Acupuncture in supportive cancer care – safe practice, evidence, and survivorship

00:00:06: Between Heaven and Earth, a podcast presented by the German Association for Chinese Medicine AG-TCM.

00:00:13: Today's topic, acupuncture in supportive cancer care with Beverly de Valois.

00:00:20: My name is Anne Hardy I'm a journalist and TCM practitioner at Frankfurt Main in Germany And today we're delighted to welcome Beverly Ann De Valois a leading researcher, acupuncturist and author with more than twenty-five years of experience in supportive cancer care.

00:00:38: Her work has focused on how acupuncture can help people living with and beyond cancer And she has shared her expertise internationally through teaching research and clinical practice also at the TCM Congress in Rothenburg last year.

00:00:53: although this year Beverly is the author of Acupuncture and Cancer Survivorship Recovery, Renewal & Transformation.

00:01:02: And has played a key role in shaping safe practice recommendations for acupuncture in cancer care.

00:01:08: She also helped establish some of first acupunctur clinics in UK dedicated to the needs of cancer survivors after treatment.

00:01:16: Good morning Beverly.

00:01:18: Hi!

00:01:18: Thank you very much for inviting me between heaven and earth.

00:01:22: Yeah I'm delighted to

00:01:24: have you

00:01:24: here.

00:01:26: So

00:01:26: first thing in your CV, I saw that you first studied modern English literature and then completed a master's degree in aesthetics.

00:01:35: ten years later You earned a licenseate at the College of Integrated Chinese Medicine.

00:01:41: How did you first become interested in Chinese medicine?

00:01:45: Well it is really interesting question.

00:01:47: The way you phrased That ten years must be an active year with lots change for me.

00:01:53: But I guess the answer is, I've kind of always been interested in what are now called integrative therapies or complementary therapies as they have known for a long time.

00:02:07: And I used to do this little bit less formally...I use to have project that every year would try new therapy and explore it see what was like.

00:02:19: so i tried lots things and around nineteen ninety-five I decided it was time to try scary acupuncture.

00:02:30: And this is a huge step for me because i am an notorious needle phobic, so... So this was quite a massive step!

00:02:40: My acupuncturist was wonderful but about the second or third treatment she said do you think that's right therapy?

00:02:46: Because we're having trouble here.

00:02:49: And so she was amazing and she stuck with treating me.

00:02:58: A few months later, I was at a crossroads in my life when saying that I don't really know what to do... She said how did you start becoming an acupuncturist?

00:03:10: Six months later it was studying!

00:03:15: Maybe it's fated….

00:03:17: Yes lots of things happen like this

00:03:21: But I think it's not such, you know.

00:03:23: just to go back to this kind of implied.

00:03:26: that is a big leap from modern English literature to Chinese medicine.

00:03:31: but i've been reflecting on this question and they're quite similar.

00:03:37: in a way It's about people stories

00:03:40: Right.

00:03:42: So so thats kinda You know there are strong links There.

00:03:45: its listening or reading People Stories analysing them.

00:03:52: It's about working out what is important there and I think, you know, I mean in the case of when we are studying modern English literature then write an essay on it.

00:04:01: but in clinical practice your doing...you're working a treatment for them or you work at next stage.

00:04:13: I understand that.

00:04:14: It's the same parallel with journalism, you also want to hear people stories!

00:04:18: Yeah yeah is it your background?

00:04:20: Yes

00:04:25: okay after qualifying You divided your time between your acupuncture practice and research at The East & North Hertfordshire NHS Trust.

00:04:35: At Mount Vernon Cancer Center where you work With a supportive oncology research

00:04:40: team

00:04:41: You have focused on cancer research ever since.

00:04:44: What drew you to this field?

00:04:47: Chants, basically so I was invited do a job share at Mount Vernon Cancer Centre.

00:04:56: there's a charitable centre called the Linda Jackson Macmillan Centre that offered complementary therapies and someone i'd met in the conference circuit who is working go down to part-time, so she invited me to apply for this job.

00:05:14: And that was as a coordinator with the Complementary Therapies and part of the training does.

00:05:23: yes you know... So they wanted paperwork and stuff and then professional organizations were not very together them.

00:05:32: They didn't have very much on safety or regulation or anything, but I provided what there was.

00:05:38: And um...I persisted and wanted to do this.

00:05:42: so it's very persistent.

00:05:43: Eventually the medical director said well if you want start up a service You need some evaluation.

00:05:53: We don't introduce new therapies without an evaluation.

00:05:56: Now she is amazing woman and her name Dr Jane Maher.

00:06:02: She was responsible for setting up the Linda Jackson McMillan Centre, which is one of the first cancer charities to be set in UK and this format.

00:06:11: And she believed that everything should...she believed in research!

00:06:14: So when she set up the Lynda Jackson McMilling Centre it had a research department in it.

00:06:20: It's called The Supportive Oncology Research Team.

00:06:26: I eventually transferred out with my role as a therapist

00:06:32: the availability of integrative cancer care in the UK, and which settings is it available?

00:06:41: So it tends to be offered at Cancer Treatment Centers.

00:06:47: In general this is because its very patchy and it differs from trust-to-trust.

00:06:52: there are many trusts But typically, with each council centre there'll be an associated charity that provides aspects of supportive care.

00:07:11: And all this is generalisation because there will be exceptions to this but in general these aren't funded by the NHS.

00:07:20: These are funded through charitable funds.

00:07:23: Often they most frequently probably offer aromatherapy massage, reflexology, Reiki things like that.

00:07:39: But again more and more has actually recorded fifteen thousand unique accesses to date.

00:07:48: That is amazing!

00:07:50: So it's out there.

00:07:53: I've certainly taken it around a lot of conferences.

00:07:57: Uh, i have a poster that has won three poster awards at three different conferences including at um Rothenburg this year and the paper itself was awarded prize for the best research paper by The International Society For Complimentary and Traditional Medicine Research ISCMA last year, so it's been very well received and we're very pleased.

00:08:29: This paper was the vision of Dr.

00:08:32: Catherine Zollman who is an oncology GP for many years worked with a charity in the UK called Penny Braun

00:08:42: U.K.,

00:08:46: she's great supporter of acupuncture extremely valuable in the supportive care of people with cancer and so she wanted to develop these guidelines.

00:09:01: She wanted to empower acupuncturists, give them information.

00:09:07: So I was in a position, she started that in twenty eighteen.

00:09:17: I started working on it and then wasn't available to join the team.

00:09:21: Her vision is they would be published widely in UK but not taken up by professional organisations.

00:09:29: Then about twenty-twenty two, twenty-one or twenty-two years ago when I persuaded Theresa Young who's my manager in the support of oncology research team that this would be a good thing to do, thinking it'd only take six months.

00:09:48: It kind of grew like topsy.

00:09:49: we decided instead just focusing on the UK and make these international.

00:09:54: We have had feedback from acupuncturists who say they find them extremely helpful.

00:10:04: teaching, people teaching acupuncture find them very helpful.

00:10:10: And part of the vision was that these should also inform policymakers and we've had feedback there that people have used then.

00:10:23: I think a lot of professionals don't realise just how much evidence for acupuncture in support of people with cancer, and so these help guide them to that information as well.

00:10:40: So it's good on many levels

00:10:43: now.

00:10:43: Yes!

00:10:44: Let us talk about the details.

00:10:45: according to the expert opinion for which indications is acupuncture safe or useful?

00:10:52: Well we say that acupunpture is safe all the way through the cancer pathway from diagnosis death through from the cancer itself or deaths for other causes.

00:11:09: So one of things that we describe in this document is a cancer pathway and given an idea, there are many permutations that can happen to person after diagnosis and treatment.

00:11:21: We say it's safe along that path.

00:11:24: way You know, you use the acupuncture to meet a person's needs and they will change along that pathway as well.

00:11:36: So it can be used in any situation.

00:11:40: And one of things we wanted Dr Zulman particularly what was happening in the UK, when she first conceived of this idea.

00:11:53: Oncologists were recommending against acupuncture for having chemotherapy and we don't know where evidence is but certainly becoming quite widespread.

00:12:09: some major cancer charities are putting it on their website that people couldn't have acupunctur when they were undergoing chemotherapy.

00:12:19: And there's an evident evidence for this, and certainly the evidence is otherwise that it's just safe.

00:12:26: There are many cancer centres around the world who offer chemotherapy even as the chemotherapies being infused.

00:12:36: So she really... That was her kind of key motivation for producing these.

00:12:43: They're now a small part.

00:12:45: That's important to get that message, it is safe for people who have acupuncture.

00:12:50: We give recommendations so we do actual blood counts in the paper.

00:12:56: So if you had access to blood count data then they can make those decisions.

00:13:02: but when a cut off point for acupuncturism not being delivered but also for people who don't have that, there's guidelines when you can administer it safely.

00:13:21: I like the traffic light system with red orange and green.

00:13:30: This is another great feature of this paper The red and amber flag symptoms, so that you know when acupuncture is contraindicated situations.

00:13:45: And the person should be referred back to their medical team urgently for care.

00:13:51: Those are the red flags symptoms.

00:13:53: Then there's the amber flag where it's okay to give them acupunctur but you need to communicate with a treating team about these symptoms arising.

00:14:05: And so we worked really hard with the publisher to get these published on double-sided, and you can point them out.

00:14:16: Our audience can't see this but I've got a printed laminated sheet that has very handy clinical guidelines in your clinic.

00:14:29: Yeah, I just used them last week for a patient that i saw.

00:14:33: So

00:14:34: can you name a few of these red flags?

00:14:40: The one that I referred to the treating team was a woman who had severe weight loss although she was more an oren amber flag than anorexia or severe weight loss malnutrition.

00:15:01: as if someone has had no minimal oral intake, a urinary output for over twelve hours.

00:15:07: Or decreased oral intake and association with significant unintentional weight loss then you would not give them acupuncture.

00:15:14: You'd refer back to their treating team.

00:15:17: That's one example Severe diarrhea, severe fatigue And obviously the golden rule, any new severe uncontrolled pain is a red flag and needs to be referred back to the treating team immediately.

00:15:32: Do

00:15:33: you also have recommendations for moxa in the paper?

00:15:37: I cannot remember...

00:15:40: Not enough!

00:15:43: I didn't treat many cancer patients, but i remember that when the blood cons went down you could do this amazing moxa treatment on the back shoe

00:15:51: points.

00:15:53: What was it?

00:15:53: Bladder seventeen eighteen and twenty

00:15:57: for about

00:15:58: a quarter of an hour And then I also showed her husband how to do it.

00:16:04: It was very helpful.

00:16:07: Yes, yes so we don't really cover moxa too much.

00:16:09: We say moxa sometimes I think in the paper when you just said moxa is that it's situations where You wouldn't want to needle Yeah Then then moxa can be.

00:16:19: but i have done another study which we've Just published The results on although we did this Study quite a long time ago uh...we Did a study To teach um people undergoing Cuban therapy In the NHS To self-moxist stomach.

00:16:33: thirty six.

00:16:35: Yes,

00:16:36: I've read that.

00:16:38: But if you're really exhausted do think you can do it or need someone to do for?

00:16:47: That's a good question!

00:16:49: When we set up that step and were familiar...I'm not sure of your sources the same as ours.

00:16:57: there was a practitioner in the UK who is from Germany called Friedrich Stabler who wrote for the Journal of Chinese Medicine, he wrote about doing treatments on-the-back and we worked with Friedrich to set up a study that we did.

00:17:18: We were concerned having treatment on the back.

00:17:23: if you are single person or people have issues significant other family might not be interested in supporting them.

00:17:32: So we wanted to empower people to be able do it themselves.

00:17:36: I see.

00:17:36: That's why we chose stomach thirty six, because people can do that themselves and some people on the study did for them selves.

00:17:45: The issue was as you say People were often very exhausted And couldn't.

00:17:52: You're very active in sharing your findings through lectures, training publications and leading medical journals.

00:17:58: And conference presentations as you have mentioned.

00:18:01: so looking back what has changed on your field since you started twenty five years ago?

00:18:07: Oh gosh I guess acupuncture is more accepted than it was then.

00:18:13: As i said certainly When I started there were very, certainly in the UK a few councillor centres that offered acupuncture.

00:18:23: Now it's more widely seen and widely used and accepted.

00:18:32: Part of what has helped is some professional organisations like the British Acupuncture Council has really helped.

00:18:42: It's become much more well-developed and professional, so there is that professional view.

00:18:49: I think it was a peak around the beginning of this century where –I think–that really helped.

00:18:56: There was government support for developing Centres Of Excellence research into complementary medicine.

00:19:06: That was very short lived but i think changes and make it... And obviously this, I mean over the years there's been much more research done so there is much more evidence which what people want.

00:19:21: So its being that slow development of you know a kind of slow flowering understanding and acceptance.

00:19:32: yeah

00:19:35: according to today's knowledge, in which ways can acupuncture improve life for patients when it is used as supportive care?

00:19:43: Okay so I'm gonna come on just some actual symptoms in a moment but i think the really big... For me they're really big thing and also I thank Dr.

00:19:53: Zolman.

00:19:54: um this something that we don't talk about in supporting and developing resilience for people undergoing cancer treatment or recovering.

00:20:06: And so one of my studies, when I finished my PhD had got government funding very prestigious funding to do a study using acupuncture to improve well-being with upper body lymphedema.

00:20:21: One of the outputs was that model improve well-being long term and support resilience.

00:20:34: And so it's taken me a long time to kind of get two grips with how important that message is, my key message now – obviously we think of symptoms when doing research where very symptom focused but I think the messages supporting resilience are really important.

00:20:57: keeping someone able to cope with their treatment as they're undergoing it, and be able to go with the recovery afterwards is really important.

00:21:07: So that's kind of whole person if you like holistic message.

00:21:12: what acupuncture can do for a person?

00:21:14: And we don't talk enough about it while people are under going active treatments.

00:21:21: there physical symptoms so there's chemotherapy induced nausea and vomiting.

00:21:27: There's fatigue, there is you know hot flashes.

00:21:32: Those are some of the physical symptoms.

00:21:34: pain again and we know that Society for Integrative Oncology in twenty-twenty two published an important guidelines about pain um and acupuncture came out very well in those.

00:21:47: so those those were really important.

00:21:50: but that acupuncture can offer and dealing with anxiety, sleep problems.

00:22:00: I think helping people to get to grips with fear of recurrence post treatment And then post-treatment, it's just helping people to recover.

00:22:12: Helping people adjust what they call the new normal after cancer treatment and again that is dealing with any physical consequences on chronic fatigue or pain.

00:22:25: all of those things may have happened.

00:22:28: It's very good in the support of care, in multidisciplinary care with people with lymphedema.

00:22:36: I don't hear to that!

00:22:41: That is a good ending for our podcast.

00:22:44: or maybe you want to mention something?

00:22:45: I haven't asked...

00:22:49: Can i mention that I do training and can There's a training coming up in the UK and November this year.

00:23:04: It is two days, there are two-day workshops that I do of using acupuncture to support cancer survivors post treatment which really is kind of workshop based around my book, contents for my book And i delivered it at Mossenberg And there's also a detach to that, but you can do it separately.

00:23:31: It is one day training which has an introduction for people who are not familiar with it and then the other half-day is going through this recommendations of safe practice.

00:23:48: so really get to grips with them and know what's in them, ask questions.

00:23:57: So that is happening at the College for Integrated Chinese Medicine which now part of Health Services University in the UK will be in Reading and it's November twenty-second.

00:24:12: You can check on your website.

00:24:14: So everybody who has listened to the podcast and is interested in knowing more about supportive acupuncture for cancer patients, this was a way to get started because I think from only reading the book.

00:24:42: in as acupuncturist, and one of the things I do is try to build community through those trainings.

00:24:52: So get people to meet each other and chat with each other as well as talk to me

00:25:00: wonderful.

00:25:01: thanks a lot for all these insights and your time

00:25:07: Having me, it's great to be able speak with colleagues in Germany and I will write an article for the AGTCM journal as well so that we'll come out next year.

00:25:19: We're looking forward too!

00:25:24: Goodbye Thank you very much.