A Retrospective Review Investigating the Feasibility of Acupuncture as a Supportive Care Agent in Children with Cancer Kathy Taromina, MS, LAc, Diane Rooney, MS, LMT, LAc, Elena J. Ladas, MS, RD, Deborah Hughes, Kara Kelly, MD Integrative Therapies Program for Children with Cancer, Columbia University, Division of Pediatric Oncology, New York, NY, United States, 10032

Background Acupuncture is an ancient Chinese method of healing and is a component of Chinese medical treatment. Published reports have cautioned against the use of acupuncture in the pediatric population Clinical trials have suggested that acupuncture may have a role as a supportive care agent in adults undergoing treatment for cancer No clinical trials have been published for children undergoing treatment for cancer.

Acupuncture and Pediatrics Pediatrics has historically been part of Chinese medicine and is widely used in China. Recommended for children of all ages and conditions Adjustments need to be made to treatment and delivery

Acupuncture and Children with Cancer More consideration needed when giving acupuncture to children already having frequent needle exposure. Developmental Stage  Difficult to avoid toddlers from moving around or grabbing at needles  Body image concerns with adolescents

Strategies Fewer needles, thinner gauge and shorter duration of treatment Needles do not have to be retained to have a therapeutic effect Gently inserting needles and coordinating breathing exercises with insertion can minimize the sensation of the needle being placed. Private room option

Acupuncture and Thrombocytopenia Many cancer patients encounter thrombocytopenia at some point in their therapy Recommendations from the acupuncture community are practitioner-dependent Theoretical concern in patients with < 50 µMol/mL

Program Description Acupuncture services were initiated in March 2005 The primary oncologist of each patient is approached by the director of the program prior to acupuncture treatment Upon physician approval, patient/guardian consent is obtained per NY State Guidelines

Acupuncture Treatment Description Treatment is integrated with outpatient and inpatient treatments Appointments not necessary Acupuncturist makes daily rounds in outpatient center and inpatient unit

Primary Objectives To describe the first year of the introduction of an acupuncture program to children with cancer. To describe the feasibility, patient acceptance, symptoms addressed, and overall experience of an acupuncture program provided to children undergoing treatment for cancer.

Methods 25 patient records of subjects between the age of 1 and 22 who were undergoing treatment for cancer Patient diagnosis, gender, age, chief complaint, number of treatments, acceptance, outcome, and adverse events were recorded over a 6-month period. Patient treated with acupuncture at the same time as receiving conventional therapies

Monitoring of Side-Effects Acute  A thorough exam of the acusites was conducted after each treatment session. Delayed  Acusites were examined during the patient’s routine visit to monitor for any delayed side- effects.

Results Over a 6-month period, we provided 172 sessions of acupuncture to children ages 1– 22 undergoing treatment for cancer The provision of services was feasible to a wide range of diagnoses and ages and in both the inpatient and outpatient settings

Demographic Data Caucasian (15) Hispanic (7) Black, not Hispanic (1) Other (2) Female (14) Male (11) N=25 Age Range: 1 to 22 years Race Gender

Patient Diagnoses # of Patients

Signs & Symptoms Treated Pain Headache Dry Mouth High Blood Pressure Fatigue / Weakness Cachexia Nausea / Vomit Anxiety Well-Being Thrombocytopenia

Side-Effects Associated with Treatment with Acupuncture Out of 172 sessions of acupuncture, only two side effects reported Two patients reported a small hematoma at the acupoint site  16-year old male with relapsed Ewings Sarcoma. Patient was receiving high-dose dexamethasone and developed a hematoma at one acusite after one treatment.  11-year old female with relapsed Ewings Sarcoma. Patient suffered chronic thrombocytopenia and developed a hematoma at one acusite after one treatment.

Patient Platelet Counts < 50 µMol/mL> 50 µMol/mL < 20 µMol/mL

Treatments Per Patient # of Treatments

Conclusions Provision of acupuncture is feasible and well- accepted among children with diverse malignancies and undergoing stem cell transplantation Provision of acupuncture is feasible in both the in/out-patient settings Acupuncture is well-accepted by a wide age range of patients Acupuncture may be a supportive care agent for a variety of therapy-related side-effects; however, this needs to be confirmed in future clinical trials

Next Steps The descriptive nature of this study helped identify potential areas where acupuncture may have a role as a supportive care agent. Future randomized, controlled trials in a homogenous patient population will aid investigators in identifying the role of acupuncture in pediatric oncology

Acknowledgements Staff of The Integrative Therapies Program for Children with Cancer  Kara Kelly, MD  Elena J Ladas, MS, RD  Deborah Hughes, BA  Diane Rooney, L.Ac  Christine Grimaldi, PhD The patients treated at the Division of Pediatric Oncology, Columbia University Medical Center