Marci Coleton

Acupuncture in the Treatment of Upper-Limb Lymphedema: Results of a Pilot Study

Current treatments for lymphedema after breast cancer treatment are expensive and require ongoing intervention. Clinical experience and our preliminary published results suggest that acupuncture is safe and potentially useful. This study evaluates the safety and potential efficacy of acupuncture on upper‐limb circumference in women with lymphedema.

A safety and efficacy pilot study of acupuncture for the treatment of chronic lymphoedema

Background Lymphoedema is a distressing problem affecting many women after breast cancer surgery. There is no cure and existing treatments are marginally beneficial, rarely reducing arm swelling in any meaningful way. Needling and even lifting of objects using the affected arm has been prohibited, but our clinical experience and that of others suggested that acupuncture was safe and that it might be a useful treatment for lymphoedema. Objective We sought to conduct a pilot study of the safety and effectiveness of acupuncture in women diagnosed with chronic lymphoedema for at least 6 months and less than 5 years. Methods Women with chronic lymphoedema (affected arm with >2 cm circumference than unaffected arm) after breast cancer surgery received acupuncture twice a week for 4 weeks. Response was defined as at least a 30% reduction in the difference in size between the affected and unaffected arms. Monthly follow-up calls for 6 months following treatment were made to obtain information about side effects. Results Study goals were met after nine subjects were treated: four women showed at least a 30% reduction in the extent of lymphoedema at 4 weeks when compared with their respective baseline values. No serious adverse events occurred during or after 73 treatment sessions. Limitations This pilot study requires a larger, randomised follow-up investigation plus enquiries into possible mechanisms. Both are in development by our group. Conclusion Acupuncture appears safe and may reduce lymphoedema associated with breast cancer surgery.

Serum 25-hydroxy vitamin D and survival in advanced colorectal cancer: a retrospective analysis.

Higher serum 25-hydroxy vitamin D [25(OH)D] levels are associated with decreased colorectal cancer (CRC) incidence. In this retrospective study of Stage IV CRC patients, we evaluate whether 25(OH)D levels at diagnosis correlate with survival. Stored sera from carcinoembryonic antigen (CEA) measurements obtained between February 2005 and March 2006 were screened. The first 250 patients with CEA ±30 days of Stage IV CRC diagnosis were included. Serum 25(OH)D levels were determined and categorized as adequate ≥30 ng/mL, or deficient <30 ng/mL. Multivariable Cox regression models controlling for albumin and Eastern Cooperative Oncology Group performance status were used to investigate whether higher 25(OH)D levels were associated with prolonged survival. A total of 207 patients (83%) were vitamin D-deficient (median = 21 ng/mL), with deficiencies significantly more likely among non-Hispanic black patients (P = 0.009). Higher levels were associated with prolonged survival in categorical variable analysis: adequate vs. deficient, hazard ratio = 0.61, 95% confidence interval = 0.38–0.98, P = 0.041. A majority of newly diagnosed Stage IV CRC patients are vitamin D-deficient. Our data suggest that higher 25(OH)D levels are associated with better overall survival. Clinical trials to determine whether aggressive vitamin D repletion would improve outcomes for vitamin D-deficient CRC patients are warranted.

Serum 25-hydroxyvitamin D testing at Memorial Sloan-Kettering Cancer Center.

9121 Background: Vitamin D (D) is a fat soluble vitamin/hormone involved in calcium homeostasis. In vitro, animal model and clinical studies show that D affects immunomodulation, apoptosis and cellular differentiation in addition to skeletal effects. D is obtained primarily through UV exposure (sunlight) or through fortified foods (milk). A recent IOM report stated most people have sufficient vitamin D levels and that supplementation is not necessary. D testing and results of serum D levels at MSKCC were evaluated to characterize the D status of MSKCC patients. METHODS A search was performed for MSKCC patients with for whom serum vitamin D 25-hydroxy levels evaluated were taken from January 1, 2003 to June 31, 2010. Demographic information including age, race, BMI and survival status also were obtained. RESULTS There were 23,909 serum 25-hydroxy vitamin D tests ordered from January 1, 2003 through June 30, 2010 for 12,817 unique individuals. The largest volume of tests (57%) was performed in breast cancer patients. The next largest volume was for colorectal cancer patients (9%), followed by leukemia (7%) and lymphoma (7%). Only 311 (1.3%) of the patients with endometrial cancer had D levels obtained. 75.8% of patients were deficient in vitamin D as defined by serum levels <30 ng/ml. The median vitamin D level was 24.6 ng/ml. In 2003 there were 396 D tests ordered; 846 D tests in 2006; 1711 D tests in 2007; 3928 D tests in 2008 and 8133 D tests in 2009. The majority of patients (53%) did not have serial D testing. CONCLUSIONS The vast majority of patients who had their serum vitamin D level monitored were deficient. An exponential increase in the volume of vitamin D tests ordered over the past 3 years was seen. Most patients are D deficient (defined by serum 25-hydroxy D < 30 ng/ml). A recent IOM consensus statement described most people as sufficient in D, however our study does not support this conclusion. Whether treating D deficiency would improve patient outcome remains to be determined. D status should be considered for all patients deficiency corrected. Clinical trials evaluating D repletion and survival are warranted.