2021 BMJ Supportive & Palliative Care

Acupuncture may be an effective and safe treatment associated with pain reduction in the palliative care of patients with cancer.

Five studies (n=189) were included in this systematic review. Results indicated a favourable effect of acupuncture on pain relief in palliative care for patients with cancer. According to OCEBM 2011 Levels of Evidence, they were level 2 in one case (20%), level 3 in two cases (40%) and level 4 in the remaining (40%). Low-level evidence adversely affects the reliability of findings.

Acupuncture may be an effective and safe treatment associated with pain reduction in the palliative care of patients with cancer. Further high-quality, adequately powered studies are needed in the future.

Acupuncture for palliative cancer pain management: systematic review Yang J, Wahner-Roedler DL, Zhou X, et al.

2021 Frontiers in Oncology

Current evidence suggests that acupuncture might improve breast cancer treatment-related symptoms measured with patient-reported outcomes including quality of life, pain, fatigue, hot flashes, sleep disturbance and anxiety.

Out of the 2, 524 identified studies, 29 studies representing 33 articles were included in this meta-analysis. At the end of treatment (EOT), the acupuncture patients’ quality of life (QoL) was measured by the QLQ-C30 QoL subscale, the Functional Assessment of Cancer Therapy-Endocrine Symptoms (FACT-ES), the Functional Assessment of Cancer Therapy–General/Breast (FACT-G/B), and the Menopause-Specific Quality of Life Questionnaire (MENQOL), which depicted a significant improvement. The use of acupuncture in BC patients lead to a considerable reduction in the scores of all subscales of the Brief Pain Inventory-Short Form (BPI-SF) and Visual Analog Scale (VAS) measuring pain. Moreover, patients treated with acupuncture were more likely to experience improvements in hot flashes scores, fatigue, sleep disturbance, and anxiety compared to those in the control group, while the improvements in depression were comparable across both groups. Long-term follow-up results were similar to the EOT results.

Acupuncture for Breast Cancer: A Systematic Review and Meta-Analysis of Patient-Reported Outcomes Zhang Y, Sun Y, Li D, Liu X, Fang C, Yang C, Luo T, Lu H, Li H, Zhang H, Liang Q, Wu J, Huang L, Xu R, Ren L, Chen Q

2020 JAMA Oncology

Compared with usual care, acupuncture resulted in significant improvement in chemotherapy-induced peripheral neuropathy symptoms.

We found therapeutic benefit of real acupuncture for neuropathic pain that is consistent with previous pilot acupuncture CIPN trials. Distinctively, our study is the first, to our knowledge, to incorporate a sham treatment and a nontreatment control to evaluate the efficacy of acupuncture for CIPN.

The addition of a sham acupuncture control in an acupuncture clinical trial is difficult owing to the challenge of incorporating a truly inert placebo. In addition, a sham control limits the ability of a small effect size to elucidate a true difference between real and sham acupuncture.

Not only did our study demonstrate the feasibility of conducting a sham-controlled acupuncture trial, it generated sufficient pilot data to inform a definitive sham-controlled efficacy trial. Our trial is limited by its small sample size, single center, and short-term follow-up.

Effect of Acupuncture vs Sham Procedure on Chemotherapy-Induced Peripheral Neuropathy Symptoms A Randomized Clinical Trial Bao T, Patil S, Chen C, et al.

2020 Medicine

Acupuncture has been shown to be more effective than vitamin B treatment in terms of clinical efficacy rate for chemotherapy induced peripheral neuropathy.

Aside from 1 study using sham-EA as a control group, all 12 studies included acupuncture versus pharmacological treatments. The results showed that acupuncture could show a superior clinical efficacy than vitamin B therapy. However, the methodological quality of the involved studies was generally low.

A systematic review and meta-analysis of the efficacy of acupuncture and electroacupuncture against chemotherapy-induced peripheral neuropathy Hwang MS, Lee HY, Choi TY, et al.

2020 Integrative Cancer Therapies

Acupuncture has therapeutic potential in management of cancer-related fatigue for cancer survivors.

Given that CRF is a debilitating symptom among cancer survivors that has proven complex to manage, it is important to explore a wide range of treatment options. The findings of this systematic review and meta-analysis suggest that acupuncture has clinical applications in the management of CRF in conjunction with standard care. Investigating the physiological mechanisms underlying the effects of acupuncture on CRF with biomarkers including cytokines will provide important insights into future clinical applications. Acupuncture for cancer survivors with fatigue, particularly those receiving chemotherapy and radiation therapy that induce fatigue, can have a beneficial effect on fatigue and overall quality of life, when used as an adjunctive intervention to conventional cancer care. Therefore, it is recommended that acupuncture be incorporated into guidelines for the management of CRF in order to improve patient care.

The Effects of Acupuncture on Cancer-Related Fatigue: Updated Systematic Review and Meta-Analysis Jang, A., Brown, C., Lamoury, G., Morgia, M., Boyle, F., Marr, I., Clarke, S., Back, M., & Oh, B.

2020 Evidence-Based Complementary and Alternative Medicine

This systematic review and meta-analysis provides evidence that acupuncture moxibustion therapy is serviceable and safe in treating breast cancer-related lymphedema.

Twelve RCTs with 778 participants were identified for further analysis. On account of the evidence we assessed, the conclusion that can be reached is that acupuncture moxibustion therapy (AMT) could be considered as an alternative option to enhance the efficacy of breast cancer-related lymphedema (BCRL) treatment.

Eight trials showed that AMT combined with physiotherapy or functional exercise for the treatment of BCRL significantly improved the total effective rate, in comparison with using conservative treatment alone. Based on changes in the difference of upper limbs before and after treatment, five trials suggested that AMT or AMT plus physical therapy was more effective than physical therapy alone. The differences in arm dimension changes were smaller in patients treated with AMT than those in untreated patients. These results showed that acupuncture and moxibustion enhance the beneficial effects of physical therapy. Moreover, pooled data from five studies showed that AMT (including cupping) had advantage over Western medicine and physiotherapy at improving the quality of life among BCRL patients.

Among the included studies, only one trial clearly recorded the adverse events that occurred during the treatment period. It can be said that AMT is basically safe and hardly bring about harm to the human body.

Several studies have taken moxibustion as an intervention measure. The results indicated that moxibustion efficiently alleviated the symptoms of edema in BCRL patients, without any obvious adverse events. Hence, after several times of professional guidance, patients could carry out moxibustion by themselves, which is free of time and place restrictions. These findings indicated that the efficacy of AMT was higher compared to other conservative treatments. Apart from this, since the adverse events of AMT were negligible, it was extraordinary attractive to women with BCRL.

Effectiveness and Safety of Acupuncture Moxibustion Therapy Used in Breast Cancer-Related Lymphedema: A Systematic Review and Meta-Analysis Huimin Jin, Yuying Xiang, Yuqian Feng, Yiting Zhang, Shan Liu, Shanming Ruan, Huamiao Zhou

2020 Integrative Cancer Therapies

The pooled results suggested that acupuncture led to moderate improvements in hot flashes, fatigue, and stiffness.

Evidence for outcome indicators of symptom management were downgraded by the GRADE system for inconsistency, indirectness, and imprecision in the included RCTs. Nonetheless, acupuncture is a moderately appropriate alternative therapy for hormone therapy–related side effects in breast cancer patients. However, it still lacks large-sample, multicenter, prospective RCTs. Future research should focus on standardizing comparison groups and treatment methods, be at least single-blinded, assess biologic mechanisms, have adequate statistical power, and involve multiple acupuncturists.

Acupuncture for Hormone Therapy-Related Side Effects in Breast Cancer Patients: A GRADE-Assessed Systematic Review and Updated Meta-Analysis Yuanqing P, Yong T, Haiqian L, Gen C, Shen X, Dong J, Qi C, Miaomiao Q.

2019 JAMA Oncology

Acupuncture and/or acupressure was significantly associated with reduced cancer pain and decreased use of analgesics.

This study found a moderate level of evidence that acupuncture and/or acupressure was significantly associated with lower pain intensity in patients with cancer compared with a sham control, which suggests a potential for a combination of acupuncture and acupressure to help reduce opioid doses in patients with cancer.

Clinical Evidence for Association of Acupuncture and Acupressure With Improved Cancer Pain A Systematic Review and Meta-Analysis He Y, Guo X, May BH, et al.

2019 Climacteric

Acupuncture significantly alleviated breast cancer treatment-related menopause symptoms for at least 3 months, but not hot flushes.

In total, 943 patients from 13 RCTs were analyzed. The meta-analysis showed that acupuncture had no significant long-term maintenance effect on the frequency or severity of hot flushes, but had a significant 3-month maintenance effect of ameliorating menopause symptoms at 3 months after treatment ended. No adverse events were reported.

The maintenance effect of acupuncture on breast cancer-related menopause symptoms: a systematic review Chien TJ, Liu CY, Fang CJ, Kuo CY

2019 Frontiers in Pharmacology

We showed that Angelica sinensis is not that stimulatory in breast cancer both in vitro and in vivo, though Angelica sinensis should still be used with caution in estrogen receptor-positive breast cancer patients.

The present findings provided further scientific evidences, which showed that the estrogenic herb AS are not that stimulatory in breast cancer both in vitro and in vivo, though it should still be used with caution particularly in ER-positive breast cancer patients. This is the first systematic pre-clinical study to illustrate the safety use of AS in breast cancer patients by providing varied levels of evidences.

Is Danggui Safe to be Taken by Breast Cancer Patients?-A Skepticism Finally Answered by Comprehensive Preclinical Evidence Yue Grace Gar-Lee, Wong Lok-Sze, Leung Hoi-Wing, Gao Si, Tsang Julia Yuen-Shan, Lin Zhi-Xiu, Law Bonita Ka-Bo, Tse Gary Man-Kit, Lau Clara Bik-San

2018 Journal of Cancer Research and Therapeutics

The use of acupuncture as an adjunct to ameliorate hot flashes is still a relatively sound treatment for breast cancer patients.

The therapeutic effect of acupuncture on hot flashes among breast cancer survivors is probably multifactorial, and the results of our research support the possibility that acupuncture could reduce hot flashes for patients suffering from breast cancer.

Acupuncture for the relief of hot flashes in breast cancer patients: A systematic review and meta-analysis of randomized controlled trials and observational studies Wang XP, Zhang DJ, Wei XD, Wang JP, Zhang DZ.

2017 European Journal of Cancer Care

Acupuncture can be adopted as part of a multimodal approach for reducing cancer-related pain.

A total of 29 RCTs yielding 36 effect sizes were included. The overall effect of acupuncture on cancer-related pain was -0.45. The subanalysis indicated that acupuncture relieved malignancy-related and surgery-induced pain but not CT- or RT-induced and HT-induced pain. Acupuncture is effective in relieving cancer-related pain, particularly malignancy-related and surgery-induced pain.

Systematic review and meta-analysis of acupuncture to reduce cancer-related pain Chiu HY, Hsieh YJ, Tsai PS.

2016 Acupuncture in Medicine

We found low-to moderate-quality evidence for the efficacy and safety of acupuncture for recovery after surgery in colorectal cancer patients.

Of 1225 screened hits, seven randomised trials with 540 participants were included. High or uncertain risk of bias and significant heterogeneity were observed. All outcomes were measured before discharge, and no trial explicitly reported post-discharge outcomes. The response to acupuncture in terms of postoperative symptoms was inconsistent across trials. QoL was not measured in the included studies. For certain outcomes reflecting physiological recovery, favourable effects of acupuncture were observed compared with sham acupuncture, namely time to first flatus and time to first defaecation. Two studies reported there were no acupuncture-related adverse events, whereas the remaining studies did not consider adverse events.

Acupuncture for recovery after surgery in patients undergoing colorectal cancer resection: a systematic review and meta-analysis Kim KH, Kim DH, Kim HY, Son GM.

2016 Integrative Cancer Therapies

There is a low level of evidence that acupuncture may be superior to sham acupuncture, drugs or hormone therapy for managing cancer-related insomnia.

Three RCTs showed equivalent effects on the Pittsburgh Sleep Quality Index and 2 RCTs showed the similar effects on response rate to those of conventional drugs at the end of treatment. The other RCT showed acupuncture was better than hormone therapy in the numbers of hours slept each night and number of times woken up each night. The 3 weeks of follow-up in 2 RCTs showed superior effects of acupuncture compared with conventional drugs, and a meta-analysis showed significant effects of acupuncture. Two RCTs tested the effects of acupuncture on cancer-related insomnia compared with sham acupuncture. One RCT showed favourable effects, while the other trial failed to do so.

There is a low level of evidence that acupuncture may be superior to sham acupuncture, drugs or hormone therapy. However, the number of studies and effect size are small for clinical significance. Further clinical trials are warranted.

Acupuncture for Managing Cancer-Related Insomnia: A Systematic Review of Randomized Clinical Trials Choi TY, Kim JI, Lim HJ, Lee MS.

2016 Medicine

Acupuncture and related therapies are effective in reducing pain, fatigue, and in improving quality of life when compared with conventional intervention alone among cancer patients.

Thirteen RCTs were included. Compared with conventional interventions, meta-analysis demonstrated that acupuncture and related therapies significantly reduced pain (2 studies, n = 175, pooled weighted mean difference: −0.76, 95% confidence interval: −0.14 to −0.39) among patients with liver or gastric cancer. Combined use of acupuncture and related therapies and Chinese herbal medicine improved quality of life in patients with gastrointestinal cancer (2 studies, n = 111, pooled standard mean difference: 0.75, 95% confidence interval: 0.36–1.13). Acupressure showed significant efficacy in reducing fatigue in lung cancer patients when compared with sham acupressure. Adverse events for acupuncture and related therapies were infrequent and mild.

Acupuncture and related therapies are effective in reducing pain, fatigue, and in improving quality of life when compared with conventional intervention alone among cancer patients. Limitations on current evidence body imply that they should be used as a complement, rather than an alternative, to conventional care. Effectiveness of acupuncture and related therapies for managing anorexia, reducing constipation, paresthesia and dysesthesia, insomnia, and limb edema in cancer patients is uncertain, warranting future RCTs in these areas.

Acupuncture and Related Therapies for Symptom Management in Palliative Cancer Care: Systematic Review and Meta-Analysis Lau CH, Wu X, Chung VC, Liu X, Hui EP, Cramer H, Lauche R, Wong SY, Lau AY, Sit RS, Ziea ET, Ng BF, Wu JC.

2016 Journal of Pain and Symptom Management

A tentative conclusion can be reached that acupuncture, tuina, tai chi and qigong represent beneficial adjunctive therapies for cancer patients.

We identified 67 RCTs (5465 patients) that met our inclusion criteria to perform this meta-analysis. Analysis results showed that a significant combined effect was observed for QOL change in patients with terminal cancer in favor of acupuncture and Tuina, whereas Tai Chi and Qigong had no effect on QOL of breast cancer survivors. The meta-analysis also demonstrated that acupuncture produced small-to-large effects on adverse symptoms including pain, fatigue, sleep disturbance, and some gastrointestinal discomfort; however, no significant effect was found on the frequency of hot flashes and mood distress. Tuina relieved gastrointestinal discomfort. TCM-FEMT lowered depression level. Tai Chi improved vital capacity of breast cancer patients. High risk of bias was present in 74.63% of the selected RCTs. Major sources of risk of bias were lack of blinding, allocation concealment, and incomplete outcome data.

Effects of Acupuncture, Tuina, Tai Chi, Qigong, and Traditional Chinese Medicine Five-Element Music Therapy on Symptom Management and Quality of Life for Cancer Patients: A Meta-Analysis Wei-Wei Tao,Hua Jiang,Xiao-Mei Tao,Ping Jiang,Li-Yan Sha,Xian-Ce Sun

2016 Cancer Nursing

Acupuncture may be used as a complementary therapy for breast cancer survivors experiencing hot flashes and other menopause-related symptoms.

We analyzed 7 studies involving 342 participants. Acupuncture significantly reduced the frequency of hot flashes and severity of menopause-related symptoms immediately after the completion of treatment. In comparison with sham acupuncture, effects of true acupuncture on the frequency and severity of hot flashes were not significantly different. At 1 to 3 months' follow-up, the severity of menopause-related symptoms remained significantly reduced.

Acupuncture may be used as a complementary therapy for breast cancer survivors experiencing hot flashes and other menopause-related symptoms; however, whether acupuncture exerts specific treatment effects other than needling or placebo effects needs to be further evaluated.

Effects of Acupuncture on Menopause-Related Symptoms in Breast Cancer Survivors Chiu, Hsiao-Yean; Shyu, Yuh-Kae; Chang, Pi-Chen, Tsai, Pei-Shan

2014 Oncology Nursing Forum

Although results are inconclusive, acupuncture and acupressure tend to be effective in relieving cancer related fatigue, with the former producing a greater improvement.

Although results are inconclusive, acupuncture and acupressure tend to be effective in relieving CRF, with the former producing a greater improvement. Future research is recommended to contribute further evidence.

Implications for Nursing: Nurses should know about the relative effectiveness of acupuncture and acupressure in the management of CRF to educate and support their patients.

Effects of acupuncture and acupressure on cancer-related fatigue: a systematic review Ling WM, Lui LY, So WK, Chan K.

2014 Supportive Care in Cancer

Acupuncture can be tried based on the available data in the treatment of xerostomia in cancer patients.

Six studies met the eligibility criteria for review: three randomized controlled trials and three prospective studies. The quality assessment and reporting was performed using PRISMA, Jadad and STROBE. These studies compared acupuncture, pilocarpine, Saliva Orthana and chewing gum with each other or with placebo. All interventions were considered effective in treating xerostomia. However, effectiveness versus placebo could not be demonstrated for Saliva Orthana. Meta-analysis could not be performed due to heterogeneity of the study type and intervention.

Limited published data exists reporting the effectiveness of measures in the treatment of xerostomia in cancer patients. Based on primary research of low quality, firm conclusions cannot be drawn. However, pilocarpine, artificial saliva, chewing gum and acupuncture can be tried based on the available data. This highlights the explicit need to improve our evidence base. Properly constructed randomized controlled trials demonstrating effectiveness of pharmacological and non-pharmacological interventions for dry mouth are required.

Systematic literature review: xerostomia in advanced cancer patients Hanchanale S, Adkinson L, Daniel S, Fleming M, Oxberry SG.