SAN ANTONIO — A course of acupuncture reduced hot flashes in women with a history of breast cancer by more than half while improving sleep and quality-of-life measures to a similar extent as hormone therapy in a Swedish randomized trial.
Particularly noteworthy was the durability of acupuncture's benefits. Nine months following conclusion of the 3-month course of acupuncture sessions, most patients continued to have a significant reduction in hot flashes and improved measures of well-being, Dr. Jessica Frisk reported at the San Antonio Breast Cancer Symposium.
She added that in her clinical practice, acupuncture has become her first-line treatment for hot flashes. Hormone therapy (HT) is more effective; indeed, it essentially eliminated hot flashes in the women randomized to the HT study arm. But Scandinavian breast cancer patients now reject HT as an option because of reports of an associated increased risk of breast cancer recurrence.
“They want other things—and acupuncture is quite a safe treatment,” said Dr. Frisk, a general surgeon at Linköping (Sweden) University.
She reported on 45 women with hot flashes who had been diagnosed with breast cancer a mean of more than 4 years earlier. In all, 27 women were randomized to 12 weeks of electrostimulated acupuncture, and 18 women to 24 months of HT. The acupuncture program consisted of two 30-minute sessions per week for the first 2 weeks, followed by once-weekly sessions for the next 10.
The median number of hot flashes dropped from 9.6 per 24 hours at baseline to 4.3 per 24 hours at week 12 in 19 women who completed the 12-week course of acupuncture. The median hot flash frequency at 1 year was 4.9 per 24 hours in 14 women who had no additional acupuncture sessions beyond the initial 12 weeks. At 2 years' follow-up, seven women had a median hot flash rate of 2.1 per 24 hours without ever having had an additional acupuncture treatment. The others had similar results with occasional acupuncture booster sessions.
Median scores on the Kupperman Index of 11 menopausal symptoms improved from a baseline of 24 to 12 after 3 months of acupuncture therapy and to 13 at 1 year.
The median score on the Psychological and General Well-Being Index in the acupuncture group improved from 78 at baseline to 79 at 12 weeks and 85 at 1 year. Patient ratings of distress because of night sweats went from a median of 5.1 on a 10-point scale at baseline to 1.3 after 12 weeks of treatment. The patients treated with acupuncture reported waking a median of 3.2 times per night at baseline, 2.2 times per night after 12 weeks, and 1.6 times per night at 1 year.
In the HT group, all patients completed treatment. The median number of hot flashes per 24 hours went from 6.6 at baseline to 0 at 12 weeks. Scores on the Kupperman Index improved from 23 at baseline to 6 at both 12 weeks and 1 year. Median scores on the Psychological and General Well-Being Index went from 75 at baseline to 90 at 12 weeks and 93 at 1 year.
Although there was no placebo arm in the randomized trial, Dr. Frisk considers it highly unlikely that the observed benefits in the acupuncture group were due to the placebo effect.
“These women had menopausal symptoms for a mean of 6–7 years, some for more than 20 years. Then you give them acupuncture, and 4 weeks later their vasomotor symptoms have at least halved,” she noted in an interview.
To view a video interview of Dr. Frisk, go to www.youtube.com/watch?v=yiNwsd5b30E
The median number of hot flashes dropped from 9.6 per 24 hours at baseline to 4.3 per 24 hours at week 12. DR. FRISK