Long-term follow-up of patients treated with acupuncture for xerostomia and the influence of additional treatment
Oral Diseases (2000) 6, 15–24
OBJECTIVE: To determine the long-term effects of acu- puncture in patients with xerostomia of different etiolog- ies and the influence of additional treatment.
DESIGN: Retrospective study.
SUBJECTS: Seventy patients, between the ages of 33 and 82, with xerostomia due to primary and secondary Sjo ̈ g- ren’s syndrome, irradiation and other causes were included. The median duration of xerostomia was 32 months.
METHODS: Salivary flow rates (SFR) for whole unstimu- lated and stimulated saliva were used as indicators of effects of treatment. Data from 67/70 patients were ana- lyzed 6 months following a baseline course of 24 acupunc- ture treatments using two-way ANOVA. Patients data up to 3 years were also compared by those who chose to receive additional acupuncture treatment vs those who did not. These data were analyzed descriptively. RESULTS: Statistically significant differences in unstimu- lated and stimulated salivary flow rates (P 0.01) were found in all etiological groups after 24 acupuncture treat- ments and up to 6 months follow-up compared to base- line. Three years observation of these patients showed that patients receiving additional acupuncture treatment had a consistently higher median SFR in both unstimu- lated and stimulated saliva compared to patients who chose not to continue acupuncture. The upper limits of the interquartile range were also higher.
CONCLUSIONS: This study shows that acupuncture treatment results in statistically significant improve- ments in SFR in patients with xerostomia up to 6 months. It suggests that additional acupuncture therapy can main- tain this improvement in SFR for up to 3 years.
Xerostomia (dry mouth) after head/neck radiation is a common problem among cancer patients, and available treatments are of little benefit. The objective of this trial was to determine whether acupuncture can prevent xerostomia among head/neck patients undergoing radiotherapy.
A randomized, controlled trial among patients with nasopharyngeal carcinoma was conducted comparing acupuncture to standard care. Participants were treated at Fudan University Shanghai Cancer Center, Shanghai, China. Forty patients were randomized to acupuncture treatment and 46 to standard care. Patients were treated 3×/wk on the same days they received radiotherapy. Subjective measures included the Xerostomia Questionnaire and MD Anderson Symptom Inventory-Head and Neck (MDASI-HN). Objective measures were unstimulated and stimulated whole salivary flow rates. Patients were followed for 6 months after the end of radiotherapy.
Xerostomia Questionnaire scores for acupuncture were statistically significantly lower than for controls starting in week 3 through the 6 months (P = .003 at week 3, all other P < .0001), with clinically significant differences as follows: week 11, relative risk (RR) 0.63 (95% confidence interval [CI], 0.45-0.87); 6 months, RR 0.38 (95% CI, 0.19-0.76). Similar findings were seen for MDASI-HN scores. Group differences emerged as early as 3 weeks into treatment for saliva (unstimulated whole salivary flow rate, P = .0004), with greater saliva flow in the acupuncture group at week 7 (unstimulated whole salivary flow rate, P < .0001; stimulated whole salivary flow rate, P = .002) and 11 (unstimulated whole salivary flow rate, P < .02; stimulated whole salivary flow rate, P < .03) and at 6 months (stimulated whole salivary flow rate, P < .003).
Acupuncture given concurrently with radiotherapy significantly reduced xerostomia and improved quality of life.
Saliva is fundamental to our oral health and our well-being. Many factors can impair saliva secretion, such as adverse effects of prescribed medication, auto-immune diseases (for example Sjögren's syndrome) and radiotherapy for head and neck cancers. Several studies have suggested a positive effect of acupuncture on oral dryness.
Pubmed and Web of Science were electronically searched. Reference lists of the included studies and relevant reviews were manually searched. Studies that met the inclusion criteria were systematically evaluated. Two reviewers assessed each of the included studies to confirm eligibility and assessing the risk of bias.
Ten randomized controlled trials investigating the effect of acupuncture were included. Five trials compared acupuncture to sham/placebo acupuncture. Four trials compared acupuncture to oral hygiene/usual care. Only one clinical trial used oral care sessions as control group. For all the included studies, the quality for all the main outcomes has been assessed as low. Although some publications suggest a positive effect of acupuncture on either salivary flow rate or subjective dry mouth feeling, the studies are inconclusive about the potential effects of acupuncture.
Insufficient evidence is available to conclude whether acupuncture is an evidence-based treatment option for xerostomia/hyposalivation. Further well-designed, larger, double blinded trials are required to determine the potential benefit of acupuncture. Sample size calculations should be performed before before initiating these studies.