Volume 4, Number 3 | Fall 2009

Japanese Acupuncture - Current Research
Acupuncture and Moxibustion Treatment for Patients withCancer in Modern Japan – A Questionnaire Survey among
Practitioners of Acupuncture and Moxibustion
Saito N, Narushima T, Kurasawa T,
Furukawa S, Tsukayama H

2) Objective
The objective of this survey is to investigate thereality of acupuncture and moxibustion treatment

1) Background

According to the results of the nationwide
survey carried out in 2001 by Yamashita, et alinvolving the people of Japan, the utilization rateof CAM was 76%. The top 5 of its best utilization
were nutrition supplement drinks (43%), healthappliances (22%), herbs/OTC (over-the-counter)
Kampo medicines (17%), massages and shiatsu(finger pressure) (15%), and Kampo medicinesprescribed by physicians (10%). The use ofacupuncture and moxibustion was 7% [1]. On theother hand, the 2001 questionnaire among
patients with cancer conducted by Hyodo, et al.
showed that the rate of patients utilizing
complementary and alternative medicine (CAM)
was 44.6%. The breakdown was: health foods byan overwhelming majority (89.1%), Kampo
medicines (7.1%), Qigong (3.8%), acupuncture(3.6%), and moxibustion (3.7%) [2]. The results ofthese two surveys cannot simply be compared as
there are small differences in classification
between these two. However, the utilization rateof acupuncture and moxibustion in patients withcancer is 3.7 % to 7.3%, which means that they
use acupuncture and moxibustion more than alittle. Since patients with cancer use CAM mainly
for the reasons of suppressing cancer progression(67.1%) and seeking cure (44.5%), it is easy toimagine that Japanese people in general useacupuncture and moxibustion for other reasons
than motor symptoms (79%). In conducting alarge scale survey among patients with cancer
who are receiving acupuncture and moxibustion
treatment, what needs to be done first is theidentification of survey participants. This isunrealistic. Thus, a survey was planned to garner2

information relating to the treatment of cancer
patients with acupuncture directly fromacupuncture practitioners.

now being performed for cancer patients from theperspective of the practitioners and to discusscancer treatment and the application range ofacupuncture and moxibustion.
3) Methods
A survey was conducted through a questionnaire
withtheauthors

whopublishedliteraturesconcerning acupuncture and moxibustion treatment
for cancer patients during the past five years.
Specifically, in November 2006 “ichushi Web”wassearched for literatures relating to “malignanttumorsandacupunctureandmoxibustion

treatment” released during the past five years. Then“a questionnaire about roles of acupuncture andmoxibustion in the treatment of cancer” was sent by
post to 83 first authors, who were invited to send
their replies.

Literatures were restricted to thosepresenting human clinical data. Basic studies andanimal studies were excluded. The period of thesurvey was three months from December 2006 toFebruary 2007.
4) Results
4-1. Profiles of respondents
Replies were received from 46 respondents withthe response rate of 55.4%. The respondents were 36
males and 10 females aged from 29 to 79 (average51±, standard deviation 12.3).
The length of their clinical experience was 3 to 50years (average 21.4±, standard deviation 11.3).
In

regardtotheemploymentstatus,

18

respondents were in practice, 20 were employees,

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 4, Number 3 | Fall 2009

and 3 were in practice concurrently employees. Five

The results were persuasive because the subjects of

respondents made no description for this question.

this survey were literature authors and many of theThe number of experienced cases was 1 to 1300

respondents belonged to medical institutions, such(average 137±, standard deviation 293.2). The mostas university hospitals, where there are necessarily

common 10-49 cases were experienced by 17

many opportunities to write literatures.

respondents, followed by less than 10 cases by 9respondents. The above 17 and 9 respondents addedby the respondents with less than 50 cases ofexperience made up the majority of the respondents.
On the other hand, 100 cases were experienced by
12 respondents (of which 2 had 1,000 cases or more).
The respondents having 1,000 or more cases ofexperience (8 out of 10 had 100 or more cases) all
answered that their sites of practice were in medical
institutions. This means that in the settings whereacupuncture and moxibustion were adopted to carefor cancer patients, there were many potentialscenes to utilize acupuncture and moxibustion.

4-3. Motives for performing acupuncture
A multi-choice question was asked as to whaturged the subject to perform acupuncture. To thisquestion,

multipleanswers

wereaccepted.

“Patient’s own decision” accounted for the highest
rate of 78.2%, followed by “request by the doctor incharge” which accounted for 41.3%.

And then“recommended by the patient’s family and/or close
relatives” accounted for 39.1%.
Analysis of the data by practice site showed that“patient’s own decision” had the great majority in allsites. Second motives were “request by the doctor incharge” in medical institutions, “recommended by
the patient’s family and/or close relatives” in4-2. Practice sites

practitioner’s

owntreatmentrooms,

andIn terms of the sites where practice was“recommended by a co-medical” in the patient’sperformed, “in a medical institution” accounted forhomes. The results suggested that factors having

50%, “in the practitioner’s own treatment room”

influences

accounted for 41.3% and “in patient’s home”13.0%.

dependent on the site of practice (Fig. 1).

onthetreatmentofcancer

wereIn institution

In practitioner’sown room

In patient’s homeOthers■Patient’s own decision ■Request by doctor ■Suggested by co-medical ■Suggested by family

Fig. 1 Motives to come to perform acpuncture (by practice site)
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 4, Number 3 | Fall 20094-4. Purposes of performing acupuncture andmoxibustion for cancer patientsTo the question as to the purposes of performing
acupuncture, the answer of “as a means to relieve
symptoms caused by cancer” had the vast majorityof 69.5%, followed by 60.8% each for “as a means torelieve adverse effects associated with cancer” and“as a means to improve cancer and complaints
unrelated to cancer and to enhance QOL.”
Analysis of the purposes by site of practice
showed no major differences from the above results.
Relatively many of the respondents, however, whoanswered that the purpose was “a means to shrink
cancer and to retard cancer progression” performthe treatment in their own treatment rooms.
4-5.Reasons to determine use of acupuncture andmoxibustion for cancer patients
A multiple-choice question was asked as to thereasons to determine the use of acupuncturetreatment. “Can obtain patient’s satisfaction”
accounted for the majority 69.5%, followed by “lessside effects and less damages” at the rate of 56.5%,
and then “expect resistance to cancer to improve by
getting the patient in shape” was 54.3%.

On the other hand, few respondents answered“connect to revenues and profits” and “there wereevidences.”
In the results by site of practice, there werenoticeable answers of “good ways/methods
unavailable” from the respondents practicing inmedical institutions. The reason mentioned by thelargest number of respondents was “expectresistance to cancer to improve by getting thepatient in shape.”
4-6.Cooperation with the doctor in charge
Aquestion
wasaskedabout
cooperation/partnership with the doctor in charge ofthe patient, to which “yes” cooperating had 47% of
the total, whereas “no” had 36%. “Others” had 17%.
The results by site of practice showed respective
70% of the respondents performing treatment inmedical institutions and those performingtreatment in the patient’s homes were cooperating
or developed a partnership with the doctor in charge.
On the other hand, respondents performing
treatment in their own treatment rooms who werecooperating or developed a partnership were shortof 30% (Fig. 2).

Cooperating

Not
cooperating

Others■In institution ■In practitioner’s own room ■In patient’s home

■OtherFig. 2 Cooperating or not cooperating with doctor in charge (by site of practice)4

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 4, Number 3 | Fall 2009

Since the method of cooperation/developing apartnership was asked for free descriptions, therewas variability among answers. In regard to themethod of contact with the doctor in charge, manyreplies were received for verbal contacts or contacts
by writing. There were answers describing that
instructions were received from the doctor in charge
and reports were made to the doctor in charge. Fromthese results, it seemed that in performing
acupuncture in medical institutions, suitable
methods of cooperation/developing a partnershipwere adopted in the doctor-centered environment.
To the question whether or not difficulties inhaving contacts with the doctor in charge ordifficulties in reporting the doctor in charge about thepatient were felt, 21.7% of the total answered “yes”
whereas 26.1% answered “no.”And “others” accounted
for 10.9% and “no answer” accounted for 10.9%.
Among the respondents who answered that they were
having contacts, half of them performing treatment inmedical institutions felt no difficulties whereas 30%
felt the difficulties. In regard to the treatment in thepatient’s homes, 70% or more felt the difficulties. Thismay have been resulted from it that the site ofpractice was not shared between the practitioner andthe doctor in charge as in medical institutions.
4-7. Issues arising from the participation of anacupuncture and moxibustion practitioner in team
medicine for cancer

To the question as to what issues would arise if
an acupuncture and moxibustion practitioner joinedin the members of team medicine, 30.4% mentioned
the points relating to “building confidence withother
staffmembers,”
23.9%
mentioned“understanding of acupuncture and moxibustion,”and 19.6% pointed out “insufficient medicalknowledge.” Many answers received were lack ofcooperation and understanding with each other.
There were requirements for building up evidences.
The results by site of practice showed that many
respondents performing practice in medical
institutions
mentioned“insufficient
medicalknowledge” and “understanding of acupuncture andmoxibustion.”Although the respondents performing
practice in their own practice rooms had different
opinions, the most common answer was tounderstand acupuncture and moxibustion.”Unlike
in medical institutions and in the patient’s homes,
the respondents performing in their own practicerooms expressed opinions concerning “techniques ofpractitioners of acupuncture and moxibustion.”The
respondents performing practice in the patient’s
home expressed eye-catching opinions about“medical treatment fees and health insurancesystem” as well as “insufficient medical knowledge”
and “cooperation” and the voices requiringunderstanding of acupuncture and moxibustion
were undistinguished (Fig. 3).

In institution

In practitioner’s
own room

In patient’s home

Others■Insufficient knowledge ■Cooperation ■Understanding ■Evidence ■Fee/insuranceof acupuncturesystem■Technique of ■Others
acupuncturistFig. 3 Issues arising from the participation of an acupuncture and moxibustion practitioner in team medicine(by site of practice)
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 4, Number 3 | Fall 2009

4-8. Symptoms difficult to have effect in thetreatment of cancer patients with acupuncture and5)

Summary
The subjects of this survey were literatureauthors, so many replies were received from thosemoxibustion
A question was asked about symptoms difficult tobelonging to medical institutions, such as university

have effect on cancer patients. Answers were varied

hospitals. Although there was a respondent’s bias, it

and it was not easy to categorize them all. In thewas suggested that the environmental conditions

answers that could be categorized, the mostsurrounding patients differed in each site ofcommon answer was “pain” (especially, sharp pain

practice.

and neuropathic pain) which accounted for 28.5%,

In the sites of medical practice, the trend offollowed by “aggravation of general conditions”

feeling difficulties in cooperating with physicians

which accounted for 19.5%.

was weak. And as issues arising from thepractitioner’s participation in team medicine,

4-9. Symptoms that could be indications for

insufficient medical knowledge and understanding

acupuncture and moxibustion treatment in cancerof acupuncture and moxibustion, which could bepatients (Table 1)translated as understanding of acupuncture andTable 1. Acupuncture treatment applicable symptoms
symptoms

No.

pointed out. In the settings where both medical

Percentage

practice and acupuncture and moxibustion practice

Cancer pain

2350.0%were performed, certain levels of cooperation were

Nausea, vomit, poor appetite

1430.4%functioning and seemed to be at the stage which

Non-cancer pain

817.4%

required better mutual understanding.

817.4%

Edema

715.2%

answered that they were cooperating as similarly as

Sleep disorder

510.9%

in the sites of medical practice, 70% felt difficulties

Post-surgery health management

36.5%

in cooperating or having a partnership with theDefecation

36.5%

doctor in charge. As issues in the participation in

Recurrence prevention

36.5%

Urination disorder

24.3%

Unidentified complaints

24.3%

Peritoneal fluid24.3%

Others2452.2%Side-effects of chemotherapy(except for nausea and vomit)

A question was asked about symptoms for which
acupuncture

wasapplicable.

“Cancerpain”

accounted for the highest rate of 50.0%, followed by“nausea, vomit, poor appetite” representing 50.0%,
and then “pains other than cancer pain” and“thermotherapy side effects (except for nausea andvomit) representing 17.4% respectively.

6

moxibustion and mutual understanding, wereOn the other hands, although the respondents
performing acupuncture in the patient’s homes

team medicine, medical fees and medical insurance
were mentioned, from which it seemed practitioners
were facing problems with systems revolving
aroundcancerpatients,physicians,

andpractitioners of acupuncture and moxibustion.
Out of the respondents performing acupuncture
and moxibustion treatment in their own practicerooms, those who were able to have cooperation
were short of 30%. The first reason for those
respondents to apply acupuncture and moxibustion
for the treatment of cancer patients was the“expectation to increase resistance to cancer bykeeping the patient fit” whereas “for the patient’ssatisfaction” was the first reason in other sites of

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 4, Number 3 | Fall 2009

practice. From these responses, it was known that
responding

surveysubjects

wereperforming

acupuncture and moxibustion treatment rather on
their

own

experienced

judgment

thanbyinstructions from physicians.
The efficacy of acupuncture and moxibustion forsick feeling, vomit, and loss of appetite in cancer
treatment

is

now

being

discussed[3].

Andacupuncture and moxibustion are also attracting
attention for the treatment of side-effects This is
supported by the symptoms that were mentioned by
the respondents of this questionnaire survey [4]. In
the meantime, pain was cited as a symptom difficult
to have effects and it was also included in theindications

foracupuncture

andmoxibustion.

Further studies are necessary on usefulness ofacupuncture and moxibustion in cancer patients.

References[1] Yamashita H, Tsukayama H, Sugishita C: Popularityof complementary and alternative medicine in Japan:
a telephone survey. Complementary Therapies inMedicine 10: 84-93, 2002.
[2] Hyodo I, Amano N, et al,: Nationwide Survey onComplementary and Alternative Medicine inCancer Patients in Japan. J Clin Oncol. 23 (12):2645-2654, 2005
[3] Ezzo J, Streitberger K, Schneider A: Cochranesystematicreviews
examineP6
acupuncture-point stimulation for nausea andvomiting. J Altern Complement Med. 12(5):489-95, 2006
[4] Shimoyama N, Kitsutani H, et al.: Gan-Chiryou
niokeru
Fukusayou
Taisakutoshiteno
Tougou-Iryou no Yakuwari (Countermeasures ofside effects and roles of integrative medicine incancer treatment): Byouin 68(11): 904-907, 2009.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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