A Retrospective Review Investigating the Feasibility of Acupuncture as a Supportive Care Agent in Children with Cancer

Kathy Taromina, MS, LAc, Diane Rooney, MS, LMT, LAc, Elena J. Ladas, MS, RD, Deborah Hughes,

Kara Kelly, MD

Integrative Therapies Program for Children with Cancer, Columbia University, Division of Pediatric Oncology,

New York, NY, United States, 10032

Background

Acupuncture is an ancient Chinese method of healing and is a component of Chinese medical treatment.

Published reports have cautioned against the use of acupuncture in the pediatric population

Clinical trials have suggested that acupuncture may have a role as a supportive care agent in adults undergoing treatment for cancer

No clinical trials have been published for children undergoing treatment for cancer.

Acupuncture and Pediatrics Pediatrics has historically been part of

Chinese medicine and is widely used in China.

Recommended for children of all ages and conditions

Adjustments need to be made to treatment and delivery

Acupuncture and Children with Cancer

More consideration needed when giving acupuncture to children already having frequent needle exposure.

Developmental Stage Difficult to avoid toddlers from moving around or

grabbing at needles Body image concerns with adolescents

Strategies Fewer needles, thinner

gauge and shorter duration of treatment

Needles do not have to be retained to have a therapeutic effect

Gently inserting needles and coordinating breathing exercises with insertion can minimize the sensation of the needle being placed.

Private room option

Acupuncture and Thrombocytopenia

Many cancer patients encounter thrombocytopenia at some point in their therapy

Recommendations from the acupuncture community are practitioner-dependent

Theoretical concern in patients with < 50 µMol/mL

Program Description

Acupuncture services were initiated in March 2005

The primary oncologist of each patient is approached by the director of the program prior to acupuncture treatment

Upon physician approval, patient/guardian consent is obtained per NY State Guidelines

Acupuncture Treatment Description

Treatment is integrated with outpatient and inpatient treatments

Appointments not necessary

Acupuncturist makes daily rounds in outpatient center and inpatient unit

Primary Objectives

To describe the first year of the introduction of an acupuncture program to children with cancer.

To describe the feasibility, patient acceptance, symptoms addressed, and overall experience of an acupuncture program provided to children undergoing treatment for cancer.

Methods

25 patient records of subjects between the age of 1 and 22 who were undergoing treatment for cancer

Patient diagnosis, gender, age, chief complaint, number of treatments, acceptance, outcome, and adverse events were recorded over a 6-month period.

Patient treated with acupuncture at the same time as receiving conventional therapies

Monitoring of Side-Effects

Acute A thorough exam of the acusites was conducted

after each treatment session. Delayed

Acusites were examined during the patient’s routine visit to monitor for any delayed side-effects.

Results

Over a 6-month period, we provided 172 sessions of acupuncture to children ages 1– 22 undergoing treatment for cancer

The provision of services was feasible to a wide range of diagnoses and ages and in both the inpatient and outpatient settings

Demographic Data

Caucasian (15)

Hispanic (7)

Black, not Hispanic (1)

Other (2)

Female (14)

Male (11)

N=25

Age Range: 1 to 22 years

Race Gender

Patient Diagnoses

0 1 2 3 4 5 6

Sickle Cell Anemia

AML

Rhabdomyosarcoma

Nasopharyngeal

Hodgkins Disease

Osteosarcoma

ALL

Ewings

Brain Tumor

# of Patients

Signs & Symptoms Treated

Pain Headache

Dry Mouth

High Blood Pressure

Fatigue / Weakness

Cachexia

Nausea / Vomit

Anxiety

Well-Being

Thrombocytopenia

Side-Effects Associated with Treatment with Acupuncture

Out of 172 sessions of acupuncture, only two side effects reported

Two patients reported a small hematoma at the acupoint site 16-year old male with relapsed Ewings Sarcoma. Patient

was receiving high-dose dexamethasone and developed a hematoma at one acusite after one treatment.

11-year old female with relapsed Ewings Sarcoma. Patient suffered chronic thrombocytopenia and developed a hematoma at one acusite after one treatment.

0

2

4

6

8

10

12

14

Patient Platelet Counts

< 50 µMol/mL > 50 µMol/mL< 20 µMol/mL

Treatments Per Patient

0

5

10

15

20

25

30

35

# of

Tre

atm

ents

Conclusions Provision of acupuncture is feasible and well-

accepted among children with diverse malignancies and undergoing stem cell transplantation

Provision of acupuncture is feasible in both the in/out-patient settings

Acupuncture is well-accepted by a wide age range of patients

Acupuncture may be a supportive care agent for a variety of therapy-related side-effects; however, this needs to be confirmed in future clinical trials

Next Steps

The descriptive nature of this study helped identify potential areas where acupuncture may have a role as a supportive care agent.

Future randomized, controlled trials in a homogenous patient population will aid investigators in identifying the role of acupuncture in pediatric oncology

Acknowledgements Staff of The Integrative Therapies Program for

Children with Cancer

Kara Kelly, MD Elena J Ladas, MS, RD Deborah Hughes, BA Diane Rooney, L.Ac Christine Grimaldi, PhD

The patients treated at the Division of Pediatric Oncology,

Columbia University Medical Center