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Supportive Care in Cancer

, Volume 20, Issue 4, pp 715–724 | Cite as

Acupuncture improves health-related quality-of-life (HRQoL) and sleep in women with breast cancer and hot flushes

  • Jessica FriskEmail author
  • Ann-Christine Källström
  • Najme Wall
  • Mats Fredrikson
  • Mats Hammar
Original Article

Abstract

Purpose

Evaluate effects of electro-acupuncture (EA) and hormone therapy (HT) on health-related quality-of-life (HRQoL) and sleep in breast cancer survivors with vasomotor symptoms.

Methods

Forty-five women, randomized to EA (n = 27) for 12 weeks or HT (n = 18) for 24 months, were followed for up to 2 years. Distress caused by, and numbers of, hot flushes, hours slept and times woken up/night, Psychological and General Well-being Index (PGWB) and Women’s Health Questionnaire (WHQ) were registered before and during treatment and at 6, 9, 12, 18 and 24 months after start of treatment.

Results

After 12 weeks of EA (n = 19), WHQ improved from 0.32 (IQR 0.23–0.53) at baseline to 0.24 (IQR 0.12–0.39; p < 0.001) and PGWB from 78 (IQR 53–89) to 79 (IQR 68–93; p = 0.002). All sleep parameters improved and Hot Flush Score (HFS) decreased by 80%. At 12 months, WHQ, PGWB and all sleep parameters remained significantly improved (n = 14) and HFS decreased by 65%. After 12 weeks of HT (n = 18), WHQ improved from 0.29 (IQR 0.15–0.44) at baseline to 0.15 (IQR 0.05–0.22; p = 0.001), PGWB from 75 (IQR 59–88) to 90 (62–97; p = 0.102) and three of five sleep parameters improved.

Conclusion

Both EA and HT increased HRQoL and sleep, probably through decreasing numbers of and distress by hot flushes. Although flushes decreased less in the EA group than in the HT group, HRQoL improved at least to the same extent maybe due to other effects of EA, not induced by HT, e.g. on anxiety, vitality and sleep, supported by subscale analyses. EA should be further evaluated as treatment for women with breast cancer and climacteric complaints, since HT no longer can be recommended for these women.

Keywords

Acupuncture Breast neoplasm Hormone therapy Menopause Health-related quality-of-life 

Notes

Acknowledgments

The authors thank the steering committee of the HABITS study for valuable advice, Lotta Lindh-Astrand for practical assistance and co-ordination of the regional substudy and to Lawrence Lundgren for language advice.

Funding

This work was supported by The Medical research council of South-East of Sweden; The Swedish Medical Research Council [K2002-72X-12651-O5C] and The County Council of Ostergotland.

Supplementary material

520_2011_1134_MOESM1_ESM.doc (39 kb)
Appendix STRICTA items that replace CONSORT 2010 item 5 when reporting an acupuncture trial (DOC 39 kb)

References

  1. 1.
    Montazeri A (2009) Quality of life data as prognostic indicators of survival in cancer patients: an overview of the literature from 1982 to 2008. Health Qual Life Outcomes 7:102PubMedCrossRefGoogle Scholar
  2. 2.
    Montazeri A (2008) Health-related quality of life in breast cancer patients: a bibliographic review of the literature from 1974 to 2007. J Exp Clin Cancer Res 27:32PubMedCrossRefGoogle Scholar
  3. 3.
    Bower JE, Ganz PA, Desmond KA, Rowland JH, Meyerowitz BE, Belin TR (2000) Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol 18:743–753PubMedGoogle Scholar
  4. 4.
    Barsevick A, Frost M, Zwinderman A, Hall P, Halyard M (2010) I'm so tired: biological and genetic mechanisms of cancer-related fatigue. Qual Life Res 19:1419–1427PubMedCrossRefGoogle Scholar
  5. 5.
    Broeckel JA, Jacobsen PB, Horton J, Balducci L, Lyman GH (1998) Characteristics and correlates of fatigue after adjuvant chemotherapy for breast cancer. J Clin Oncol 16:1689–1696PubMedGoogle Scholar
  6. 6.
    Okuyama T, Akechi T, Kugaya A, Okamura H, Imoto S, Nakano T, Mikami I, Hosaka T, Uchitomi Y (2000) Factors correlated with fatigue in disease-free breast cancer patients: application of the Cancer Fatigue Scale. Support Care Cancer 8:215–222PubMedCrossRefGoogle Scholar
  7. 7.
    Gupta P, Sturdee D, Pallin S, Majumder K, Fear R, Marshall T, Paterson I (2006) Menopausal symptoms in women treated for breast cancer; the prevalence and severity of symptoms and their perceived effects on quality of life. Climacteric 9:49–58PubMedCrossRefGoogle Scholar
  8. 8.
    Savard J, Davidson JR, Ivers H, Quesnel C, Rioux D, Dupere V, Lasnier M, Simard S, Morin CM (2004) The association between nocturnal hot flashes and sleep in breast cancer survivors. J Pain Symptom Manage 27:513–522PubMedCrossRefGoogle Scholar
  9. 9.
    Rand KL, Otte JL, Flockhart D, Hayes D, Storniolo AM, Stearns V, Henry NL, Nguyen A, Lemler S, Hayden J, Jeter S, Carpenter JS (2011) Modeling hot flushes and quality of life in breast cancer survivors. Climacteric 14:171–180. doi: 10.3109/13697131003717070 PubMedCrossRefGoogle Scholar
  10. 10.
    Kronenberg F (1990) Hot flashes: epidemiology and physiology. Ann NY Acad Sci 592:52–86, discussion 123–133PubMedCrossRefGoogle Scholar
  11. 11.
    Harris PF, Remington PL, Trentham-Dietz A, Allen CI, Newcomb PA (2002) Prevalence and treatment of menopausal symptoms among breast cancer survivors. J Pain Symptom Manage 23:501–509PubMedCrossRefGoogle Scholar
  12. 12.
    Cella D, Fallowfield L (2008) Recognition and management of treatment-related side effects for breast cancer patients receiving adjuvant endocrine therapy. Breast Cancer Res Treat 107:167–180PubMedCrossRefGoogle Scholar
  13. 13.
    Fahlen M, Wallberg B, von Schoultz E, Carlstrom K, Svensson G, Wilking N, Brandberg Y (2010) Health-related quality of life during hormone therapy after breast cancer: a randomized trial. Climacteric Epub ahead. doi: 10.3109/13697131003660593 Google Scholar
  14. 14.
    Chlebowski RT, Hendrix SL, Langer RD, Stefanick ML, Gass M, Lane D, Rodabough RJ, Gilligan MA, Cyr MG, Thomson CA, Khandekar J, Petrovitch H, McTiernan A (2003) Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the women's health initiative randomized trial. JAMA 289:3243–3253PubMedCrossRefGoogle Scholar
  15. 15.
    Beral V (2003) Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet 362:419–427PubMedCrossRefGoogle Scholar
  16. 16.
    Holmberg L, Iversen OE, Rudenstam CM, Hammar M, Kumpulainen E, Jaskiewicz J, Jassem J, Dobaczewska D, Fjosne HE, Peralta O, Arriagada R, Holmqvist M, Maenpaa J (2008) Increased risk of recurrence after hormone replacement therapy in breast cancer survivors. J Natl Cancer Inst 100:475–482PubMedCrossRefGoogle Scholar
  17. 17.
    Filshie J, Bolton T, Browne D, Ashley S (2005) Acupuncture and self acupuncture for long-term treatment of vasomotor symptoms in cancer patients–audit and treatment algorithm. Acupunct Med 23:171–180PubMedCrossRefGoogle Scholar
  18. 18.
    Walker EM, Rodriguez AI, Kohn B, Ball RM, Pegg J, Pocock JR, Nunez R, Peterson E, Jakary S, Levine RA (2010) Acupuncture versus venlafaxine for the management of vasomotor symptoms in patients with hormone receptor-positive breast cancer: a randomized controlled trial. J Clin Oncol 28:634–640PubMedCrossRefGoogle Scholar
  19. 19.
    MacPherson H, Altman DG, Hammerschlag R, Li Y, Wu T, White A, Moher D (2010) Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT statement. Acupunct Med 28:83–93PubMedCrossRefGoogle Scholar
  20. 20.
    Wyon YLR, Lundeberg T, Hammar M (1995) Effects of acupuncture on climacteric vasomotor symptoms, quality of life, and urinary excretion of neuropeptides among postmenopausal women. Menopause 2:3–12CrossRefGoogle Scholar
  21. 21.
    Sloan JA, Loprinzi CL, Novotny PJ, Barton DL, Lavasseur BI, Windschitl H (2001) Methodologic lessons learned from hot flash studies. J Clin Oncol 19:4280–4290PubMedGoogle Scholar
  22. 22.
    Wiklund I, Karlberg J, Lindgren R, Sandin K, Mattsson LA (1993) A Swedish version of the Women's Health Questionnaire. A measure of postmenopausal complaints. Acta Obstet Gynecol Scand 72:648–655PubMedCrossRefGoogle Scholar
  23. 23.
    Hunter M (1992) The Women´s Health Questionnaire: a measure of mid-aged women´s perceptions of their emotional and physical health. Psychol Health 7:45–54CrossRefGoogle Scholar
  24. 24.
    Dupuy HJ (1984) The Psychological General Well-Being (PGWB) index. Le Jacq Publishing Inc, New YorkGoogle Scholar
  25. 25.
    Wiklund I, Karlberg J (1991) Evaluation of quality of life in clinical trials. Selecting quality-of-life measures. Control Clin Trials 12:204S–216SPubMedCrossRefGoogle Scholar
  26. 26.
    Croog SH, Levine S, Testa MA, Brown B, Bulpitt CJ, Jenkins CD, Klerman GL, Williams GH (1986) The effects of antihypertensive therapy on the quality of life. N Engl J Med 314:1657–1664PubMedCrossRefGoogle Scholar
  27. 27.
    Frisk J, Carlhall S, Kallstrom AC, Lindh-Astrand L, Malmstrom A, Hammar M (2008) Long-term follow-up of acupuncture and hormone therapy on hot flushes in women with breast cancer: a prospective, randomized, controlled multicenter trial. Climacteric 11:166–174PubMedCrossRefGoogle Scholar
  28. 28.
    Lee HJ, Lee JH, Lee EO, Lee HJ, Kim KH, Lee KS, Lee CH, Nam DW, Kim SH, Lee HJ, Ahn KS (2009) Substance P and beta endorphin mediate electroacupuncture induced analgesic activity in mouse cancer pain model. Acupunct Electrother Res 34:27–40PubMedGoogle Scholar
  29. 29.
    Han JS (2004) Acupuncture and endorphins. Neurosci Lett 361:258–261PubMedCrossRefGoogle Scholar
  30. 30.
    Thornton AA, Madlensky L, Flatt SW, Kaplan RM, Pierce JP (2005) The impact of a second breast cancer diagnosis on health related quality of life. Breast Cancer Res Treat 92:25–33PubMedCrossRefGoogle Scholar
  31. 31.
    Pariente J, White P, Frackowiak RS, Lewith G (2005) Expectancy and belief modulate the neuronal substrates of pain treated by acupuncture. Neuroimage 25:1161–1167PubMedCrossRefGoogle Scholar
  32. 32.
    Qin W, Tian J, Bai L, Pan X, Yang L, Chen P, Dai J, Ai L, Zhao B, Gong Q, Wang W, von Deneen K, Liu Y (2008) FMRI connectivity analysis of acupuncture effects on an amygdala-associated brain network. Mol Pain 4:55PubMedCrossRefGoogle Scholar
  33. 33.
    Alfhaily F, Ewies AA (2007) Acupuncture in managing menopausal symptoms: hope or mirage? Climacteric 10:371–380PubMedCrossRefGoogle Scholar
  34. 34.
    Hegadoren KM, O'Donnell T, Lanius R, Coupland NJ, Lacaze-Masmonteil N (2009) The role of beta-endorphin in the pathophysiology of major depression. Neuropeptides 43:341–353PubMedCrossRefGoogle Scholar
  35. 35.
    Pluchino N, Merlini S, Cubeddu A, Giannini A, Bucci F, Casarosa E, Cela V, Angioni S, Luisi M, Genazzani AR (2009) Brain-region responsiveness to DT56a (Femarelle) administration on allopregnanolone and opioid content in ovariectomized rats. Menopause 16:1037–1043PubMedCrossRefGoogle Scholar
  36. 36.
    Akhan SE, Gurel T, Has R, Iyibozkurt AC, Turfanda A (2002) Effects of long-term oral hormone replacement therapy on plasma nitric oxide and beta-endorphin levels in postmenopausal women. Gynecol Obstet Investig 54:196–200CrossRefGoogle Scholar
  37. 37.
    ter Riet G, de Craen AJ, de Boer A, Kessels AG (1998) Is placebo analgesia mediated by endogenous opioids? A systematic review. Pain 76:273–275PubMedCrossRefGoogle Scholar
  38. 38.
    Maclennan AH, Broadbent JL, Lester S, Moore V (2004) Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database Syst Rev CD002978Google Scholar
  39. 39.
    Pockaj BA, Gallagher JG, Loprinzi CL, Stella PJ, Barton DL, Sloan JA, Lavasseur BI, Rao RM, Fitch TR, Rowland KM, Novotny PJ, Flynn PJ, Richelson E, Fauq AH (2006) Phase III double-blind, randomized, placebo-controlled crossover trial of black cohosh in the management of hot flashes: NCCTG Trial N01CC1. J Clin Oncol 24:2836–2841PubMedCrossRefGoogle Scholar
  40. 40.
    Carpenter JS, Storniolo AM, Johns S, Monahan PO, Azzouz F, Elam JL, Johnson CS, Shelton RC (2007) Randomized, double-blind, placebo-controlled crossover trials of venlafaxine for hot flashes after breast cancer. Oncologist 12:124–135PubMedCrossRefGoogle Scholar
  41. 41.
    Col NF, Guthrie JR, Politi M, Dennerstein L (2009) Duration of vasomotor symptoms in middle-aged women: a longitudinal study. Menopause 16:453–457PubMedCrossRefGoogle Scholar
  42. 42.
    White A, Cummings M, Barlas P, Cardini F, Filshie J, Foster NE, Lundeberg T, Stener-Victorin E, Witt C (2008) Defining an adequate dose of acupuncture using a neurophysiological approach–a narrative review of the literature. Acupunct Med 26:111–120PubMedCrossRefGoogle Scholar
  43. 43.
    Frisk J, Spetz AC, Hjertberg H, Petersson B, Hammar M (2009) Two modes of acupuncture as a treatment for hot flushes in men with prostate cancer-a prospective multicenter study with long-term follow-up. Eur Urol 55:156–163PubMedCrossRefGoogle Scholar
  44. 44.
    Borud EK, Alraek T, White A, Fonnebo V, Eggen AE, Hammar M, Astrand LL, Theodorsson E, Grimsgaard S (2009) The Acupuncture on Hot Flushes Among Menopausal Women (ACUFLASH) study, a randomized controlled trial. Menopause 16:484–493PubMedCrossRefGoogle Scholar
  45. 45.
    Nedstrand E, Wijma K, Wyon Y, Hammar M (2005) Vasomotor symptoms decrease in women with breast cancer randomized to treatment with applied relaxation or electro-acupuncture: a preliminary study. Climacteric 8:243–250PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Jessica Frisk
    • 1
    • 2
    • 6
    Email author
  • Ann-Christine Källström
    • 3
    • 6
  • Najme Wall
    • 4
  • Mats Fredrikson
    • 5
    • 6
  • Mats Hammar
    • 1
    • 6
  1. 1.Obstetrics and Gynaecology, Faculty of Health SciencesLinköping University, University HospitalLinköpingSweden
  2. 2.Clinical Department of SurgeryCounty Council of ÖstergötlandNorrkopingSweden
  3. 3.Clinical Department of Surgery, Division of OncologyHelsingborg HospitalHelsingborgSweden
  4. 4.Clinical Department of OncologyUniversity Hospital of LinköpingLinköpingSweden
  5. 5.Occupational and Environmental MedicineLinköping UniversityLinköpingSweden
  6. 6.Department of Clinical and Experimental Medicine, Faculty of Health SciencesLinköping UniversityLinköpingSweden

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