Acupuncture and Breast Cancer Care

Acupuncture and Breast Cancer CareJessica Quinlan-Woodward, RN, BSN, STAR-C

A pilot randomized controlled trial to assess the impact of acupuncture on pain, nausea, anxiety and coping in women undergoing a mastectomyGode A,1 Quinlan-Woodward J,1 Kolste A,2 Reinstein A,2 Dusek J,2 Trebesch

D,2 Migliori M,3 Johnson J,2 Sendelbach S.1

University of Minnesota, School of Nursing Research DayApril 24th, 2015

1Abbott Northwestern Hospital, 2Penny George Institute for Health and Healing, Minneapolis, MN., 3MMK Plastic Surgery, Edina, MN.

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There are no conflicts of interest or relevant financial interests that have been disclosed by this presenter or the rest of the planners and presenters of this activity that apply to this learning session.

We would like to thank the Abbott Northwestern Hospital Foundation and the Virginia Piper Cancer Institute for their generous funding of this project.

DISCLOSURES

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• One in eight (12%) women will develop breast cancer in her lifetime1

• Surgical intervention is the standard of care for breast cancer2

• Up to 60% of breast surgery patients experience severe acute postoperative pain3

• Post-operative nausea and vomiting (PONV) are common and unpleasant symptoms following surgery4

Background/Significance

1 http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics (Accessed 3/6/2015)2 NCCN Clinical Practice Guidelines in Oncology™: Breast Cancer (Version 1.2015) http://www.nccn.org (Accessed 3/6/2015).3Fecho K et al. (2009). Acute and persistent postoperative pain after breast surgery. Pain Medicine, 10(4):708-715).4Collins, A. S. (2011). Postoperative nausea and vomiting in adults: Implications for critical care. Critical Care Nurse, 31(6), 36-45. doi:10.4037/ccn2011470

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• Acupuncture (AQ) and massage have been demonstrated to be efficacious for pain, nausea and vomiting in patients undergoing surgery for cancer,1 and patients undergoing chemotherapy2

• One recent study demonstrated feasibility of acupuncture and improved pain, anxiety, and tension specific to postoperative breast cancer patients3 (Massage was given in addition… to 60% of the women in this study)

• The current study uniquely explores whether an acupuncture only intervention is efficacious for pain relief relative to a control group in a breast cancer population

Background/Significance

1 Mehling WE et al. (2007). Symptom management with massage and acupuncture in postoperative cancer patients: A randomized controlled trial. Journal of Pain and Symptom Management; 33(3):258-266.2Chao LF et al. (2009). The efficacy of acupoint stimulation for the management of therapy-related adverse events in patients with breast cancer: A systematic review. Breast Cancer Research & Treatment, 118:255-267.3Molly,M.J. (2015). Acupuncture in the Postoperative Setting for Breast Cancer Patients: A Feasibility Study. The American Journal of Chinese Medicine, 43(1):45-56.

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1. Examine the feasibility of delivering acupuncture to women undergoing unilateral or bilateral mastectomy surgery.

2. Determine the difference, if any, on the level of post-operative mastectomy pain, nausea, anxiety and ability to cope for women receiving acupuncture compared to the usual care group in women after mastectomy surgery.

Aims

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Study design: Randomized, controlled trial

Sample:Inclusion: Women 18 years of age or older, undergoing a mastectomy surgery (unilateral simple mastectomy, bilateral simple mastectomy, unilateral extended simple mastectomy, bilateral extended simple mastectomy), with or without reconstruction surgery.

Exclusion: Non-English speaking, pregnant, or also undergoing an oophorectomy, Transverse rectus abdominis myocutaneous flap or Latissimus flap surgery

Methods

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• RN Care Coordinators introduced the study

• Consent was obtained by research coordinator

•Women were randomized to two different groups– Acupuncture group– Usual Care group

Design

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• Acupuncture:– A licensed acupuncturist delivered the ~30 minute

acupuncture intervention– Treatment was individualized based on patients

symptoms at time of treatment

• Usual Care:– No acupuncture treatment– Otherwise usual care

Intervention

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• Patient demographics

• Scores obtained from both groups– Intervention group: Pre and post scores obtained

with acupuncture treatment. – Usual care group: Pre and post scores obtained 30

minutes apart

Data collection methods

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• Pain1, nausea, and anxiety scores (0-10 scale) – 0 = no pain, nausea or anxiety – 10 = the worst pain, nausea or anxiety

• Ability to cope– 0 = no ability to cope– 10 = completely able to cope

1Paice, J.A. and F.L. Cohen, Validity of a verbally administered numeric rating scale to measure cancer pain intensity. Cancer Nurs, 1997. 20(2): 88-93.

Measurement

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• All scores were entered into a computerized tablet

• Results unknown to study staff during study period

Measurement

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Results- Consort Diagram

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• No stratification occurred during the study• All participants were white (non Hispanic or Latino)• Education, employment status, family income, and

marital status did not have statistically significant difference between groups• Age did have a statistically significant difference

between groups with a p value of 0.031

* P-value from t- or chi-square test comparing AQ and control groups

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Demographics

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Mean change in anxiety, coping, nausea and pain – Visit 1

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Mean change in anxiety, coping, nausea and pain – Visit 2

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• It is feasible to deliver acupuncture in adult women undergoing a mastectomy

• In adult women undergoing a mastectomy, acupuncture delivered postoperatively can improve outcomes relative to the control group

Conclusion

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• Small sample size

• Lack of minorities

• Significant differences in age

Limitations

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• Larger sample size

•More ethnically diverse population

• Explore timing of the interventions

Future research

2020

Research funded by Abbott Northwestern Hospital

Foundation

ONF article published Nov 2016

[email protected]

Thank you!