Teaching cancer patients undergoing chemotherapy in the National Health Service to use daily self-moxibustion to reduce chemotherapy-induced pancytopenia: a feasibility study

Cancer patients receiving myelosuppressive chemotherapy risk developing chemotherapy-induced pancytopenia (neutropenia, anemia, thrombocytopenia) with possible negative impact on survival due to dose delays or reductions. Moxibustion, the use of heat to stimulate acupuncture points, is a traditional East Asian intervention that may have potential to reduce pancytopenia. This study explored the feasibility of teaching chemotherapy patients in a National Health Service (NHS) cancer center a 10-minute daily intervention. It also aimed to obtain preliminary data to assess the completion of chemotherapy according to both dosage and schedule and assess any reduction of chemotherapy toxicities.

This uncontrolled, single-arm study aimed to recruit breast, colorectal or gynecological cancer patients undergoing chemotherapy regimens for which granulocyte-colony stimulating factor (G-CSF) is not indicated. The primary outcome was concordance with daily self-administered moxibustion (starting 7‒10 days before commencing chemotherapy and continuing for three weeks after the final cycle) measured by daily moxibustion diaries. Secondary measures included blood counts, variation to planned chemotherapy schedule, health-related quality of life measured by functional assessment of cancer therapy (FACT)–general, FACT–anemia, and FACT–neutropenia, patient activation measure (PAM-13), chemotherapy-related toxicities, and adverse events of moxibustion.

Twenty-five participants were recruited. Of a potential 2944 applications, 1369 were recorded; overall concordance rate was 46.5% (individual range 4%‒96%). Main reasons for non-concordance included chemotherapy-related sickness, fatigue, and forgetfulness. There were no serious adverse events. The intervention was acceptable to some patients and oncology healthcare professionals. Challenges to collecting and analyzing data using the outcome measures were identified.

This was the first known attempt in the West to research using self-applied moxibustion in a conventional cancer care setting. The results indicate this intervention is generally acceptable and that it is possible to recruit to a study. The challenges identified inform recommendations for future study design.