Researchers from Israel have shown that applying acupuncture during surgery for gynecologic cancers significantly reduces high-intensity postoperative pain, while preoperative acupressure can decrease anxiety.
Patients undergoing surgery for gynecologic cancers often experience anxiety both before and after surgery, which has in turn been associated with an increased risk for pain during surgical recovery, write Eran Ben-Ayre from the Lin Medical Center in Haifa, and co-authors in Cancer.
They investigated how integrative oncology impacts perioperative pain and anxiety in 99 patients with ovarian, endometrial, or cervical cancer.
The Society for Integrative Oncology defines integrative oncology as “a patient-centered, evidence-informed field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. Integrative oncology aims to optimize health, quality of life, and clinical outcomes across the cancer care continuum and to empower people to prevent cancer and become active participants before, during, and beyond cancer treatment”.
Speaking to Inside Precision Medicine, Ben-Ayre said that in clinical practice the term typically includes “herbal medicine, acupuncture and other traditional Chinese medicine modalities, manual (acupressure included) and movement therapies, mind-body therapies, and additional systematic schools of practice such as ayurvedic medicine, anthroposophic medicine, and other modalities.”
In the current study, the participants were randomly assigned to one of three groups. Group A (n=45) received preoperative touch and relaxation techniques, including acupressure, Shiatsu foot massage, and breathing and relaxation exercises, beginning within 3 hours before surgery and continuing until the patient began undergoing general anesthesia and intubation. This was followed by acupuncture – using points shown to be effective for reducing pain – throughout surgery. The intervention was delivered by experienced integrative oncology practitioners.
Group B (n=25) received preoperative touch and relaxation only and a control group (Group C; n=29) received standard care.
The researchers found that individuals in the two intervention groups reported significantly less anxiety on the Quality of Recovery (QOR)-15 questionnaire 24 hours post-surgery compared with before surgery. They also experienced significantly greater improvements in anxiety scores than participants in the control group.
For postsurgical pain, patients in Group A reported significantly less severe pain than those in the control group.
Participants in Group A also reported greater improvements in nausea and vomiting than those in Group B from pre- to post-surgery, while those in both intervention groups showed improvements in depression scores after surgery whereas control participants did not.
Ben-Ayre believes that it would be feasible to incorporate acupressure and acupuncture into the care pathway for patients undergoing surgery for gynecologic cancer but there is still a need for open-mindedness and investment in training followed by mentoring of trainees by experienced integrative oncology practitioners.
“The integrative process is a collaborative effort, taking place together with a team of surgeons, anesthesiologists and nurses throughout all stages of peri-operative care of the gynecology oncology patient,” he said. “Implementation in real-life practice requires extensive medical education training for the integrative oncology team as well as the multi-disciplinary team working in the surgery ward, including surgeons, anesthesiologists, nurses, and other healthcare practitioners.”
The take home message from the study is that “manual and relaxation therapies should be offered to patients prior to the gynecologic oncology surgery; and acupuncture should be offered during the surgery itself,” concluded Ben-Ayre.
The researchers now plan to expand their research to additional cancer centers within the framework of a multicenter study that will incorporate additional study outcomes, including objective physiologic parameters.
