Publications
Insight, Spring 2007
Learn about findings presented at the 29th annual San Antonio Breast Cancer Symposium and hear how acupuncture can help you improve your quality of life. Also, Li-Chen Chin shares her story of pregnancy after treatment and talks about cultural barriers that may keep Asian immigrants from getting breast cancer treatment.
Table of Contents
The Benefits of Acupuncture: Using Traditional Chinese Medicine to Manage Side Effects
After Letha Kern, 56, had surgery, chemotherapy and radiation for stage 3 breast cancer, she took the hormonal therapy tamoxifen, which caused intense hot flashes.
Uncomfortable and unable to come to terms with her experience, Letha became anxious and depressed. As a registered nurse, she felt guilty that she had not caught her cancer earlier.
"[During treatments,] you are so focused on getting better that you don’t dwell on what you have been through," she says. "But it hit me, and it was very hard to deal with."
Letha decided to try acupuncture. Four days after her first treatment, her hot flashes were gone, and her anxiety decreased significantly. One year and ten treatments later, Letha has never experienced another hot flash.
Why Use Acupuncture?
According to Traditional Chinese Medicine (TCM), the body must maintain a balance between yin and yang, or mind and emotions, to remain healthy. This balance occurs when vital energy, or qi (pronounced "chee"), flows freely throughout the body along pathways called meridians.
Originating in China more than 2,000 years ago, acupuncture maintains health by removing blockages of qi. To remove blockages, an acupuncturist inserts hair-thin needles one-quarter to one inch deep at acupuncture points located along the meridians. These points may be located on the border of a muscle or bone and are an inch to several inches above a wrist, ankle or knee crease, depending on the person.
Western medicine cannot fully explain how acupuncture works; however, researchers have suggested that acupuncture may relieve pain and side effects by improving blood flow and stimulating the nervous system.
"[Acupuncture] does not enhance survival; it enhances quality of life," says physician and acupuncturist Raymond Chang, MD, FACP, medical director of Meridian Medical Group in New York City. "One can do acupuncture in the midst of chemotherapy treatments to reduce side effects, especially nausea, [and] during hormone treatments to reduce side effects such as hot flashes. If, at late stages, there is pain related to cancer, one can use acupuncture to alleviate pain."
Acupuncture should not replace traditional therapies, but researchers have reported it may improve quality of life during and after treatment.
In a December 2000 Journal of the American Medical Association study of 104 women with breast cancer undergoing chemotherapy, researchers found that women treated with five consecutive days of acupuncture had fewer episodes of vomiting than women treated with placebo needle treatments or anti-nausea medications.
A small, uncontrolled study in the December 2006 issue of the Journal of Psychosomatic Obstetrics and Gynaecology showed improved psychosocial
well-being in 38 women after 12 weeks of acupuncture or applied relaxation for treatment-related hot flashes, mood changes, insomnia and memory problems.
After Kelly Reichart, 36, had chemotherapy and a mastectomy for stage 2 cancer, she developed sleep problems, a chronic cough, stress and fatigue. Kelly, who tested positive for one of the BRCA gene mutations, had a hysterectomy to decrease her risk for developing a recurrence or ovarian cancer. The anesthesia and surgery caused severe nausea and bloating.
Kelly has had acupuncture once weekly since the surgery, and her hot flashes, anxiety, coughing, insomnia and digestive problems have decreased.
"The night [of the treatment] I get the best sleep I ever get," Kelly says. "I can stay up and read to [my sons] because I’m not so mentally and physically exhausted. Two weeks after surgery, I was on my hands and knees cleaning the house, and I didn’t have any pain at all from the incisions."
What You Need to Know
During your visit, your acupuncturist will determine the best course of treatment by gathering your detailed medical history. Your practitioner will examine your tongue and pulses, clean your skin and place needles at various acupuncture points depending on your symptoms.
Letha’s acupuncturist placed needles in her head, ear, wrist, hands, lower legs and feet.
"I was fascinated that I couldn’t tell she was putting needles in during the first treatment," she says.
A typical acupuncture session lasts between 15 and 60 minutes, and you must stay still to avoid pain. The U.S. Food and Drug Administration requires licensed acupuncturists to use sterile, nontoxic, disposable needles. Most people feel a twinge or no pain as the needles are inserted. You may feel minor discomfort if your acupuncturist wiggles the needles manually or through a battery-operated device.
Relief from symptoms can occur immediately or days after treatment. People respond differently to various styles of acupuncture, and women with severe symptoms may need more treatments than those with mild symptoms.
Kathleen Livingston, 53, was diagnosed with advanced (metastatic) inflammatory breast cancer at age 44. She has had constant treatment with surgery, chemotherapy or radiation for nine years, yet has remained active in patient advocacy, mentoring, tennis, skiing, travel and volunteering.
Kathleen’s monthly acupuncture treatments alleviate the soreness and inflammation caused by IBC, as well as side effects from treatment.
"In general, [acupuncture] is one of the modalities I use to help myself withstand the harsh treatments," she says. "It helps make my body stronger so I have a functional life."
Letha, Kelly and Kathleen had traditional acupuncture. Other techniques include electroacupuncture, which sends pulses of weak electric current through the skin, and laser acupuncture, which uses a laser beam instead of a needle. In moxibustion, an herb is burned above the body or placed on the tip of a needle to warm a meridian and increase flow of qi.
Certain medical issues may make it unwise to have acupuncture. If either your red or white blood cell counts are below normal, you should avoid acupuncture because the small punctures to the skin could invite infections, Dr. Chang says.
If you have had lymph nodes removed, acupuncture to the involved arm may put you at risk for lymphedema. Also, avoid acupuncture if you are taking blood thinners or if you are pregnant.
Some acupuncturists recommend herbal supplements. Always speak with your doctor before taking any vitamins or supplements because they could interact with your treatment.
Where Do I Start?
Dr. Chang advises asking your oncologist to recommend an acupuncturist who is licensed in your state.
Consult the American Academy of Medical Acupuncture at http://www.medicalacupuncture.org to find a licensed practitioner trained to perform acupuncture. Acupuncturists who are not medical doctors should be accredited with the National Certification Commission for Acupuncture and Oriental Medicine; go to http://www.nccaom.org to learn more. Ask whether your acupuncturist has experience treating people affected by breast cancer and is familiar with your primary treatments.
While some insurance plans cover acupuncture during cancer treatments, you may need preauthorization from your insurance company or a physician referral. If your insurance plan does not cover acupuncture, ask your doctor’s office about financial assistance.
The choice to have acupuncture is personal, but you should share your decision with your oncologist or primary care physician.
"What’s important to most breast cancer survivors is to feel like you are actively fighting your disease," Kelly says. "It gives you power, control and makes you feel healthy."
Li-Chen Chin: Moving on After Breast Cancer
Li-Chen Chin, 37, and her fiancé, Chris, were completing plans for an October wedding when Li-Chen discovered a lump during a breast self-exam in July 2004.
With no family history of breast cancer, Li-Chen, a first generation Asian immigrant and college administrator, assumed it was nothing to worry about. She took a scheduled business trip and had her mammogram after she returned.
She was shocked when her radiologist recommended that she see a breast surgeon. The surgeon performed a needle biopsy and called the following day to inform Li-Chen that she had early-stage breast cancer.
"I had a gut feeling it was going to be bad news," she says. "For me, it was a relief to know what I had. I thought it would have been tougher to go on not knowing about it."
Li-Chen had a lumpectomy and an additional surgery to remove any potential cancer cells from the tissue surrounding the tumor before embarking on four rounds of chemotherapy and seven weeks of radiation treatments.
After learning about chemotherapy-related hair loss, Li-Chen decided to shave her head ahead of time. Chris, her best supporter, shaved his as well. However, Li-Chen’s hair started growing back before chemotherapy even started. Her hair fell out the morning after her second treatment.
"When I found my hair all over the pillow and in the shower, that’s when it really sunk in," she says.
Li-Chen spoke with a counselor she had been seeing before diagnosis who helped her to cope with the emotional effects of treatment and the side effects she was experiencing, including weight loss, nausea, fatigue and cognitive difficulties. She found some relief from the nausea from medications and a miso soup her friend recommended.
Working also took her mind off her treatment. She could discuss her diagnosis and treatments with her supervisor, and her coworkers gave extra support. Outside of work, Li-Chen played clarinet in the community band. She and Chris went ahead with their wedding while Li-Chen was in chemotherapy.
She also began to help others. Li-Chen was in her doctor’s office one day when a nurse asked whether she would talk to a Chinese woman who was having a difficult time dealing with her own diagnosis. Li-Chen agreed, and the two began to share their stories.
"My friend felt she caused [breast cancer] to happen," Li-Chen says. "There is still a shame factor, that you must have done something to get the cancer. I think this is common among Asian women who get any type of cancer."
Together, the two attended LBBC’s educational networking meetings and Yoga Unites for Living Beyond Breast Cancer, a May event where women can experience the healing effects of yoga while raising money for LBBC’s educational programs.
Despite these efforts, Li-Chen still had trouble processing what she was going through. After treatment ended, she lost her dog, Fu, an extremely important member of her family. The guilt she experienced about deciding to put him to sleep was compounded by her physical and emotional fatigue from her treatments.
"After my dog died, when bad things would happen, I couldn’t stop crying. I couldn’t sleep very well and kept thinking about things that went wrong. I thought, ‘What do I do now?’" she says.
Her counselor suggested she take time off from work to deal with depression and stress, but Li-Chen struggled with the idea.
"Asians don’t usually complain; [they] accept things as they are," she says. "I didn’t always feel comfortable expressing how I was feeling. For me, being a first generation immigrant, I felt I had to work extra hard. The concept of not working was not an option."
Friends, coworkers and her counselor helped Li-Chen make the decision to take time away from work. During that time, she read, helped her husband set up a business, did Internet research to get more information on her cancer and adopted another dog. She also cared for her husband when he had appendicitis, and the couple finally took their honeymoon to London and Paris.
After six weeks, Li-Chen felt ready to return to work and move forward with her life. She missed her busy routine. The transition back to work was smooth because she had been in communication with her colleagues during her absence.
Since then, Li-Chen and Chris decided to start a family. During her pregnancy, Li-Chen continued seeing her surgeon, oncologist and radiologist for follow-up. She also visited specialists for pre-natal testing. She gave birth to a baby girl, Sheya, 17 months after her treatment ended, which, along with her faith, has helped her to move forward with her life.
"Having a baby helped me realize you have to take care of someone else, that others are more important and take priority. I felt fortunate to have a healthy and happy child," she says.
She took a course on breastfeeding, but the teacher could not answer Li-Chen’s questions because she did not have any information about breastfeeding for women who had experienced breast cancer. When she learned that Sheya was underweight, Li-Chen remembered the useful information she had learned while attending Living Beyond Breast Cancer events.
She decided to post her questions about breastfeeding on an LBBC message board. She got several responses and suggestions about methods to try, including a message from a young woman around her age who had a similar experience.
"I felt my situation was unique, but talking to this woman helped me know someone else was doing it," she says.
Throughout her diagnosis and recovery, talking to and helping others with breast cancer has helped Li-Chen to feel better about her experience and to move past breast cancer.
"Just realize that you aren’t the only one," she says. "There is no shame in being diagnosed. It is possible to have a great life beyond that."
Would you like to share your experiences with others? If so, please drop us a short message at .
Test for Circulating Tumor Cells
Smerage JB, et al. Apoptosis and Bcl-2 expression in circulating tumor cells from women being treated for metastatic breast cancer. 29th Annual San Antonio Breast Cancer Symposium. Abstract 5005.
A new blood test successfully measures the activity of metastatic breast cancer, results of a pilot study show.
The test, CellSearch, measures the number of circulating tumor cells (CTCs) in a sample of blood. The test shows promise for women with advanced disease, who normally receive a treatment until the cancer stops responding. Researchers hope that by measuring the number of CTCs before a woman begins treatment and following it over time, they may determine sooner whether the therapy works for that woman’s particular cancer.
An ongoing study seeks to determine whether measurement of certain markers, or signals of biological activity, in these CTCs can indicate whether they are dying (called apoptosis) or activated. The researchers also want to find out the best times to take blood samples to see whether treatment is working.
Doctors collected 30 ml of whole blood from participants before they started a new treatment for progressive metastatic disease. After participants began therapy, doctors collected blood again after 24, 48 or 72 hours and 3-4 weeks. Researchers used a special processing instrument and automated microscope to look for CTCs and evaluate the M30 (apoptosis) and Bcl-2 expression (activation). Participants received a variety of treatments, including taxane and non-taxane chemotherapy and hormonal therapy.
As of mid-December 2006, researchers had analyzed blood samples from 41 of 54 study participants. Early results showed promise for detecting CTCs and measuring over-expression of Bcl-2. Analysis of the blood samples will continue with the goal of getting more information about the relationship between treatment and the level of cell death and Bcl-2 expression over time.
The results using markers are very early. The U.S. Food and Drug Administration (FDA) has approved CellSearch only for CTC counting as an aid to monitoring people in treatment for advanced disease. This study continues to accrue participants at the University of Michigan. For information, visit http://www.clinicaltrials.gov and search for NCT00156273.
Another study, SWOG-S0500, is underway to determine whether CTCs may be used to guide treatment decisions. For information, visit http://www.lbbc.org/clinical-trial-detail.asp?id=40§ion_tag=G or go to the "open protocol" page at http://www.swog.org
Read the abstract about circulating tumor cells at http://www.abstracts2view.com/sabcs06/view.php?nu=SABCS06L_793&terms=
