Acupuncture as a Complementary Therapy During Radiation Treatment Can Reduce Dry Mouth

During radiation therapy, up to 80% of patients with head and neck cancer will experience dry mouth, a side effect of treatment that can affect quality of life. However, acupuncture delivered during treatment can reduce the incidence and severity of dry mouth, according to study findings from The University of Texas MD Anderson Cancer Center in Houston.

“The radiation is there for curative intent but it’s also damaging the salivary glands. This is really quite a debilitating side effect of radiation treatment,” principal investigator, Dr. Lorenzo Cohen, professor of palliative, rehabilitation, and integrative medicine and director of the Integrative Medicine Program at MD Anderson, said in a press release. “The symptoms severely impact quality of life and oral health, and current treatments have limited benefits.”

Researchers conducted a phase 3 clinical trial that included 339 patients with head and neck cancer who were undergoing radiation treatment at MD Anderson and Fudan University Cancer Center in Shanghai, China, between December 2011 and July 2015. The patient population was mostly men (77.6%) who ranged in age from 21-79 years old. Prior to the study, none of the patients had ever received acupuncture.

Patients were divided into three groups: 112 received true acupuncture; 115 received sham acupuncture, which involved a real needle at a point not indicated for dry mouth, real needles at sham points and placebo needles at sham points; and 112 received oral health education but no acupuncture.

Acupuncture lasted six to seven weeks and was administered to the patients in the two groups three days a week on the same day as their radiation treatment.

Patients completed an eight-item questionnaire to assess symptoms of dry mouth at the beginning of the study, at the end of radiation therapy and at three, six and 12 months after treatment.

Researchers also used the Acupuncture Expectancy Scale to examine patient expectations at the start of the trial with clinical response to acupuncture. This was completed at the start of the study, after four acupuncture sessions and at the end of acupuncture treatment.

They discovered that true acupuncture resulted in significantly fewer and less severe radiation-induced dry mouth symptoms during treatment through one year after treatment compared with oral health education. No difference was seen between the sham acupuncture and the oral health education groups. Overall, the incidence of dry mouth at the end of therapy was 35% in the true acupuncture group, 48% in the sham acupuncture group and 55% in the oral health education group.

“The evidence is to a point where patients should incorporate acupuncture alongside radiation treatment as a way to prevent the severity of dry mouth symptoms,” Cohen said. “I think with this study we can add acupuncture to the list for the prevention and treatment of (dry mouth), and the guidelines for the use of acupuncture in the oncology setting should be revised to include this important chronic condition.”

In a secondary analysis, the researchers saw a significant difference between cancer center sites in response to placebo. “The Chinese patients had little to no placebo response to sham acupuncture whereas the MD Anderson patients had a large placebo response, showing both forms of acupuncture worked,” the researchers wrote.

The researchers also noted that few side effects are seen with the use of acupuncture and the complementary therapy has a lower cost compared with standard treatment, such as medication and saliva substitutes.

“Acupuncture has been shown to improve multiple aspects of a patient’s quality of life and really should be considered as the standard of care,” Cohen said.