A randomised study comparing the effectiveness of acupuncture or morphine versus the combination for the relief of dyspnoea in patients with advanced non-small cell lung cancer and mesothelioma

Our plain-English summary of A randomised study comparing the effectiveness of acupuncture or morphine versus the combination for the relief of dyspnoea in patients with advanced non-small cell lung cancer and mesothelioma, by A. Minchom, R. Punwani, J. Filshie, et al (European Journal of Cancer, 2016).

The study

• Authors: A. Minchom, R. Punwani, J. Filshie, J. Bhosle, K. Nimako, J. Myerson, R. Gunapala, S. Popat, M.E. O'Brien
• Journal: European Journal of Cancer
• Published: 2016;61:102-10
• Type of article: Randomized trial
• Cited by: 33 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Dyspnoea is one of the commonest symptoms of lung cancer. Opioids can reduce dyspnoea. This study investigates acupuncture for relief of breathlessness in lung cancer.

Methods: We performed a single-centre, randomised phase II study of 173 patients with non-small cell lung cancer or mesothelioma with dyspnoea score of ≥4 on visual analogue scale (VAS). Randomisation was to acupuncture alone (A), morphine alone (M) or both (AM). Acupuncture was administered at upper sternal, thoracic paravertebral, trapezius trigger points and LI4. Manubrial semi-permanent acupuncture studs were inserted and massaged when symptomatic. Arm A patients received rescue morphine. Primary end-point was proportion of patients achieving ≥1.5 improvement in VAS dyspnoea at 4 h. Measurements continued to day 14 and included VAS relaxation, line analogue rating (Lar) anxiety, hospital anxiety and depression and European Organisation for Research and Treatment of Cancer quality-of-life scores.

Results: Dyspnoea VAS improved ≥1.5 in 74%, 60% and 66% of arms A, M and AM, respectively, and was maintained in 45% at 2 weeks. There was no statistically significant difference between arms. VAS relaxation improved in arms A (1.06 points) and AM (1.48 points) compared to arm M (-0.19 points, p<0.001). At 7 d, the Lar anxiety score improved in arm A (1.5 points), arm AM (1.2 points) and arm M (no change, p=0.003). Fewer patients received at least one morphine dose in arm A compared with arm M or AM (21% versus 87% versus 87%, respectively, p<0.001).

Conclusions: A, M and AM were effective in relieving dyspnoea. Acupuncture relieved anxiety and was morphine sparing, providing an alternative to morphine.

Copyright © 2016 Elsevier Ltd. All rights reserved.

In plain English

This was an open (not blinded), single-centre phase II randomised trial at the Royal Marsden Hospital in Sutton, UK, recruiting between 2006 and 2014. It included 173 breathless patients with non-small cell lung cancer or mesothelioma (36 with mesothelioma). Each was assigned to acupuncture alone, oral morphine alone, or both. The study did not look at asbestos exposure. The main measure was the share of patients whose breathlessness score improved by at least 1.5 points at 4 hours. This happened in 74% of the acupuncture arm, 60% of the morphine arm and 66% of the combination arm. These differences were not statistically significant, and the authors called the primary end-point negative. Relaxation scores improved in both acupuncture arms and worsened slightly with morphine alone. Fewer acupuncture-alone patients took any morphine (21%, versus 87% in each other arm). Among the 123 patients with toxicity data, 1% of the acupuncture-alone arm reported side-effects, versus 39% of the morphine arm. The authors concluded that acupuncture was effective, morphine-sparing and reduced anxiety, with minimal toxicity. They noted that the study was not blinded.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Open (unblinded), single-centre, phase II randomised controlled trial with three arms
• Who was studied: 173 outpatients at the Royal Marsden Hospital, Sutton, UK, with non-small cell lung cancer (137) or mesothelioma (36) who were breathless at rest (dyspnoea score of 4 or more on a visual analogue scale). Recruited July 2006 to June 2014. Median age 73 years.
• Exposure: No asbestos exposure was studied. The treatments compared were acupuncture (needles at upper sternal, paraspinal, trapezius and LI4 points, followed by sternal studs patients could massage), oral morphine solution (Oramorph, 2.5 mg four-hourly with breakthrough doses), or both.
• Main results:
  • Breathlessness improved by at least 1.5 points at 4 hours in 74% of the acupuncture arm, 60% of the morphine arm and 66% of the combination arm (115 patients, 66%, overall). There was no significant difference between arms.
  • The breathlessness response was maintained at week 2 in 45% of patients overall.
  • Relaxation (visual analogue scale) changed differently between arms (p less than 0.001). The mean improvement was 1.06 points in the acupuncture arm and 1.48 points in the combination arm. In the morphine arm the score worsened by 0.19.
  • Anxiety on the line analogue rating scale improved at day 7 in the acupuncture arm (median 1.5) and the combination arm (1.2), with no change in the morphine arm (p = 0.003).
  • At least one dose of morphine was taken by 21% of the acupuncture arm, 87% of the combination arm and 87% of the morphine arm (p less than 0.001).
  • Median total morphine dose over the study was 32 mg (range 1 to 60) in the acupuncture arm, 40.6 mg (3 to 154) in the combination arm and 53 mg (13 to 163) in the morphine arm (p = 0.007).
  • There was no statistically significant difference between arms in change in respiratory rate or lung function (FEV1, peak flow).
  • Toxicity data were available for 123 patients. Among them, 39% of the morphine arm reported grade 1 side-effects such as constipation, nausea and drowsiness, and 35% of the combination arm reported toxicity.
  • Among the 123 patients with toxicity data, 1% of the acupuncture-alone arm reported toxicity. Two cases of skin irritation were attributed to the acupuncture site dressings.
• The authors' conclusion: The authors concluded that acupuncture alone or with morphine is effective for relief of breathlessness, and that acupuncture is morphine-sparing and reduces anxiety, with minimal toxicity, in breathless lung cancer patients.
• Limitations the authors state:
  • The study was not blinded.
  • No placebo was used because the ethics committee advised against it, and the acupuncture arm had access to rescue morphine.
  • Only 13% of patients had performance status 3, and these patients had a higher dropout rate.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Non-Small Cell Lung Cancer, Mesothelioma, Lung Cancer.

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