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Integrative Medicine Use Important and unique aspect of cancer care inan integrative model 62% of Americans using some form of CAMtherapy 12% consulted with a licensed CAM practitioner 30 – 75% of people diagnosed with cancer usingCAM therapies Important to communicate to oncologistCancer Treatment Centers of AmericaAcupuncture In OncologyAOMA Graduate School of Integrative MedicineKatherine Anderson ND, FABNODirector of Naturopathic MedicineCancer Treatment Centers of AmericaDate: April 17, 2012 2008 Rising Tide, Kft.2 2011 Rising Tide4Concept of “Qi”What is Acupuncture? Acupuncture is theinsertion of fine needlesat precise points alongthe body. It is a safe and effectiveform of medicine backedby thousands of years ofpractice and a significantamount of scientificresearch. 2011 Rising Tide3Indications for Acupuncture in the Oncology Setting(Inpatient and out patient) Patients who don’t respond well tomedications– Insomnia– Pain– Constipation/DiarrheaNausea/VomitingChemotherapy and radiation-inducedfatiguePeripheral neuropathyStress/AnxietyPoor appetiteHiccupsGeneral quality of lifeIrritable bowel syndrome World Health Organization Treatment of digestive and respiratory disorders Treatment of neurological and musculardisorders Treatment of urinary, menstrual andreproductive problemsHot flashesLymphedemaDepressionXerostomiaImmune boostingAcute and chronic painHeadachesStroke recoveryWound healing/surgery recoveryVertigoArthritisSmoking cessationAllergies/AsthmaAcute cold/flu 2011 Rising Tide tml 2011 Rising Tide61

Scientific Explanation of AcupunctureScientific Explanation of Acupuncture Pet scan studiesdemonstrate a number ofchanges in areas of thebrain related to gastriccontrol when stomach 36is stimulated Another pet scan studydemonstrates 10 measureablechanges in the brain (prefrontalcortex and hippocampus)followed by stimulation ofSpleen 6. This point is oftenused for insomnia, depression,anxiety and 48350 2011 Rising Tide7 2011 Rising TideScientific Explanation of AcupunctureScientific Explanation of Acupuncture Prefrontal cortex: involved inplanning complex cognitivebehavior, expressingpersonality and intelligence,and expressing appropriatedsocial behavior Hippocampus: involved informing memories andemotional responses Pain relief 2011 Rising Tide8– Endorphin theory: Studies show that acupuncturecauses endorphin release, which is one theory whyacupuncture helps to relieve painhttp://www.ncbi.nlm.nih.gov/pubmed/710079– Gate theory: Acupuncture stimulates nerve fibers toblock the ability to feel pain9 2011 Rising Tide10Cautions/Side effectsSuccess Case Cautions– Thrombocytopenia– Neutropenia– Lymphedema– Needle phobia Side effects– Typically none– Occasionally pain may worsen for a day before improving– Changes in appetite, sleep, bowel or urinary patterns, andemotional state may be triggered as the body moves towardbalance– Deep relaxation 50 y/o Female triple negative breast cancer Chief complaints: Hot flashes, insomnia, anxiety, neck and shoulderpain Frequency of acupuncture: 2-4 times per week while receiving dailyradiation treatments After 3 treatments, sleeping 8-10 hours per night, significantreduction in hot flashes and anxiety, pain 50% improved Upon follow up 5 weeks later, continuing to sleep well, anxiety low,occasional hot flashes, neck and shoulder tension still needsimprovement 2011 Rising Tide11 2011 Rising Tide122

Hot flashesAcupuncture for hot flashes in patients with prostate cancer.Points of ResearchBeer TM et al.Source : Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, Oregon 97239, USA.CONCLUSIONS:Multiple placebo-controlled trials have demonstrated a 25%response rate to placebo treatment for hot flashes. Of the 22patients, 41% had responded by week 4 and 55% overall inthe present pilot study, providing evidence of a potentiallymeaningful benefit. Additional studies of acupuncture for hotflashes in this population are warranted.Insert cartoon 2011 Rising Tide13 2008 Rising Tide, Kft.14Nausea and VomitingLymphedemaAcupuncture to alleviate chemotherapy-induced nausea andvomiting in pediatric oncology 29 women, status post unilateral breast surgery –segmentectomy or mastectomy with axillary lymph nodedissection 6 months post for 21 women, and over 10 years for 8women 93% had radiation treatment 66% had adjuvant chemotherapy in addition to radiation All had lymphedema – grade I and/or restricted range ofmotion greater than 20 degrees in flexion and abductionGottschling et al. 2008 Nov-Dec;220(6):365-70. Epub 2008 Oct 23.Source: Department of Pediatric Hematology and Oncology, Saarland University, Homburg, Germany.RESULTS: Forty-six chemotherapy courses with or without acupuncture werecompared. The need for rescue antiemetic medication was significantlylower in acupuncture courses compared to control courses (p 0.001)Episodes of vomiting per course were also significantly lower in courseswith acupuncture (p 0.01). Except for pain from needling (4/23) no sideeffects occurred. Patients acceptance of acupuncture was high.CONCLUSIONS: Acupuncture as applied here seems to be effective inpreventing nausea and vomiting in pediatric cancer patients. 2008 Rising Tide, Kft.15 2011 Rising Tide1617 2011 Rising Tide18Lymphedema Once weekly for 6 months Acupuncture protocol was intended to promote lymphcirculation, reduce lymphedema and lymphatic cysts,reduce the heaviness in the limb, promote movement,reduce pain, promote blood flow and reduce edema Needles were inserted at the contralateral limb Results: 100% had a significant improved range of motion 3rd month: improved abduction 6th month: improved flexion Subjective improvement in heaviness and tightness 2011 Rising Tide3

Hot FlashesHot FlashesDeValois et al 2010DeValois et al 2010 Once weekly for 8 weeks Monitored for 30 weeks, starting two weeks priorto the start of acupuncture treatment Evaluation completed at 5 different times overthe 30 weeks via hot flash diary andquestionnaires (2 weeks prior, after 4thtreatment, at end of treatment, 4 and 18 weekspost treatment)50 women with early breast cancer 35 yoa, 6 months status post treatmentTaking Tamoxifen 6 or more monthsHot flash records were reported at a frequencyof more than 4 hot flashes per 24 hours for 3months Diagnosed as having a Kidney Yin deficiency 2011 Rising Tide19 2011 Rising Tide20 2011 Rising Tide22Hot FlashesDeValois et al, 2010 46% reported 50% or greater reduction in hotflashes and night sweats Longer term benefits: 41% reduction at 4 and 18weeks post treatment Other side benefits: improved well-being,concentration, sleep and decreased anxiety 2011 Rising Tide21Chemotherapy Induced NauseaChemotherapy Induced Nausea Consider acupuncture as an addition to youranti-emetic protocols. Patients received acupuncture on the same dayas or 30 minutes prior to chemotherapy. Repeat acupuncture on the 4th day ifchemotherapy administered for more than 3days. Acupuncture has the ability to facilitate 5-HTrelease in the brain, which interacts withserotonin to inhibit its release (Guerra, MC)Results7 of the 8 patients in this case report respondedto acupuncture treatment for control of nauseaand vomitinghttp://www.medicalacupuncture.org/aama marf/journal/vol16 1/case2.html 2011 Rising Tide23 2011 Rising Tide244

Southwestern Regional Medical CenterTulsa, OKChemotherapy Induced Nausea Conclusion (Guerra, MC):– Fewer hospitalizations for treatment of nausea andvomiting would improve patient quality of life andreduce treatment costs.– Improves tolerance and compliance for chemotherapywhich can improve clinical outcomes for patients– Acupuncture is useful in patients who are refractory tostandard pre-medications with steroids, serotoninreceptor antagonists, and sedatives in the preventionof Chemotherapy induced nausea and vomiting. 2011 Rising Tide25 2008 Rising Tide, Kft.What makes CTCA unique?What makes CTCA unique? Unique model of care- We offer a fullyintegrated, innovative treatment model thatcombines advanced medical treatments,technologies and supportive therapies such asnaturopathic medicine, nutrition, and mind-bodymedicine to heal the who, person and improvequality of life. Complete care under one roof- At CTCA,surgery, radiation, imaging, nutrition, medicaloncology, rehabilitation, acupunctureeverything- is all under one roof. CTCA only treats cancer Patients are at the center of our care Weekend services Survival results 2008 Rising Tide, Kft.27PEC Model 2008 Rising Tide, Kft.2628History at Southwestern Acupuncture program was started in 2009 with apart-time contract Acupuncturist. We successfully grew the program anddetermined 2 FTE full-time acupuncturists wereneeded to serve our patients. Providers:– Shana Deneen, ND LAc. hired August 2010– Sunara Sotelo, DAOM hired September 2011 2008 Rising Tide, Kft.295

Patient Care Delivered Dr. Sunara SoteloSunara Sotelo, DAOM joinedSouthwestern in September 2011.She holds gold standard traininghaving completed her Doctorate ofOriental and Asian Medicine throughBastyr University in Seattle , WA.She completed her Master’s inOriental Medicine. She deliversexceptional care to patients andalways goes above and beyond!Four intake roomsAcupuncture tablesElectrical StimulationAuricular therapySpa aesthetics to increase relaxationexperience:– Light dimmers– Recliners– Soft musicDr. Shana DeneenSRMC Patient feedbackShana Deneen , ND LAc joinedSouthwestern in August 2010. Shecompleted her Naturopathic Degreefrom Southwest College in Arizona in2007. Additionally, she completedher Masters in Acupuncture in 2009.By combining both Naturopathic andAcupuncture training she is able todeliver exceptional patient care. “Since acupuncture has helped me with side effects I try to scheduleit when I am here but a lot of times it is not available.” “My supplements are fully explained and I appreciate knowing howthey can improve my well bring. I also appreciate the acupunctureservices provided.” “Also, I'm completely satisfied with Shana as she controlled sideeffects of treatment with acupuncture.” “More acupuncture. Hard to schedule. Fully booked for weeks.” “Move acupuncture to a quieter area.” “Make Acupuncture area quieter while treating.”RESOLUTION: Director of Naturopathic Medicine replied - We are hopeful with thestakeholder lunch room moved from just outside the treatment area that traffic willlessen, decreasing noise volume. We offer patient ear plugs and also play relaxingFuture Acupuncture PlansIntegrative Medicine Conference 2012- Oct 26th & 27th Additional treatment space and time Introduce herbal therapies Combined Acupuncture and Laser appointmentsfor patients. Hire cross functional NDs that have Acupuncturetraining Community Acupuncture Program Acupuncture Residency Program 2008 Rising Tide, Kft.Committee Conference Chairs:Katherine Anderson, ND, FABNOSunara Sotelo, AC, LACFeatured Speakers:Lise Alschuler, ND, FABNODaniel Weber, PhD MScMaster Li JunfengJeanne A. Drisko, MDThere are two ways to register:Mail to: The Department of Naturopathic Medicine CancerTreatment Centers of America10109 East 79th Street, Tulsa, OK 74133Fax to: 918-249-7529 Online: www.okanp.orgWho Should Attend:This conference is perfect for those seeking to gain knowledgethey can take back to their practice within the area of integrativeprimary healthcare. Speakers will present evidence-basedinformation on primary health care and integrative oncology. Thisconference is open to NDs, MDs, DOs, Oncologists, NursePractitioners, and Licensed Acupuncturists. Proceeds from thisevent will benefit Gateway for Cancer Research(www.demandcurestoday.org). Nilsz356