Breast cancer patients love and hate aromatase inhibitors. We love them because the little pills we take daily for five to ten years are a powerful medication that blocks the production of estrogen for women with hormone positive cancers. But, we hate them because they cause serious side effects, like debilitating joint pain. According to breastcancer.org, about 25 percent of women stop taking these medications due to adverse side effects.
This is especially troubling because aromatase inhibitors are tremendously effective in reducing rates of recurrence. Women who stop taking them are 61 percent more likely to have their breast cancer return than those who continue. So, what are these patients and their doctors to do?
The Pain Point
Dawn L. Hershman, M.D. and leader of the Breast Cancer Program at New York Presbyterian/Columbia University Irving Medical Center, was troubled by these figures.
“A substantial number of women come off their medication,” Dr. Hershman said in a phone call with HealthCentral. “And we know the hormonal medications for breast cancer are extremely effective and while there are a lot of reasons why people stop taking them, one of the most common is because of the side effects. So, a big part of improving breast cancer outcomes is to make sure we can get patients to take drugs that we know work.”
In an effort to find a way to alleviate the joint pain, Dr. Hershman set up a three-arm, multicenter trial that compared acupuncture treatments to sham acupuncture and to a waitlist control. Dr. Hershman and her colleagues chose to provide sham acupuncture procedures in an effort to decrease the possibility of a placebo effect. However, one of the disadvantages of the sham was that there were still sometimes physiologic benefits that could mimic some of the effects of the prescribed procedure. The waitlist group did not receive any acupuncture during the trial but were given vouchers for treatment at a later date.
“We've come to realize what a truly meaningful difference it has made for the individuals,” Dr. Hershman said. “If an individual has a 30 percent reduction in their pain or a two-point difference on a pain score from 0 to 10, and that happens for about 60 percent of patients in the acupuncture group, compared to 30 percent in the other two groups, that gives you a sense of the magnitude of the difference.”
Getting to the Point
Understanding why acupuncture works to alleviate joint pain is difficult, partly because no one really knows what causes the joint pain to begin with. However, Jun J. Mao, M.D., chief of integrative medicine at Memorial Sloan Kettering Cancer Center, said in a phone call with HealthCentral that he has treated a lot of women with debilitating joint pain, and while not every single one benefitted, the vast majority have gone on to continue their medications and have a good quality of life.
Even so, Dr. Mao is not sure he can say exactly why the acupuncture treatment works.
“We don’t completely understand why aromatase inhibitors cause pain in women with breast cancer,” Dr. Mao said. “But one theory may be that the drop in estrogen can lead to an increased perception of pain due to some of the interactions between estrogen and brain neurochemicals. There is some basic evidence from animal research that acupuncture can stimulate a release of endogenous opiates such as endorphins, and that is sort of a natural pain killer and therefore it can reduce the pain experienced by the patient.”
And this reduction in pain experienced by the patient lasted long after the trial was over.
“We found that the improvement was persistent not only during the treatment but also after the intervention was completed,” Dr. Hershman said. “Even though the intervention period was 12 weeks, when you looked over a 24-week period, there was still a significant benefit to acupuncture over the sham and the waitlist control.”
The End Point
Now that we have this knowledge of the treatment’s efficacy, Dr. Hershman sees the next challenge as finding ways to make acupuncture available to more patients. That means overcoming a variety of obstacles, such as getting insurance plans to cover the charges, qualifying acupuncturists for certain conditions, and connecting patients with trained practitioners in their area.
“Trying to figure out how to qualify people for certain conditions is an important step,” Dr. Hershman said. “But I think of it more from a public policy or from a health policy perspective. We need to figure out how to make sure patients have access to this because we certainly don't want patients to be taking narcotics or coming off their medication."