For a long time, Eastern and Western practices of medicine have been seen as quite mutually exclusive; two distinctly different options for treating illness. But increasingly patients and doctors alike are valuing the overlap, when the space where East meets West equals more patient-centred options to relieve the side-effects of mainstream treatments.
One such example is in cancer care symptom management. Data from the World Cancer Research Fund International indicates that Australia has one of the highest per capita rates of cancer in the globe.
Radiation and chemotherapy often gives many patients a good chance of survival. But sometimes, these treatments come with undesirable side effects. This is where Eastern knowledge steps in.
Dr Byeongsang Oh, PhD, is a Clinical Associate Professor at the University of Sydney, a research fellow at Harvard Medical School, and the integrative medicine consultant at Sydney’s Royal North Shore Hospital (RNSH). From his consultation room in the Northern Sydney Cancer Centre, RNSH, Dr Oh uses his 15 years experience to provide public sector cancer patients with chemotherapy and radiotherapy-specific acupuncture free of charge.
He tells SBS, “acupuncture is popular among the general public for muscular symptoms or pain but we can also apply it to all cancer pain.”
“When treating cancer, we do the best care with Western medicine but then there are a lot of side effects during and after treatment. There are a lot of options to improve these, but one of them is acupuncture where we can improve a lot of symptoms.”
Acupuncture is not a one size fits all treatment for the symptoms of chemotherapy or radiation. Its results are varied according to cancer and treatment type, the person's own experience of disease and treatment, the acupuncturist and their level of training in this field, and the individual's body. However, as various research shows, it is helping to alieviate the symptoms of cancer therapy in some patients.
Not a placebo
Over the past three decades, research has steadily been building in the US and UK that shows that symptoms such as nausea and vomiting, fatigue, hot flushes, depression and anxiety, and pain caused as a by-product of cancer treatment can be actively improved by acupuncture.
There is also evidence to suggest that the practice can help immune function by supporting white blood cell count, and reduce the dry mouth feeling and difficulty swallowing experienced by many throat and neck cancer patients.
Scientific testing - that includes monitoring patient experience with acupuncture, compared to prescribed drugs or a placebo - has slowly dispelled the once-held myth that the benefits of acupuncture were simply imagined. In fact, the results for some chemotherapy induced symptoms have been so compelling that in July this year, the American Society of Clinical Oncology listed acupuncture as a means of delivering one of the best practice methods of care for cancer-related pain.
So how does it work?
Dr Oh offers two explanations for how acupuncture treatment can help alleviate undesirable symptoms associated with chemo, radio and hormone therapy. Within Chinese medicine theory, acupuncture works to maintain a free flow of energy in the body, something which is associated with good health, a long life and no pain.
Both physical and mental factors - like an inflammation, anxiety or stress, for example - can cause a stagnation or blockage in the energy flow, causing pain or illness as a result. The stimulation of acupuncture points along the body works to release this blockage and restore balance, with Dr Oh explaining that “once you create a free flow of energy you can improve a lot of medical symptoms including pain, anxiety, depression and hormone imbalance.”
Western medicine takes a different approach to understanding acupuncture and looks at how the body responds when sensory nerves located under our skin and in muscle tissue, are stimulated.
“When you stimulate certain acupuncture points, the nerve that is connected to our skin sends a signal to the brain through our spinal cord,” Dr Oh explains. “This stimulates the production of hormones and changes neurotransmitters in the brain and endorphins, serotonin, natural opioids are released, controlling pain and reducing inflammation”.
“The release of endorphins and serotonin reduces pain, but it also makes you happy which is why acupuncture can also improve anxiety and depression,” he adds.
Research conducted under MRI scanning has shown that administering acupuncture in certain parts of the body causes a reaction in parts of the brain, “for example the part controlling pain activates or deactivates, so we know that there is a direct effect on the brain responding to acupuncture treatment,” says Dr Oh.
As with many forms of medicine however, results vary depending on the person and their medical symptoms. “Some patients respond very well, some patients don’t respond, and for others it takes longer,” he says. “For example some patients see a big improvement in two to three treatments, some patients maybe six weeks later, some patients it takes longer than 12 weeks of treatment.”
When it takes longer...
Wendy is one of Dr Oh’s patients and was diagnosed with breast cancer two years ago. After completing chemotherapy and undergoing a mastectomy, she was referred to acupuncture by her oncologist after experiencing side effects from the oestrogen blocking drugs she takes to prevent the cancer returning. These routinely prescribed drugs are traditionally taken for five years, but new research suggests that should now be extended to ten.
“Unfortunately this drug has a lot of side effects, and the side effect that’s really bothering me is it affects your tendons,” Wendy tells SBS, “I’ve had very painful tendon issues in my hips and in December last year I got it in my hand.”
“I don’t want to go off the drug but the pain is really debilitating on a day to day basis,” she explains.
As the hospital Wendy was treated at for cancer does not offer in-house acupuncture, she goes to a private clinic twice weekly but remains unsure of how effective her treatment will be.
“It’s difficult because it’s slow but it’s definitely improving,” she says, “The jury’s out for me, I think it’s helping me but is it going to cure this particular tendon problem? I’m not sure.”
Not all public hospitals can help
Acupuncture is not currently part of standard cancer care in NSW public hospitals and the acupuncture treatments Dr Oh offers his patients at Royal North Shore Hospital are supported by the Dry July Foundation and the Northern Sydney Local Health District.
While funding is tight, demand is only increasing with one of Dr Oh’s own research papers indicating that a large majority of cancer patients who are invited to participate in acupuncture services say they would consider it.
As a result, the private sector is often sought to fill the gap, but treatment – particularly when administered more than once a week – can be costly. Natalie Dalton is an acupuncturist and doctor of traditional Chinese medicine (TCM) on Sydney’s Northern Beaches and is opening a program for cancer patients at operational costs.
After losing six friends to cancer, Dr Dalton (TCM) wants to see more patients get access to proactive chemotherapy support to help them cope with their treatment and improve their quality of life both during and after chemo.
“Cancer is expensive and best quality care shouldn’t be based on whether you can afford it,” she tells SBS.
“What we’d like to do is support patients through their chemotherapy regime to help them track from one chemo treatment to the next without having to either drop out of their prescribed chemo treatment plan or to reduce the dosage of the medication prescribed by the oncologist.
“We’re not treating cancer, we’re treating patients going through chemotherapy as acupuncture does offset the side effects of chemotherapy.”
While Dr Dalton already treats a number of cancer patients at a discounted rate, she’s adding the finishing touches to a chemotherapy support treatment centre which she hopes to open as a not for profit in 2017 to bring the out of pocket cost of treatment down to around $15 per session. In privately run clinics, acupuncture sessions can cost between $50 and $200, depending on the practitioner's experience and level of education.
Dr Oh has established an acupuncture internship program which caters to the same need, and involves students from the University of Technology Sydney to provide free acupuncture services at the Concord Repatriation General Hospital.
Currently operating as a pilot study, the students work in collaboration with Associate Professor Chris Zaslawski, from UTS' Chinese Medicine Department, and medical oncologist Professor Janette Vardy of the Sydney Medical School, as part of the program which is the first of its kind to be introduced in a hospital environment in a Western country.
When East and West don't mix
As more and more people begin to look outside of Western medicine to supplement their healthcare - whether that be with meditation, yoga, t'ai chi, herbal medicine, dietary supplements or the like - Dr Oh stresses that communication between complementary medicine practitioners and doctors is crucial.
The benefits of acupuncture for cancer patients going through chemo, radio or hormone therapy have been well documented, but the same can't be said for every other alternative practice, and some may even interfere with medication prescribed by doctors.
“Sometimes we are not sure what the patient is doing so that’s why during treatment a lot of doctors are very concerned about the use of other supplementary or complementary medicine," he explains.
To combat this, Dr Oh is working within the medical community in Sydney to create stronger communication lines between doctors and complementary medicine practitioners. He also wants complimentary medicine practitioners to explain which treatments are evidence based as part of best practice care, and ensure that any potential risks are clearly discussed with both the patient and their regular doctor.