ASCO 2008: Acupuncture demonstrates promise in treating symptoms after neck dissection

A small study suggests that acupuncture has the potential to reduce pain and dysfunction in patients with head and neck cancer who have undergone neck dissection, said David G. Pfister, MD, chief, Head and Neck Medical Oncology, Memorial Sloan Kettering Cancer Center, New York.

Pain and shoulder dysfunction are common after comprehensive neck dissection, particularly during unmodified procedures (no preservation of nonlymphatic structures).

Typically, physical therapy and nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed to address pain and shoulder dysfunction after neck dissection, but pain relief and a return of function are often incomplete.

Seventy patients who had pain and/or dysfunction following neck dissection and radiation were randomized to either weekly acupuncture sessions or usual care for 4 weeks. Eighty-three percent of the patients had undergone a modified radical neck dissection. The most common reason for neck dissection was squamous cell carcinoma.

The primary end point was a composite score of pain, function, and activities of daily living (Constant-Murley score; range, 0 to 100, with higher scores demonstrating better results). Standard and optional acupuncture points were used in an attempt to maximize efficacy and reproducibility of acupuncture.

End point data were available for 58 patients. The difference in the Constant-Murley score from baseline was 11 points higher in the group randomized to acupuncture versus those randomized to usual care (p = .008). In addition, 39% of patients in the acupuncture group had a 3% or greater improvement in the Constant-Murley score compared with 7% of patients in the usual care group (p = .004).

Xerostomia, another side effect of neck dissection, was also improved significantly in the acupuncture group compared with the usual care group (p = .02).

Future research should better define which patients are more likely to respond to acupuncture for pain, dysfunction, and xerostomia, as well as the optimal timing and frequency of therapy, said Dr Pfister.