Acupuncture to relieve treatment side effects: Sarah Wald

When Sarah Wald first tried acupuncture, a complementary therapy that inserts very thin needles into the skin, she was worried it would hurt. Instead, she found the approach to be pain-free and relaxing. She used it periodically from her early 20s into her 30s.

“During that time, acupuncturists treated my seasonal allergies, lingering coughs, side effects from medications, headaches including migraines, and other minor ailments,” says Sarah, a university professor who lives in Eugene, Oregon. When she was 25 years old, she had thyroid cancer and used acupuncture to alleviate stress related to that diagnosis.

In March 2019, at age 39, Sarah was having weekly acupuncture sessions to deal with a persistent cold. “It wasn’t usual for me and it was interfering with my work. Something felt off,” she says. One morning she also found a breast lump. Her doctors first thought it was early-stage breast cancer but further testing found a few bone metastases. She had metastatic disease.

As part of her preparation for breast cancer treatment, Sarah read studies that looked at whether acupuncture could relieve side effects. Research has shown that it may help with joint pain from taking aromatase inhibitors, fatigue and peripheral neuropathy caused by chemotherapy, menopausal symptoms, and more.

“The notion that acupuncture is complementary to traditional care is really important,” says Sarah. “Sometimes when I tell people I’m going to see an acupuncturist for breast cancer side effects, they think I’m not doing traditional therapies. I’m doing everything.” Sarah spoke with LBBC contributor Robin Warshaw about her experiences using acupuncture.

Robin: What breast cancer treatments have you received?

Sarah: I was on leuprolide (Lupron) until I had an oophorectomy. I also started an aromatase inhibitor, anastrozole (Arimidex), and went on ribociclib (Kisqali), a CDK 4/6 inhibitor, as well as zoledronic acid (Zometa) for the bone mets.

After being responsive to treatment for 9 months, my team authorized a lumpectomy and axillary node dissection, followed by radiation for a month. I know that’s not typical for stage IV, but my team felt it was the right call and I agreed with them

My liver enzymes started to rise, due to an adverse reaction to the ribociclib, so I was put on palbociclib (Ibrance). I’m now on that, anastrozole, and zoledronic acid.

Robin: Was your health care team open to the idea of acupuncture?

Sarah: I’m very lucky because I have an amazing team. In addition to my traditional oncologist, I see a provider who has a doctorate in naturopathic medicine and is a licensed acupuncturist. After diagnosis, I continued to see my regular acupuncturist every other week.

The naturopathic oncologist was recommended to me by a friend, another faculty member where I work. My naturopathic oncologist has FABNO certification and participates in the local tumor board [a group of providers that discusses cancer cases]. When my oncologist does my blood work, my naturopathic oncologist has access to results through her computer. My oncologist fully supports me working with her.

My training is not medical and I respect the expertise of my doctors.

Robin: When did you start using acupuncture for treatment side effects?

Sarah: As someone who was getting knocked into early menopause at 39, I didn’t wait until I started getting hot flashes to go see an acupuncturist. I think acupuncture is really useful not just in responding to things but in prevention.

My naturopathic oncologist told me initially, “If you start to get a side effect, tell me.” It’s easier to prevent something from coming on than to wait until it’s really bad and try to get rid of it.

Knowing this is gonna be for the rest of my life, one of my goals is to keep my quality of life as high as possible for as long as possible.

Robin: What side effects do you think have been helped by acupuncture?

Sarah: I barely had a hot flash during the 4 months I received Lupron and the period after my oophorectomy. My oncologist confirmed it was working through a blood test. I really think it was because of the acupuncture that I didn’t get hot flashes when I was pushed into early menopause. It is more impressive because the medicine I’m on can also cause hot flashes.

In March, when COVID-19 shut down nonessential medical services, all acupuncture stopped for a couple of months. That’s when I started getting persistent hot flashes. And I noticed previously if I missed a treatment, I would get more hot flashes.

The only time I ever had fatigue was when I wasn’t going to acupuncture due to COVID. I remember really noticing the hot flashes and fatigue.

I didn’t have any joint pain at first but it increased over time, which is expected the longer you’re on an aromatase inhibitor. Again, I felt it more when I wasn’t going to acupuncture during COVID.

Robin: How are you using acupuncture now?

I go most weeks. The way it works is not as simple as giving me a needle at a certain point for hot flashes. I come in and see my acupuncturist. We talk, they look at my tongue, take my pulses, ask what’s going on. The treatment is very responsive to how I am in the moment.

I’m doing acupuncture to treat or prevent side effects and to keep my body as healthy and balanced as possible. This is so I can withstand future treatments and my body is in the best position to delay progression.

Acupuncture is part of my regular routine. It’s as foundational to what I’m doing as anything else although the goals are a little different. Acupuncture is not going to cure my cancer but it might strengthen my immune system. I have no doubt that it’s decreasing my side effects.

It’s part of the reason that 15 months into this, after multiple surgeries and all kinds of treatments, my quality of life has changed remarkably little. If you take away the emotional consequences of being told you have a terminal diagnosis in your 30s, my physical abilities have almost no change. Some of that is the wonders of our current medicines and the luck of my response to them but I think acupuncture definitely plays a role.

Robin: Does insurance cover acupuncture costs?

Sarah: You have to go to an acupuncturist who takes your insurance. Both practices I see take mine and I pay a $10 co-pay. If you’re seeing somebody every week, that does build up over time. I consider that part of my treatment cost.

I think more people might have acupuncture covered than realize it. It’s not something that jumps out at you on the plan unless you go looking for it.

There are also acupuncture clinics that have sliding-scale fees so it costs less when you don’t have insurance coverage for it. They are called community acupuncture clinics. You get therapy in a large room with other people. I went to sliding-scale acupuncture group clinics in the past when I didn’t have it covered.

Robin: Have you used other complementary therapies for side effects?

Sarah: I see a shiatsu massage practitioner. I didn’t know a lot about it before I started. Shiatsu is more like acupuncture than traditional massage. It uses acupressure points, but there’s no needles. If you are really turned off by needles, I would recommend shiatsu.

I received shiatsu for hip and knee pain, probably caused by the medication. I saw improvement from both. I also received shiatsu before and after my lumpectomy and axillary node dissection. I got full range of motion back quickly and was very pleased with the experience.

This article was supported by the Grant or Cooperative Agreement Number 1 U58 DP005403, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.