Effect of Acupuncture on Immune Function
Effect of Acupuncture on Cancer Pain
Effect of Acupuncture on Chemotherapy-Induced Nausea and Vomiting
Effect of Acupuncture on Cancer and Cancer Treatment-Related Side Effects

Effect of Acupuncture on Immune Function

At least seven human studies have evaluated the effect of acupuncture on immune system function in patients with cancer (see table ¹ at end of this section).[1-7] These studies were all conducted in China. Five were reported in English,[1-3,6,7] and two were reported in Chinese with English abstracts.[4,5]

Four randomized controlled trials,[1,2,4,5] a nonrandomized clinical study,[3] and two case series [6,7] found that acupuncture enhanced or regulated immune function.

The first randomized controlled trial found that acupuncture treatment enhanced platelet count and prevented leukocyte decrease after radiation therapy or chemotherapy, in comparison with the control group.[1]

A second study involved a group of 40 postoperative cancer patients, 20 of whom received daily acupuncture treatment and 20 of whom served as a control group. After 3 days, leukocyte phagocytosis was enhanced in the treated group, compared with the baseline measurement (P < .01); no such enhancement was observed in the control group.[2]

A third study observed the effect of acupuncture on interleukin-2 (IL-2) and natural killer (NK) cell activity in the peripheral blood of patients with malignant tumors. The patients were divided into an acupuncture treatment group (n = 25), which received 30 minutes of acupuncture daily for 10 days, and a nonacupuncture control group (n = 20). The data showed that IL-2 level and NK cell activity were significantly increased in the acupuncture group, compared with the control group (P < .01).[4]

A fourth study observed the effect of acupuncture on T- lymphocyte subsets (CD₃+, CD₄+, and CD₈+), soluble IL-2 receptor (SIL-2R), and beta- endorphin (beta-EP) in the peripheral blood of patients with malignant tumors. The data showed that acupuncture treatment increased the proportion of the CD₃+ and CD₄+ T-lymphocyte subsets, the CD₄+/CD₈+ ratio (P < .01), and the level of beta-EP. It decreased the level of SIL-2R (P < .01). The investigators suggested that the anticancer effect of acupuncture may be mediated via the mechanism of immunomodulation. [5]

The nonrandomized clinical study showed that microwave acupuncture (MAT), a newly developed technique in which a specially designed device attached to a normally inserted acupuncture needle is used to deliver microwave radiation to a given point, enhanced the immunologic function of cancer patients. Although there was an increase in white blood cell count in the MAT group, the change was not significantly different from that seen in the control group under drug treatment.[3]

In a clinical case series, 28 cancer patients who were treated with electroacupuncture (EA) while undergoing chemotherapy experienced no declines in T cells (CD₃+, CD₄+, CD₈+) or in NK cell activity, both of which are usually suppressed by chemotherapy.[7] Similar findings were reported in a study comparing EA to the control in patients receiving chemotherapy for breast, colorectal cancer, and non-Hodgkin lymphoma.[8]

In another clinical case series, 48 patients with leukopenia —including two cancer patients—who were treated with manual acupuncture experienced improvements in leukocyte count, intracutaneous phytohemagglutinin (PHA), and immunoglobulin (IgG, IgA, and IgM) levels after 14 daily acupuncture treatments, compared with their pretreatment levels.[6]

Table 2. Clinical Studies of Acupuncture: Immune System Function^a

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Reference Citation(s)	Type of Study	Condition Investigated	No. of Patients: Enrolled; Treated; Controlb	Strongest Benefit Reportedc	Concurrent Therapy Used (Yes/No/ Unknown)d	Level of Evidence Scoree
[1]	RCT	Immune system function and symptoms related to cancer and treatment	76; 38 radiation therapy and chemotherapy plus acupuncture; 38 radiation therapy and chemotherapy alone	Enhanced immune system function, weight gain, symptom relief, and fewer side effects from chemotherapye	No	1iiC
[2]	RCT	Leukocyte activity in cancer patients following surgery	40; 20 standard care plus acupuncture; 20 standard care alone	Leukocyte phagocytic activity enhancedf	No	1iiD
[4]	RCT	Changes in blood IL-2 levels and NK cell activity in cancer patients	45; 25 acupuncture; 20 no additional treatment or sham	Enhanced immune system function: Increases in IL-2 levels and NK cell activityg	No	1iiD
[5]	RCT	Changes in blood T-cell populations and SIL-2R and beta-endorphin levels in cancer patients	40; 20 acupuncture; 20 no additional treatment or sham	Enhanced immune system function: increases in CD3+ cells, CD4+ cells, the CD4+: CD8+ cell ratio, and beta-endorphin levels; decrease in SIL-2R levelsh	No	1iiD
[3]	Nonrandomized controlled trial	Leukopenia after radiation therapy	49; 20 MAT alone; 29 drugs alone	Increase in average WBC count for both groupsi	No	2D
[6]	Nonconsecutive case series	Leukopenia, caused by cancer, radiation therapy, or chemotherapy, rheumatoid arthritis; and other causes	48; 48 acupuncture (2 with cancer); none	Increase in leukocyte levels; improvement in immune system function as measured by IgG, IgA, and IgM levels; PHA-induced lymphocyte proliferative responses; and complement protein C3 levelsj	Unknown	3iD
[7]	Nonconsecutive case series	T-cell levels and NK cell activity in patients treated with chemotherapy	28; 28 EA; none	No decline in T-cell levels or NK cell activity after chemotherapyk	No	3iiD
[8]	Nonconsecutive case series	T-cell levels and NK cell activity in patients treated with chemotherapy	139; 48 EA; 49	No decline in T-cell levels, NK cell activity, humoral immunity, or leukocyte count after chemotherapy	Unknown	3iiiD

EA = electroacupuncture; IgA, IgG, and IgM = immunoglobulins; IL-2 = interleukin-2; MAT = microwave acupuncture; NK = natural killer cell; No. = number; PHA = phytohemagglutinin; RCT = randomized controlled trial; SIL-2R = soluble IL-2 receptor; WBC = white blood cell.

aSee text and the NCI Dictionary 3 for additional information and definition of terms.

bStrongest evidence reported that the treatment under study has activity or improves the well-being of cancer patients.

cFor information about levels of evidenceanalysis and an explanation of the level of evidence scores, see Levels of Evidence for Human Studies of Cancer Complementary and Alternative Medicine 4.

dConcurrent therapy for symptoms treated (not cancer).

e P < .05, acupuncture treatment versus control.

f P < .01, daily acupuncture treatment versus control.

g P < .01, daily acupuncture treatment versus control.

h P < .01, postacupuncture treatment versus baseline levels.

i P > .05, MAT versus drug treatment controls. Drugs:vitamin B4, leucogen, butylalcohol, unspecified Chinese herbs, interferon,transfer factor (a dietary supplement purported to enhance the immune system, available through distributors on the Web), anion inhalation. An unknown drug, NDA, was also given to patients in the drug group.

j P = .05, postacupuncture treatment versus baseline levels.

k P = .05, no significant declines postacupuncture treatment versus baseline levels.

Effect of Acupuncture on Cancer Pain

Eight clinical studies of acupuncture as a treatment for cancer-related pain have been reported in the English language (see table ⁵ at end of this section).[9-16] Three studies were randomized controlled clinical trials, with two studies conducted in China and one in France.[10,11,16] Two studies were nonrandomized clinical trials conducted in France and Germany.[12,13] Three studies were case series, with one each from England, Hong Kong, and the United States.[9,14,15]

One randomized trial compared classical Chinese acupuncture; acupuncture point injection with freeze-dried human transfer factor; and conventional analgesic treatment in patients with stomach cancer pain.[10] The investigators reported an equivalent analgesic effect among the three groups observed after 2 months of treatment; however, the conventionally treated group experienced significantly superior analgesia compared with both acupuncture treatment groups during the first 10 days of treatment. The researchers reported that the patients in both acupuncture treatment groups also experienced improved quality of life and a decrease in the side effects of chemotherapy, in addition to analgesia.

The second randomized clinical trial evaluated the effect of various combinations of auricular acupuncture, Chinese herbs, and epidural morphine to relieve postoperative pain in 16 patients with liver cancer.[11] The study design was complicated and had a very small sample size (n = 2 per group). On the basis of the Visual Analog Scale (VAS) (0–100 mm), all of the combination treatment groups experienced better analgesia than did a placebo -treated control group.

A nonrandomized single-arm observational clinical study evaluated the effect of auricular acupuncture in 20 cancer patients who were still experiencing pain after treatment with analgesics.[12] While patients continued their analgesic medication, auricular acupuncture needles were embedded in ear acupuncture points chosen according to clinical symptoms and electrodermal response and were left in place until they fell out. In some cases, the needles remained in place for 35 days, while in others they fell out after 5 days. Pain intensity was measured by a nurse on the VAS on day 0 and day 60, and the data were analyzed using a t test. The results showed that pain intensity decreased or remained stable after auricular acupuncture in all patients, with a significant average pain intensity decrease of 33 mm (P < .001). The same investigators later reported a larger (n = 90) randomized blinded controlled trial in which cancer pain intensity was significantly decreased (by 36%) in an auricular acupuncture treatment group, in comparison with control groups (acupuncture at placebo points or auricular seeds placed at placebo points) after 2 months of treatment (P < .001).[16]

Another nonrandomized study investigated the effect of acupuncture in postoperative pain management and arm movement in breast cancer patients after surgical excision of the cancer and axillary lymph node dissection.[13] Forty-eight patients were treated with acupuncture on the third, fifth, and seventh days after surgery and on the day of patient discharge. Compared with a control group of 32 patients who had the same surgery but did not receive acupuncture treatment, the acupuncture group had significant pain relief during arm movement on the fifth and seventh days following surgery and at the time of discharge. The range of arm motion also increased significantly in the treatment group, compared with the control group, during the postoperative period (P < .001). The authors concluded that acupuncture point selection based on the state of the patient and obtaining a needling "de qi" sensation were important to achieving an effective acupuncture treatment.

In a case series involving 183 cancer patients who were treated with acupuncture for cancer-related pain, 52% were significantly helped (P value not stated).[14] Multiple treatments at intervals of 1 to 4 weeks were nearly always necessary for significant and long-term pain control.

In another case series, 29 patients with malignant tumors who developed pain received EA treatment.[15] All experienced various degrees of pain relief, and 25 out of 29 were able to either reduce or eliminate their analgesic requirements following multiple EA treatments.

A third case series produced similar results.[9] After auricular EA treatment, five patients with cancer pain reported improvements.

Although most of these studies were positive and demonstrated the effectiveness of acupuncture in cancer pain control, the findings have limited significance because of methodologic weaknesses such as small sample sizes, an absence of patient blinding to treatment in most cases, varying acupuncture treatment regimens, a lack of standard outcome measurements, and an absence of adequate randomization. Further investigations into the effects of acupuncture on cancer pain using rigorous scientific methodology are warranted.

Table 3. Clinical Studies of Acupuncture: Cancer-Related Pain^a

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Reference Citation(s)	Type of Study	Condition Treated	No. of Patients: Enrolled; Treated; Controlb	Strongest Benefit Reportedc	Concurrent Therapy Used (Yes/No/ Unknown)d	Level of Evidence Scoree
[10]	RCT	Stomach cancer pain	48; 16 acupuncture and 16 acupuncture point injection of freeze-dried human transfer factor; 16 conventional analgesics	In long-term treatment, equal or better analgesia than conventional drugsf	No	1iiC
[11]	RCT	Postoperative pain in liver cancer patients	16; 12 Chinese herbs, auricular EA, or epidural morphine given alone or in combination; 4 placebo controls	Combination treatment better than placebo and EA alone, Chinese herbs alone, or epidural morphine aloneg	Yes (Chinese herbs; epidural morphine)	1iC
[16]	RCT	Cancer pain	90; 28 auricular acupuncture; 51 acupuncture at placebo points in ear or auricular seeds fixed at placebo points with adhesive	Pain intensity decreased by 36% at 2 monthsh	Yes (analgesics and co-analgesics, including tricyclic antidepressants and antiepileptics)	1iiC
[12]	Nonconsecutive case series	Cancer pain	20; 20 auricular acupuncture; none	Average pain intensity decreased by 43%, using VAS (0–100 mm)i	Yes (analgesics)	3iiiC
[13]	Nonrandomized controlled trial	Local pain and limitation of arm movement after breast cancer surgery and axillary lymph node dissection	80; 48 acupuncture; 32 no acupuncture	Improved postoperative pain; improved range of arm motionj	Unknown	2C
[14]	Nonconsecutive case series	Cancer-related pain	183; 183 acupuncture; none	95 (52%) “significantly helped”	Yes (analgesics)	3iC
[15]	Nonconsecutive case series	Cancer pain	29; 29 EA; none	Pain reduced; injection of analgesics reduced or no longer required	Yes (analgesics)	3iC
[9]	Best case series	Cancer pain	5; 5 auricular EA; none	Symptoms improved	Unknown	4

EA = electroacupuncture; No. = number; RCT = randomized controlled trial; VAS = Visual Analog Scale.

aSee text and the NCI Dictionary 3 for additional information and definition of terms.

bNumber of patients treated plus number of patients control may not equal number of patients enrolled; number of patients enrolled equals number of patients initially recruited/considered by the researchers who conducted a study; number of patients treated equals number of enrolled patients who were given the treatment being studied AND for whom results were reported.

cStrongest evidence reported that the treatment under study has activity or otherwise improves the well-being of cancer patients.

dConcurrent therapy for symptoms treated (not cancer).

eFor information about levels of evidence analysis and an explanation of the level of evidence scores, see Levels of Evidence for Human Studies of Cancer Complementary and Alternative Medicine 4.

f P < .05, acupuncture treatment versus conventional analgesics.

g P < .05, combination of traditional Chinese medicine (acupuncture and Chinese herbs) and epidural morphine versus placebo.

h P < .0001, acupuncture versus placebo.

i P < .00001, day 60 after start of acupuncture treatment versus day 0.

j P < .01, acupuncture treatment versus no acupuncture treatment.

Effect of Acupuncture on Chemotherapy-Induced Nausea and Vomiting

Of all the investigated effects of acupuncture on cancer-related or chemotherapy-related symptoms and disorders, the positive effect of acupuncture on chemotherapy-induced nausea and vomiting (N/V) is the most convincing, as demonstrated by the consistency of the results of a variety of clinical study types, including randomized clinical trials, nonrandomized trials, prospective consecutive case series, and retrospective studies (see table ⁷ at end of this section). Consistent with the findings from clinical studies of acupuncture on N/V due to other causes such as postoperative N/V and morning sickness, these studies showed acupuncture to be effective in the treatment of chemotherapy-induced N/V. A well-documented example is discussed below.

A systematic review of the effect of acupuncture on N/V describes five clinical trials of chemotherapy-induced N/V, conducted by different investigators on different groups of patients and using different forms of acupuncture point stimulation.[17] All five trials yielded positive results. These consistent results support the claim that acupuncture is useful for treating chemotherapy-induced N/V. More recently, the efficacy of acupuncture point stimulation for chemotherapy-induced N/V has been reviewed, suggesting that acupuncture is more effective for acute vomiting than for acute or chronic nausea.[18]

A number of clinical studies of the effect of acupuncture on chemotherapy-induced N/V have been reported.[19-31]

A randomized placebo-controlled clinical trial investigated the effect of EA on chemotherapy-induced emesis in 104 patients with breast cancer who were undergoing a highly emetogenic chemotherapy regimen. [21] The patients were randomly assigned to receive low-frequency EA at classic antiemetic acupuncture points once daily for 5 days (n = 37), minimal needling at control points with mock EA on the same schedule (n = 33), or no adjunct needling (n = 34). All patients received concurrent antiemetic drugs (prochlorperazine, lorazepam, and diphenhydramine) and high-dose chemotherapy (cyclophosphamide, cisplatin, and carmustine). The main outcome measures were the total number of emesis episodes and the proportion of emesis-free days occurring during the 5-day study period. The data revealed fewer emesis episodes in the EA treatment group compared with those in the minimal needling and drug-only control groups (P < .001), although differences among the groups were not significant during the 9-day follow-up period (P = .18). These findings are consistent with results reported by other investigators.[19,20,22,23,25,26,29] However, another published study showed that acupuncture had no additional effect on the prevention of acute N/V in patients receiving high- dose chemotherapy when combined with ondansetron.[31] One study suggested decreased delayed nausea from acupressure at point p6 compared with sham acupressure.[32]

Table 4. Clinical Studies of Acupuncture: Nausea and Vomiting^a

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Reference Citation(s)	Type of Study	Condition Treated	No. of Patients: Enrolled; Treated; Controlb	Strongest Benefit Reportedc	Concurrent Therapyd	Level of Evidence Scoree
[21]	RCT	N/V related to high-dose chemotherapy for breast cancer	104; 37; 67 (sham EA or no EA)	Less N/V in EA groupf	Yes (prochlorperazine, lorazepam, and diphenhydramine)	1iiC
[19,25,26]	RCT	N/V from chemotherapy	10; 10 (EA); 10 sham EA (crossover study)	Significantly less N/V than controlg	Yes (metoclopramide)	1iiC
[22]	RCT	N/V from chemotherapy	100 (these patients were used more than once because of nature of crossover study); 27 surface electrodes; 11 rubber electrodes; 14 crossover study; 24 transcutaneous electrical stimulation	75% achieved considerable benefith	Yes (metoclopramide, thiethylperazine, prochlorperazine, cyclizine, lorazepam, and steroid)	1iiC
[29]	RCT	N/V from chemotherapy	16 (the same 16 patients treated twice in a crossover study); 16 ondansetron plus transcutaneous electrical stimulation; 16 cross-over treatment ondansetron only	Symptom-free patient days: 58.8%i	Yes (ondansetron)	1iiC
[27]	RCT	N/V from chemotherapy	53 enrolled; 38 completed; 38 acupressure; 38 crossover to acupressure at a sham point	55% reduction in N/Vj	Yes (antiemetics)	1iiC
[31]	RCT	N/V from high-dose chemotherapy	80; 41 acupuncture; 39 noninvasive placebo acupuncture	Nonek	Yes (ondansetron)	1iiC
[30]	RCT	N/V from chemotherapy	739; 233 bilateral acupressure bands and 234 transcutaneous electrical stimulation bands; 233 no bands; 39 not evaluable	Less N/V in treatment groups than in controll	Yes (5-HT3 receptor antagonist, prochlorperazine, and/or others)	1iiC
[33]	RCT	N/V from chemotherapy	36; 17 acupressure; 19 control	Significantly lower N/V	Yes (antiemetics)	1iiC
[20]	Nonrandomized controlled trial	N/V from chemotherapy	105; EA at P6	63%, complete relief, at least 8 h	Yes (metoclopramide; prednisolone)	2C
[23,25]	Consecutive case study	N/V from chemotherapy	40; 40 acupressure	8–24 h relief	Yes (not specified)	3iiC
[20]	CT	N/V from chemotherapy	43; 38 10 Hz EA; 5 sham (crossover subset)	8–10 h relief; 32 patients had complete relief	Yes (antiemetics)	2C
[28]	CT	N/V from chemotherapy	18; 18 acupressure bands; 18 (crossover study—incorrect placement of acupressure bands)	Effective for N/V	Yes (antiemetics: prochlorperazine, maxalon, and domperidone suppository)	2C
[24]	Nonconsecutive case series	N/V from chemotherapy	26; 26 acupuncture; 51 historical controls—no acupuncture	Mean no. of episodes and duration of N/V reduced	Yes (metoclopramide,dexamethasone, and diphenhydramine)	3iiiC
[19]	Nonconsecutive case series (pilot study)	N/V from chemotherapy	15; 15 EA; none	12 patients—no symptoms for 8 h	Yes (antiemetic: metoclopramide)	3iiiC
[34]	Consecutive, uncontrolled case series	N/V from chemotherapy mean no. of emesis 7–3	27; no controls	10 patients had complete response to EA and had no vomiting	Yes (antiemetics: either ondansetron 8 mg or granisetron 3 mg)	3iiiC
[32]	RCT	N/V from moderate to highly emetogenic chemotherapy	160; 96; 54	Decreased delayed N/V for acupressure	Yes (anthracycline and cyclophosphamide and an antiemetic)	1iiC

CT = controlled trial; EA = electroacupuncture; h = hour; No. = number; N/V = nausea and vomiting; RCT = randomized controlled trial.

aSee text and the NCI Dictionary 3 for additional information and definition of terms.

bNumber of patients treated plus number of patients control may not equal number of patients enrolled; number of patients enrolled equals number of patients initially considered by the researcher who conducted a study; number of patients treated equals number of enrolled patients who were given the treatment being studied AND for whom results were reported; historical control subjects are not included in number of patients enrolled.

cStrongest evidence reported that the treatment under study has activity or improves the well-being of cancer patients.

dConcurrent therapy for symptoms treated (not cancer).

eFor information about levels of evidence analysis and an explanation of the level of evidence scores, see Levels of Evidence for Human Studies of Cancer Complementary and Alternative Medicine 4.

f P < .001, low-frequency EA at classical antiemetic acupuncture points daily versus minimal needling at control points with sham EA versus no adjunct needling.

g P < .001, EA versus sham EA.

h P < .001, surface electrodes versus rubber electrodes.

i P < .00059.

j P < .02, acupressure versus acupressure at a sham point.

k P < .05, acupuncture versus noninvasive placebo acupuncture.

l P < .05, acupressure and acustimulation wrist bands versus no treatment.

Effect of Acupuncture on Cancer and Cancer Treatment-Related Side Effects

Nine studies have reported on the effects of acupuncture on cancer or other cancer treatment–related symptoms, including weight loss, cough, thoracodynia, hemoptysis, fever, anxiety, depression, night sweats, hot flashes, xerostomia, rectitis, dysphonia, esophageal obstruction, and postoperative lymphedema.[1,9,35-41] Four studies were from China,[1,37-39] one from Italy,[36] one from Japan,[40] and three from the United States.[9,35,41] Most were case studies or case series,[9,37-39] one was a retrospective survey study,[35] one was a phase I pilot study,[36] and two were randomized clinical trials.[1,41] The findings from these studies are summarized in a table ⁹ at the end of this section.

In a randomized clinical trial,[1] 76 patients with various types of cancer, including 38 with esophageal cancer, 24 with stomach cancer, and 14 with lung cancer, were randomly assigned to two groups (n = 38 per group). The treatment group received acupuncture in combination with radiation therapy or chemotherapy, and the control group was treated with radiation therapy or chemotherapy alone. The data showed that the patients in the acupuncture group gained significantly more body weight than patients in the control group (P < .001). The acupuncture group also showed greater improvement than the controls in the symptoms of cough, thoracodynia, hemoptysis, and fever for patients with lung cancer and the symptoms of chest pain, mucus vomiting, and difficulty in swallowing for patients with esophageal cancer. In addition, the acupuncture group suffered fewer side effects (poor appetite, N/V, dizziness, or fatigue) from radiation therapy or chemotherapy than the control group. However, no statistical analysis was performed on these data. A randomized controlled trial of 138 patients treated with acupuncture plus massage versus usual care showed decreased pain (P = .05) and decrease in depressive mood (P = .003) in postoperative cancer patients.[42] A small randomized controlled trial of EA compared with hormone therapy in women with breast cancer suggested a prolonged effect of EA on hot flushes after 24 months. Seven of 19 women initially randomly assigned to EA had 2.1 flushes in 24 hours compared with a baseline of 9.6 flushes in 24 hours.[43]

In a randomized controlled trial, 47 cancer patients with moderate to severe fatigue were randomly assigned to one of three groups. One group received six 20-minute sessions of acupuncture (n = 15), one group was instructed to use acupressure (n = 16), and the third group, the sham acupressure group (n = 16), was taught to apply pressure in three points unrelated to true acupressure. All three groups continued with the same technique for 2 weeks. The study concluded acupuncture was a more effective method than acupressure or sham acupressure.[44]

The phase I pilot study evaluated the effect of acupuncture on tamoxifen -induced menopause symptoms.[36] Fifteen patients with breast cancer who were taking tamoxifen were treated with acupuncture weekly for 3 months. The Greene Menopause Index was used for outcome assessments at baseline before treatment and at 1, 3, and 6 months. The results showed that anxiety, depression, and somatic and vasomotor symptoms, but not libido, were significantly improved in comparison with baseline (P < .001). A pilot study of acupuncture for joint symptoms related to adjuvant aromatase inhibitor therapy was performed in postmenopausal breast cancer patients. Acupuncture reduced all related joint symptoms and improved functional ability; however, there was no control or blinding with this study.[45] A retrospective evaluation of 194 patients with predominantly breast or prostate cancer and experiencing vasomotor symptoms found long-term relief of vasomotor symptoms associated with acupuncture and self-acupuncture. The authors suggested that overall treatment dose may be more important than point location, but favored SP6.[46]

The retrospective survey study involved patients of an oncology clinic who were offered acupuncture treatment for potential palliation of symptoms.[35] Among 89 patients treated with acupuncture, 79 responded to a telephone questionnaire survey. The data indicated that the major reasons for referral included pain (53%), xerostomia (32%), hot flashes (6%), and nausea/loss of appetite (6%). Sixty percent of the patients showed at least 30% improvement in their symptoms, and about one-third had no change in the severity of symptoms. Patients were not questioned regarding acupuncture treatment expectations.

Several case series reports describe clinically observed improvement of symptoms following acupuncture treatment.[9,37-39,47-49] These symptoms included cancer therapy–induced night sweats, hot flashes, rectitis, xerostomia, dysphonia, cancer-related esophageal obstruction, and postoperative lymphedema in patients following intrapelvic lymph node dissection for malignant gynecologic tumors.

Table 5. Clinical Studies of Acupuncture: For Other Cancer-Related or Cancer Treatment–Related Symptoms^a

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Reference Citation(s)	Type of Study	Condition Treated	No. of Patients: Enrolled; Treated; Controlb	Strongest Benefit Reportedc	Concurrent Therapy (Yes/No/ Unknown)d	Level of Evidence Scoree
[1]	RCT	Symptoms of weight loss, cough, thoracodynia, hemoptysis, fever, and side effects of chemotherapy and radiation therapy	76; 38 acupuncture; 38 no acupuncture	Weight gain, symptom relief, fewer side effectsf	No	1iiC
[36]	Phase I pilot study	Menopausal symptoms in breast cancer patients treated with tamoxifen	15; 15 acupuncture; none	Anxiety, depression, and somatic and vasomotor symptoms improvedg	No	3iiiC
[45]	Pilot study	Musculoskeletal pain related to adjuvant aromatase inhibitor therapy	21; 19 acupuncture; none	Reduced severity and increased functional ability	Analgesics(acetaminophen, NSAIDs, or COX-2 inhibitors) and various CAM approaches	3iiiC
[36]	Nonconsecutive case series, surveyed retrospectively	Unspecified symptoms (including pain, xerostomia, hot flashes, nausea/loss of appetite) from cancer or cancer treatment	79; 79 traditional Chinese acupuncture, auricular acupuncture, percutaneousnerve stimulation, Korean hand acupuncture, or Japanese scalp acupuncture; none	60% showed at least 30% improvement	Yes (standard medical therapies)	3iiiC
[37]	Nonconsecutive case series	Radiation rectitis in women treated for cervical cancer	44; 44 acupuncture; none	73% radiation rectitis cured: no blood or mucus for 15 days	No	3iiiC
[40]	Nonconsecutive case series	Postoperative lower extremity lymphedema in women treated for gynecologic tumors	24; 24 acupuncture and moxibustion; none	Edema prevented or markedly reduced	Unknown	3iiiC
[9]	Nonconsecutive case series	Xerostomia after radiation therapy in patients with cancer	13; 13 acupuncture; none	Symptoms improved	Yes (not specified)	3iiiC
[9]	Nonconsecutive case series	Night sweats, hot flashes in patients with cancer	6; 6 acupuncture; none	Symptoms improved	Yes (not specified)	3iiiC
[38]	Case report	Dysphonia after radiation therapy	1; 1 acupuncture; none	Voice recovered	Unknown	Not applicable
[39]	Case report	Esophageal obstruction in patients with esophageal cancer	2; 2 acupuncture; none	Obstruction relieved and normal bowel movements restored	Yes (not specified)	Not applicable
[46]	Nonconsecutive case series	Vasomotor symptoms for breast and prostate cancer	194; 194; none	79% showed 50% or greater reduction in hot flashes	none	3iiiC
[42]	RCT	Pain/depression	138; 93 acupuncture and massage; 45 usual care	Increased pain relief/decreased depression	Yes (usual care)	1iiC
[41]	RCT	Hot flashes in breast cancer patients treated with tamoxifen and aromatase inhibitors	72; 42; 30	Reduction of hot flashes but no statistical difference between acupuncture and sham treatment	Yes; SSRIs	1iiC
[44]	RCT	Cancer-related fatigue	47; 31; 16	Improved fatigue levels	None	1iiC
[43]	RCT	Hot flushes	45; 27 EA; 18 hormone therapy	Vasomotor symptoms improved	Unknown	1iiC

EA = electroacupuncture; No. = number; RCT = randomized controlled trial; SSRIs = selective serotonin reuptake inhibitors.

aSee text and the NCI Dictionary 3 for additional information and definition of terms.

bNumber of patients treated plus number of patients control may not equal number of patients enrolled; number of patients enrolled equals number of patients initially considered by the researcher who conducted a study; number of patients treated equals number of enrolled patients who were given the treatment being studied AND for whom results were reported.

cStrongest evidence reported that the treatment under study has anticancer activity or otherwise improves the well-being of cancer patients.

dConcurrent therapy for symptoms treated (not cancer).

eFor information about levels of evidence analysis and an explanation of the level of evidence scores, see Levels of Evidence for Human Studies of Cancer Complementary and Alternative Medicine 4.

f P < .001, versus baseline.

g P < .001, versus baseline.

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11. Li QS, Cao SH, Xie GM, et al.: Combined traditional Chinese medicine and Western medicine. Relieving effects of Chinese herbs, ear-acupuncture and epidural morphine on postoperative pain in liver cancer. Chin Med J (Engl) 107 (4): 289-94, 1994.  [PUBMED Abstract]
    
    
12. Alimi D, Rubino C, Leandri EP, et al.: Analgesic effects of auricular acupuncture for cancer pain. J Pain Symptom Manage 19 (2): 81-2, 2000.  [PUBMED Abstract]
    
    
13. He JP, Friedrich M, Ertan AK, et al.: Pain-relief and movement improvement by acupuncture after ablation and axillary lymphadenectomy in patients with mammary cancer. Clin Exp Obstet Gynecol 26 (2): 81-4, 1999.  [PUBMED Abstract]
    
    
14. Filshie J, Redman D: Acupuncture and malignant pain problems. Eur J Surg Oncol 11 (4): 389-94, 1985.  [PUBMED Abstract]
    
    
15. Wen HL: Cancer pain treated with acupuncture and electrical stimulation. Mod Med Asia 13 (2): 12-6, 1977. 
    
    
16. Alimi D, Rubino C, Pichard-Léandri E, et al.: Analgesic effect of auricular acupuncture for cancer pain: a randomized, blinded, controlled trial. J Clin Oncol 21 (22): 4120-6, 2003.  [PUBMED Abstract]
    
    
17. Vickers AJ: Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials. J R Soc Med 89 (6): 303-11, 1996.  [PUBMED Abstract]
    
    
18. Ezzo JM, Richardson MA, Vickers A, et al.: Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. Cochrane Database Syst Rev (2): CD002285, 2006.  [PUBMED Abstract]
    
    
19. Dundee JW, Ghaly RG, Fitzpatrick KT, et al.: Acupuncture prophylaxis of cancer chemotherapy-induced sickness. J R Soc Med 82 (5): 268-71, 1989.  [PUBMED Abstract]
    
    
20. Dundee JW, Ghaly RG, Fitzpatrick KT, et al.: Optimising antiemesis in cancer chemotherapy. Br Med J (Clin Res Ed) 294 (6565): 179, 1987.  [PUBMED Abstract]
    
    
21. Shen J, Wenger N, Glaspy J, et al.: Electroacupuncture for control of myeloablative chemotherapy-induced emesis: A randomized controlled trial. JAMA 284 (21): 2755-61, 2000.  [PUBMED Abstract]
    
    
22. Dundee JW, Yang J, McMillan C: Non-invasive stimulation of the P6 (Neiguan) antiemetic acupuncture point in cancer chemotherapy. J R Soc Med 84 (4): 210-2, 1991.  [PUBMED Abstract]
    
    
23. Dundee JW, Yang J: Prolongation of the antiemetic action of P6 acupuncture by acupressure in patients having cancer chemotherapy. J R Soc Med 83 (6): 360-2, 1990.  [PUBMED Abstract]
    
    
24. Aglietti L, Roila F, Tonato M, et al.: A pilot study of metoclopramide, dexamethasone, diphenhydramine and acupuncture in women treated with cisplatin. Cancer Chemother Pharmacol 26 (3): 239-40, 1990.  [PUBMED Abstract]
    
    
25. Dundee JW, McMillan CM: Clinical uses of P6 acupuncture antiemesis. Acupunct Electrother Res 15 (3-4): 211-5, 1990.  [PUBMED Abstract]
    
    
26. Dundee JW, Ghaly RG, Fitzpatrick KT, et al.: Acupuncture to prevent cisplatin-associated vomiting. Lancet 1 (8541): 1083, 1987.  [PUBMED Abstract]
    
    
27. Price H, Lewith G, Williams C: Acupressure as an antiemetic in cancer chemotherapy. Complementary Medical Research 5 (2): 93-4. 
    
    
28. Stannard D: Pressure prevents nausea. Nurs Times 85 (4): 33-4, 1989 Jan 25-31.  [PUBMED Abstract]
    
    
29. McMillan C, Dundee JW, Abram WP: Enhancement of the antiemetic action of ondansetron by transcutaneous electrical stimulation of the P6 antiemetic point, in patients having highly emetic cytotoxic drugs. Br J Cancer 64 (5): 971-2, 1991.  [PUBMED Abstract]
    
    
30. Roscoe JA, Morrow GR, Hickok JT, et al.: The efficacy of acupressure and acustimulation wrist bands for the relief of chemotherapy-induced nausea and vomiting. A University of Rochester Cancer Center Community Clinical Oncology Program multicenter study. J Pain Symptom Manage 26 (2): 731-42, 2003.  [PUBMED Abstract]
    
    
31. Streitberger K, Friedrich-Rust M, Bardenheuer H, et al.: Effect of acupuncture compared with placebo-acupuncture at P6 as additional antiemetic prophylaxis in high-dose chemotherapy and autologous peripheral blood stem cell transplantation: a randomized controlled single-blind trial. Clin Cancer Res 9 (7): 2538-44, 2003.  [PUBMED Abstract]
    
    
32. Dibble SL, Luce J, Cooper BA, et al.: Acupressure for chemotherapy-induced nausea and vomiting: a randomized clinical trial. Oncol Nurs Forum 34 (4): 813-20, 2007.  [PUBMED Abstract]
    
    
33. Molassiotis A, Helin AM, Dabbour R, et al.: The effects of P6 acupressure in the prophylaxis of chemotherapy-related nausea and vomiting in breast cancer patients. Complement Ther Med 15 (1): 3-12, 2007.  [PUBMED Abstract]
    
    
34. Choo SP, Kong KH, Lim WT, et al.: Electroacupuncture for refractory acute emesis caused by chemotherapy. J Altern Complement Med 12 (10): 963-9, 2006.  [PUBMED Abstract]
    
    
35. Johnstone PA, Polston GR, Niemtzow RC, et al.: Integration of acupuncture into the oncology clinic. Palliat Med 16 (3): 235-9, 2002.  [PUBMED Abstract]
    
    
36. Porzio G, Trapasso T, Martelli S, et al.: Acupuncture in the treatment of menopause-related symptoms in women taking tamoxifen. Tumori 88 (2): 128-30, 2002 Mar-Apr.  [PUBMED Abstract]
    
    
37. Zhang ZH: Effect of acupuncture on 44 cases of radiation rectitis following radiation therapy for carcinoma of the cervix uteri. J Tradit Chin Med 7 (2): 139-40, 1987.  [PUBMED Abstract]
    
    
38. Yao W: Prof. Sheng Canruo's experience in acupuncture treatment of throat diseases with yan si xue. J Tradit Chin Med 20 (2): 122-5, 2000.  [PUBMED Abstract]
    
    
39. Feng RZ: Relief of oesophageal carcinomatous obstruction by acupuncture. J Tradit Chin Med 4 (1): 3-4, 1984.  [PUBMED Abstract]
    
    
40. Kanakura Y, Niwa K, Kometani K, et al.: Effectiveness of acupuncture and moxibustion treatment for lymphedema following intrapelvic lymph node dissection: a preliminary report. Am J Chin Med 30 (1): 37-43, 2002.  [PUBMED Abstract]
    
    
41. Deng G, Vickers A, Yeung S, et al.: Randomized, controlled trial of acupuncture for the treatment of hot flashes in breast cancer patients. J Clin Oncol 25 (35): 5584-90, 2007.  [PUBMED Abstract]
    
    
42. Mehling WE, Jacobs B, Acree M, et al.: Symptom management with massage and acupuncture in postoperative cancer patients: a randomized controlled trial. J Pain Symptom Manage 33 (3): 258-66, 2007.  [PUBMED Abstract]
    
    
43. Frisk J, Carlhäll S, Källström AC, et al.: Long-term follow-up of acupuncture and hormone therapy on hot flushes in women with breast cancer: a prospective, randomized, controlled multicenter trial. Climacteric 11 (2): 166-74, 2008.  [PUBMED Abstract]
    
    
44. Molassiotis A, Sylt P, Diggins H: The management of cancer-related fatigue after chemotherapy with acupuncture and acupressure: a randomised controlled trial. Complement Ther Med 15 (4): 228-37, 2007.  [PUBMED Abstract]
    
    
45. Crew KD, Capodice JL, Greenlee H, et al.: Pilot study of acupuncture for the treatment of joint symptoms related to adjuvant aromatase inhibitor therapy in postmenopausal breast cancer patients. J Cancer Surviv 1 (4): 283-91, 2007.  [PUBMED Abstract]
    
    
46. Filshie J, Bolton T, Browne D, et al.: Acupuncture and self acupuncture for long-term treatment of vasomotor symptoms in cancer patients--audit and treatment algorithm. Acupunct Med 23 (4): 171-80, 2005.  [PUBMED Abstract]
    
    
47. Nedstrand E, Wyon Y, Hammar M, et al.: Psychological well-being improves in women with breast cancer after treatment with applied relaxation or electro-acupuncture for vasomotor symptom. J Psychosom Obstet Gynaecol 27 (4): 193-9, 2006.  [PUBMED Abstract]
    
    
48. Frisk J, Spetz AC, Hjertberg H, et al.: Two Modes of Acupuncture as a Treatment for Hot Flushes in Men with Prostate Cancer-A Prospective Multicenter Study with Long-Term Follow-Up. Eur Urol : , 2008.  [PUBMED Abstract]
    
    
49. Meidell L, Holritz Rasmussen B: Acupuncture as an optional treatment for hospice patients with xerostomia: an intervention study. Int J Palliat Nurs 15 (1): 12-20, 2009.  [PUBMED Abstract]
    
    

Glossary Terms

A drug that reduces pain and fever (but not inflammation). It belongs to the family of drugs called analgesics.

The application of pressure or localized massage to specific sites on the body to control symptoms such as pain or nausea. It is a type of complementary and alternative medicine.

The technique of inserting thin needles through the skin at specific points on the body to control pain and other symptoms. It is a type of complementary and alternative medicine.

A stainless steel needle that is slightly thicker than a human hair. Acupuncture needles are inserted through the skin at specific points on the body to control pain and other symptoms.

A specific spot on the body where an acupuncture needle may be inserted to control pain and other symptoms. Also called acupoint.

A procedure in which drugs, vitamins, herbal extracts, or other fluids are injected into the body at an acupuncture point using a syringe and needle.

Mild electrical stimulation of acupuncture points to control symptoms such as nausea and vomiting.

Symptoms or signs that begin and worsen quickly; not chronic.

Pain relief.

A drug that reduces pain. Analgesics include aspirin, acetaminophen, and ibuprofen.

A process in which anything complex is separated into simple or less complex parts.

In medicine, a substance that stops the action or effect of another substance. For example, a drug that blocks the stimulating effect of estrogen on a tumor cell is called an estrogen receptor antagonist.

A drug that prevents or reduces nausea and vomiting.

A drug or other substance used to prevent or stop seizures or convulsions. Also called anticonvulsant.

Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.

A drug that prevents the formation of estradiol, a female hormone, by interfering with an aromatase enzyme. Aromatase inhibitors are used as a type of hormone therapy for postmenopausal women who have hormone-dependent breast cancer.

Having to do with the ear.

A lymph node in the armpit region that drains lymph from the breast and nearby areas.

Surgery to remove lymph nodes found in the armpit region. Also called axillary dissection.

An initial measurement that is taken at an early time point to represent a beginning condition, and is used for comparison over time to look for changes. For example, the size of a tumor will be measured before treatment (baseline) and then afterwards to see if the treatment had an effect.

Affecting both the right and left sides of the body.

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

The long, tube-shaped organ in the abdomen that completes the process of digestion. The bowel has two parts, the small bowel and the large bowel. Also called intestine.

Glandular organ located on the chest. The breast is made up of connective tissue, fat, and breast tissue that contains the glands that can make milk. Also called mammary gland.

Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.

An anticancer drug that belongs to the family of drugs called alkylating agents.

A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin).

A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

Cancer that forms in tissues of the cervix (the organ connecting the uterus and vagina). It is usually a slow-growing cancer that may not have symptoms but can be found with regular Pap tests (a procedure in which cells are scraped from the cervix and looked at under a microscope). Cervical cancer is almost always caused by human papillomavirus (HPV) infection.

Treatment with drugs that kill cancer cells.

A drug used to treat many types of cancer. Cisplatin contains the metal platinum. It kills cancer cells by damaging their DNA and stopping them from dividing. Cisplatin is a type of alkylating agent. Also called Platinol.

Having to do with the examination and treatment of patients.

Cancer that develops in the colon (the longest part of the large intestine) and/or the rectum (the last several inches of the large intestine before the anus).

A treatment that is given at the same time as another.

In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works.

A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all.

A nonsteroidal anti-inflammatory drug used to relieve pain and inflammation. COX-2 inhibitors are being studied in the prevention of colon polyps, and as anticancer drugs. Also called cyclo-oxygenase-2 inhibitor.

To heal or restore health; a treatment to restore health.

A drug that is used to treat many types of cancer and is being studied in the treatment of other types of cancer. It is also used to treat some types of kidney disease in children. Cyclophosphamide attaches to DNA in cells and may kill cancer cells. It is a type of alkylating agent. Also called CTX and Cytoxan.

Tingling, numbness, heaviness, and other feelings that occur after an acupuncture needle has been properly placed in the body. The needle may be twirled, moved up and down at different speeds and depths, heated, or charged with a small electric current until the de qi sensation occurs.

A mental condition marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life. Other symptoms of depression include feelings of worthlessness and hopelessness, loss of pleasure in activities, changes in eating or sleeping habits, and thoughts of death or suicide. Depression can affect anyone, and can be successfully treated. Depression affects 15-25% of cancer patients.

A synthetic steroid (similar to steroid hormones produced naturally in the adrenal gland). Dexamethasone is used to treat leukemia and lymphoma and may be used to treat some of the problems caused by other cancers and their treatment.

A product that is added to the diet. A dietary supplement is taken by mouth, and usually contains one or more dietary ingredient (such as vitamin, mineral, herb, amino acid, and enzyme). Also called nutritional supplement.

A drug used to treat allergies and relieve cough and itching caused by insect bites, sunburn, and poison oak or ivy. It is also used to treat mild Parkinson disease, to prevent and treat motion sickness, to relieve cough and cold symptoms, and as a sleep aid. It is a type of antihistamine.

In medicine, a disturbance of normal functioning of the mind or body. Disorders may be caused by genetic factors, disease, or trauma.

The amount of medicine taken, or radiation given, at one time.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

Trouble with the voice when trying to talk, including hoarseness and change in pitch or quality or voice.

Swelling caused by excess fluid in body tissues.

A procedure in which pulses of weak electrical current are sent through acupuncture needles into acupuncture points in the skin. This procedure is being studied in the prevention of nausea and vomiting in patients undergoing chemotherapy.

Vomiting.

Describes a substance that causes vomiting. Also called emetic.

One of several substances made in the body that can relieve pain and give a feeling of well-being. Endorphins are peptides (small proteins) that bind to opioid receptors in the central nervous system. An endorphin is a type of neurotransmitter.

Having to do with the space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space.

Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach.

Cancer that forms in tissues lining the esophagus (the muscular tube through which food passes from the throat to the stomach). Two types of esophageal cancer are squamous cell carcinoma (cancer that begins in flat cells lining the esophagus) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids).

Removal by surgery.

A condition marked by extreme tiredness and inability to function due lack of energy. Fatigue may be acute or chronic.

Monitoring a person's health over time after treatment. This includes keeping track of the health of people who participate in a clinical study or clinical trial for a period of time, both during the study and after the study ends.

A method used to dry substances, such as food, to make them last longer. The substance is frozen and then dried in a vacuum.

A tool used by researchers to study the symptoms of menopause. It is a standard list of 21 questions which women use to rate how much they are bothered by menopause symptoms such as hot flashes, night sweats, rapid heartbeat, and difficulty sleeping.

Having to do with the female reproductive tract (including the cervix, endometrium, fallopian tubes, ovaries, uterus, and vagina).

Coughing or spitting up blood from the respiratory tract.

An intensive drug treatment to kill cancer cells, but that also destroys the bone marrow and can cause other severe side effects. High-dose chemotherapy is usually followed by bone marrow or stem cell transplantation to rebuild the bone marrow.

An individual treated in the past and used in a comparison group when researchers analyze the results of a clinical study that had no control group. The use of a control, or comparison, group helps researchers determine the effects of a new treatment more accurately.

Treatment that adds, blocks, or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. To slow or stop the growth of certain cancers (such as prostate and breast cancer), synthetic hormones or other drugs may be given to block the body’s natural hormones. Sometimes surgery is needed to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy, and hormone treatment.

A sudden, temporary onset of body warmth, flushing, and sweating (often associated with menopause).

One of a group of related proteins made by leukocytes (white blood cells) and other cells in the body. IL-2 is made by a type of T lymphocyte. It increases the growth and activity of other T lymphocytes and B lymphocytes, and affects the development of the immune system. Aldesleukin (IL-2 made in the laboratory) is being used as a biological response modifier to boost the immune system in cancer therapy. IL-2 is a type of cytokine. Also called interleukin-2.

Production and action of cells that fight disease or infection.

The complex group of organs and cells that defends the body against infections and other diseases.

The condition of being protected against an infectious disease. Immunity can be caused by a vaccine, previous infection with the same agent, or by transfer of immune substances from another person or animal.

A protein that acts as an antibody. Immunoglobulins are made by B cells and plasma cells. An immunoglobulin is a type of glycoprotein with two heavy chains and two light chains. Also called Ig.

Change in the body's immune system, caused by agents that activate or suppress its function.

In medicine, refers to the act of taking a substance into the body by breathing.

A biological response modifier (a substance that can improve the body's natural response to infections and other diseases). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and -gamma. The body normally produces these substances. They are also made in the laboratory to treat cancer and other diseases.

One of a group of related proteins made by leukocytes (white blood cells) and other cells in the body. Interleukin-2 is made by a type of T lymphocyte. It increases the growth and activity of other T lymphocytes and B lymphocytes, and affects the development of the immune system. Aldesleukin (interleukin-2 made in the laboratory) is being used as a biological response modifier to boost the immune system in cancer therapy. Interleukin-2 is a type of cytokine. Also called IL-2.

Within the skin. Also called intradermal.

Within the pelvis, the lower part of the abdomen between the hip bones.

In medicine, the place where two or more bones are connected. Examples include the shoulder, elbow, knee, and jaw.

A type of immune cell. Most leukocytes are made in the bone marrow and are found in the blood and lymph tissue. Leukocytes help the body fight infections and other diseases. Granulocytes, monocytes, and lymphocytes are leukocytes. Also called WBC and white blood cell.

A condition in which there is a lower-than-normal number of leukocytes (white blood cells) in the blood.

A ranking system used to describe the strength of the results measured in a clinical trial or research study. The design of the study (such as a case report for an individual patient or a randomized double-blinded controlled clinical trial) and the endpoints measured (such as survival or quality of life) affect the strength of the evidence.

Sexual desire. Also called sex drive and sexual urge.

A large organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile.

Primary liver cancer is cancer that forms in the tissues of the liver. Secondary liver cancer is cancer that spreads to the liver from another part of the body.

A drug that is used to treat anxiety and certain seizure disorders (such as epilepsy), and to prevent nausea and vomiting caused by chemotherapy. It belongs to the families of drugs called antiemetics and benzodiazepines.

One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.

Cancer that forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.

A surgical procedure in which the lymph nodes are removed and examined to see whether they contain cancer. For a regional lymph node dissection, some of the lymph nodes in the tumor area are removed; for a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed. Also called lymphadenectomy.

A condition in which extra lymph fluid builds up in tissues and causes swelling. It may occur in an arm or leg if lymph vessels are blocked, damaged, or removed by surgery.

A type of immune cell that is made in the bone marrow and is found in the blood and in lymph tissue. The two main types of lymphocytes are B lymphocytes and T lymphocytes. B lymphocytes make antibodies, and T lymphocytes help kill tumor cells and help control immune responses. A lymphocyte is a type of white blood cell.

Cancerous. Malignant tumors can invade and destroy nearby tissue and spread to other parts of the body.

A statistics term. The average value in a set of measurements. The mean is the sum of a set of numbers divided by how many numbers are in the set.

The time of life when a woman’s ovaries stop producing hormones and menstrual periods stop. Natural menopause usually occurs around age 50. A woman is said to be in menopause when she hasn’t had a period for 12 months in a row. Symptoms of menopause include hot flashes, mood swings, night sweats, vaginal dryness, trouble concentrating, and infertility.

In medicine, the rules and procedures for doing research and evaluating results.

A drug that increases the motility (movements and contractions) of the stomach and upper intestine. It is used to treat certain stomach problems and nausea and vomiting caused by chemotherapy. It is a type of antiemetic and a type of motility agent. Also called Reglan.

A type of acupuncture in which a microwave device is attached to an acupuncture needle to give microwave radiation at an acupuncture point.

A drug used to treat moderate to severe pain. It binds to opioid receptors in the central nervous system and some other tissues. Morphine sulfate is made from opium. It is a type of opiate and a type of analgesic agent.

In traditional Chinese medicine, a type of heat therapy in which an herb is burned on or above the skin to warm and stimulate an acupuncture point or affected area.

A thick, slippery fluid made by the membranes that line certain organs of the body, including the nose, mouth, throat, and vagina.

A type of immune cell that has granules (small particles) with enzymes that can kill tumor cells or cells infected with a virus. A natural killer cell is a type of white blood cell. Also called NK cell and NK-LGL.

A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.

In acupuncture, the insertion of a thin needle into a specific place on the body to unlock qi (vital energy). The needle may be twirled, moved up and down at different speeds and depths, heated, or charged with a low electric current.

A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.

Any of a large group of cancers of lymphocytes (white blood cells). Non-Hodgkin lymphomas can occur at any age and are often marked by lymph nodes that are larger than normal, fever, and weight loss. There are many different types of non-Hodgkin lymphoma. These types can be divided into aggressive (fast-growing) and indolent (slow-growing) types, and they can be formed from either B-cells or T-cells. B-cell non-Hodgkin lymphomas include Burkitt lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), diffuse large B-cell lymphoma, follicular lymphoma, immunoblastic large cell lymphoma, precursor B-lymphoblastic lymphoma, and mantle cell lymphoma. T-cell non-Hodgkin lymphomas include mycosis fungoides, anaplastic large cell lymphoma, and precursor T-lymphoblastic lymphoma. Lymphomas that occur after bone marrow or stem cell transplantation are usually B-cell non-Hodgkin lymphomas. Prognosis and treatment depend on the stage and type of disease. Also called NHL.

A clinical study that includes some, but not all, of the eligible patients identified by the researchers during the study registration period. This type of study does not usually have a control group.

In medicine, it describes a procedure that does not require inserting an instrument through the skin or into a body opening. In cancer, it describes disease that has not spread outside the tissue in which it began.

A clinical trial in which the participants are not assigned by chance to different treatment groups. Participants may choose which group they want to be in, or they may be assigned to the groups by the researchers.

A drug that decreases fever, swelling, pain, and redness. Also called nonsteroidal anti-inflammatory drug.

A health professional trained to care for people who are ill or disabled.

Closely monitoring a patient's condition but withholding treatment until symptoms appear or change. Also called active surveillance, expectant management, and watchful waiting.

Blockage of a passageway.

The study of cancer.

The active ingredient in a drug used to treat nausea and vomiting caused by cancer treatment. Ondansetron is a type of serotonin receptor antagonist and a type of antiemetic.

A specific result or effect that can be measured. Examples of outcomes include decreased pain, reduced tumor size, and improvement of disease.

A statistics term. A measure of probability that a difference between groups during an experiment happened by chance. The lower the p-value, the more likely it is that the difference between groups was caused by treatment.

Relief of symptoms and suffering caused by cancer and other life-threatening diseases. Palliation helps a patient feel more comfortable and improves the quality of life, but does not cure the disease.

Passing through the skin, as an injection or a topical medicine.

Blood circulating throughout the body.

The process by which a phagocyte (a type of white blood cell) surrounds and destroys foreign substances (such as bacteria) and removes dead cells.

The first step in testing a new treatment in humans. These studies test the best way to give a new treatment (for example, by mouth, intravenous infusion, or injection) and the best dose. The dose is usually increased a little at a time in order to find the highest dose that does not cause harmful side effects. Because little is known about the possible risks and benefits of the treatments being tested, phase I trials usually include only a small number of patients who have not been helped by other treatments.

A substance found in plants that causes red blood cells to clump together and certain white blood cells to divide.

The initial study examining a new method or treatment.

An inactive substance or treatment that looks the same as, and is given the same way as, an active drug or treatment being tested. The effects of the active drug or treatment are compared to the effects of the placebo.

Refers to a clinical study in which the control patients receive a placebo.

A tiny piece of a cell found in the blood that breaks off from a large cell found in the bone marrow. Platelets help wounds heal and prevent bleeding by forming blood clots. Also called thrombocyte.

Having to do with the time after menopause. Menopause (“change of life”) is the time in a woman's life when menstrual periods stop permanently.

After surgery.

In medicine, action taken to decrease the chance of getting a disease or condition. For example, cancer prevention includes avoiding risk factors (such as smoking, obesity, lack of exercise, and radiation exposure) and increasing protective factors (such as getting regular physical activity, staying at a healthy weight, and having a healthy diet).

A drug used to prevent or reduce nausea and vomiting. It belongs to the family of drugs called antiemetics.

In medicine, a study or clinical trial in which participants are identified and then followed forward in time.

A molecule made up of amino acids that are needed for the body to function properly. Proteins are the basis of body structures such as skin and hair and of substances such as enzymes, cytokines, and antibodies.

The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.

Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

When referring to an experiment or clinical trial, the process by which animal or human subjects are assigned by chance to separate groups that compare different treatments or other interventions. Randomization gives each participant an equal chance of being assigned to any of the groups.

A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial.

A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell.

Inflammation of the mucous membrane that lines the rectum (the last several inches of the large intestine closest to the anus). Also called proctitis.

A treatment plan that specifies the dosage, the schedule, and the duration of treatment.

In medicine, an improvement related to treatment.

An autoimmune disease that causes pain, swelling, and stiffness in the joints, and may cause severe joint damage, loss of function, and disability. The disease may last from months to a lifetime, and symptoms may improve and worsen over time.

In clinical trials, the step-by-step plan for how patients are to be treated; for example, the drug or type of radiation therapy that is to be given, the method by which it is to be given, the amount of time between courses, and the total length of treatment.

An inactive treatment or procedure that is intended to mimic as closely as possible a therapy in a clinical trial. Also called placebo therapy.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

In statistics, describes a mathematical measure of difference between groups. The difference is said to be significant if it is greater than what might be expected to happen by chance alone. Also called statistically significant.

Able to be dissolved in a liquid.

Having to do with the body.

In medicine, treatment that experts agree is appropriate, accepted, and widely used. Health care providers are obligated to provide patients with standard therapy. Also called best practice and standard of care.

An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.

Cancer that forms in tissues lining the stomach. Also called gastric cancer.

A form of medicine contained in a small piece of solid material, such as cocoa butter or glycerin, that melts at body temperature. A suppository is inserted into the rectum, vagina, or urethra and the medicine is absorbed into the bloodstream.

A small device that is attached to the skin to measure or cause electrical activity in the tissue under it. Surface electrodes may be used to look for problems with muscles and nerves.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

A type of immune cell that can attack foreign cells, cancer cells, and cells infected with a virus. T cells can also help control immune responses. A T cell is a type of white blood cell. Also called T lymphocyte and thymocyte.

A drug used to treat certain types of breast cancer in women and men. It is also used to prevent breast cancer in women who have had ductal carcinoma in situ (abnormal cells in the ducts of the breast) and in women who are at a high risk of developing breast cancer. Tamoxifen is also being studied in the treatment of other types of cancer. It blocks the effects of the hormone estrogen in the breast. Tamoxifen is a type of antiestrogen. Also called tamoxifen citrate.

Treatment.

A drug used to prevent or reduce nausea and vomiting. It belongs to the families of drugs called antiemetics and phenothiazines.

Chest pain. Also called thoracalgia.

A medical system that has been used for thousands of years to prevent, diagnose, and treat disease. It is based on the belief that qi (the body's vital energy) flows along 20 meridians (channels) throughout the body and keeps a person’s spiritual, emotional, mental, and physical health in balance. Traditional Chinese medicine aims to restore the body’s balance and harmony between the natural opposing forces of yin and yang, which can block qi and cause disease. Traditional Chinese medicine includes acupuncture, diet, herbal therapy, meditation, physical exercise, and massage. Also called Oriental medicine and TCM.

A procedure in which mild electric currents are applied to some areas of the skin. Also called TENS.

A substance made by some white blood cells. Transfer factor from one person’s white blood cells may be able to cause a specific immune response when injected into the skin of another person.

A type of drug used to treat depression.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.

Affecting the narrowing and widening of the blood vessels.

A tool used to help a person rate the intensity of certain sensations and feelings, such as pain. The visual analog scale for pain is a straight line with one end meaning no pain and the other end meaning the worst pain imaginable. A patient marks a point on the line that matches the amount of pain he or she feels. It may be used to help choose the right dose of pain medicine. Also called VAS.

A nutrient that the body needs in small amounts to function and stay healthy. Sources of vitamins are plant and animal food products and dietary supplements. Some vitamins are made in the human body from food products. Vitamins are either fat-soluble (can dissolve in fats and oils) or water-soluble (can dissolve in water). Excess fat-soluble vitamins are stored in the body’s fatty tissue, but excess water-soluble vitamins are removed in the urine. Examples are vitamin A, vitamin C, and vitamin E.

To eject some or all of the contents of the stomach through the mouth.

A type of immune cell. Most white blood cells are made in the bone marrow and are found in the blood and lymph tissue. White blood cells help the body fight infections and other diseases. Granulocytes, monocytes, and lymphocytes are white blood cells. Also called leukocyte and WBC.

Dry mouth. It occurs when the body is not able to make enough saliva.