Acupuncture could benefit ICU patients recovering from surgery for head and neck cancer
In this blogpost, I want to discuss a research paper that was published in June on the use of acupuncture in head and neck cancer patients.
A Taiwanese randomised controlled trial was carried out by Ben-Arie et al. which compared the effects of two acupuncture protocols on feeding intolerance after surgery from head and neck cancer. Malnourishment is a serious problem amongst all cancer patients but head and neck cancer patients are particularly at risk. The reason for this is that surgical resection is frequently carried out on these patients which requires admission to ICU post-operatively. Factors associated with ICU admission such as prolonged immobility and use of sedatives are unfortunately linked with feeding intolerance which places these cancer patients at even greater risk of malnourishment. Hence any interventions that can help reduce this risk are important for patient prognosis.
Treatments for feeding intolerance can involve strong medications such as metoclopramide or post-pyloric feeding, interventions which are unfortunately commonly associated with side-effects. The key aim for healthcare providers is to minimise the risk of malnourishment amongst these patients without adding further complications to an already vulnerable population. This group of researchers set about comparing two different forms of acupuncture to see which, if either, would be helpful for improving markers of malnourishment amongst head and neck cancer patients.
Both acupuncture groups used a pre-defined fixed set of acupuncture points during the trial - one group used acupuncture points that specifically supported the digestive system whilst the other group used general acupuncture points known not to be directly associated with helping with digestive symptoms. Treatment was carried out for 30 minutes on a daily basis by a trained acupuncturist over three consecutive post-operative days on 28 patients. The group that received digestion-specific acupuncture reached their target energy expenditure significantly earlier than the group receiving general acupuncture - in 4 days as opposed to 6.69 days. Furthermore, the digestion-specific acupuncture group also required less prokinetic medication (metoclopramide 20.77mg versus 68.46mg) and the authors concluded that digestion-specific acupuncture could help reduce feeding intolerance in head and neck cancer patients.
This is an extremely small study (after dropouts, 26 patients were eventually included) and there is clearly a need for a further larger-scale study to support these initial findings. Nonetheless this research stood out to me for a number of reasons.
Having now known many patients talk about their post-operative ICU experiences (cancer or otherwise), it’s clear this is a seriously under-researched area of clinical treatment. Acupuncture has the potential to play a huge role in a range of hospital settings but what this study demonstrates is that outcomes in even critically ill patients in ICU can be vastly improved with an inexpensive, safe and quick-to-administer treatment. Unfortunately this study did not involve a no-acupuncture control group so we as the readers don’t know what would have happened in a comparative group receiving no acupuncture. This can be seen as a weakness of the study. However, from a practical viewpoint, it is quite possible that patients would not be willing to be randomised to a no-treatment group after being briefed by researchers about the potential for acupuncture to support their post-operative recovery, particularly in Taiwan where the population is accustomed to acupuncture treatment and can access it readily. This sounds a bit obscure to most of us but finding patients who will consent to randomisation in a clinical trial can be tricky - a problem that haunts many researchers and isn’t isolated to cancer patients or research carried out in hospital settings. Having said that, the patients received acupuncture whilst they were under post-operative sedation or not in a fully conscious state. This is interesting as the placebo effect can be present in all interactions with patients, even amongst those without a formal intervention per se. For example a Swedish study found that even simple tactile touch as an intervention was associated with lower levels of anxiety amongst intensive-care patients. It could be argued that ‘conscious’ placebo effects due to patient expectation for example would theoretically have had little to no effect amongst sedated patients in this study. The ‘unconscious’ aspects of the placebo effect in turn were probably actually better controlled for in the study e.g. effects from touch, additional attention from a healthcare professional, being spoken to in a calm and warm manner which means that both groups effectively received the same level of effect from this perspective. This design essentially means that the main differentiator between the two groups is the acupuncture protocols used and suggests that even when other components of the placebo effect were taken into account, the digestion-specific acupuncture protocol fared better.
Obviously this is a small research study and one that needs to be supported by evidence from a larger scale study. However, as a clinician the results to me are extremely exciting and promising especially with a brief intervention such as acupuncture that is safe and easy to administer. To my eyes this is well worth further investigation for all critically-ill patients in ICU, not just head and neck cancer patients but also other patients who have received highly complex or emergency surgery, or those considered at particularly high-risk. This could vastly improve outcomes in these at-risk patients as well as potentially lead to those all-important cost-savings within the NHS.
For more information on acupuncture used as an adjunct to cancer care in current cancer care units around the UK, please visit:
Pioneering research at the Christie in Manchester shows how acupuncture helps chemo patients