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Acupuncture treatment for hot flushes in women with breast cancer and men with prostate cancer
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The group of women and men with a history of cancer and distressing hot flushes and sweating is growing. The flushes negatively affect Health Related Quality of Life (HRQoL), perhaps partially by disturbing sleep. Treatments that are effective, tolerable and safe need to be developed. There are a number of treatment alternatives that are often not very effective or associated with more or less serious side-effects. Based on theories on the mechanisms behind hot flushes and acupuncture, treatment with acupuncture has been tried in menopausal women with hot flushes and in a few studies in women with breast cancer (BCa).

Aim: The general aim of the research leading to this thesis was to evaluate the effect of acupuncture on hot flushes, HRQoL and sleep in men with prostate cancer (PCa) and women with BCa. To evaluate the effect in women with BCa of 12 weeks of electrostimulated acupuncture (EA) and two years of hormone therapy (HT) on number of, and distress caused by, hot flushes, and on HRQoL and sleep. To evaluate whether acupuncture therapy could be used to treat hot flushes in men with PCa treated with castration therapy, and then to evaluate in men with PCa and hot flushes the effect of 12 weeks of traditional acupuncture (TA) or EA on number of, and distress caused by, hot flushes and on urinary excretion of CGRP, HRQoL and sleep.

Subjects and methods: Forty-five women with a history of BCa were randomized to oral HT for two years or EA for 12 weeks and were followed up till two years after start of therapy. Thirty-eight men with PCa and hot flushes were treated with acupuncture. Seven men were treated with EA for 10 to 12 weeks in a pilot study. After positive results from this study 31 men were randomized between EA and TA for 12 weeks and followed up till nine months after end of treatment. Hot flushes, HRQoL and sleep were monitored by means of log books and validated questionnaires.

Results: The pilot study showed that 10 to 12 weeks of EA in men with PCa reduced number of hot flushes to below 50% of baseline with persistent effects at a follow up three months later. The two randomized studies showed that treatment with acupuncture in women with a history of BCa, and men with PCa was associated with a decrease in both the number of and distress caused by hot flushes by at least 50%. HT almost eliminated the hot flushes. There was no difference in reduction of hot flushes between men receiving EA or TA. Reduction of the number of hot flushes and distress caused by hot flushes probably leads to decreased disturbances at night, and was associated in women with a significant improvement in HRQoL and sleep variables. The improvement in HRQoL was as great in women treated with EA as in women receiving HT although the latter group had a more substantial reduction in number of flushes than the EA group suggesting that EA might have other effects in addition to those on hot flushes. In the men HRQoL did not change significantly. We saw very few and non-serious side-effects in the acupuncture groups and no signs that acupuncture activated the cancer or ovarian/testicular function.

Conclusions: Acupuncture reduced the number of hot flushes and distress caused by hot flushes with at least 50% in women and men with hot flushes and a cancer disease and also improved HRQoL and sleep at least in women. Acupuncture should be further evaluated in these patient groups and could be a treatment alternative in patients with troublesome symptoms.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2011. , 110 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1245
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-68806ISBN: 978-91-7393-180-9OAI: oai:DiVA.org:liu-68806DiVA: diva2:421125
Public defence
2011-06-10, Berzeliussalen, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-06-07 Created: 2011-06-07 Last updated: 2011-06-07Bibliographically approved
List of papers
1. Acupuncture treatment of vasomotor symptoms in men with prostatic carcinoma: A pilot study
Open this publication in new window or tab >>Acupuncture treatment of vasomotor symptoms in men with prostatic carcinoma: A pilot study
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1999 (English)In: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 161, no 3, 853-856 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Most men who undergo castration therapy for prostatic carcinoma will have vasomotor symptoms that usually persist for years. Vasomotor symptoms are elicited from the thermoregulatory center, possibly due to a decrease in hypothalamic opioid activity induced by low sex steroid concentrations. Acupuncture treatment in women, which stimulates hypothalamic opioid activity, alleviates vasomotor symptoms. We report on men treated with acupuncture for relief of vasomotor symptoms after castration therapy.

MATERIALS AND METHODS: We asked 7 men with vasomotor symptoms due to castration therapy to receive acupuncture treatment 30 minutes twice weekly for 2 weeks and once a week for 10 weeks. Effects on flushes were recorded in logbooks.

RESULTS: Of the 7 men 6 completed at least 10 weeks of acupuncture therapy and all had a substantial decrease in the number of hot flushes (average 70% after 10 weeks). At 3 months after the last treatment the number of flushes was 50% lower than before therapy. Therapy was discontinued after 10 weeks because of a femoral neck fracture in 1 man and after 3 weeks due to severe back pain in 1.

CONCLUSIONS: Acupuncture may be a therapeutic alternative in men with hot flushes after castration therapy and merits further evaluation.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25941 (URN)10.1016/S0022-5347(01)61789-0 (DOI)000078492300030 ()10387 (Local ID)10387 (Archive number)10387 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2013-02-22
2. Long-term follow-up of acupuncture and hormone therapy on hot flushes in women with breast cancer: a prospective, randomized, controlled multicenter trial
Open this publication in new window or tab >>Long-term follow-up of acupuncture and hormone therapy on hot flushes in women with breast cancer: a prospective, randomized, controlled multicenter trial
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2008 (English)In: Climacteric, ISSN 1369-7137, E-ISSN 1473-0804, Vol. 11, no 2, 166-174 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the effects of electro-acupuncture (EA) and hormone therapy (HT) on vasomotor symptoms in women with a history of breast cancer.

Methods: Forty-five women were randomized to EA (n = 27) for 12 weeks or HT (n = 18) for 24 months. The number of and distress caused by hot flushes were registered daily before, during and up to 24 months after start of treatment.

Results: In 19 women who completed 12 weeks of EA, the median number of hot flushes/24 h decreased from 9.6 (interquartile range (IQR) 6.6-9.9) at baseline to 4.3 (IQR 1.0-7.1) at 12 weeks of treatment (p < 0.001). At 12 months after start of treatment, 14 women with only the initial 12 weeks of EA had a median number of flushes/24 h of 4.9 (IQR 1.8-7.3), and at 24 months seven women with no other treatment than EA had 2.1 (IQR 1.6-2.8) flushes/24 h. Another five women had a decreased number of flushes after having additional EA. The 18 women with HT had a baseline median number of flushes/24 h of 6.6 (IQR 4.0-8.9), and 0.0 (IQR 0.0-1.6; p = 0.001) at 12 weeks.

Conclusion: Electro-acupuncture is a possible treatment of vasomotor symptoms for women with breast cancer and should be further studied for this group of women.

Keyword
Acupuncture, Breast Neoplasms, Hot Flushes, Hormone Replacement Therapy, Menopause
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12622 (URN)10.1080/13697130801958709 (DOI)
Note

Original publication: J. Frisk, S. Carlhäll, A. -C. Källström, L. Lindh-Åstrand, A. Malmström and M. Hammar, Long-term follow-up of acupuncture and hormone therapy on hot flushes in women with breast cancer: a prospective, randomized, controlled multicenter trial, 2008, Climacteric, (11), 2, 166-174. Copyright © Taylor & Francis Group, an informa business

Available from: 2008-09-18 Created: 2008-09-18 Last updated: 2014-06-25Bibliographically approved
3. Acupuncture improves health-related quality-of-life (HRQoL) and sleep in women with breast cancer and hot flushes
Open this publication in new window or tab >>Acupuncture improves health-related quality-of-life (HRQoL) and sleep in women with breast cancer and hot flushes
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2012 (English)In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 20, no 4, 715-724 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Evaluate effects of electro-acupuncture (EA) and hormone therapy (HT) on health-related quality-of-life (HRQoL) and sleep in breast cancer survivors with vasomotor symptoms.

METHODS: Forty-five women, randomized to EA (n = 27) for 12 weeks or HT (n = 18) for 24 months, were followed for up to 2 years. Distress caused by, and numbers of, hot flushes, hours slept and times woken up/night, Psychological and General Well-being Index (PGWB) and Women's Health Questionnaire (WHQ) were registered before and during treatment and at 6, 9, 12, 18 and 24 months after start of treatment.

RESULTS: After 12 weeks of EA (n = 19), WHQ improved from 0.32 (IQR 0.23-0.53) at baseline to 0.24 (IQR 0.12-0.39; p < 0.001) and PGWB from 78 (IQR 53-89) to 79 (IQR 68-93; p = 0.002). All sleep parameters improved and Hot Flush Score (HFS) decreased by 80%. At 12 months, WHQ, PGWB and all sleep parameters remained significantly improved (n = 14) and HFS decreased by 65%. After 12 weeks of HT (n = 18), WHQ improved from 0.29 (IQR 0.15-0.44) at baseline to 0.15 (IQR 0.05-0.22; p = 0.001), PGWB from 75 (IQR 59-88) to 90 (62-97; p = 0.102) and three of five sleep parameters improved.

CONCLUSION: Both EA and HT increased HRQoL and sleep, probably through decreasing numbers of and distress by hot flushes. Although flushes decreased less in the EA group than in the HT group, HRQoL improved at least to the same extent maybe due to other effects of EA, not induced by HT, e.g. on anxiety, vitality and sleep, supported by subscale analyses. EA should be further evaluated as treatment for women with breast cancer and climacteric complaints, since HT no longer can be recommended for these women.

Place, publisher, year, edition, pages
Springer, 2012
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-68804 (URN)10.1007/s00520-011-1134-8 (DOI)000301525700006 ()21468626 (PubMedID)
Note
funding agencies|Medical research council of South-East of Sweden||Swedish Medical Research Council| K2002-72X-12651-O5C |County Council of Ostergotland||Available from: 2011-06-07 Created: 2011-06-07 Last updated: 2012-04-12Bibliographically approved
4. Two Modes of Acupuncture as a Treatment for Hot Flushes in Men with Prostate Cancer—A Prospective Multicenter Study with Long-Term Follow-Up
Open this publication in new window or tab >>Two Modes of Acupuncture as a Treatment for Hot Flushes in Men with Prostate Cancer—A Prospective Multicenter Study with Long-Term Follow-Up
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2009 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 55, no 1, 156-163 p.Article in journal (Refereed) Published
Abstract [en]

Background: Hot flushes are common and distressing among men with castrational treatment for prostate cancer. Of the few treatments, most have side effects.

Objective: Assess changes in hot flushes of electrostimulated (EA) and traditional acupuncture (TA).

Design, Setting, and Participants: Thirty-one men with hot flushes due to prostate cancer treatment were recruited from three urological departments in Sweden, from 2001 to 2004.

Intervention: Thirty-one men were randomized to EA (4 electrostimulated needle points) or TA (12 needle points) weekly for 12 wk.

Measurements: Primary outcome: number of and distress from hot flushes in 24h and change in “hot flush score.” Secondary outcome: change in 24-h urine excretion of CGRP (calcitonin gene–related peptide).

Results and Limitations: Twenty-nine men completed the treatment. Hot flushes per 24h decreased significantly, from a median of 7.6 (interquartile range [IQR], 6.0–12.3) at baseline in the EA group to 4.1 (IQR, 2.0–6.5) (p=0.012) after 12 wk, and from 5.7 (IQR, 5.1–9.5) in the TA group to 3.4 (IQR1.8–6.3) (p=0.001). Distress by flushes decreased from 8.2 (IQR, 6.5–10.7) in the EA group to 3.3 (IQR, 0.3–8.1) (p=0.003), and from 7.6 (IQR, 4.7–8.3) to 3.4 (IQR, 2.0–5.6) (p=0.001) in the TA group after 12 wk, (78% and 73% reduction in “hot flush score,” respectively). The effect lasted up to 9 mo after treatment ended. CGRP did not change significantly. Few, minor side effects were reported.

Limitations: small number of patients; no placebo control, instead a small group controlled for 6 wk pretreatment.

Conclusions: EA and TA lowered number of and distress from hot flushes. The hot flush score decreased 78% and 73%, respectively, in line with or better than medical regimens for these symptoms. Acupuncture should be considered an alternative treatment for these symptoms, but further evaluation is needed, preferably with a non- or placebo-treated control group.

Keyword
Hot flushes, Prostate neoplasms, Acupuncture, Castration
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12621 (URN)10.1016/j.eururo.2008.02.002 (DOI)
Note
Original publication: Jessica Frisk, Anna-Clara Spetz, Hans Hjertberg, Bill Petersson, Mats Hammar, Two Modes of Acupuncture as a Treatment for Hot Flushes in Men with Prostate Cancer—A Prospective Multicenter Study with Long-Term Follow-Up, 2008, European Urology. Copyright: Elsevier B.V., http://www.elsevier.com/ Available from: 2008-09-18 Created: 2008-09-18 Last updated: 2011-08-30
5. The effect of acupuncture on Health Related Quality of Life and sleep
Open this publication in new window or tab >>The effect of acupuncture on Health Related Quality of Life and sleep
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Hot flushes are well-known, disturbing side effects of Androgen  Deprivation Therapy (ADT) in men with advanced prostate cancer, and the hot flushes negatively affect HRQoL and sleep. Acupuncture has been shown effective and without side effects, as treatment for hot flushes in men with (ADT). The effect on flushes lasts up to nine months after treatment has ended, but little is known about its effect on HRQoL and sleep. This study adds knowledge about the association between hot flushes, HRQoL and sleep. It shows that the number of hot flushes /night decrease significantly for up to 12 months. It concludes however, that there are many other factors that affect the patients general HRQoL, and perhaps that is one reason why we cannot show an improvement in general HRQoL.

Objective:

  • To evaluate the effect of electro-acupuncture (EA) and traditional acupuncture (TA)on HRQoL and sleep in men with castrationally treated prostate cancer and hotflushes.

Patients:

  • thirty-one men were randomized to traditional acupuncture (TA; n=16) or electrostimulated acupuncture (EA;n=15) for 12 weeks, with a study period of 12 months.

Methods:

  • TA or EA was given for 30 minutes, twice a week for two weeks, and then once a week for 10 weeks. The patients were seen at the outpatient clinic before treatment, after 12 weeks of treatment, and at 6, 9, and 12 months follow up.
  • Log books , where the patients recorded number of and distress by hot flushes, tiredness, depressed mood, number of hours slept/night , and times woken up/night, were filled in before treatment, daily during the 12 weeks of treatment, and then one week before the 6, 9, and 12 months follow up visit.
  • Psychological and General Well-Being Index (PGWB) measured HRQoL at baseline, 12 weeks of treatment, and 6, 9 and 12 months follow up.
  • A six week waiting list with eight patients served as a control for changes in log-bookdata

Results:

  • The number of hot flushes/night decreased significantly in both groups at all measuring points, except at nine months in the TA group.
  • No changes in hot flushes and times woken up/night during a six weeks pretreatment waiting list in eight patients, but significant changes in these patients after four weeks of treatment.
  • HRQoL, measured by log-book data and PGWB did neither improve nor deteriorate over 12 months. (A clinically significant change in PGWB was seen in 8/29 patients after 12 weeks of treatment, and a deterioration in 11/29).
  • The patients reported no change in hours slept/night, and times woken up/night decreased significantly only in the EA group after 12 weeks of treatment.
  • There is a strong association between numbers of hot flushes, sleep and HRQoL.

Conclusion:

  • HF are associated with HRQoL and sleep, and EA/TA decrease hot flush numbers and distress, and thereby possibly increase sleep quality. This may sustain HRQoL.
  • HRQoL neither improved nor deteriorated during 12 months follow up, which may in this patient group, be explained by other factors, probably related to the advanced PCa, that have negative impact on HRQoL.
  • EA/TA merits further evaluation regarding the effects on HRQoL with a rigid measure of signs of disease progression, and also using a prostate cancer or hormone deprivation specific HRQoL questionnaire.
Keyword
Hot flushes, Prostate cancer, acupuncture, HRQoL, sleep
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-68805 (URN)
Available from: 2011-06-07 Created: 2011-06-07 Last updated: 2011-08-30Bibliographically approved

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