Acupuncture has been recommended for chronic pain in cancer survivors by the practice guideline of the American Society of Clinical Oncology (ASCO). In the past 20 years, Integrative Oncology, a branch of integrative medicine, combines complementary therapies alongside conventional mainstream oncology care. Clinical trial-generated evidence has shown that acupuncture is safe and effective as an adjunctive treatment for managing cancer related symptoms. However, despite thousands of years of practice outside of conventional medical system, acupuncture use as an adjunctive therapy within a mainstream oncology setting presents an entirely new challenge.

Oncology Acupuncture, a new breed of acupuncture, has emerged as a subspecialty in cancer symptom management. We have established an Oncology Acupuncture Specialty Clinic at Dana-Farber Cancer Institute (DFCI), a U.S. top cancer hospital and a principal teaching affiliate of Harvard Medical School, since 2000. Our practice focuses on symptom management during the full spectrum of cancer journey, from the active treatment phase to the end-of-life care. In addition, we have conducted several randomized clinical trials (RCT) of acupuncture in cancer care. We will present the unique features of Oncology Acupuncture, describe the practice model of Oncology Acupuncture at DFCI, review RCT- leveled evidence of acupuncture for chronic pain syndromes associated with cancer treatments, and discuss future directions of Oncology Acupuncture research and practice in cancer care.

Anxiety, depression and sleeping problems are common and affect all dimensions of life. The effect of medication is modest with severe side effects. It is essential to find a safe and effective treatment that reduces suffering. Complementary methods are wanted.

Acupuncture has effect and could be used in all three symptoms. Our talk focuses on evidence, clinical experiences and implementation of acupuncture in psychiatric care as an interesting option. We will also present our results from four studies. In two qualitative studies on ear-acupuncture in Anorexia Nervosa, interviews were conducted with patients receiving acupuncture as an adjunct to usual care in a highly specialised ward for eating disorders. An interview study with health care professionals who use ear-acupuncture in different psychiatric settings reports how they perceive acupuncture as a valuable tool, and a mixed method study describes implementation of acupuncture in a psychiatric ward.

Background
Chemotherapy-induced peripheral  neuropathy(CIPN). Taxane-induced CIPN is a frequent side-effect, observed in 15–60% of breast cancer patients. It can produce severe neurological deficits and neuropathic pain and it is a potential reason for interrupting or reducing the dose of chemotherapy. Specific and effective treatments are lacking.

Aim
We conducted a multicentric pilot study to assess the feasibility, safety and preliminary effect of acupuncture for taxane-based CIPN in breast cancer.

Materials and methods
From October 2017 untill January 2018 we enrolled 9 patients, with breast cancer who were experiencing CIPN (I-III grade)  after the completion of a taxane neoadjuvant chemotherapy for at least 1 week.All of these have completed an informed consent.
Patients received 12 sessions of acupuncture over 6 weeks:EORTC QLQ–CIPN20 was assessed at baseline, after 3 weeks of treatment, at the end of the treatment and after 3 weeks of follow-up.NRS was assessed at baseline,before every session of acupuncture and after 3 weeks from the end of the treatment. We also registered side effects and every change in other symptoms affected the quality of life reported at the baseline.

Results
At this time 4 patients completed the sessions and the follow up(44,4%). We analysed their data, using the Friedman-test for multiple comparison. CIPN-20 improved, with no statistical significance, from the baseline (T0) to the end of the treatment (T2) and also at follow-up (T3) for all the scales: sensory ( T1: 19,00±6,683, T2: 13,75±4,425, T3: 13,75 4,425,  p=0,142), motor (T1:11,50±3,317, T2: 10,25±1,708, T3: 10,75± 2,5 p= 0,392), autonomic (T0:2,75±1,5 T2: 2,25±0,5,  T3: 2,25±0,5 p= 0,572).The percentage of the improvement is 25% for sensory scale and 5,5% for motor scale at follow-up.We assessed a significant improvement of the NRS scale (p=0.001) that is maintained at follow-up.No side effects occurred. We also registered improvement/resolution of fatigue, insomnia, hot flashes, muscle cramps, peptic disorders: however these data were not statistically analyzed.

Conclusion
These preliminary data suggest that acupuncture is a feasible and safe treatment for CIPN in breast cancer patients. Although the sample analyzed is very small, the results show that acupuncture can significantly improve the subjective perception of pain; acupuncture seems also to have an impact in reducing CIPN-related symptoms. Further and large studies are needed to confirm these results.

The project is a feasibility study for a small scale pragmatic RCT of acupuncture for treating generalised anxiety disorder. Its purpose is to assess: recruitment and retention; safety, possible side-effects; show whether patients liked acupuncture as well as CBT; whether patients felt the same or different after CBT or acupuncture. The study is ongoing. Progress and results to date will be presented.

Stroke is a major cause of mortality and disability in the UK. In China, acupuncture used is routinely used as an intervention in post stroke care is rarely mentioned in the west. There is some evidence from Cochrane reviews which suggests that acupuncture may improve aspects of daily living including  neurological function and swallowing. Given the heterogeneity of stroke symptoms and the growing general evidence for the use of acupuncture for pain, depression and anxiety, acupuncture may provide a useful cost effective option for post stroke care rehabilitation. This British Acupuncture Council funded study has 2 aims, firstly to explore whether any international clinical guidelines recommended acupuncture for stroke patients and secondly to ascertain the perceptions and views of BAcC acupuncturists and NHS healthcare professionals (who work with stroke patients) regarding the use and feasibility of introducing traditional acupuncture into post stroke care.  Results from the study will be presented and recommendations for the future suggested.

The presentation will discuss the initial results of a retrospective cohort study of the effects of adjuvant acupuncture on IVF reproductive outcomes.  The study compares patients who have had acupuncture to a matched cohort of patients who received IVF usual care only at an NHS Fertility clinic between Jan 2011- Dec 2017.
The study aims to investigate the effect of acupuncture on IVF outcomes of live birth and clinical pregnancy rate and whether number of acupuncture sessions or age range correlates with improved outcome.

Symposium 2019

Posters 2019

The use of daily self-administered indirect moxibustion during chemotherapy - is it feasible and acceptable in an NHS setting? - Beverley de Valois

Does electrical stimulation to the hands (transcutaneous electroacupuncture stimulation, TEAS) have frequency-specific effects on heart rate variability (HRV)? - David Mayor

Five Element Acupuncturists’ experiences of building rapport and therapeutic relationship with patients – a qualitative, exploratory study - Sally Anderson

Moxa on St 36 has been used for centuries in Asian medicine for strengthening the body, improving health, nourishing blood and supporting the immune system. This has implications for use during active cancer treatment, particularly chemotherapy (which destroys blood cells as well as cancer cells) to reduce toxicities and improve outcomes.

Building on published clinical observations by Staebler (2009) and Davies (2013), this study is the first step in investigating whether application of moxa on ST 36 reduces chemotherapy-induced cytopenia (neutropenia, anaemia, thrombocytopenia). It explores the feasibility of conducting this research within the NHS, teaching cancer patients undergoing chemotherapy to self-administer moxa on St 36 daily throughout the duration of their treatment. The primary outcome is adherence to daily self-administered moxibustion (measured by daily diaries. Secondary measures include blood counts, adherence to planned chemotherapy schedule, health-related quality of life, and adverse events of moxibustion. Acceptability of using moxa to cancer patients and their healthcare professionals is also explored.

In this first presentation of the study results, the Principal Investigator Beverley de Valois will discuss the challenges of introducing a novel intervention into the NHS and some of the surprises that emerged during this study funded by the British Acupuncture Council.

This is the 20th Annual ARRC Symposium. As part of a twenty-year celebration, I will look back at the learning curve for those of us involved in acupuncture research over the last 20 years or so. In this presentation, I will identify some of the key concepts and publications that have led to a substantial shift not just in the evidence base, but also in attitudes to acupuncture research from within, as well as from outside of, the profession. The path has involved the support of many colleagues and institutions, the enthusiasm and commitment from many acupuncturists, and the willingness by countless patients to be involved in interviews, focus groups, trials and surveys. The story has highs and lows, trials and tribulations, and set-backs and steps forward. I will draw on my own journey in acupuncture research and present some thoughts on where we are now, and where we might be heading in the years ahead.

NB there were various issues with sound for the first half of this session.

Ed Fraser is a researcher for Healthwatch Norfolk, which is the independent and statutory representative for people using health and care services in Norfolk. A member of The Health Foundation’s “Q Community” for leaders in health and care improvement, Ed specialises in public involvement in research and is particularly interested in translating evidence into tangible improvements in services for patients and families. Since October 2014, Ed has been researching the health and wellbeing needs of veterans from the British Armed Forces. His two-year qualitative study into veterans’ experiences of NHS mental health services in Norfolk and Suffolk was published in the Journal of Public Mental Health (Volume 16; Issue 1) and he is currently co-authoring a chapter on military psychology for a landmark Palgrave book about masculine psychology (upcoming, 2018). Over the last three years, veterans and families have helped Ed to deliver 23 service improvements. His work has received three national awards, including an NHS England “Celebrating Participation in Healthcare” grant in 2016. More generally, Ed is a passionate advocate for people living with mental health conditions and he promotes the parity of esteem agenda through his active membership on a number of mental health networks across the country.

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