Cupping Therapy and Palliative Care: What about Hematologic Malignancies?

To the editor:

Cupping therapy (CT) is among the oldest medical manipulations practiced by our ancestors. It’s a traditional and widely-used healing method in various countries and regions, e.g., in Arabia, China, Central Europe, India, and parts of Africa [1]. Bleeding was one of the first casualties as medicine transformed itself from an art to a science. The CT technique involves a glass cup and a horn, plastic or bamboo, to create suction on the skin over an acupuncture point, a reflex zone, or a painful area. There are many types of CT, with wet cupping (also called bleeding cupping) being the most practiced and favored cupping method of practitioners. Each kind of CT may be used for different diseases or different treatment purposes. It is regularly observed to bring about pain relief and to increase a patient’s general feeling of well-being, and it is applied to increase the local circulation of blood and lymph and to relieve painful muscle tension [2]. CT has also been used to improve subcutaneous blood flow and to stimulate the autonomic nervous system. CT is also a commonly-used traditional intervention for various conditions: pain, hypertension and stroke rehabilitation.

A considerable number of cancer patients use traditional medicine in order to alleviate different symptoms, such as depression and pain, occurring in connection with cancer. Hematologic malignancies are not an exception, especially when the healing phase is over and the therapy has to be continued with palliative intent. Pain is an unpleasant feeling and remains one of the most common symptoms experienced by patients nearing the end of life. Because the progression of disease, the simultaneous presence of severe pain, and any pharmacological treatment may cause a number of side effects, patients suffering with a hematological malignancy frequently turn to complementary medicine therapies as an adjunctive treatment to ease the symptoms [3].

Hematological malignancies are cancers of the bone marrow and the immune system. Consequently, treatment is more complex than other cancer treatments, with increased risk of severe infection and more need for bone marrow support with platelet and red-cell transfusions.

Therefore, CT is capable of inducing anemia if applied over a prolonged period. It seems plausible that in the hematological system, cupping can regulate the coagulation and the anti-coagulation systems [4]. As another example, polycythemias comprise a group of disorders related to an excess number of red cells. Phlebotomy for erythrocytosis aims to alter blood viscosity by lowering hematocrit levels to less than 45%, rather than by reducing iron stores [5].

CT has frequently been criticized by advocates of conventional medicine. Moreover, its clinical effectiveness remains uncertain, and many clinicians are skeptical about its value. In the future, a large-scale sham-controlled trial is needed to evaluate the efficacy of CT for palliative care.