Breast Neoplasms, Colorectal Neoplasms, Genital Neoplasms, Female, Toxicity Due to Chemotherapy
Conditions
Keywords
Health related quality of life, Moxibustion, Cancer, Chemotherapy, Neutropenia, Anaemia, Thrombocytopenia, Self management, Wellbeing
Brief summary
This study investigates whether it is feasible to teach cancer patients undergoing chemotherapy to self-administer daily moxibustion to reduce chemotherapy side effects. Moxibustion is a therapy used in traditional Chinese medicine that uses heat.
Detailed description
Chemotherapy drugs are used to treat cancer cells. However, they can also affect bone marrow and reduce the ability to make certain types of blood cells. Low white blood cell counts can leave patients vulnerable to infection. Low red blood cell counts can lead to anaemia and feelings of fatigue and weakness. Low platelet counts can lead to bruising and bleeding. Blood counts are therefore monitored. If they fall too low, the dose of chemotherapy may be reduced or the time between doses extended. This may affect survival as well as quality of life. Research studies in China and the West suggest that moxibustion applied by a practitioner can improve blood counts and immunity, and reduce side effects of chemotherapy. Moxibustion (also called moxa) is a form of traditional Chinese medicine that uses heat to stimulate acupuncture points. This heat comes from a smouldering herb called mugwort, that is rolled into a cigar shape to gently warm the point. Many patients regard this as a pleasant, relaxing experience. The researchers will teach patients to self-administer moxa to an acupuncture point just below the knee. This is a feasibility study to see if patients are willing and able to self-administer moxa daily throughout chemotherapy. Patients will keep a moxa diary to record their activity. The researchers will also use a questionnaire to assess whether patients see themselves as active managers of their health. This may help the researchers to screen suitable patients in future studies. The researchers will also monitor blood counts, any delays or dose reductions to the chemotherapy, and any chemotherapy side effects. Participants will complete quality of life questionnaires at intervals during and after their chemotherapy. If results are favourable, they will be used to design a randomised controlled trial comparing daily moxibustion with a no treatment control arm.
Interventions
OTHERMoxibustion
Participants are taught to self administer moxibustion to acupuncture point Zusanli St-36 daily throughout the course of their chemotherapy
Sponsors
British Acupuncture Council
East and North Hertfordshire NHS Trust
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* with breast, gynaecologic, or colorectal cancer who are prescribed radical or adjuvant chemotherapy in the early disease setting, or first or second line chemotherapy is in the metastatic setting * about to commence a course of chemotherapy for which granulocyte-colony stimulating factor (G-CSF) is not routinely indicated * with a life expectancy of more than six months * with blood cell counts within the normal range * with calculated creatinine levels of ≥ 50ml/min * English speaking * able to understand instructions for self-administration of moxibustion and carry out the procedure * able to give informed consent
Exclusion criteria
* having a haematological cancer diagnosis * prescribed a chemotherapy regimen for which G-CSF is indicated * having third or fourth line chemotherapy * having metastatic bone cancer * who have concomitant severe medical problems preventing participation * with cognitive impairment that would impact participant's ability to safely administer self-moxibustion * having renal dysfunction * with lymphedema in the lower body.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Adherence to moxa regimen assessed by Daily Moxa Diary | 21 days after last chemotherapy cycle | The primary aim of this study is to assess the feasibility of teaching cancer patients undergoing chemotherapy in the National Health Service (NHS) to self-administer daily indirect moxibustion to St 36 Zusanli, according to a protocol that begins ideally 7 to 10 days prior to the first chemotherapy cycle and continues until 21 days after the final chemotherapy cycle. Participants will complete a Daily Moxa Diary to record their adherence to the daily protocol. They will be asked also to log any days they miss, and give reasons why. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Blood counts, specifically white blood cells, neutrophils, haemoglobin, and platelets | Throughout chemotherapy, on 1st day of each cycle, according to chemotherapy schedule. This is usually fortnightly for colorectal (Days 1, 15, 19, 43, 57, 71, 85, 99) and 3-weekly for breast and gynaecologic cancers (Days 1, 22, 43, 64, 85, 106) | Blood counts will be collected from the participants' medical notes to monitor incidents of neutropenia, anaemia, or thrombocytopenia. |
| Variation to planned chemotherapy schedule | Throughout chemotherapy, on 1st day of each cycle, according to chemotherapy schedule. This is usually fortnightly for colorectal (Days 1, 15, 19, 43, 57, 71, 85, 99) and 3-weekly for breast and gynaecologic cancers (Days 1, 22, 43, 64, 85, 106) | Any delays in chemotherapy schedule and the reasons why will be collected from the participants' medical records |
| Chemotherapy related toxicities | Throughout chemotherapy, on 1st day of each cycle, according to chemotherapy schedule. This is usually fortnightly for colorectal (Days 1, 15, 19, 43, 57, 71, 85, 99) and 3-weekly for breast and gynaecologic cancers (Days 1, 22, 43, 64, 85, 106) | Data will be collected from the participants' medical records, specifically the Common Terminology Criteria for Adverse Events (CTCAE), which is the standard form used in the Chemotherapy Suite to record information about any toxicities experienced by the patient resulting from chemotherapy (such as fatigue, vomiting, etc) |
| Safety assessed by all incidents including allergies, burns, and other accidents | Through study completion, spanning 16 to 28 weeks depending on chemotherapy regimen | The safety of moxibustion is under-reported in the literature. The researchers will monitor and record all incidents affecting safety, including allergies, burns, and other accidents |
| Patient self-management | At Baseline, cycle 3, and one month after final cycle: typically Days 29 and 127 for colorectal; Days 43 and 134 for breast and gynaecological cancers | Patients with a high level of activation are likely to engage in positive health behaviours and participate in managing their health conditions more effectively. The Patient Activation Measure (PAM) will be used to explore whether it is possible to identify patients who will be most likely to follow a daily healthcare regimen. |
| Incidents of additional interventions administered as prophylaxis or therapy to maintain or improve blood counts | Through study completion, spanning 16 to 28 weeks depending on chemotherapy regimen | The researchers will record whether participants are taking or having therapies that affect blood cell counts, such as steroids, iron supplements and other dietary supplements as prophylaxis, or blood and platelet transfusions to improve low blood counts. |
| Health related quality of life (HRQOL) | At Baseline, cycles 2, 3, and 6 (or final cycle), and one month after final cycle: typically Days 15, 29, 71, 127 for colorectal; Days 22, 43, 106, 134 for breast and gynaecological cancers | The study will seek to identify changes in quality of life, to help with hypothesis generation for future studies. Validated questionnaires from the Functional Assessment for Cancer Therapy (FACT) will be used, including: FACT-G: a 27 item compilation of general questions covering physical, social/family, emotional and functional wellbeing; FACT-N: a 19-item neutropenia subscale designed to capture symptoms and impact on HRQOL related to neutropenia; FACT-An - a 20-item questionnaire assessing fatigue and anaemia-related concerns in people with cancer. |
Countries
United Kingdom
Contacts
Primary ContactClare Scarlett, BA (Hons)
Backup ContactBeverley A de Valois, PhD
Outcome results
None listed