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 of the Complementary Therapies and part of the setup is if you did it could do session.

00:05:26: I have day or week on your therapy although i had been working in cancer care before I had trained as an acupuncturist.

00:05:37: I wanted to offer acupuncture to people with cancer and went into the job saying that very clearly, i was coming as an Acupunctuist not a Zeneromotherapist.

00:05:49: And um... As time went on there was no sign of me being able start this clinic for Acupuncture Clinic.

00:05:58: so I persisted in kept asking questions and kept being phobbed off.

00:06:03: eventually They said, well we think... I mean this was back in nineteen ninety-nine two thousand and acupuncture is very new then.

00:06:15: Certainly cancer care.

00:06:17: And they say that it's an invasive therapy.

00:06:22: We're concerned about an invasive therapist like acupuncturism being delivered by someone who isn't medically trained Not medically trained as you know.

00:06:33: And so eventually they wanted paperwork and stuff, you know the professional organizations were not very together then.

00:06:40: They didn't have very much on safety or regulation but I provided what there was...and um i persisted..I wanted to do this ..i was very persistent ...and eventually the medical director said well if you want to start up a service ,you need some evaluation.

00:07:01: who don't introduce new therapies without evaluation.

00:07:04: Now, she was an amazing woman and her name is Dr Jane Maher And She...she was responsible for setting up the Linda Jackson McMillan Centre which was one of the first cancer charities to be set-up in UK In this format and she believed that everything should..She believed in research.

00:07:23: So when she sat at the Linda Jaxson McMillian Centre it had a research department.

00:07:27: It's called The Supportive Oncology Research Team And so I was kind of eventually transferred out with my role as a therapy coordinator and taken under the wing, an amazing woman who worked for twenty-five years.

00:07:45: Theresa Young taught me just about everything that i know about research.

00:07:50: We did first research project which is to look at using Chinese medicine acupuncture breast cancer patients who were suffering from Tamoxifen-related hot flushes and night sweats.

00:08:05: And the rest is history, that was a successful project.

00:08:10: we then went on to look at using the NADA air acupuncture protocol.

00:08:14: those two studies formed my PhD and then we just kept going until she retired.

00:08:21: I guess it's about two years ago now.

00:08:24: so yeah

00:08:25: So now you're in your private practice only?

00:08:29: Yeah, I'm just about to join.

00:08:31: I'm joining another trust in the UK and I left Mount Vernon after Teresa left.

00:08:36: And um i'm joining a new trust this autumn and i'll be doing more research there.

00:08:41: so But at the moment i've been private practice.

00:08:45: yeah,

00:08:45: and how in general is the situation for The Availability of integrative cancer care in the uk?

00:08:55: in which settings?

00:08:56: Is it available?

00:08:58: So it tends to be offered in councillor treatment centres, because this is very patchy and differs from trust-to-trust.

00:09:09: There are many trusts in the UK.

00:09:12: they're regional but typically with each council centre there'll an associated charity that provides aspects of supportive care.

00:09:28: And all this is generalization because there will be exceptions to this, but in general these aren't funded by the NHS.

00:09:37: These are funded through charitable funds that the charity raises and often they most frequently probably offer aromatherapy massage reflexology Reiki things like.

00:09:56: but again, more and more acupuncture is coming into it.

00:10:01: Often like at Mount Vernon its simply ear acupuncture rather than body acupunpture.

00:10:07: that varies And there are some hospitals and cancer treatment centers That have very well-developed Acupuncture programs In terms... in terms of Chinese medicine, herbal medicine that isn't offered.

00:10:31: it's not well accepted.

00:10:32: Yes same in Germany

00:10:35: yeah.

00:10:36: so okay

00:10:39: let's come back to your research.

00:10:41: you and an international team have recently published a peer-reviewed expert opinion on the safe use of acupuncture and cancer care.

00:10:50: how has?

00:10:54: Well, that has been quite overwhelming.

00:10:58: It's being quite amazing.

00:11:00: so That was published in March of twenty-twenty four and the publishers website Has actually recorded fifteen thousand unique accesses.

00:11:15: To be amazing that is amazing.

00:11:18: So it's out there.

00:11:20: um I've certainly taken it around a lot of conferences.

00:11:25: Uh, i have a poster that has won three poster awards at-at three different conferences including at uh Rothenburg this year.

00:11:34: um 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.

00:11:58: This paper was the vision of Dr.

00:12:00: Catherine Zollman who is an oncology GP.

00:12:06: for many years worked with a charity in the UK called Penny Braun

00:12:10: U.K.,

00:12:15: she's great supporter of acupuncture extremely valuable in the supportive care of people with cancer and so she wanted to develop these guidelines.

00:12:29: She wanted to empower acupuncturists, give them information.

00:12:41: So I was in a position, she started that in twenty eighteen.

00:12:45: I started working on it and then wasn't available to join the team.

00:12:49: Her vision is they would be published widely in UK but not taken up by professional organisations.

00:12:58: 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.

00:13:16: It kind of grew like topsy.

00:13:18: we decided instead just focusing on the UK and make these international... We assembled an international team with people who were acupuncture savvy if they weren't actually practicing at themselves.

00:13:33: but We wanted them from acupuncture professional organizations, we wanted them for leading edge oncology centers around the world.

00:13:44: And so we assembled this team and developed this paper.

00:13:48: took us two years instead of six months that I'd anticipated but it was really worth it.

00:13:54: So...and that has realized Katherine Dr Zillman's vision which is absolutely great.

00:14:04: It's so important to have these recommendations and be confident because you don't want to mess up something with a cancer

00:14:11: patient.

00:14:13: I think acupuncturists, certainly when i've taken my book out... ...to promote it.

00:14:21: sometimes they get the feedback.

00:14:22: well acupuncture is not interested in treating people with cancer cause its too scary.

00:14:29: So this helped answer that And we've had feedback from acupuncturists and acupuncture groups who say they find them extremely helpful.

00:14:42: People teaching acupunpture find them very helpful, part of the vision was that these should also inform policymakers—and I think a lot of people, health care professionals don't realize just how much evidence there is for acupuncture in the supportive care with cancer.

00:15:12: And so these help guide them to that information as well.

00:15:17: So it's good on many levels.

00:15:20: Yes!

00:15:21: Let us talk about details.

00:15:22: according to expert opinion which indications are safe and useful?

00:15:29: Well, we say that acupuncture is safe all the way through the cancer pathway from diagnosis to end of life whether it's death itself or deaths from other causes.

00:15:46: So one thing in this document is a cancer pathway and give an idea about many permutations happening after treatment.

00:15:58: we say that it's safe along that pathway and you use the acupuncture to meet a person needs.

00:16:08: The persons need will change as well, so I can be used in any situation.

00:16:18: one of things Dr Zollmann particularly wanted what was happening in the UK, when she first conceived of this idea.

00:16:30: Oncologists were recommending against acupuncture for having chemotherapy and we don't know where evidence is but certainly it's becoming quite widespread.

00:16:46: some major cancer charities are putting us on their website that people couldn't have acupunpture when they were undergoing chemotherapy.

00:16:56: And there's an evident evidence for this, and certainly the evidence is otherwise that it's just safe.

00:17:03: There are many cancer centres around the world who offer chemotherapy even as the chemotherapies being infused.

00:17:13: So she really... That was her kind of key motivation for producing these.

00:17:20: They're now a small part.

00:17:22: But that's important to get the message, it is safe for people who have acupuncture.

00:17:27: We give recommendations so we give actual blood counts in paper.

00:17:33: So if they had access to blood count data then They can make those decisions.

00:17:39: but when a cut off point for Acupuncture not being delivered Is appropriate but also for people who don't have that, there's guidelines when you can administer it safely.

00:17:58: I like the traffic light system with red orange and green.

00:18:08: This is another great feature of this paper The red and amber flag symptoms so that you know when it is, uh...when acupuncture is contraindicated situations.

00:18:22: And the person should be referred back to their medical team urgently for care.

00:18:28: Those are the red flags symptoms?

00:18:30: And then there's the amber flag where um..it's recommended.

00:18:35: You know It's okay to give them acupuncture But you need to communicate with the treating teams That these symptoms are arising.

00:18:42: And so we worked really hard with the publisher to get these published on double-sided, and you can point them out.

00:18:53: Our audience can't see this but I've got a printed laminated sheet where they have very handy clinical guidelines that you just keep in your clinic.

00:19:06: Yeah, I just used them last week for a patient that i saw.

00:19:10: So can

00:19:11: you name a few of these red flags?

00:19:18: 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, as if someone has had no minimal oral intake or urinary output for over twelve hours.

00:19:44: Or decreased oral intake and association with significant unintentional weight loss.

00:19:49: then you would not give them acupuncture.

00:19:51: You'd refer back to their treating team.

00:19:54: 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.

00:20:10: Do you also have recommendations for moxa in the paper?

00:20:14: I cannot remember...

00:20:17: Not enough!

00:20:20: 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 points.

00:20:30: What was it?

00:20:30: Bladder seventeen eighteen and twenty

00:20:34: for about

00:20:35: a quarter of an hour And then I also showed her husband how to do it.

00:20:42: It was very helpful.

00:20:44: Yes, yes so we don't really cover moxa too much.

00:20:47: We say moxa sometimes I think in the paper we just said moxa is you know it's situations where You wouldn't want to needle.

00:20:54: Yeah Then then moxa can be.

00:20:57: but i have done another study which we've Just published The results on.

00:21:00: 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 thirty

00:21:12: six.

00:21:12: Yes, I've read that.

00:21:15: But if you're really exhausted do think you can do it or need someone to

00:21:24: help?

00:21:24: That's a good question!

00:21:26: When we set up that staffer... We were familiar with the same sources as ours.

00:21:34: There was a practitioner in the UK who came 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.

00:21:55: We were concerned having treatment on their backs.

00:22:00: if you are single person or people have issues significant other or family might not be interested in supporting them.

00:22:09: So we wanted to empower people to be able do it themselves, that's why we chose stomach thirty six and because people can do that themselves And some people on the study did for themselves.

00:22:22: The issue was as you say People were often very exhausted.

00:22:30: You're very active in sharing your findings through lectures, training publications and leading medical journals.

00:22:35: And conference presentations as you have mentioned.

00:22:39: so looking back what has changed on your field since you started twenty five years ago?

00:22:44: Oh gosh I guess acupuncture is more accepted than it was then.

00:22:50: As i said certainly When I started there were very, certainly in the UK a few councillor centres that offered acupuncture.

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

00:23:11: Part of what has helped is some professional organisations like the British Acupuncture Council has really helped.

00:23:19: It's become much more well-developed and professional, so there is that professional view... I think it was a peak around the beginning of this century where—I think that really helped in government support for developing Centres of Excellence research into complementary medicine.

00:23:43: That was very short lived but 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 is what people want.

00:23:58: So um It has been that slow development of you know a kind of slow flowering understanding and acceptance.

00:24:09: yeah

00:24:12: According to today's knowledge, in which ways can acupuncture improve life for patients when it is used as supportive care?

00:24:20: Okay.

00:24:21: So I'm gonna come on just some actual symptoms in a moment but i think the really big... For me, The Really Big Thing and also I thank Dr Zollmann Is something that we don't talk about And its acupuncturist role in supporting and developing resilience for people undergoing cancer treatment or recovering.

00:24:43: 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.

00:24:58: One the outputs was that model improve well-being long term and support resilience.

00:25:11: And so it's taken me a long time to kind of get two grips with how important that message is, and its my key message now – obviously we think about symptoms when doing research where very symptom focused but I think the messages supporting resilience are really important.

00:25:34: keeping someone able to cope with their treatment as they're undergoing it, and be able to coped with the recovery afterwards is really important.

00:25:44: So that's kind of whole person if you like holistic message.

00:25:49: what acupuncture can do for a person?

00:25:51: And we don't talk enough about it while people are under going active treatments.

00:25:58: there physical symptoms so there's chemotherapy induced nausea and vomiting.

00:26:04: There's fatigue, there is you know hot flashes.

00:26:09: Those are some of the physical symptoms.

00:26:11: 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.

00:26:24: so those.

00:26:24: those were really important.

00:26:27: but there's also the emotional support and dealing with anxiety, sleep problems.

00:26:37: I think helping people to get to grips with fear of recurrence post-treatment so... And then post treatment it's just you know kind of helping people recover, helping people adjust what they call the new normal after cancer treatment again that is dealing any physical consequences on chronic fatigue or pain all of those things that may have happened.

00:27:05: It's very good in the support of care, or in the multidisciplinary care with people with lymphedema, cancer treatment related lymphedemas which is another subject very dear to my heart and I do a lot work.

00:27:20: talking about.

00:27:22: it's interesting.

00:27:23: this came into me this week.

00:27:25: i've got new patient very complex presentation.

00:27:31: Some of it is cancer-related, some have other chronic issues and she's seeing so many different consultants that are all in their silo.

00:27:43: when she comes to see me I'm seeing her as the whole person pulling together supporting her totally rather than for each individual symptom And I think that's kind of valuable and unique, important.

00:28:04: How do you deal with these emotional issues?

00:28:07: I mean isn't it weighing on

00:28:10: you?

00:28:10: Um... I don't do end-of-life care.

00:28:16: okay so people need to be more well to come see me obviously but still i have patients who require.

00:28:29: I like treating people who are in post-cancer treatment because that's kind of hopeful and optimistic.

00:28:38: You're helping people, you know?

00:28:40: People who are very depleted down...you're lifting them up so it is good for the people to recur.

00:28:57: things happen and you know I have professional supervision so that is a place where i can deal with it.

00:29:05: That's hard, what do you say?

00:29:12: It's the risk of business!

00:29:17: And I have acupuncture myself.

00:29:21: So do I...I have supervision and acupuncture With same person.

00:29:25: thats very good two in one.

00:29:29: So what are your plans for the future?

00:29:31: What would you most like to see happen.

00:29:35: My immediate plan is I have some funding, some philanthropic funding and i'm going to join The Royal London Hospital for Integrative Medicine in London And i am gonna do a similar paper To say practice recommendations but focusing on safe practice of acupuncture for people with cancer treatment related lymphedema.

00:30:06: And because there's a lot of un-clarity about what is safe practice, um...with acupunctur.

00:30:15: So that's kind my next big project and we'll also part of the role will be planning an update safety recommendations as well.

00:30:28: What would I like to see generally?

00:30:29: Well, obviously you know wider understanding and acceptance.

00:30:35: And support for acupuncture for people with and recovering from cancer.

00:30:40: yeah

00:30:41: i don't her too that

00:30:45: indeed Yeah

00:30:46: That's a good ending to our podcast.

00:30:49: maybe or Maybe You want To mention something I haven't asked.

00:30:54: I don't know.

00:30:55: Can i mention that?

00:30:58: I do training, can I mentioned it though?

00:31:00: Yes you can!

00:31:01: So there's a training coming up in the UK and in November this year It is kind of two days.

00:31:12: There are two-day workshops that I do using acupuncture to support cancer survivors post treatment which really is kind of a workshop based around my book, the contents for my book.

00:31:27: And I delivered that at Rothenburg this year and there's also an attached to it but you can do it separately as one-day training in introduction to cancer for people who are not familiar with it And then that's a half day.

00:31:48: The other half-day is going through the recommendations for the safe practice of acupuncture, so people can understand those and really get to groups with them and know what's in them and ask questions and things.

00:32:03: So that's 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 I think November to November, twenty-second.

00:32:18: You can check on your website so everybody who has listened to the podcast and is interested in knowing more about supportive acupuncture for cancer patients.

00:32:29: this is a way to get started because I think from only reading the book i wouldn't be sure enough if I could do it.

00:32:39: So thank

00:32:39: you.

00:32:40: And I like to have the impulse training.

00:32:45: I think we work in silos.

00:32:48: We worked very much on our own, as acupuncturists and one of the things i do is try to build community through those trainings.

00:32:57: so get people to meet each other and chat with each other as well as talk to me.

00:33:05: wonderful thanks a lot for all these insights.

00:33:12: Thank you for having me.

00:33:13: It's great to be able to speak with colleagues in Germany, and I will write an article about the AGTCM journal as well so that we'll come out on New Year.

00:33:25: We're looking forward it!

00:33:31: Goodbye!