Patients receiving high-dose chemotherapy found that electroacupuncture treatments combined with anti-nausea medication were more effective than medication alone in controlling their chemo-related vomiting, according to a study reported in the Dec. 6 issue of The Journal of the American Medical Association. According to cancer experts, the study adds to the evidence that non-traditional therapies can be helpful to patients suffering from side effects of chemotherapy.

"Certainly loss of appetite and hair loss are concerns during chemo. But nausea and vomiting are major concerns for patients," says Joannie Shen, MD, MPH, the lead author and a researcher at the National Institutes of Health. This study looked at 104 women with high-risk breast cancer who had high-dose, multiple-drug chemotherapy given in an inpatient setting for five days during 1996-97. All of the women received the anti-nausea medications that were acceptable at the time for bone marrow transplant patients.

However, a co-author says medications have improved in the three years since the study took place. "The newer approach to chemotherapy -- especially serotonin receptor antagonist-based medications -- have dramatically decreased the incidence of nausea and vomiting in chemo patients," says John Glaspy, MD, MPH, an Oncologist at UCLA?s Johnson Cancer Center. "But there are still patients who, no matter what you do, will have nausea and vomiting." He says electroacupuncture could help those patients.

In this study, all of the women received the same three anti-nausea medications: prochlorperazine, lorazepam and diphenhydramine hydrochloride. Thirty-seven of the women also had electroacupuncture treatments each day before chemotherapy. The treatment consisted of needles inserted in classic antiemetic (anti-vomiting) acupuncture points -- in both arms over the wrist, and on the outside of both legs near the knees. A pulse generator connected to the needles provided an electrical current to the points. The evaluation and treatment procedure took about 30 minutes. Treatments were always given within two hours before chemotherapy.

The study also included a group of 33 women who received "minimal needling" treatments, which were set up to look like electroacupuncture. In this group, the needles were inserted in locations that did not effect vomiting, but would not cause harm to the patient. And, although the pulse generator appeared to be running, no electrical current was passed to the needles.

During the five days, the median number of vomiting episodes was five for the electroacupuncture group, 10 for the minimal needling group and 15 for the group receiving medication alone, adding support to the anti-vomiting effect of the electroacupuncture. The differences between the groups diminished during a nine-day follow-up period when the patients went home. Because the patients who received minimal needling also showed a benefit, researchers theorize that "attention and the clinician-patient interaction" are possible explanations for this response. "I think there is an effect of thinking you're receiving a treatment that causes an improvement. The so-called placebo effect," says Glaspy.

"Although relatively few chemotherapy patients have this type of inpatient treatment -- most are outpatient -- I'd like to see the patients who can't be helped by medication receive electroacupuncture," he says. "And I'd like to see additional research to improve it."

David Rosenthal, MD, Chair of the American Cancer Society's (ACS) national advisory committee on complementary and alternative medicine, agrees that more research is merited. "The effects of this treatment might vary between different chemotherapy patient populations," he says. "You would also like to know if the benefit is enough, not only in efficacy but in efficiency. Is it cost-effective?" He says most health insurance does not cover acupuncture.

Still, he says patients are finding that acupuncture can sometimes be effective in dealing with "pain, nausea, and treatment of mucositis (ulcerations in the mouth)." The treatment is being provided at many cancer centers, including the Dana-Farber Cancer Institute in Boston, where Rosenthal is in charge of integrative therapies. "We began offering acupuncture a month ago and the appointments are already filled," he says.

"If patients are interested in this therapy, they should talk to their oncologist," Rosenthal says.