17 november 2022: De definitieve resultaten uit onderstaand beschreven studie zijn deze maand gepubliceerd.

Acupunctuur  vermindert aan aromataseremmers gerelateerde gewrichtspijn.  

Belang van deze studie vertaald uit abstract: Acupunctuur ging gepaard met een statistisch significante afname van aan aromataseremmers gerelateerde gewrichtspijn die 40 weken na stopzetting van de interventie aanhield, wat wijst op langetermijnvoordelen van deze therapie.

Klik op de titel voor het volledige studierapport, onderaan abstract plus referentielijst: 

Comparison of Acupuncture vs Sham Acupuncture or Waiting List Control in the Treatment of Aromatase Inhibitor–Related Joint Pain



13 juni 2021: Bron: ASCO 2021

Bij patiënten met borstkanker die 12 weken lang acupunctuur kregen naast hun aromataseremmers verminderden de gewrichtsklachten en de pijn behoorlijk. 64 vs 45 procent tussen echte acupunctuur en nep-acupunctuur. En de verbeteringen bleven aanhouden nadat de acupunctuur werd verminderd in aantal. De voordelen van acupunctuur hielden ook aan na 52 weken, zelfs nadat alle patiënten acupunctuur was aangeboden.

Dit blijkt uit een gerandomiseerde studie bij totaal 220 borstkankerpatiënten. 1 groep kreeg echte acupunctuur (N = 110), andere groep sham - nep acupunctuur (N = 59) en derde groep kreeg regelmatig een inventarisatie van de pijnscores en daarop werd indien nodig medicatie aangepast (N = 57) . 

Het percentage patiënten dat een statistisch significante (> 2) vermindering (d.w.z. verbetering) in BPI-WP ervoer, was 64% voor echte acupunctuur vergeleken met 45% voor sham acupunctuur en 53% voor medicatie op basis van pijnscoresinterventie. Patiënten die echte acupunctuur kregen hadden een verminderde BPI-pijninterferentie na 52 weken vergeleken met sham acupunctuur (aangepast verschil = 0,58, 95% BI: 0,00-1,16, p = 0,05) maar niet vergeleken met pijnscores interventie (aangepast verschil = 0,33, 95% BI: - 0,28-0,93, p = 0,29). 

Conclusie van de onderzoekers:

Vrouwen met borstkanker die acupunctuurbehandeling kregen en behandeld werden met 12 weken acupunctuur voor gewrichtssymptomen hadden minder last van ernstige pijn in vergelijking met controlepatiënten. Een effect dat een jaar aanhield ondanks voltooiing van het protocol acupunctuur na 12 weken, en het aanbieden van acupunctuur voor alle deelnemers na 24 weken. 

Het abstract van deze studie  NCT01535066 werd op ASCO 2021 gepubliceerd.

Long-term results from a randomized blinded sham- and waitlist-controlled trial of acupuncture for joint symptoms related to aromatase inhibitors in early stage breast cancer (S1200).

Authors:
Dawn L. Hershman, Joseph M. Unger, Heather Greenlee, Jillian Capodice, Danika Lew, Amy Darke, Lori M. Minasian, Michael Jordan Fisch, Norah Lynn Henry, Katherine D. Crew; Columbia University Irving Medical Center, New York, NY; Fred Hutchinson Cancer Research Center, Seattle, WA; Columbia University Medical Center, New York, NY; Mount Sinai School of Medicine, New York, NY; Southwest Oncology...
Abstract Disclosures

Research Funding:

U.S. National Institutes of Health

Background:

Musculoskeletal symptoms are the most common side effect of aromatase inhibitors (AIs) among breast cancer (BC) survivors. We previously reported that true acupuncture (TA) resulted in better pain outcomes than either sham acupuncture (SA) or wait-list controls (WC) at 6 weeks with durable effects through 24 weeks, with minimal toxicity. We now report the 52-week outcomes.

Methods:

We conducted a SWOG multicenter randomized controlled trial among postmenopausal women with early-stage BC. Patients taking an AI for ≥30 days and reporting a worst pain score of ≥3 out of 10 using the Brief Pain Inventory-Worst Pain (BPI-WP) were eligible. Subjects were randomized 2:1:1 to TA vs. SA vs. WC. Both the TA and SA protocols consisted of a 12-week intervention, with 2 sessions per week for 6 weeks, followed by 1 session per week for 6 additional weeks. At 24 weeks, all subjects remained blinded to intervention arm but were offered 10 sessions of true acupuncture. Endpoints included BPI scores, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for hips and knees, the Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH), PROMIS Pain Inventory Short Form (PI-SF), and Functional Assessment of Cancer therapy Endocrine Symptoms (FACT-ES).

Results:

Among 226 patients registered, 110 were randomized to TA, 59 to SA and 57 to WC. Baseline characteristics were similar among the arms. At 52 weeks, follow-up assessments were available for 91 (82.7%) TA, 53 (89.8%) SA, and 47 (82.5%) WC patients. In a linear regression adjusting for the baseline score and stratification factors, 52-week mean BPI-WP scores were 1.08 points lower (correlating with less pain) in the TA compared to SA arm (95% CI: 0.24-1.91, p =.01), and were 0.99 points lower in the TA compared to WC arm (95% CI: 0.12-1.86, p =.03). The proportion of patients experiencing a clinically meaningful (>2) reduction (i.e. improvement) in BPI-WP was 64% for TA compared to 45% on SA and 53% on WC. Patients randomized to TA had reduced BPI pain interference at 52 weeks compared to SA (adjusted difference = 0.58, 95% CI: 0.00-1.16, p =.05) but not compared to WC (adjusted difference = 0.33, 95% CI: -0.28-0.93, p =.29). Also, at 52 weeks, patients randomized to TA had improved PROMIS PI-SF T-scores compared to SA (adjusted difference = 2.35, 95% CI: 0.07-4.63, p =.04) but not compared to WC (adjusted difference = 1.28, 95% CI: -1.09-3.66, p =.29). No statistically significant differences were observed in other measures.

Conclusions:

Women with breast cancer receiving AI therapy and treated with 12 weeks of TA for joint symptoms had reduced levels of worst pain compared to control patients, an effect that was durable through one year despite completion of protocol acupuncture at 12 weeks, and the offering of acupuncture to all participants at 24 weeks. Clinical trial information: NCT01535066

First Author:
Dawn L. Hershman, FASCO, MD
Meeting:
2021 ASCO Annual Meeting
Session Type:
Poster Discussion Session
Session Title:
Symptoms and Survivorship
Track:
Symptoms and Survivorship
Subtrack:
Palliative Care and Symptom Management
Abstract #:
12018
Clinical Trial Registry Number:
NCT01535066
Citation:
J Clin Oncol 39, 2021 (suppl 15; abstr 12018)
DOI:
10.1200/JCO.2021.39.15_suppl.12018
AcupunctureFunctional assessmentAromatase inhibitorsBreast cancerJoint pain
2021 Annual Meeting Proceedings Notices

This material on this page is ©2021 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org.

November 11, 2022

Comparison of Acupuncture vs Sham Acupuncture or Waiting List Control in the Treatment of Aromatase Inhibitor–Related Joint PainA Randomized Clinical Trial

Dawn L. Hershman, MD, MS1; Joseph M. Unger, PhD, MS2,3; Heather Greenlee, ND, PhD2; et alJillian Capodice, MS4; Danika L. Lew, MA2,3; Amy Darke, MS2,3; Lori M. Minasian, MD5; Michael J. Fisch, MD6; N. Lynn Henry, MD7; Katherine D. Crew, MD, MS1
Author Affiliations Article Information
JAMA Netw Open. 2022;5(11):e2241720. doi:10.1001/jamanetworkopen.2022.41720
visual abstract icon 
Visual
Abstract
Comparison of Acupuncture vs Sham Acupuncture or Waiting List Control in the Treatment of Aromatase Inhibitor–Related Joint Pain: A Randomized Clinical Trial
Key Points

Question  Does short-term acupuncture confer long-term reduction of joint pain related to aromatase inhibitors among women with breast cancer?

Findings  In this multicenter randomized clinical trial of 226 women with early-stage breast cancer, patients in the true acupuncture group who received 12 weeks of acupuncture, compared with those in the sham acupuncture group or the waiting list control group, had statistically significant reductions in joint pain scores at 52 weeks.

Meaning  Acupuncture was associated with a statistically significant decrease in aromatase inhibitor–related joint pain that persisted at 40 weeks after discontinuation of the intervention, suggesting long-term benefits of this therapy.

Abstract

Importance  Aromatase inhibitors (AIs) have proven efficacy for the treatment of hormone-sensitive breast cancer; however, arthralgias (pain and stiffness) contribute to nonadherence with therapy for more than 50% of patients.

Objective  To examine the effect of acupuncture in reducing AI-related joint pain through 52 weeks.

Design, Setting, and Participants  A randomized clinical trial was conducted at 11 sites in the US from May 1, 2012, to February 29, 2016, with a scheduled final date of follow-up of September 5, 2017, to compare true acupuncture (TA) with sham acupuncture (SA) or waiting list control (WC). Women with early-stage breast cancer were eligible if they were taking an AI and scored 3 or higher on the Brief Pain Inventory Worst Pain (BPI-WP) item (score range, 0-10; higher scores indicate greater pain). Analysis was conducted for data received through May 3, 2021.

Interventions  Participants were randomized 2:1:1 to the TA (n = 110), SA (n = 59), or WC (n = 57) group. The TA and SA protocols were composed of 6 weeks of intervention at 2 sessions per week (12 sessions overall), followed by 6 additional weeks of intervention with 1 session per week. Participants randomized to WC received no intervention. All participants were offered 10 acupuncture sessions to be used between weeks 24 and 52.

Main Outcomes and Measures  In this long-term evaluation, the primary end point was the 52-week BPI-WP score, compared by study group using linear regression, adjusted for baseline pain and stratification factors.

Results  Among 226 randomized women (mean age, 60.7 [8.6] years; 87.7% White; mean baseline BPI-WP score, 6.7 [1.5]), 191 (84.5%) completed the trial. In a linear regression, 52-week mean BPI-WP scores were 1.08 (95% CI, 0.24-1.91) points lower in the TA compared with the SA group (P = .01) and were 0.99 (95% CI, 0.12-1.86) points lower in the TA compared with the WC group (P = .03). In addition, 52-week BPI pain interference scores were statistically significantly lower in the TA compared with the SA group (difference, 0.58; 95% CI, 0.00-1.16; P = .05). Between 24 and 52 weeks, 12 (13.2%) of TA, 6 (11.3%) of SA, and 5 (10.6%) of WC patients reported receipt of acupuncture.

Conclusions and Relevance  In this randomized clinical trial, women with AI-related joint pain receiving 12 weeks of TA had reduced pain at 52 weeks compared with controls, suggesting long-term benefits of this therapy.

Trial Registration  ClinicalTrials.gov Identifier: NCT01535066

Article Information

Accepted for Publication: September 28, 2022.

Published: November 11, 2022. doi:10.1001/jamanetworkopen.2022.41720

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Hershman DL et al. JAMA Network Open.

Corresponding Author: Dawn L. Hershman, MD, MS, Columbia University Irving Medical Center, 161 Fort Washington Ave, 10th Floor, Room 1068, New York, NY (dlh23@columbia.edu).

Author Contributions: Drs Hershman and Unger had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Hershman, Unger, Greenlee, Capodice, Crew.

Acquisition, analysis, or interpretation of data: Hershman, Unger, Greenlee, Lew, Darke, Minasian, Fisch, Henry, Crew.

Drafting of the manuscript: Hershman, Unger.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Unger, Lew, Darke.

Obtained funding: Hershman, Unger, Crew.

Administrative, technical, or material support: Hershman, Greenlee.

Supervision: Unger, Greenlee, Capodice.

Conflict of Interest Disclosures: Dr Fisch reported being employed by AIM Specialty Health, a subsidiary of Elevance, outside the submitted work. Dr Henry reported receiving payments from BlueNote Therapeutics to her institution for pharmaceutical company–sponsored clinical trials and personal fees from UpToDate outside the submitted work. No other disclosures were reported.

Funding/Support: This study was sponsored by grants R01AT006376, UG1CA189974, and U10CA37429 from the National Center for Complementary and Integrative Health of the National Institutes of Health and the Office of Research on Women’s Health.

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Meeting Presentation: This article was presented at the American Society of Clinical Oncology Annual Meeting; June 6, 2021; virtual.

Data Sharing Statement: See Supplement 3.

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acupunctuur, sham acupunctuur, borstkanker, aromatase remmers, pijn, gewrichtsklachten


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1 Reactie op "Acupunctuur vermindert sterk pijn en gewrichtsklachten bij vrouwen met borstkanker die aromatase remmers gebruiken. En verbetering blijkt uit duurzaam te zijn"

  • e.valstar :
    20/11/2022
    Acupunctuur vermindert pijn onder vele condities. Er zijn tientallen gerandomiseerde studies van goede kwaliteit. Wie dat als arts nu na zorgvuldige bestudering nog ontkent is een oncowappie oftewel een kwakzalver. Feit is wel dat pijnreductie op vele manieren kan, juist ook met reguliere pijnstilling. Bij zeer hevige pijn is reguliere medicatie onontbeerlijk, maar het resultaat voor acupunctuur blijft staan.
    Comment

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