression in cancer patients.[7-9,55-58] The evidence from most of these clinical studies is inconclusive, despite their positive results; either poor research design or incompletely described methodologic procedures limit their value. The positive results of the studies on chemotherapy-induced nausea and vomiting, which benefit from scientifically sound research designs, are the most convincing.

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Glossary Terms

In biology, to stimulate a cell in a resting state to become active. This causes biochemical and functional changes in the activated cell.

The application of pressure or localized massage to specific sites on the body to control symptoms such as pain or nausea. It is a type of complementary and alternative medicine.

The technique of inserting thin needles through the skin at specific points on the body to control pain and other symptoms. It is a type of complementary and alternative medicine.

A stainless steel needle that is slightly thicker than a human hair. Acupuncture needles are inserted through the skin at specific points on the body to control pain and other symptoms.

A specific spot on the body where an acupuncture needle may be inserted to control pain and other symptoms. Also called acupoint.

A procedure in which drugs, vitamins, herbal extracts, or other fluids are injected into the body at an acupuncture point using a syringe and needle.

Another treatment used together with the primary treatment. Its purpose is to assist the primary treatment. Also called adjunctive therapy.

Pain relief.

Having to do with anatomy (the study of the structure of a plant or animal).

The study of the structure of a plant or animal.

Having to do with reducing inflammation.

Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.

Having to do with the ear.

The part of the nervous system that controls muscles of internal organs (such as the heart, blood vessels, lungs, stomach, and intestines) and glands (such as salivary glands and sweat glands). One part of the autonomic nervous system helps the body rest, relax, and digest food and another part helps a person fight or take flight in an emergency. Also called ANS and involuntary nervous system.

Pertaining to biology or to life and living things. In medicine, refers to a substance made from a living organism or its products. Biologicals may be used to prevent, diagnose, treat or relieve of symptoms of a disease. For example, antibodies, interleukins, and vaccines are biologicals. Biological also refers to parents and children who are related by blood.

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

A test to check the number of red blood cells, white blood cells, and platelets in a sample of blood. Also called CBC and complete blood count.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

The brain and spinal cord. Also called CNS.

Treatment with drugs that kill cancer cells.

In traditional Chinese medicine, meridians are channels that form a network in the body, through which qi (vital energy) flows. Blocked qi causes pain or illness. The flow of qi is restored by using pressure, needles, suction, or heat at hundreds of specific points along the meridians.

A disease or condition that persists or progresses over a long period of time.

Having to do with the examination and treatment of patients.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical trial.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.

The comparison of the structure (anatomy) of one animal or plant with the structure of a different animal or plant.

Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices generally are not considered standard medical approaches. Standard treatments go through a long and careful research process to prove they are safe and effective, but less is known about most types of CAM. CAM may include dietary supplements, megadose vitamins, herbal preparations, special teas, acupuncture, massage therapy, magnet therapy, spiritual healing, and meditation. Also called CAM.

A program of the National Institutes of Health to bring together an independent group of experts to review scientific evidence related to an important public health issue. For a specific issue, a panel of experts (such as doctors and scientists) reviews reports and papers on the subject, listens to information presented by other experts in the field, and hears comments from the general public. Based on the evidence presented, the panel writes a report summarizing the findings, which is made available to the public. The report is not intended to be a practice guideline.

A type of acupuncture based on a form of Oriental medicine in which treatment is based on a person’s constitution. According to this type of medicine, the constitution is the specific way a person’s organs affect health and how he or she looks, thinks, behaves, and responds to treatment. Also called Korean acupuncture.

A procedure in which a rounded glass cup is warmed and placed upside down over an area of the body, creating suction that holds the cup to the skin. Cupping increases the flow of blood. In traditional Chinese medicine, it is also thought to increase the flow of qi (vital energy).

A substance that is made by cells of the immune system. Some cytokines can boost the immune response and others can suppress it. Cytokines can also be made in the laboratory by recombinant DNA technology and used in the treatment of various diseases, including cancer.

Tingling, numbness, heaviness, and other feelings that occur after an acupuncture needle has been properly placed in the body. The needle may be twirled, moved up and down at different speeds and depths, heated, or charged with a small electric current until the de qi sensation occurs.

A mental condition marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life. Other symptoms of depression include feelings of worthlessness and hopelessness, loss of pleasure in activities, changes in eating or sleeping habits, and thoughts of death or suicide. Depression can affect anyone, and can be successfully treated. Depression affects 15-25% of cancer patients.

The length of a straight line that extends from one edge of a tumor or other object, through its center and to the opposite edge. It is usually used to measure the size of round or spherical shapes.

Frequent and watery bowel movements.

In medicine, a disturbance of normal functioning of the mind or body. Disorders may be caused by genetic factors, disease, or trauma.

In medicine, refers to a part of the body that is farther away from the center of the body than another part. For example, the fingers are distal to the shoulder. The opposite is proximal.

Trouble with the voice when trying to talk, including hoarseness and change in pitch or quality or voice.

Effectiveness. In medicine, the ability of an intervention (for example, a drug or surgery) to produce the desired beneficial effect.

A procedure in which pulses of weak electrical current are sent through acupuncture needles into acupuncture points in the skin. This procedure is being studied in the prevention of nausea and vomiting in patients undergoing chemotherapy.

Vomiting.

Produced inside an organism or cell. The opposite is external (exogenous) production.

Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach.

A condition marked by extreme tiredness and inability to function due lack of energy. Fatigue may be acute or chronic.

An ancient form of acupuncture based on the principle that there are five universal elements (wood, fire, earth, metal, and water) that affect a person's emotions, personality, health, and response to treatment. Each person is affected by one element more than the others. Also called traditional acupuncture.

An agency in the U.S. federal government whose mission is to protect public health by making sure that food, cosmetics, and nutritional supplements are safe to use and truthfully labeled. The Food and Drug Administration also makes sure that drugs, medical devices, and equipment are safe and effective, and that blood for transfusions and transplant tissue are safe. Also called FDA.

Coughing or spitting up blood from the respiratory tract.

A type of medicine that uses roots, stems, leaves, flowers, or seeds of plants to improve health, prevent disease, and treat illness.

Having to do with homeostasis, which is a state of balance among all the body systems, needed for the body to function correctly.

One of many chemicals made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs. Some hormones can also be made in the laboratory.

A sudden, temporary onset of body warmth, flushing, and sweating (often associated with menopause).

The area of the brain that controls body temperature, hunger, and thirst.

Production and action of cells that fight disease or infection.

The complex group of organs and cells that defends the body against infections and other diseases.

Having to do with inflammation (redness, swelling, pain, and a feeling of heat that helps protect tissues affected by injury or disease).

Difficulty in going to sleep or getting enough sleep.

In clinical trials, refers to a drug (including a new drug, dose, combination, or route of administration) or procedure that has undergone basic laboratory testing and received approval from the U.S. Food and Drug Administration (FDA) to be tested in human subjects. A drug or procedure may be approved by the FDA for use in one disease or condition, but be considered investigational in other diseases or conditions. Also called experimental.

The use of a low-level laser beam instead of an acupuncture needle to stimulate an acupuncture point.

Specific place where something is located or occurs. It may refer to a specific place on the body (such as an acupuncture point) or the place on a chromosome where a specific gene is found.

A type of white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infections and other diseases.

A treatment in which the soft tissues of the body are kneaded, rubbed, tapped, and stroked. Massage therapy may help people relax, relieve stress and pain, lower blood pressure, and improve circulation. It is being studied in the treatment of cancer symptoms such as lack of energy, pain, swelling, and depression.

An instrument, tool, machine, test kit, or implant that is used to prevent, diagnose, or treat disease or other conditions. Medical devices range from tongue depressors to heart pacemakers and medical imaging equipment.

In traditional Chinese medicine, one of 20 channels that form a network through which qi (the body's vital energy) flows and that connect the body’s acupuncture sites.

In medicine, the rules and procedures for doing research and evaluating results.

A form of exercise that combines body movement with mental focus and controlled breathing to improve strength, balance, flexibility, and overall health. Examples of mind/body exercises are yoga, tai chi, and qigong.

A method of treatment. For example, surgery and chemotherapy are treatment modalities.

In traditional Chinese medicine, a type of heat therapy in which an herb is burned on or above the skin to warm and stimulate an acupuncture point or affected area.

A federal agency that uses science to explore complementary and alternative medicine (CAM) practices, trains CAM researchers, and provides authoritative information about CAM to professionals and the public. NCCAM awards grants for research projects, training, and career development in CAM; sponsors conferences, educational programs, and exhibits; studies ways to use proven CAM practices along with conventional medical practice; and supports adding CAM to medical, dental, and nursing school programs. NCCAM is part of the National Institutes of Health. Also called NCCAM.

A federal agency in the U.S. that conducts biomedical research in its own laboratories; supports the research of non-Federal scientists in universities, medical schools, hospitals, and research institutions throughout the country and abroad; helps in the training of research investigators; and fosters communication of medical information. Access the National Institutes of Health Web site at http://www.nih.gov. Also called NIH.

A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.

In acupuncture, the insertion of a thin needle into a specific place on the body to unlock qi (vital energy). The needle may be twirled, moved up and down at different speeds and depths, heated, or charged with a low electric current.

A member of a class of protein-like molecules made in the brain. Neuropeptides consist of short chains of amino acids, with some functioning as neurotransmitters and some functioning as hormones.

A chemical that is made by nerve cells and used to communicate with other cells, including other nerve cells and muscle cells.

A type of white blood cell that contains granules with enzymes that can kill tumor cells or microbial cells. Also called large granular lymphocyte and natural killer cell.

Blockage of a passageway.

A drug used to treat moderate to severe pain. Opioids are similar to opiates such as morphine and codeine, but they do not contain and are not made from opium.

A medical system that has been used for thousands of years to prevent, diagnose, and treat disease. It is based on the belief that qi (the body's vital energy) flows along 20 meridians (channels) throughout the body and keeps a person’s spiritual, emotional, mental, and physical health in balance. Oriental medicine aims to restore the body’s balance and harmony between the natural opposing forces of yin and yang, which can block qi and cause disease. Oriental medicine includes acupuncture, diet, herbal therapy, meditation, physical exercise, and massage. Also called TCM and traditional Chinese medicine.

The part of the nervous system that slows the heart, dilates blood vessels, decreases pupil size, increases digestive juices, and relaxes muscles in the gastrointestinal tract.

Having to do with a sign or symptom that is specific to a certain disease.

Any compound consisting of two or more amino acids, the building blocks of proteins.

Medical doctor.

The main endocrine gland. It produces hormones that control other glands and many body functions, especially growth.

After surgery.

In traditional Chinese medicine, vital energy or life force that keeps a person’s spiritual, emotional, mental, and physical health in balance.

A form of traditional Chinese mind/body exercise and meditation that uses slow and precise body movements with controlled breathing and mental focusing to improve balance, flexibility, muscle strength, and overall health.

The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.

Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

Inflammation of the mucous membrane that lines the rectum (the last several inches of the large intestine closest to the anus). Also called proctitis.

Having to do with the senses.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

The part of the nervous system that increases heart rate, blood pressure, breathing rate, and pupil size. It also causes blood vessels to narrow and decreases digestive juices.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of symptom management is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called comfort care, palliative care, and supportive care.

Affecting the entire body.

A form of traditional Chinese mind/body exercise and meditation that uses slow sets of body movements and controlled breathing. Tai chi is done to improve balance, flexibility, muscle strength, and overall health.

Having to do with treating disease and helping healing take place.

Treatment.

Chest pain. Also called thoracalgia.

A group or layer of cells that work together to perform a specific function.

A medical system that has been used for thousands of years to prevent, diagnose, and treat disease. It is based on the belief that qi (the body's vital energy) flows along 20 meridians (channels) throughout the body and keeps a person’s spiritual, emotional, mental, and physical health in balance. Traditional Chinese medicine aims to restore the body’s balance and harmony between the natural opposing forces of yin and yang, which can block qi and cause disease. Traditional Chinese medicine includes acupuncture, diet, herbal therapy, meditation, physical exercise, and massage. Also called Oriental medicine and TCM.

Use of acupuncture to treat pain by inserting needles into trigger points on the body. Trigger points are places on the body where injury has occurred, but the pain has been sent along nerves and is felt in another place in the body.

Chinese massage that uses kneading, pressing, rolling, shaking, and stretching of the body. Tui na is thought to regulate qi (vital energy) and blood flow, and improve the function of tendons, bones, and joints.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancerous), or malignant (cancerous). Also called neoplasm.

Necessary to maintain life. Breathing is a vital function.

To eject some or all of the contents of the stomach through the mouth.

Dry mouth. It occurs when the body is not able to make enough saliva.