Clinical Study On The Efficiency Of Direct Contact Moxibustion On Toxicity And Side Effects Resulted From Chemotherapy

Background:Malignant tumor, a commonly seen fetal disease in clinical work is mainly treated with surgery, radiotherapy or chemotherapy now, of which, chemotherapy refers to using chemical drugs which can instantly distribute all over the body to treat both localized tumor and distant metastasis. Chemotherapy stands out from the other two treatments by effectively treating hematopoietic tumors, diffuse metastasis and sub-clinical tumor, which show little or no response to radiotherapy and are hard to be eradicated by surgery. Besides, chemotherapy can also be supplemental to radiotherapy or surgery to improve the therapeutic effects. However, it lacks target specificity, and kills healthy cells in normal tissues as well, especially vigorously growing cells in blood and lymphoid tissues. In this way it induces toxicity and side effects that can destroy patients'life quality and restrain it from long term use, for example, marrow suppression, immune suppression, digestive disorder, general reactions and alopecia ect. Thus, how to reduce the above mentioned toxicity and side effects is the focus of many researches in medical field.From TCM aspect, chemotherapy is actually to eliminating pathogenic factors, the induced toxicity and side effects are the manifestations of consumptive disease, which is resulted from damaged primordial qi and deficient essence and blood. In the recent years, TCM therapy, especially acupuncture and moxibution has shown great improvements in reducing toxicity and side effects including marrow depression, heart or peripheral nerve toxicity as well as side effects of digestive, urinary and respiratory systems. Objective:To observe effects of direct contact moxibustion on the toxicity and side effects of chemotherapy and its influences to patients'emotion and life quality by designing the prospective controlled clinical trial. Methods:A total of 62 eligible cases that underwent chemotherapy in the douliu part of the Taiwan University Hospital were chosen and enrolled in this study after consent was obtained from two physicians with medium or senior professional title. All cases were randomized divided into treatment group (groupⅠ,32 cases) and control group (groupⅡ,30 cases), and were given chemotherapy and conventional treatment of dexamethasone (Anti-allergic agents) and ondansetron (Controlling nausea and vomiting) to reduce side and toxicity effects, while the treatment group was also given an extra treatment of direct contact moxibustion on bilateral Geshu (BL17), Danshu(BL19), Gaohuang(BL43), and Zusanli (ST36). The specific manipulations are:Spread a thin layer of Die Da Wan Hua Oil (activating blood flow) around the points which are located according to the descriptions in National Standard of the People's Republic of China:acupuncture points, then lay and light a moxa cone (0.5×0.8 cm2) made of moxa wool. Remove the moxa cone when it's burnt to the last 1/3 height and the patient feels slight scorching pain, repeat it for three times each day.Chemotherapy regimen applied to the patients were selected according to the type of tumor and its pathological stages, and were mainly consists of cisplatin (DDP), docetaxel (Taxotere), gemcitabine (Gemcitabine), oxaliplatin, cyclophosphamide (CTX), vincristine (VCR) or 5-fluorouracil (5-FU) separately. Dexamethasone (Anti-allergic agents) and ondansetron (Controlling nausea and vomiting) were also used for preventing or reducing toxicity and side effects. Started from the first day of chemotherapy,7 days makes a treatment course. Observe the effects according to 2 weeks follow up. Therapeutic effects were evaluated before and after the treatment and counted parameters include hematological changes (hemoglobin, white blood cell, granulocyte and platelet counts), gastrointestinal toxicity reactions (nausea and vomiting degree which is categorized as 0-Ⅳaccording to WHO criteria for acute and sub-acute toxicity of anti-cancer agents, Karnofsky and ZPS scores, scores of Hamilton anxiety scale and Hamilton depression scale, and life quality. All the collected data were analyzed with SPSS13.0 and Epitable software. Structural difference between groups were analyzed by x2 test, blood test results and KPS scores were processed with one sample t-test, Differences before and after the treatment in the same group were analyzed with paired sample t-test, data of blood system toxicity, and nausea and vomiting degree were analyzed using Ridit analysis.Results:No significant difference of the observed parameters was shown between the two groups before chemotherapy (P＞0.05) indicating they were comparable. After chemotherapy, hemoglobin (HGB) levels was lower while degree of HGB hematotoxicity was greater for both groups comparing with that of before the treatment though no significant difference was observed in any of the two groups (P＞0.05), besides, HGB levels of both groups were not significant different from each other neither after the treatment (P＞0.05).After treatment, hematotoxicity degree of white blood cells (WBC), neutrophils (NEU) and platelet count (PLT) were greater than that before treatment, while WBC, NEU and PLT levels were lower for both groups with significant differences between the two (P＜0.05) indicating better effects of preventing WBC, NEU and PLT levels from decreasing in the treatment group. Nausea and vomiting scores were higher than that before treatment for both groups after chemotherapy, but more obvious in the control group indicating better therapeutic effects on nausea and vomiting for the treatment group. Karnofasky and ZPS scores declined in both groups after chemotherapy but more obvious in the control group (P＜0.05, P＜0.01) indicating physical condition of the treatment group was better than that of the control. After chemotherapy, scores of Hamilton anxiety and depression scale were both raised compared with that before treatment (P＜0.05, P＜0.01) with significant differences between the two groups (P＜0.05), indicating emotional disorders of anxiety and depression in the control group was more serious than that of the treatment group. Life quality scores of both groups were both lower than that before treatment, but more obvious for the control group (P<0.05) showing better effects of improving patients'life quality in the treatment group.Conclusions:Direct contact moxibustion can alleviate toxicity and side effects resulted from chemotherapy including marrow suppression, gastrointestinal reactions, fatigue, and emotional disorder; particularly, it can significantly prevent blood cell levels of WBC, NEU, and PLT from dropping, thus improve patients'life quality and create a better physical condition for further treatment.