Talking Hope: The benefits of acupuncture in cancer care

Darrin Godin:

Hello, everybody, and thank you for joining us for another episode of Talking Hope. I'm Darrin Godin and I'm pleased to be speaking with Amy Truong, City of Hope's first acupuncturist-oncologist. Dr. Truong brings extensive knowledge in both public health and traditional Chinese medicine. She holds a master's and a doctorate in traditional Chinese medicine and a master's degree in public health with a focus on health policy and management. Today, we want to better understand the benefits of acupuncture for patients with cancer. So Dr. Truong, thank you so much for joining us on Talking Hope today.

Dr. Amy Truong:

Thank you so much, Darrin, for inviting me to be on this show. I'm very excited to be here and looking forward to our conversation today.

Darrin Godin:

Well, I think you have such an incredible and unique background. So why don't you start with telling us what drew you to this field and what brought you specifically to City of Hope?

Dr. Amy Truong:

I think that's a great question because acupuncture and Chinese medicine was not quite on my radar. I've always was more on the Western medicine side. My background was more on the biomedical side. I studied biochem at UCLA for undergrad, did a lot of biomedical research prior to my encounter of traditional Chinese medicine. And it happens when I was doing research at Stanford, looking at gene interactions between cancer care, or excuse me, breast cancer and DiGeorge syndrome. And one of the projects I was on was actually looking at hearing loss in kidney disease, and the gene that we were looking at particularly was contributing to the fact that there might be a relationship.

I didn't quite understand how that could be. I was actually in a seminar learning a little bit more about Chinese medicine in which they talked about hearing loss, or excuse me, the ears as well as the kidneys. And that to me sparked an interest in me in like, "Oh. Well, maybe there's something more about this Chinese medicine thing or acupuncture that we could actually capitalize on in terms of improving general healthcare for everyone." So that embarked my interest and then I started going into it year after year, clinic after clinic, patient after patient. I started seeing some of these benefits, and it just drew me into the field itself, specifically to oncology and specific to City of Hope.

I think one of the things that is greatly valuable to me is life in general, and I think everybody deserves to live a high quality of life. It doesn't matter what type of disease you might have. City of Hope, particularly in my opinion, has been very strong in terms of our values, our mission. And I think that alignment between me and what I want to be. An individual who is contributing to the betterment of society, it just made sense for me to join City of Hope. So I'm extremely thrilled and excited to be a part of this pioneering group of people who are developing integrative oncology for City of Hope.

Darrin Godin:

Awesome. Well, you certainly are pioneering it here at City of Hope, Orange County, and we couldn't be more blessed to have you. So let me ask you a couple questions because there's a lot of confusion probably around acupuncture. What exactly is it, how does it work, and what are the common methods that you use?

Dr. Amy Truong:

That's a great question. And you're right, there's a lot of confusion. Acupuncture itself is actually a therapeutic component of what is called traditional Chinese medicine or TCM, which you might see a lot in papers and whatnot. Acupuncture is this particular modality that utilizes thin single-use needles. You put it in certain points on the body and it causes a therapeutic effect.

The question then is how does it cause a therapeutic effect? It was popularized in the United States, I think in the '70s, and studies started to emerge. And one of the landmark studies talked about how the application of acupuncture actually induces our body to release some of these, I call it neuroendocrine substances. Just to make it simple, it's just certain substances that make your body feel good. So this is going into the pain management world and that how acupuncture became so popular, it's just the pain management side of things. There's also studies that talks about the release of endorphins and serotonin, which is another type of hormone that helps your body feel good, the sense of wellbeing and happy. So if we were to bring it down, it's just basically working on the neural pathway, just how our body communicate with our brain and vice versa.

Darrin Godin:

Walk us through what a typical acupuncture treatment would look like. From the time a new patient comes to you, what do you do? How long is that treatment? What does that treatment look like?

Dr. Amy Truong:

I think it's important for us to differentiate between what we do here at the cancer center compared to what the community does. In the community, the scope of practice for acupuncture and Chinese medicine is pretty wide in which you can do a lot of things like herbal consults and whatnot. Here at the cancer center, the way that it works is that we have this very established collaborative sort of model where we work with other physicians and other care providers. So we get a referral in from a physician. And from there, the patient comes in. Prior to that, I usually scan their notes to make sure that their labs look okay. For example, their blood counts are healthy. They don't have any contraindications of utilizing acupuncture.

And then what happens is once they come in, I walk them through the process of what acupuncture is. So it starts with an education piece because most of our patients may not have had access to it before. The conversation starts out with an initial intake of the patient's history, getting a general idea of why is it that they're coming in to get acupuncture even though we have a plethora of other sort of interventions that they could utilize. From there, seeking out what the patient wants and what the patient needs is the core principle of what I do and also what City of Hope is about in terms of patient-centric care.

And then from there, I take their pulse. I look at their tongue. I give an assessment in terms of what's going on inside of them and taking it from a TCM perspective. Then I analyze in terms of which particular pathway that is being affected. And then that's when I let the patient know whether it is that I am going to choose specific points on their body and then whether or not I'm going to do regular acupuncture or am I going to do electroacupuncture, am I going to use points on their ear, their hands, their feet, and which areas, all of those things are being communicated with the patients prior to the actual application.

Thereafter, the patient rests for about 30 minutes or so. The intake itself can take a little bit longer depending on the patient, but the patient is resting with the needles. They generally fall asleep. They rest, they relax, try not to move obviously because they got needles on you or in you. And then afterwards, we come back in, take out the needles, and then we reevaluate to see how the patient is feeling post-treatment. And then that gives me an idea of how to do the treatment planning for their future visits and so on.

Darrin Godin:

Very, very interesting. I just learned a ton right there myself. So have never had it, but I've heard people talk about it. I'm sure a lot of our listeners are learning a lot as well. How often would a patient receive this type of treatment or how long would a normal treatment plan go for?

Dr. Amy Truong:

Great question. Again, I think it really depends on the patient and it depends on the issue. So if you think about an individual, say, in survivorship, no more, they don't have the cancer in them any more per se or active treatments and now they went and played basketball and got a sore neck or a swollen ankle or something like that, and so they exhibit pain. For those type of patients, treatments can be very quick. It could probably just take one or two treatments. For patients who are on active treatments or having a lot of other comorbidities, I think it would take a little bit longer. It could go anywhere from four to six visits before they could see a significant difference. And then the ongoing process of it could actually continue to go on. But it really depends on how the patient progresses. The treatment plan actually adjusts. But if you were to ask me to give a blanket statement, usually I would tell people that it takes about four to six visits before they could see a significant difference.

Darrin Godin:

Okay. Let's get to the heart of this as we talk about patients with cancer. We know that acupuncture is relatively new in the field of oncology treatment. What do you see as the opportunities for acupuncture to benefit patients who specifically are going through active cancer treatment?

Dr. Amy Truong:

The American Society of Clinical Oncology and the Society of Integrative Oncology are very big professional organizations focused on oncology. And those two organizations are very strong in terms of going into the research to look at the evidence and the literature to see what and how can acupuncture be applied to the patient's care journey. From the studies and what is seen in literature and research, pain management, nausea and vomiting is at the highest level in terms of efficacy for the patients. Moderate efficacy of utilizing acupuncture is stuff for anxiety, for fatigue, for hot flashes, both in men and women. And then there's also emerging studies now that are showing it's beneficial for dry mouth, sleep issues, insomnia, tingling and numbness that's associated with chemotherapy, for example. But then there's also tingling and numbness in patients with diabetes as well. And as you know, City of Hope also works with that group of population. And then there's also other studies that talks about constipation and headaches and whatnot.

Darrin Godin:

Interesting. I know acupuncture oncology is a key part of City of Hope's, we'll call it the first of its kind national integrative oncology model, our program that's bringing together Eastern medicine, Western medicine, and those treatments that are making a difference for patients. This is truly something that's different and unique for the Orange County patient because as far as we know, we are the first to really integrate it into active oncology treatment, which is an awesome thing for patients to have under one roof. So what sort of things excite you about the integration of acupuncture and this sort of treatment into supportive care and integrative medicine?

Dr. Amy Truong:

Wow, I have so much to say to that.

Darrin Godin:

Please, I want to hear it.

Dr. Amy Truong:

I think to start, what you had shared about how this is like the pivotal part of integrative oncology, we've never really integrate acupuncture in oncology care before. I think that's important for us to also highlight that other health centers or health systems offer acupuncture. But I think the key differentiation between us, City of Hope in particular, is the fact that we really are working together collaboratively with one another as a whole care team. And I think the most exciting part of all of this is really, first of all, I want to thank the Cherng family too to develop the Cherng Family Center for Integrative Oncology to allow us to really dive into the research, having the clinical trials that are necessary for us to optimize and ensure that we are now going to elevate the entire integrative oncology field so that we can give the patient the access that they need in a way that is evidence-based as well as effective to the patient.

Darrin Godin:

You mentioned clinical trials. Do you foresee some clinical trials being brought forth from here in Orange County around acupuncture and supportive care and integrative care?

Dr. Amy Truong:

Yeah, absolutely. Currently, I'm working, I'm part of the research team at Orange County. And what we're looking at or the protocol I'm working on is the application of acupuncture and how it is working in the development of anxiety or how do we treat the anxiety patients. That is something that is in the works, and I do foresee it being part of our bigger vision or objective of trying to making sure that we're educating our population, our physicians, as well as the endeavors within the scientific community.

Darrin Godin:

You mentioned anxiety. I know you're not referring to this type of anxiety, but I think I would be remiss not to ask the question.` What about people who have a fear of needles? What do you suggest when you talk about acupuncture? What do you suggest for that person who says, "I'm afraid of needles"?

Dr. Amy Truong:

So acupuncture, as I mentioned, is one of the modalities within traditional Chinese medicine. There's adjunct therapies in addition to acupuncture as well that we also practice, things like acupressure. You also have cupping, gua sha, or scraping as well. So when a patient comes in, while the needle component is what means acupuncture, but the combination of those other therapies could also be utilized as an intro, I don't want to say it's a gate. What is it called? It's like a gateway towards their involvement of it.

Sometimes, I also think that the fear of needles also comes down to not having enough trust. There's a fear of the provider messing up or doing something. So I think one of the key things that I always advise patients, whether it's providers who are referring patients or patients referring patients, is to let them know to just show up and have a conversation or get to know the provider. And I think one of the key takeaways from all of that is really too to look into who is it that's doing it and then developing that sort of rapport. And I think over time, you start to develop that trust and then that allows the patient to be more open to utilizing the actual needles for the acupuncture treatment.

Darrin Godin:

Great. Thank you for that. So we ask this question of every guest on the show. What does hope or the concept of hope really mean to you?

Dr. Amy Truong:

I actually thought about this, and I thought about this for a long time because I think it's such a powerful word that for me to just say one thing, it might not be good, but I think the best way that I can think about this is hope to me is the embodiment of remaining joyful and comfortable in the face of the unknown.

Darrin Godin:

Well, that really ties back to what you said at the beginning of wanting to have people have this quality of life, whether they're going through a cancer treatment or something else. So that really ties into what you're doing. Thank you for sharing that. What is your message for our listeners today? If you had, you've already had some moments to share, but what is the message that you would share with people when they ask you what you do? What is that message that you share that you want them to take away?

Dr. Amy Truong:

I would say that in relation to acupuncture and the bigger picture of acupuncture in oncology care is that the service I provide is not just one thing, meaning it's not just Eastern medicine. It's really truly an integrative approach in which it is applied towards the Western component of how we're also offering the care to the patient. So it's not really siloed in any way.

And I think at the end of the day, one of the things I want to let the patients know is that they do have options. The fact that we're doing this development of this integrative oncology program at City of Hope is a pivotal example of these advances that we're doing towards evidence-based treatments. So they themselves don't need to worry so much in terms of, "Okay, is this particular practice something that we would really want to incorporate in our care?" The answer is it's already integrated into our system here at City of Hope. So I think the other thing I also want to mention is just to consider your clinical team as your support system and to reach out, whether it is to your supportive care providers and your integrative medicine providers, to really help you answer any of the questions or concerns that you might have.

Darrin Godin:

So if you are in treatment at City of Hope, City of Hope Orange County, your doctors are going to know that this is available. They're likely to recommend it to you if you might be a good candidate for that. Or if they don't, you can ask for that referral to that care. What about folks who are not part of City of Hope but are going through cancer treatment or cancer journeys right now and they are thinking as they hear you, "I would like to try this. I would like to access this." Even if it's not here at City of Hope, what do you recommend? Do they tell that to their main oncologist? Who do they talk to about accessing this type of care?

Dr. Amy Truong:

I think in terms of coordination of care, well, first I would probably recommend them to get a second opinion at City of Hope and then go from there. But I think the other way to approach it if they don't have access to City of Hope is to talk to their medical provider, and hopefully the provider would also be able to give them some sort of references. But if not, I'm also very open to helping the community. So if that becomes a question and if it's allowable, I'm more than happy to connect the patient to any sort of community acupuncturist of whom I have in contact with.

Darrin Godin:

That's very kind of you. Well, thank you so much for your time today. I think this has been really enlightening and helpful for a lot of folks, and I'm really excited about where this next part of our journey as City of Hope is going to take us with integrative care and integrative medicine. You mentioned the Cherng family and the establishment of the new center. We're very excited about that. And I know you're a part of that. So thank you so much for sharing of your expertise today and spending some time with us. We really appreciate it.

Dr. Amy Truong:

Many thanks to you too, Darrin, and also to the City of Hope team.

Darrin Godin:

Well, thank you, Dr. Truong. And thank you all for joining us today. We really appreciate you listening to the podcast. Be sure to share it, be sure to like it, and be sure to join us on our next episode. We'll see you next time.