by Jennifer Southall
Women who underwent surgery for gynecologic cancers experienced decreased symptoms of anxiety and pain with the use of acupressure before surgery and acupuncture during surgery, according to study results published in Cancer.
Further investigation is needed to confirm the findings and to better understand the implications, researchers concluded.
Rationale and methods
Researchers conducted the study as part of an initiative that aimed to provide continuity of integrative oncology care to women with gynecologic cancer, Eran Ben Arye, MD, physician at the oncology service of Lin Medical Center in Haifa, Israel, told Healio.
“During the past 14 years, we have been offering integrative oncology treatments without charge for patients undergoing chemotherapy, which have helped improve their quality of life and increased their adherence to the conventional oncology treatment protocol,” Ben-Arye said. “The research presented in the current paper examined the introduction of the integrative treatment from as early as the time of cancer diagnosis and throughout the presurgical, surgical and postsurgical inpatient setting. The integrative process was a collaborative effort, including a team of surgeons, anesthesiologists and nurses throughout all stages of perioperative care among patients with gynecologic cancer.”
Researchers randomly assigned 99 women who presented for gynecologic surgery for new or recurrent cervical, endometrial or ovarian cancer to one of three groups: preoperative touch/relaxation techniques plus intraoperative acupuncture (group A; n = 45; mean age, 64.1 years), preoperative touch/relaxation only (group B; n = 25; mean age, 59.9 years) or standard care/controls (group C; n = 29; mean age, 63.5 years).
The groups had similar baseline demographic and surgery-related characteristics.
Researchers used the Measure Yourself Concerns and Wellbeing (MYCAW) and Quality of Recovery (QOR-15) questionnaires to score pain and anxiety before and after surgery. They specifically used Part B of the QOR-15 to assess pain, anxiety and other quality-of-life parameters.
Compared with the standard care group, postoperative QOR-Part B scores appeared significantly higher among women assigned to the acupuncture combination and preoperative touch/relaxation only groups (P = .005), including scores for severe pain (P = .011) and anxiety (P = .007).
Of note, researchers observed between-group improvement in the acupuncture combination group compared with the standard care group for severe pain (P = .011), and within-group improvements for QOR depression subscales among the two intervention groups only (P < .0001).
However, women assigned to the acupuncture combination group appeared to achieve better improvements in MYCAW-reported concerns than women in the preoperative touch/relaxation only group (P = .025).
“The most important finding of the study was that intraoperative acupuncture significantly improved high-intensity pain, as reported by patients 24 hours postoperatively,” Ben-Arye told Healio. “We also found that within 3 hours before surgery, manual and relaxation techniques — mainly acupressure and guided imagery — decreased postoperative anxiety levels among patients. Moreover, a similar effect was observed in patients undergoing treatment with manual/relaxation therapies before surgery.”
Limitations of the study included the mixed population of surgical approaches, differences in extent and length of surgery and prognosis of cure after surgery, and lack of blinding or inclusion of a nonintegrative oncology control intervention, researchers noted.
The findings support incorporation of integrative oncology therapies in the perioperative setting, as these treatments are provided by a team of complementary medicine practitioners and acupuncturists who have undergone specialized training in integrative oncology and can play an important role in reducing pain and anxiety among women undergoing gynecologic oncology surgery, Ben-Arye told Healio.
“Manual and relaxation therapies should be offered to patients before surgery and acupuncture should be offered during the surgery itself,” he said. “Of note, there are many challenges that the integrative practitioner is required to overcome in the extremely cramped environment of the operating theater, coordinating treatments with the team of surgeons, anesthesiologists and nurses.”
Researchers now plan to expand the research model presented in this paper to additional cancer centers within the framework of a multicentered study.
“This research will incorporate additional study outcomes to evaluate the impact of the integrative oncology modalities, mainly acupuncture, including objective physiological parameters,” Ben-Arye said.
The study shows the impact of an integrative oncology approach, relaxation and acupuncture on perioperative anxiety and pain associated with gynecological oncology surgery, although a larger study is needed to confirm the results, according to an accompanying editorial by Ana Maria Lopez, MD, MPH, MACP, FRCP, vice chair of medical oncology and chief of cancer services at Jefferson Health New Jersey Sidney Kimmel Cancer Center.
“Ultimately, these data add to the body of integrative medicine and integrative oncology literature that are now included in National Comprehensive Cancer Network and American Society of Clinical Oncology guidelines that support reimbursement for integrative oncology interventions, such as acupuncture,” Lopez wrote.
Acupuncture and acupressure may help alleviate pain and anxiety in patients undergoing surgery for gynecologic cancer (press release). Published Jan. 17, 2023. Accessed Jan. 17, 2023.
This article was published by Healio.