MOXIBUSTION AND CHEMOTHERAPY
I read recently about a new trial to assess whether self-administered moxa on ST36 can reduce chemotherapy-induced pancytopenia, specifically neutropenia, anaemia, and thrombocytopenia, thus enabling patients to complete courses of chemotherapy without delays or dose reduction.
The aim of the researchers is to recruit 25 breast, colorectal, or gynaecological cancer patients to perform this simple technique which takes less than 10 minutes per day.
Nearly half of cancer patients prescribed chemotherapy receive less than 85% of the planned dose, having potential impacts on treatment efficacy and survival. A major contributor to this is CIP (chemotherapy induced pancytopenia) or myelosuppression, which is a serious side effect of various chemotherapy agents that decrease bone marrow activity. Pancytopenia is a condition that involves simultaneous decrease in numbers or white cells, red cells, and platelets in the blood. This may cause neutropenia (or leukopenia), anaemia, or thrombocytopenia respectively.
Neutropenia is the most common and potentially serious of these side-effect. Severe or ferbrile neutropenia are major risk factors for infection-related morbidity and mortality. Patients therefore may receive reduced or delayed doses of chemotherapy if leucocytes fall below what is considered safe, thus impacting on the effeciency of treatment.
In addition, patients with neutropenia risk serious infection and potentially with use of hospital A&E departments, hospital admission, and impact on quality of life. The cost of an episode of febrile neutropenia to the NHS is at least £2.300 and often significantly higher.
G-CSF (granulocyte-colony stimulating factor) is the recommended prophylactic treatment but is not universally used and is not indicated for some types of cancer.
Chemotherapy-induced anaemia associated with reduced red blood cell count is the most common issue and can involve symptoms such as fatigue, weakness, impaired cognitive abilities, chest pain, and respiratory distress. There may be need for hospital admission or blood transfussion, iron supplementation, or other potentially risky and expensive treatment options.
Chemotherapy-induced thrombocytopenia can cause bleeding and bruising. Severe instances are associated with advanced metastatic cancers. While it is reported in 10 – 36 % of patients, most do not require treatment beyond advice about bleeding and monitoring of platelet level.
Based upon previous work carried out in this field by some of the authors, this study aims to test the effectiveness of moxa treatment in patients with the cancers listed above to assess whether it can reduce the incidence and/or severity of CIP, reduce other side-effects of chemotherapy, and thus help to maintain chemotherapy treatment schedules to maximise efficacy.
Moxibustion involves the use of the heat generated by the smouldering herb Artemesia Vulgaris (mugwort) to stimulate specific areas on the body, usually acupuncture points. One of the major functions of moxibustion in classical Chinese medicine literature is the stimulation of the immune system.
There are several studies that suggest moxa treatment can be beneficial in this area. One study from the Harvard Cancer Centre (Lu et al, 2009), reported higher counts of white blood cells, absolute neutrophil count, B cells, and NK cells in an acupuncture group with a sham control group in ovarian cancer patients.
The mechanisms of moxa treatment have not been fully established in western medical terms. One theory generally held is that it influences multiple cortical, subcortical and limbic system, and brainstem areas of the brain, partly through opioid and monoaminergic neurotransmission. An alternative theory is that it influences heat shock proteins based upon research in rats. A third theory is that it improves immune cell function by a neuro-hormonal regulatory function. Moxibustion has also been shown to enhance cytokine production and increase NK cell activity in mice with tumours.
Previous studies of this kind in the UK involved large amounts of non-compliance by the participants due to the amount of acupuncture points that were required to be stimulated with moxa and the need for somebody to assist. It is hoped that this simplified protocol will make it easier for patients.
