ANAHEIM, CALIFORNIA—Significant weight loss due to loss of appetite affects more than 50% of patients with gastrointestinal (GI) cancer. In this study, the feasibility of acupuncture as an intervention for patients with GI tract cancer was investigated. Appetite was improved in patients with GI cancer who received acupuncture therapy, according to a study presented at the Oncology Nursing Society (ONS) 39th Annual Congress.
Cachexia associated with cancer is characterized by anorexia, unintentional weight loss, systemic inflammation, and loss of muscle mass. Cachexia causes a depletion of adipose tissue and skeletal muscle mass. The changes in body composition are similar to infection or injury rather than starvation. Cachexia affects approximately 30% of patients with cancer. It decreases quality of life and overall survival of patients, with physiological function impaired by weight loss greater than 15% and death predicted by weight loss of 30%.
Anorexia is loss of the desire to eat. It has a negative impact on patient tolerance for treatment, quality of life, and outcomes. Anorexia is a reduced food intake (1,500 kcal/day) with weight loss (10% or more) and a systemic inflammatory response (CRP, 10 mg/L or higher). Anorexia results in malnutrition and unintentional weight loss in more than 50% of patients with cancer in treatment.
Saunjoo Yoon, PhD, RN, and colleagues investigated the efficacy of acupuncture as a complementary therapy to manage anorexia in patients receiving chemotherapy for GI tract cancer. Chemotherapy and tumor-mediated metabolic changes affect anorexia and nutritional status, and these are challenging to manage. Commonly used interventions include megestrol acetate and corticosteroids, surgery, oral supplements, enteral tube feeding, and parenteral nutrition. The disadvantage of these methodologies is that their effects are short term, they are not tolerated by some patients, and they can cause somatic stress.
Acupuncture is a nonpharmacologic, noninvasive intervention. Its physiologic benefits include inhibition of α-MSH, decreased circulating cortisol levels, increased GI motility in noncancer patients, and decreased proinflammatory cytokines and increased opioid peptides. The potential benefits to patients include increased appetite, higher caloric intake, and weight gain.
The study was designed as a feasibility study. Inclusion criteria for participants were age 21 years or older, speak or understand English, a diagnosis of gastrointestinal or colorectal cancer, and had a weight loss of 5% or more compared with prediagnosis weight. The intervention consisted of eight sessions of acupuncture with predetermined primary and secondary points. Primary points were for anorexia, and secondary points were for pain, fatigue, insomnia, constipation and diarrhea, and nausea and vomiting. Results were measured by number of participants who withdrew, percent of missed appointments, and weight changes. Pre- and postintervention measures were taken using visual analogue scale (VAS), Karnofsky Performance Status (KPS), and Simplified Nutritional Appetite Questionnaire (SNAQ).
Seven participants, age 34 to 62 years, met the eligibility criteria. All of the participants completed the full intervention, and none missed any appointments. A significant overall improvement in appetite was found, with an average improvement of 3.47 cm out of 10 cm on the VAS measuring appetite. Although the participants lost an average of 2.17 lb over the 8-week study period, representing a 1.25% loss, VAS and SNAQ scores were improved.
The study results demonstrate that acupuncture is well-accepted by patients and has potential for managing anorexia in patients with GI cancers. However, the study did have some limitations. The researchers had no information on the participants’ cancer stage, it was a small group, there was no follow-up to determine a lasting effect, and the study did not have a control group.
Yoon reported that further research will include a control group, extend to efficacy for cachexia (not just appetite loss), and other types of cancer and pancreatic cancer.
Yoon S, Grundmann O, Williams J, et al. Cancer-associated anorexia and cachexia in adults with GI tract cancer: Novel intervention with acupuncture. Presented at: Oncology Nursing Society (ONS) 39th Congress; May 1-5, 2014; Anaheim, CA.