Acupuncture in cancer care: recommendations for safe practice (peer-reviewed expert opinion).

BACKGROUND: Up-to-date recommendations for the safe practice of acupuncture in integrative oncology are overdue with new cancer treatments and an increase in survivors with late effects of disease; 17 years have elapsed since Filshie and Hester's 2006 guidelines. During 2022/2023 an expert panel assembled to produce updated recommendations aiming to facilitate safe and appropriate care by acupuncturists working with people with cancer. METHODS: A core development team comprising three integrative oncology professionals comprehensively updated pre-existing unpublished recommendations. Twelve invited international experts (senior acupuncturists with and without experience of working in oncology settings, oncologists, physicians and nurses trained in integrative oncology, researchers, academics, and professional body representatives) reviewed the recommendations. In multiple iterations, the core team harmonised comments for final ratification. To aid dissemination and uptake the panel represents national and international integrative oncology associations and major cancer treatment centres in Europe, USA, Australia, and the Middle East. RESULTS: These recommendations facilitate safe care by articulating contra-indications, cautions, and risks for patients both on and off treatment (surgery, SACT, radiotherapy). Situations where acupuncture may be contra-indicated or practices need adapting are identified. "Red and Amber Flags" highlight where urgent referral is essential. CONCLUSION: These are the first international, multidisciplinary peer-reviewed recommendations for safe acupuncture practice in integrative oncology. Concerns about safety remain a significant barrier to appropriate referral from oncology teams, to use by acupuncturists and to uptake by patients. Disseminating trustworthy, widely accessible guidance should facilitate informed, confident practice of acupuncture in and outside of oncology healthcare settings.

Y-V preputioplasty for adult phimosis: a review of 89 cases.

OBJECTIVES: Numerous surgical techniques have been proposed for preputial relief to avoid circumcision. We aimed to review the indications, techniques, and outcomes of Y-V preputioplasty for men with phimosis treated at our institution between 1995 and the present. METHODS: We retrospectively examined the case notes of 89 patients who underwent Y-V preputioplasty since 1995. Indication, technique, and immediate outcomes were recorded. We have subsequently attempted to contact these patients for the completion of a satisfaction questionnaire. RESULTS: All case notes were retrieved; 87 of 89 procedures were undertaken by a single surgeon (I.A.). The median age at operation was 29 years (range, 18-84 years) and median follow-up was 4 years. Seven patients required revision surgery (3: Y-V preputioplasties; 2: circumcisions; 1: adhesion division; and 1: frenuloplasty), whereas 2 patients reported unresolved symptoms but have not undergone additional procedures. Currently, we have successfully contacted 31 of 89 (35%) patients by telephone. These cases appear to have similar demographic features to the whole group. All agreed to complete a satisfaction questionnaire, and 30 replies were received. Overall, 12 patients (40%) were very satisfied and 10 (33%) were satisfied, whereas 4 (13%) were indifferent and 4 (13%) were dissatisfied. Two patients have subsequently undergone circumcision. Twenty-one (70%) patients described their cosmetic result as very good or good, and 22 (73%) patients would recommend the operation to a friend. Dissatisfaction with the procedure seemed to be associated with pre-existing erectile dysfunction, and not retracting the foreskin postoperatively. CONCLUSIONS: Y-V preputioplasty would seem a good alternative to circumcision for men with phimosis who wish to preserve their foreskin.