September 22, 2008

Jenna Glazer was diagnosed with breast cancer in 2004 at age 34. And then she experienced one of the most intense and disturbing side effects of cancer treatment for young women, enduring up to 50 hot flashes a day and night sweats that constantly disturbed her sleep.

“I was having several hot flashes an hour, which was absolutely brutal," Glazer said of her therapy-triggered menopausal symptoms. "I would be sitting in the living room in the middle of winter with the windows open and the air conditioning on in boxer shorts and a tank top.”

Now a new study suggests that acupuncture can help such symptoms. Indeed, it seems to be just as effective as Effexor, an antidepressant commonly used to treat treatment-related hot flashes, but without side effects such as insomnia, constipation, dizziness, or a lag in sex drive.

In fact, the study, which will be presented at the American Society for Therapeutic Radiation and Oncology meeting in Boston on Monday, suggests that women might get more than just symptom relief.

“It had benefits in terms of increased energy [and] increased clarity of thinking,” said study author Eleanor Walker, MD, a radiation oncologist at the Henry Ford Hospital in Detroit. “Overall, patients felt better and, in some patients, they had an increase in their sex drive.”

Next page: What the study found

What the study found
Dr. Walker and her colleagues randomly assigned 47 patients who were taking tamoxifen or Arimidex (two breast cancer drugs that can cause menopausal symptoms) to a 12-week course of either acupuncture or Effexor.

On average, the women had 6 to 10 moderate-to-intense hot flashes a day and woke 2 to 3 times a night due to night sweats.

They found that the response was about the same for both treatments—65% of women received a benefit. However, when patients stopped Effexor, they started having hot flashes again in two weeks, while it took 15 weeks for symptoms to return in the acupuncture group.

Although some patients didn't respond at all to the acupuncture, many reported significant relief. One woman in the study started with 27 hot flashes a day, said Dr. Walker, and “within two treatments, her [symptoms] dropped to half that.”

Dr. Walker said it was unlikely that the response was due to a placebo effect.

A previous study of women with breast cancer–related hot flashes compared acupuncture to sham acupuncture, in which needles are inserted in the wrong places at insufficient depth.

In that study, the real acupuncture reduced daytime hot flashes by 50% compared to the control treatment.

Next page: Why breast cancer patients have hot flashes

Why breast cancer patients have hot flashes
Such menopausal symptoms are common because the drugs used to fight cancer do so by blocking estrogen. About 80% of breast cancers are sensitive to estrogen, and will grow more rapidly in its presence.

Glazer said her symptoms started after she underwent chemotherapy but became much worse after she had surgery to remove her ovaries (which produce estrogen).

Typically, severe menopausal symptoms in women without cancer might respond to a short course of hormone therapy, but that’s not a safe option for breast cancer patients.

Sometimes doctors use inflammation-fighting corticosteroids instead, but those aren’t a great choice because “you gain weight and there are long-term side effects to steroids also in terms of your bones and joints,” said. Dr. Walker.

That’s why so many women take the antidepressant Effexor, which can alleviate hot flashes and depression.

Glazer tried both acupuncture and Effexor for her symptoms and found some relief with both. However, going off the antidepressant was harder than she thought, even though she tapered the dose.

“I gradually came off of it, it was not a cold turkey thing at all,” she said. “It almost felt like when I took a step...my brain was rattling around in my head—I felt dizzy and disoriented.”

Each time Glazer dropped her dosage, she had those symptoms for one to three days. When she finally stopped, it took a week before she felt normal again.

Next page: Will your insurance company pay for acupuncture?

Will your insurance company pay for acupuncture?
Although insurance companies do pay for Effexor, they don’t always pay for acupuncture.

“Here in the Midwest, insurance does not pay for [acupuncture] at all,” said Dr. Walker. “In the East Coast and on the West Coast, insurance will pay at least 50% for acupuncture treatment.”

Glazer had to pay $90 out of pocket for each one of her acupuncture sessions.

However, she notes that one nonprofit organization in New York, called You Can Thrive, provides acupuncture, massage, and reflexology to breast cancer patients at no cost.

“I always think it's just penny wise and pound foolish because these drugs that they put you on to control side effects are expensive, they’re intense, and they cause other problems—then maybe you need to go on more drugs,” says Glazer. “If some of these things can be controlled with acupuncture, these insurance companies should wise up and realize it’s to their benefit to open their minds a little bit.”

Dr. Walker hopes that insurance companies “will recognize the importance of this study, and this option for women, and at least pay 50% of the cost, if not 100% of the cost.”

The Susan G. Komen Foundation funded the study.

By Theresa Tamkins

(PHOTO: ISTOCKPHOTO)


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