Xerostomia, or oral dryness, is one of the most common
complaints experienced by cancer patients who have radiotherapy of the oral
cavity and neck region. Radiation-induced xerostomia (RIX), together with difficulty
in chewing, swallowing and speaking can have a significant impact on the
quality of life. At present there is no causal treatment for established
xerostomia. Temporary symptomatic relief can be provided by moistening agents
and saliva substitutes. Acupuncture has been reported to effectively relieve RIX.
A phase 3, randomized, sham-controlled, patient- and assessor-blinded
clinical trial was conducted to assess effect of true acupuncture (TA n=132),
compared with sham acupuncture (SA n=134) or a standard care control (SCC n=133)
on the incidence or severity of RIX among patients with head and neck cancer.
Acupuncture treatment was given concurrently with a 6- to 7-week course of
radiation therapy. In TA group acupuncture needles were inserted into following
body acupoints: Ren
24, LU7, and K6. The following ear points were used: Shenmen, Point Zero,
Salivary Gland 2' (SG 2-prime), and Larynx. All
points were used bilaterally except for Ren 24, which is located in the midline.
In SA group non-penetrating needles with the Park device were placed at
inactive points 0.5-1.0 cun away from true acupoints. In SCC group patients received standard care information about oral
hygiene such as brushing with fluoride toothpaste, flossing, and daily use of
fluoride tray applications.
The criterion standard for measuring
xerostomia XQ was used to compare patient-reported outcome scores for
xerostomia among the TA, SA, and SCC groups. The acupuncture expectancy scale18
was used to evaluate the association of baseline expectations related to
acupuncture with clinical response. Adverse events were recorded using Common
Terminology Criteria for Adverse Events version 3.0. Patient-reported
Xerostomia Questionnaires (XQs) and sialometry data were collected at baseline,
at the end of radiation therapy (week 7), and 3, 6, and 12 months after the end
of radiation therapy.
Results showed that xerostomia score in the TA group was
significantly lower than in the SCC group and marginally lower but
not statistically significant different from the SA group. One year after
radiation therapy follow-up showed that incidence of clinically
significant xerostomia followed a similar pattern with 38
patients in the TA group (34.6%), 54 patients in the SA group (47.8%), and 60
patients in the SCC group (55.1%) experiencing clinically significant xerostomia.
Data from this
phase 3, randomized clinical trial suggested that acupuncture therapy statistical
significantly reduced the incidence of radiation-induced xerostomia compared
with standard care controls in patients with head and neck cancer.
Reference:
Garcia MK, et al. (2019) Effect of True and Sham
Acupuncture on Radiation-Induced Xerostomia Among Patients With Head and Neck
Cancer: A Randomized Clinical Trial. JAMA Netw Open. PMID 31808921. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2757250
