Blake Langley ’19, a staff scientist at Fred Hutchinson Cancer Center, assesses feasibility of auricular acupressure to reduce pain, improve quality of life.

Blake Langley, ND, LAc, a National University of Natural Medicine (NUNM) alumnus, is a staff scientist at the Fred Hutchinson Cancer Center, where he serves as the principal investigator on an acupressure clinical trial and a research acupuncturist for ongoing trials under the leadership of Dr. Heather Greenlee in the Division of Public Health Sciences. Langley’s research focuses on complementary and integrative healthcare approaches to support patient quality of life and symptom management during active cancer treatment and into survivorship.

As a recipient of a career development award through a National Center of Complementary and Integrative Health administrative supplement to the Institute of Translational Health Sciences (ITHS) KL2 Multidisciplinary Clinical Research Career Development program, Langley’s primary project assesses the feasibility of auricular acupressure to promote a healthy appetite in patients with upper gastrointestinal cancers.

Understanding Upper Gastrointestinal Cancers Impact on Patient Appetite

As a staff scientist in the Fred Hutch Cancer Prevention Program, Langley studies how acupressure to the ear affects the appetite and weight of patients with stage II-IV gastric, esophageal, or pancreatic cancer. Patients with these upper GI cancers often suffer from anorexia, or low appetite, which can progress and lead to malnourishment and reduced caloric intake, resulting in dangerous weight loss, called cancer cachexia. Primary tumor complications and treatment side effects, including difficulty swallowing, pain, and chemotherapy-induced nausea and vomiting, can further negatively impact a patient’s quality of life which are also under investigation in the trial. 

While acupuncture has a whole spectrum of uses, this therapy is often used to help patients with cancer manage pain, neuropathy, fatigue, and emotional distress. Auricular acupressure (or ear acupressure) is a form of micro-acupuncture that stimulates the central nervous system by applying adhesive-taped pellets, often referred to as ear seeds, to specific locations on the external ear. These ear seeds have been shown to improve pain, fatigue, insomnia, nausea and vomiting, depression, and quality of life in both cancer and non-cancer settings.

Dr.  Langley’s Research Journey

Langley graduated from NUNM in 2019 with both a Doctor of Naturopathic Medicine and Master of Science in Oriental Medicine (now MAc) degree.

“While I was pursuing funding in research, Ryan Bradley, ND, MPH (Director of Research & Senior Research Investigator at NUNM’s Helfgott Research Institute) supported my application under his RO1 grant, and that’s where I got introduced to all the pieces of clinical research.”

During his time at the Helfgott Research Institute, Langley’s research training revolved around natural product supplementation in people with Crohn’s Disease.

Subsequently, Langley became a Building Research across Inter-Disciplinary Gaps T90 postdoctoral fellow, which is a collaborative research training program between NUNM and the University of Washington (UW) led by NUNM’s Heather Zwickey, PhD and Ryan Bradley, ND, MPH plus UW’s Cathryn Booth-LaForce, PhD and Yvonne Lin, PhD. Throughout this training, Langley’s clinical research focus began to shift to complementary and integrative healthcare interventions delivered in outpatient settings in patients undergoing active treatment for cancer. This is how Langley met his mentor, Dr. Heather Greenlee, at the Fred Hutchinson Cancer Center.

“When Dr. Greenlee rejoined Fred Hutch in 2017, she vastly expanded UW’s offerings to non-conventionally trained medical providers,” Langley said. “We now have three naturopathic doctors, four clinical acupuncturists, and four research acupuncturists on the team. It’s so amazing to be a part of that.”

Langley has since served as a research acupuncturist on two of Dr. Greenlee’s clinical trials assessing acupuncture. The first trial is to improve neuropathy from chemotherapy in gastrointestinal cancer, and the second trial is to reduce pain following bone marrow transplant in myelodysplastic syndromes.

“We also have two or three different projects where we’re doing secondary data analysis,” Langley said. “It’s been really interesting exploring the data to see if there is something else clinically important that we didn’t ask as a main outcome.”

To further develop his skills with coding and managing and cleaning data, Langley is currently pursuing a master’s degree in Epidemiology with a track focus on clinical and translational research at UW.

Ear Seeds in a Conventional Care Setting

Langley’s study on ear seeds for healthy appetites in patients with upper gastrointestinal cancers is currently assessing the feasibility and acceptability for such a trial in a conventional care setting.

“We’re really just doing a proof of concept,” Langley said. “Can we get the trial up and off the ground? Can we recruit the necessary number of participants? Can we retain them and keep them in the trial?”

Since Fred Hutch’s integrative medicine team falls under the umbrella of supportive care, it is considered an ancillary supportive care service. These ancillary services include services such as psychiatry, exercise medicine, nutrition, acupuncture and naturopathic medicine. As these services are not systems-based within the conventional care setting, like GI oncology or hematology, integrative medicine must implement a trial within a disease service.

“We’re scheduling these study visits in accordance with a patient’s chemotherapy,” Langley said. “At Fred Hutch, we use a neighborhood care model, so patients sit in the same room for all their visits related to their treatment each day they receive care.  We’re trying to reduce the burden to the patient, so that means that when they come in, they sit in the same room for 6 to 8 hours. They get blood drawn and processed in that room, and their chemotherapy is going to be delivered in that room. Any additional infusions or procedures are going to come to them. And then support care teams, like nutrition and acupuncture will also come to see them. It is a bit mindboggling to coordinate all those different pieces.”

In addition to recruiting and retaining participants, Langley’s study also teaches auricular acupressure to both nurses, advance practice providers (APPs), and participants. The study uses training videos and modules to teach ear seed placement. The feasibility and acceptability for this ear seed training is also then measured and assessed.

“Ear seeds are very affordable,” Langley said, “so having a way for patients and providers to kind of self-manage symptoms or do it in a noninvasive, very cost-effective manner is a clinical benefit I hope we’ll find in the trial.”

Study Design

This study aims to evaluate the feasibility of an 8-week auricular acupressure intervention combined with usual care, compared to usual care alone, in patients undergoing cancer treatment.

• Primary objectives include assessing recruitment, adherence, retention, fidelity, and acceptability of the intervention.
• Secondary objectives involve examining the feasibility of collecting data on cancer anorexia and body weight changes.
• Exploratory objectives include evaluating the feasibility of collecting data on circulating inflammatory cytokines and quality of life.

Patients are randomized into two arms, with Arm I receiving auricular acupressure in addition to usual care, while Arm II receives usual care alone. Both groups undergo blood sample collection during the study, and patients in Arm I are followed up at eight weeks after active treatment completion.

When asked about his experience with working in a conventional, medical setting verses a naturopathic model, Langley said, “I think collaborative medicine is the way to move forward. As NDs and acupuncturists, we are trained in a different way, and still have vast amounts of medical knowledge, but we don’t always speak the same systems language as MDs or other conventionally-trained providers. So, if we want to meet on the same playing field, we have to learn each other’s language.”

Founded in 2003, NUNM’s Helfgott Research Institute is a professionally independent, non-profit research institute conducting rigorous, high quality research on the art and science of healing.

Established in 1956, National University of Natural Medicine (NUNM) is the longest active, accredited naturopathic medical university in North America and a leader in natural medicine education and evidence-based research. Learn more at nunm.edu.

_{by Jessica Salazar, Communications Manager}