Patients with breast cancer who want to manage hot flashes with complementary medical treatments, but want to know that those treatments have a basis in research, might find encouragement in a study published in the Journal of Clinical Oncology (JCO). The randomized controlled trial found that acupuncture—the ancient practice of inserting thin needles into meridian points in the body—combined with self-care, is associated with significantly lower hot flash scores, compared to self-care alone. The study, “Acupuncture As an Integrative Approach for the Treatment of Hot Flashes in Women With Breast Cancer: A Prospective Multicenter Randomized Controlled Trial (AcCliMaT),” was published online ahead of print, March 28. 

The study, carried out in five specialist care hospitals and one primary health care center in northern Italy, assigned 105 patients to the enhanced self-care group and 85 patients to the enhanced self-care plus acupuncture group; self-care includes prescriptions for diet, exercise, and psychological support. In addition to experiencing lower severity of hot flashes, the treatment group also reported higher quality of life (QOL), compared to the control group, in terms of vasomotor, physical, and psychological symptoms.

A design that captures real clinical experience and minimizes placebo effect

According to study coauthor Giorgia Razzini, PhD, the strength of the study published in JCO is its rigorous and pragmatic design. Previous studies have compared acupuncture for hot flashes to “sham” or non-optimal acupuncture, with the goal of controlling for the therapeutic response that might arise from patients receiving increased attention and a laying on of hands (i.e., the placebo effect). However, this study compared acupuncture to the treatment women with breast cancer would actually receive in clinic, that is, self-care. To further strengthen the study’s design, the acupuncturists paid great attention to minimizing behaviors that could potentially contribute to a placebo effect.

"The acupuncturists worked with a multidisciplinary team of oncologists and clinical trial managers to share their expertise and their knowledge and made an effort to  standardize the acupuncture as much as possible to reduce the placebo factors present in many complementary medicines. In fact, acupuncturists delivered the intervention without talking to the patient, or at least keeping the talking to a minimum. The study was conducted with extreme attention to trying to minimize the placebo effect,” said Dr. Razzini.

Helping Women Cope with Symptoms Over Many Years of Adjuvant Therapy

Finding effective treatments for hot flashes among women with breast cancer is important for several reasons. Not only do women with breast cancer experience a higher incidence of bothersome and more severe hot flashes and other menopausal symptoms, but adjuvant therapy exacerbates hot flashes and sweating, impacting activities and leading to a poorer QOL. To make matters worse, the main treatment for these symptoms—hormonal replacement therapy—is contraindicated because it increases the risk of breast cancer.

“It is important to reduce patient suffering and improve the clinical process for women with breast cancer, especially younger women, who are actively raising families and involved in their professions,” said Dr. Razzini. “Adjuvant therapy is recommended for at least 5 years, and now some studies say more than 5 years, so any treatment that improves QOL will enable women to stay on treatment for a longer time.” 

Giorgia Razzini, PhD, is a researcher in the Unit of Medical Oncology Civil Hospital, in Carpi, Italy. 

Abstract of the original JCO article. 

PDF of the original JCO article.

Lesi G, Razzini G, Assunta M, et al. Acupuncture as an integrative approach for the treatment of hot flashes in women with breast cancer: a prospective multicenter randomized controlled trial (AcCliMaT). J Clin Oncol. Epub 2016 March 28.  

The Exclusive Coverage series on ASCO.org highlights selected research from JCO, JOP, and JGO with additional perspective provided by the lead or corresponding author.

@ 2016 American Society of Clinical Oncology