Acupuncture As an Integrative Approach for the Treatment of Hot Flashes in Women With Breast Cancer: A Prospective Multicenter Randomized Controlled Trial (AcCliMaT)  

Lesi, Razzini, Musti et. al., 2016

 2016 May 20;34(15):1795-802. doi: 10.1200/JCO.2015.63.2893. Epub 2016 Mar 28.


One thing I love about going to conferences is getting to meet the researchers behind publishing high quality data on acupuncture. At this years Society in Acupuncture Research Conference, a recent paper was presented on hot flashes in women with breast cancer. What I truly appreciate about this article, is the focus on integrative approaches. The authors compared acupuncture plus enhanced self-care, vs enhanced self care alone. In my opinion, this is the most clinically relevant approach to data collection. Not only looking at one modality, but real world applications. Most breast cancer patients seek out integrative medicine as they search for relief from annoying hot flashes, night sweats, flushed face, sweaty palms/feet; to name a few. 
The authors gathered 190 women with breast cancer, of those 105 used self care and 85 used self care plus acupuncture. The self care was supplied as a brochure, and has recommendations on diet, exercise and psychological support.


The Study's Self Care Advice

Diet:

  • A diet based on vegetables and fresh fruit reduces many symptoms of estrogen deficiency.  In particular, the consumption of vegetables belonging to the cabbage family, such as cabbage, turnip, radish, broccoli, cauliflower, and arugula, is a valuable aid in preventing cancer.

  • Reduce your intake of red meat, especially sheep and cattle (no more than 300 g per week); white meat and fish are recommended. It is useful to eat fish at least twice a week, and clinical evidence suggests a fish in take of about 35g per day.

  • Consider increasing the consumption of fiber and antioxidant elements, because they can decrease the absorption of lipids and exogenous cholesterol. Those who are not used to these foods must introduce them gradually to allow time for the intestine to adapt, remembering to chew well and eat slowly.

  • Limit your intake of salt to no more than 5 g per day, and limit intake of foods preserved in salt. Choose instead to use sea salt, and enrich food with herbs.

  • Consider minimizing your sugar intake, increasing fiber and complex carbohydrates and dividing calorie intake throughout the day. It is strongly advised to avoid fizzy drinks and sweets as well as the consumption of white sugar, fructose, and chocolate.

  • Moderate alcohol consumption may be associated with the appearance of insomnia and hot flashes, especially when consumed before bedtime, so it is advisable to reduce or avoid consumption of alcohol. 

  • The use of caffeine-containing beverages can facilitate the onset of hot flashes and insomnia, especially when taken before bed; therefore, it is advisable to reduce your intake of coffee.  

Exercise: 

  • Physical activity has therapeutic value only if done methodically and with constant frequency (at least twice per week). 


Psychological support: 

  • Stress has a negative impact on quality of life, especially in postmenopausal women, and can cause a variety of symptoms that worsen in some pathologic conditions. For this reason, you must also consider the following opportunities: • Psychological support from psychologists or psycho-oncologists, self-help groups, or leisure activities. 

  • General advice for coping with hot flashes: • Wear cotton and other natural fibers and avoid synthetic fibers • Dress in layers 


Both groups were followed for 12 weeks, the acupuncture group received 10 treatments in addition to following the self care guidelines.  If you love graphs as much as I do, here’s what the results showed (see graph above). 

The acupuncture plus self care group showed a significantly reduced hot flash score.  This trend continued for 3 and 6 month follow up visits.  I was impressed that the authors didn’t end the study after the 12 weeks.  I haven’t read much acupuncture research that includes long term results (a changing trend).  While there are quite a few well regarded articles demonstrating the efficacy of acupuncture in treating hot flashes, again what inspired me was the inclusive nature of this trial.  As an evidence based acupuncturist, I use research to guide my treatment plans.  But as your practitioner, I combine as many tools as possible to help you get through your cancer journey.  

https://www.ncbi.nlm.nih.gov/pubmed/27022113