Acupuncture for Cancer Patients

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Welcome to Yale Cancer Answers with Drs. Anees Chagpar, Susan Higgins and Steven Gore.  I am Bruce Barber.  Yale Cancer Answers is our way of providing you with the most up-to-date information on cancer care by welcoming oncologists and specialists who are on the forefront of the battle to fight cancer.  This week, Dr. Chagpar welcomes Dr. Olympia Dreszer for a conversation about acupuncture for cancer patients.  Dr. Dreszer is a Naturopathic Physician and Acupuncturist and Dr. Chagpar is an Associate Professor in the Department of Surgery at Yale School of Medicine and the Assistant Director for Global Oncology at Yale Comprehensive Cancer Center.

Chagpar Olympia, maybe we can start by having you tell us about acupuncture.  It seems to be a holistic kind of therapy that a lot of people have an interest in, but maybe you can tell us a little bit more about what exactly it is and the potential benefit for cancer patients.

Dreszer Acupuncture is an over 2000 years old type of Chinese therapy that was brought here to America probably within the past century and can be very beneficial for cancer patients. It involves inserting thin needles, disposable needles of course, into the skin to stimulate energy and movement in the body. 

Chagpar How is this used?  Does it get rid of cancer, does it help with symptoms?  Tell us more about how acupuncture fits into the cancer management for a patient.

Dreszer I think that with any kind of cancer diagnosis, you have to be followed by your oncologist, which I think is very important, but acupuncture as a modality can be very beneficial to help with those side effects such as nausea and vomiting from chemotherapy, sleep issues, constipation, anxiety, related to the cancer diagnosis.  It can help you relax and when you are more relaxed, your body can actually heal and function better.

Chagpar When we think about acupuncture, people present with so many symptoms, right?  Whether it is constipation or diarrhea, whether it is anxiety or an inability to sleep or nausea, so how do acupuncturists know where to insert these needles?  I mean it almost seems a little bit like voodoo for people who have not really studied it.

Dreszer Acupuncturists usually study for a period of 3 years.  It is a master’s degree program.  Some schools offer doctorate degree programs and we study all the different points.  We look at your tongue, which is kind of a foreign thing for conventional practitioners and we check your pulse and we can find out a lot about how your body is working through those.

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Chagpar Talk more about that.  How can you tell how my body is working by looking at my tongue?

Dreszer On the tongue, you have a different representation of your organs, the organs that are in Chinese medicine responsible for certain channels. For example, if your tongue is white and puffy and you have teeth marks, then that means that more than likely you are anxious, you have more anxiety, you worry about a lot of things, so all of those kind of signs can point us in the direction of which points we need to do and which points are going to be most beneficial for you.

Chagpar And then there are points on your body where you insert these needles depending on the symptoms that people have?

Dreszer Yes, there are many acupuncture points and 12 main meridians that course along your body and you have these channels, kind of like a highway so to speak, and they allow energy to flow through them and so the more flowing everything is, the better your body functions.

Chagpar How much science is there behind acupuncture?  Because if you put on your skeptic hat, everything you just said sounds well kind of hokey.

Dreszer I definitely know, I was a nonbeliever myself years back.  I got into a car accident and I tried the medication route, that did not work for me, and so acupuncture was what helped me and it let me to further study what it means to do acupuncture and to actually choose the right points, and I would say if you have never tried it, there are a lot of opportunities out there to try it and more and more studies are coming out about the scientific proof and even a recent study in February suggested that you try acupuncture actually as a first line of treatment.

Chagpar Not to treat the cancer per se, but to treat the symptoms.

Dreszer Yes, the symptoms.

Chagpar Pain or anything else and certainly when we think about pain, especially that is cancer associated pain, and we think about the opioid epidemic that we face in this country. 

Dreszer Exactly.

Chagpar Certainly, other modalities like acupuncture may be beneficial.  I am interested to know more about your experience because you had experience both as a patient as well as a practitioner of acupuncture.  Tell us more about what that first 

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experience was like when you first went in as a nonbeliever, as a patient who had pain after a car accident.  What was that like?

Dreszer It was very weird.  I have studied medicine and I have a conventional background.  I finished medical school in Poland and so when I was actually studying for my boards, I got into this car accident and I was unable to move my neck correctly and my shoulders were all tight and locked up and I also started a naturopathic school because I knew that there needed to be some other modality that could help me better than just pain medicine. I am an acupuncturist now and on that first visit, I did not know that to except, but like I said, you go in, you talk about what is going on, you identify.  They look at your tongue, they feel your pulse and then they decide on the treatment.  And I would say probably after the first treatment I had about 30% relief of pain, so I was very happy.

Chagpar Did the needles hurt?

Dreszer Yes.  The initial insertion can be slightly painful.  It is kind of like a pinch, like a mosquito bite and some areas are going to be more sore and tender than others.  

Chagpar So how does that work exactly?  You induce pain to relieve pain?

Dreszer The scientific explanation is when you insert the needle, there is a release of endorphins and the nociceptors, the pain receptors in that area, actually become numb and so it is inducing pain but as the needle goes in and as you stimulate the needle and the appropriate stimulation is there, you let the patient relax for about 20 minutes, 20 to 35 minutes, and during that time usually there is no pain.  People usually fall asleep during that time.

Chagpar While you have needles in?

Dreszer Yes.

Chagpar And then you take the needle out?

Dreszer Yes.

Chagpar And is that how long a treatment lasts, usually about half an hour?

Dreszer The intake can vary, 15, 20, 30 minutes depending on how many issues are going on and placing the needles is about 5-10 minutes, and then the needles remain for about 20 to 30 minutes.

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Chagpar How long do these treatments go on for?  If you have a tumor and you go for surgery, the surgery is one day and that is it.  It is a one-time kind of thing usually.  Is acupuncture something that is a lifelong thing or is it an episodic thing?  I have nausea now, I am going to get my prescribed regimen of how many acupuncture sessions and then that is it?

Dreszer I have a busy practice and some things in life are stressful and I feel that it can help with a lot of that, it can allow you to relax, and I think that is why I have continued.  There are patients that I treat maybe 4-5 times and I never see them until the next issue comes up.  So it is not something that you have to continue with but as long as you are feeling well enough if your nausea is gone, I do not want you to come back to see me because I have done my job, so that is good.

Chagpar I guess the other question is that some patients who have cancer may ask about the risk of infection?  I mean patients going through chemotherapy are at an increased risk of infection, some patients have gone through lymph node surgery and may have lymphedema and they may be wondering about whether acupuncture is safe in those situations.

Dreszer Like I mentioned before, they are very thin, disposable needles.  They are stainless steel and once they are used on that one person, they are never used on anybody else obviously, but when we decide the placement of the needles, we are also very aware of, is there any swelling or bruising or rashes on the skin next to the needle and so we would not place it there.

Chagpar Many patients who have cancer oftentimes will go through their cancer diagnosis, they will find themselves a cancer center and oncologist, surgeon, medical oncologist, radiation oncologist.  How do patients find their way, particularly if they have symptoms and are interested in alternative therapies or complementary therapies or naturopathic therapies or acupuncture, how do they find their way to such a provider or are those providers often found in cancer centers?  How does one go about finding these people?

Dreszer A lot of times acupuncturists can be found in hospital settings, attached to maybe an oncologist, but for anybody who is interested, I would recommend that they do their research about their provider, make sure that they are licensed.  There is state accreditation that you can look at which is NCCAOM and you can find an acupuncturist who has done the training and has knowledge and experience with that specific stuff.

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Chagpar I think that is really important because most people are aware that you can look up your doctor, you can see that they are board certified, you can see that they have practiced for “x” number of years, that they are published, that they are well regarded in that specialty, but I think that in acupuncture, for example, many people may not know how to look up somebody’s credentials.  So you mentioned that they could have a master’s degree or even a doctorate. And then be certified and places need to be accredited?

Dreszer Yes.

Chagpar And every state in the union has set the accreditation?

Dreszer Yes.  For example, the state of Connecticut has rigorous systems to make sure that you have completed the appropriate tests and you get a license just like a doctorate.  So it is very official.

Chagpar Excellent.  We are going to take a short break for a medical minute, but hopefully you will stay tuned to learn more information about acupuncture for cancer patients with my guest Dr. Olympia Dreszer.

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Chagpar This is Dr. Anees Chagpar and I am joined tonight by my guest, Dr. Olympia Dreszer.  We are talking about acupuncture for cancer patients and this is a topic that for so many of you, is really of interest because nobody wants to go through a diagnosis of cancer and nobody wants the side effects or the drugs for the side effects that are caused by the treatment for the cancer.  And so many people are 

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starting to look at alternative or complementary therapies that may be beneficial and acupuncture is one of them. Before the break Olympia, you and I were talking a little bit about how exactly acupuncture works and we were talking about these long thin needles that you use to help you alleviate symptoms.  Maybe you can talk a little bit about what you do when people really do not want the needles.  I for one am not a big fan of needles even though I am a surgeon.  I would much rather be on this side of the knife than on the other and the same goes for needles. Tell us a little bit about acupressure.  Is that a thing like acupuncture without the needle?

Dreszer Acupressure is basically using your thumb or finger to stimulate or massage a certain point.  A lot of times I have patients who initially we do may do some acupressure and then they kind of graduate into doing the acupuncture once they realize that they feel so much better, but I have to say that even though you might be scared, you would be surprised that a lot of people who think they are actually scared once they get a treatment, they are not that scared.  But acupressure would be massaging certain acupuncture points to help relieve stagnation, so it relieves stuck energy and helps with muscle tension also.

Chagpar And so is it less effective than acupuncture?  Or is it equally effective?

Dreszer I think it is equally effective as long as you do it for about 5 minutes per point.  When you have the needles instead of acupressure, it is constant stimulation as long as the needles are in and so it is a little bit of a different approach, but it still is very effective.

Chagpar Let’s talk a little bit about acupressure and acupuncture.  It sounds like these are both targeting the same points in order to unstick this energy.  Is that pretty much it?

Dreszer Right, to help with flow, to relieve muscle tension.

Chagpar And we talked a little bit before the break about a variety of symptoms, maybe you can tell us a little bit about where these points are and how exactly this treatment works for various symptoms that cancer patients might face.  One of the most common things that cancer patients have on occasion is nausea.  What do you do for that?

Dreszer For nausea, a lot of times it is about the treatments that they are receiving, they may have chemotherapy or radiotherapy and for nausea there is a very simple 

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point.  It is about 2 fingerbreadths above your wrist on the inside of your hand and they actually sell bracelets that actually apply pressure to this acupuncture point to help relieve nausea, not only for cancer patients but they can also be helpful for people who are pregnant.

Chagpar What about for diarrhea?

Dreszer Diarrhea a lot of times is an imbalance in the stomach and spleen meridian which there are points for on your lower leg, about 2 fingerbreadths down from your knee.  I think it would be easier for me to show you but since we are on a radio show right now, it is a little bit difficult to explain. But there are also points on the belly which can help to relieve some of the diarrhea.

Chagpar And so with various symptoms, you will do various things in various parts of the body?

Dreszer Needle insertion into specific points, yes.

Chagpar And so how do you help patients with anxiety and that kind of thing?

Dreszer Anxiety is a little bit different for everybody.  Lots of times anxiety can stem from the diagnosis of cancer and it involves a lot of thinking about the disease and thinking about what is going to happen in terms of treatment, but there is a simple point in between your eyebrows which helps to relax the mind and helps to de-stress and there are points on the ears that help with relaxation and improving sleep can also help with anxiety, as you know a lot of times cancer patients they cannot sleep.

Chagpar And so how do you help to improve that?  Is it still the needles in those same points?

Dreszer In the specific points, yes.

Chagpar And so when patients come to see you, you will ask them about their symptoms and then you will apply these needles to various points.  Are there other things that you can do that can help them?

Dreszer I can also do something called Moxa.  Moxa is a Chinese herb called mugwort that you can use to heat the needle and very popular recently is cupping.  Cupping helps to relax muscles and relax the tension in the muscles and those are 

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also modalities.  There was also electro acupuncture which involves electric current you attach to the needles and help to move pain.

Chagpar How do you decide which of these many modalities you are going to use on a particular patient?

Dreszer A lot of times it depends on the patient and what they are open to trying.  People who are sensitive to smells do not like Moxa, but it can be very beneficial especially if they are having pain related to the cancer and maybe the joint is very cold.  It helps to heat up the area kind of like with heat therapy.

Chagpar And so acupuncture is one of a whole series of complementary or what some people will call alternative therapies.  Do you practice other alternative therapies and can you tell us more about those?

Dreszer I am a naturopathic doctor and I utilize a lot of different things to help with the patients who are going through the side effects of their cancer diagnosis or working with another M.D. or other professionals.  I offer acupuncture, homeopathy, I look at their diet, a lot of times when it comes to cancer patients it is very important for them to have the adequate nutrition, so that they do not continue to lose weight, that they maintain their weight and they get strong and healthy.  I also use like I said cupping, and I believe also that there are a lot of emotions that can be involved with cancer and so I think talking about them is very important.

Chagpar It sounds to me like many of these therapies all are synergistic, so for example, you have a patient that comes in and is complaining of diarrhea or constipation or nausea, oftentimes a nutritionist or somebody who is a naturopath can talk to them about their diet and things that they can do in terms of both food preparation as well as foods to avoid or not avoid, that can help them with that.

Dreszer Yeah.

Chagpar Whereas acupuncture also helps with that, so how do you use these in concert or do you kind of use them in sequence, one after the other seeing if one thing works or that the other thing works or do you kind of do everything altogether? How does that work and how do you network with a patient’s healthcare team in terms of their nutritionist, their oncologist, their radiation therapist, etc.?

Dreszer A lot of times I think to be able to give the person the best chance and the best support, it is truly important to talk about the diet, especially when doing acupuncture you can definitely talk about them at the same time and the person 

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can start making the changes right away.  In terms of communicating with their oncologist, I always tell my patients that there needs to be open communication because I think it is just as important for their medical providers to have that close communication so that there is no question or nobody hiding anything in terms of giving that person the best care.

Chagpar And I think that it is really important for listeners to remember that many times your healthcare team will have no problems with you seeing a naturopath, taking various vitamins.  It is really important however that you keep the lines of communication open so that your oncologist knows what you are taking and can advise you on things that may have drug interactions with various chemotherapy regimens, etc., so make sure that if you are pursuing alternative therapies that it is not just alternative, it is complementary right?

Dreszer Exactly.

Chagpar Because I think that a lot of patients, I should not say a lot, but some patients may want to relieve themselves of “traditional medicine or western medicine” and see if things like acupuncture, homeopathy, cleanses, etc., can rid them of their cancer.  How do you feel about that?

Dreszer Since I have my background also as an M.D., I feel that seeing your oncologist is super important and can allow you to take care of the issues, the cancer and get the support that you need.  In the state of Connecticut, acupuncturists at this moment cannot really order labs, so I think in terms of cancer and monitoring your health, it is very important, and I would definitely seek out someone who can help you in that way, but I definitely think that there needs to be communication and I think it is in the best interest of the patient, but in terms of acupuncture because it does not involve drugs, I would love a lot more doctors to recommend that and to be open about it.

Dr. Olympia Dreszer is a Naturopathic Physician and Acupuncturist.  If you have questions, the address is canceranswers@yale.edu and past editions of the program are available in audio and written form at YaleCancerCenter.org.  I am Bruce Barber reminding you to tune in each week to learn more about the fight against cancer here on WNPR, Connecticut's Public Media Source for news and ideas.