Acupuncture therapy improved radiation-induced xerostomia in cancer patients

Acupuncture treatment has been shown to significantly reduce severe radiation-induced xerostomia in patient with head and neck cancer compared with standard care control in a randomized clinical trial, according to the data published in the JAMA Network Open.

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