Case study: Claire and the changing needs of a breast cancer survivor over time
by Beverly de Valois
Introduction
Many people treated successfully for cancer continue to experience uncomfortable and distressing symptoms after cancer treatment ends. These may be short term or chronic, may change over time, and may remain a problem for many years. Claire’s case study illustrates how needs may change over time. Claire (not her real name) has consented to the publication of her case, which is fully detailed in my book Acupuncture and Cancer Survivorship: Recovery, Renewal, and Transformation. [1]
Claire’s cancer history and management of cancer treatment-related hot flushes
Claire, diagnosed with breast cancer at age 36, was treated with surgery and radiotherapy. She was aware that hot flushes and night sweats were a consequence of adjuvant hormonal treatments to reduce the risk of cancer recurrence. These were Zoladex injections, prescribed for two years, and tamoxifen, which Claire would ultimately take for over seven years. At a breast cancer support meeting, Claire discovered that acupuncture could manage these menopausal symptoms came to see me.
Claire had regular (weekly or bi-weekly) acupuncture treatment to manage the hot flushes which reduced dramatically. Her sleep and mood improved and, most importantly, she felt fully back in control of her cancer journey. On completing the 2-year course of Zoladex, Claire was so pleased with acupuncture that she decided to continue to have treatment to manage her overall health.
Treating a side effect of Zoladex
Constipation is a common side effect of Zoladex, and the medication exacerbated Claire’s natural tendency. Additionally, she experienced bleeding on defecation and continual pain. Diagnosing a thrombosed external haemorrhoid and an anal fissure, her doctor prescribed a topical ointment for the fissure and advised Claire to take ispaghula husk to ease bowel movements. Because of her dislike of acupuncture needles, Claire declined the offer to address this problem with acupuncture (especially when she found DU-1 would be involved!) However, five years later, the discomfort drove her to see a specialist who offered a lateral sphincterotomy. Claire was not enthusiastic about the possible consequences of this surgery and decided to brave having acupuncture.
I addressed the problem using DU-1 (with moxa on the needle) to treat haemorrhoids and difficult defecation, DU-20 to raise yang and counter prolapse, and BL-57 and BL-58 as distal points to treat haemorrhoids. Twelve weeks (and about 8 treatments) later, Claire returned to her consultant. His examination found no spasm, the scar tissue on the fissure had improved dramatically, and he concluded that surgery was no longer necessary. “Continue what you are doing” was his advice to Claire, who was greatly relieved to have been spared surgery, as well as to be discomfort free.
An acute episode of fear of recurrence
Fear of recurrence, the fear that cancer could return, is one of most reported problems experienced by cancer survivors and may happen any time in the cancer trajectory. It can have a powerful impact on physical and emotional health, as demonstrated here.
Claire, who was normally not one to worry, experienced an unusual and intense episode of fear of recurrence over seven years after her cancer diagnosis. Tamoxifen played a key role in maintaining Claire’s peace of mind; she called it her “safety blanket”. At a time when Tamoxifen was routinely prescribed for 5 years, Claire persuaded her oncologist to extend her adjuvant treatment. Coming off the prescription after 7½ years provoked a crisis.
Claire began to experience strange sensations, reminiscent of symptoms she experienced prior to her cancer diagnosis. Careful questioning uncovered that she was uncharacteristically worried about her upcoming annual mammogram, and that this anxiety was associated with her discontinuation of Tamoxifen. Taking control of the situation, she saw her oncologist and was relieved when the physical examination revealed nothing to cause concern. He remarked that it was a good sign that she had no breast pain, a comment that sparked rather than calmed Claire’s anxieties. As she explained:
“On leaving the hospital I found I was getting strange pains in my left breast, which I had not experienced before. I couldn’t explain what these were and then recalled the earlier comment my consultant had made and my anxiety levels were raised again.”
She developed multiple, unusual symptoms including poor sleep, difficulty breathing, palpitations, chest pains, and breast pains. These intensified when she developed a rash between her breasts, another symptom that had preceded her initial cancer diagnosis.
We discussed how these symptoms had followed on from the oncologist’s chance remark, and how Claire might be somatising her anxieties around the possibilities of cancer recurrence after ceasing tamoxifen. Claire had never experienced anxiety before, and she was fascinated by the power of her mind over her body.
Over the next 10 weeks, Claire anxiously awaited (delayed) mammogram results and follow-up with her oncologist. Acupuncture treatment focussed on managing her anxiety and relieving the breast symptoms. To manage anxiety, I used Shen calming points and protocols, such as the “Toasted Pericardium Sandwich” (moxa on BL-43 and REN-17), Yintang, and the Five Element Internal Dragons protocol. I addressed breast pain using distal points such as SP-4, SP-21, and GB-41, with LIV-3 to harmonise qi. As I also treated Claire using a Five Element Constitutional Acupuncture approach, I used points on the Stomach and Spleen channels (I assessed Claire’s constitutional factor (CF) as Earth) to address her constitution. These treatments helped her to cope, until she received the “all clear”, when magically, all her symptoms disappeared. The intensity of this period was remarkable, especially as such anxiety was so uncharacteristic of Claire’s approach to life.
Twenty years on…
Claire still has acupuncture regularly, using it in combination with conventional medicine. “I can’t imagine life without it,” she says. “Acupuncture was definitely the right thing for me.”
Summary
Over the decades, we have dealt with many health crises that have arisen in Claire’s life. Her case illustrates how the issues that arise after cancer treatment change over time. Acupuncture managed the hot flushes and night sweats that started during her cancer treatment; some years later, acupuncture managed the anal fissures that were a late effect of Zoladex and saved her having surgery; and even later, acupuncture helped her cope with the extreme anxiety and fear of cancer recurrence that arose when she stopped taking tamoxifen.
References
1. de Valois B, Survivorship: Navigating the Milestones, in Acupuncture and Cancer Survivorship: Recovery, Renewal, and Transformation. 2023, Singing Dragon: London. p. 341-379.
2. de Valois B, Young T, Robinson N, et al., Using traditional acupuncture for breast cancer-related hot flashes and night sweats. Journal of Alternative & Complementary Medicine, 2010. 16(10): p. 1047-57.
3. de Valois B, Young T, Thorpe P, et al., Acupuncture in the real world: evaluating a 15-year NADA auricular acupuncture service for breast cancer survivors experiencing hot flushes and night sweats as a consequence of adjuvant hormonal therapies. Support Care Cancer, 2022. 30(6): p. 5063-5074.
Acupuncture and Cancer Survivorship
Recovery, Renewal and Transformation
Beverley de Valois, PhD LicAc FBAcC MBLS, is a practising acupuncturist in the UK, where she studied at the College of Integrated Chinese Medicine. She is a distinguished researcher of acupuncture for the supportive care of people living with and beyond cancer at Mount Vernon Cancer Centre in the UK’s National Health Service. For nearly 25 years she has been a Research Acupuncturist / Researcher in Integrative Medicine in the Supportive Oncology Research Team and has conducted several pioneering studies into using acupuncture to manage the consequences of cancer treatments. Beverley is an Honorary Research Fellow in the School of Social and Community Medicine, University of Bristol, and a Fellow of the British Acupuncture Council. She chaired the British Lymphology Society Scientific Committee from 2017-2020. She has many publications in scientific journals, and lectures internationally.
